bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of weather and mobility on respiratory viruses before and during the COVID-19 pandemic
Authors: Perfeito L , Varela-Lasheras I , Mesquita S , Gonçalves-Sá J
Published: October 2024

Background

The flu season is caused by a combination of different pathogens, including influenza viruses, which cause the flu, and non-influenza respiratory viruses, that cause common colds or influenza-like illness. These viruses exhibit similar dynamics and, given that outbreaks occur mostly in the winter and there is almost no circulation during the summer, in temperate regions, meteorological conditions have historically been regarded as a principal modulator of their epidemiology. However, after the emergence of SARS-CoV2, in late 2019, the dynamics of these respiratory viruses were strongly perturbed worldwide: some infections displayed near-eradication, while others experienced temporal shifts or occurred “off-season”. This disruption raised questions regarding the dominant role of weather while also providing an unique opportunity to investigate the roles of other determinants in their epidemiological dynamics.

Methods

Weather, mobility and epidemiological surveillance data was collected for Influenza, RSV, hCOV and hMPV, from Canada and the USA, from 2016 to 2023. Statistical analysis and modeling were employed to test the effects of weather and mobility on viral dynamics, before and during the COVID-19 pandemic.

Results

Using Beta Regressions, we found that whereas in the pre-COVID-19 pandemic period, weather had a strong effect, in the pandemic period, this effect was strongly reduced post-pandemic with mobility playing a more significant role.

Conclusions

These results, together with previous studies, dispute the general belief that respiratory viral dynamics are mostly dictated by weather and indicate that behavioral changes resulting from the non-pharmacological interventions implemented to control SARS-CoV2, played a key role. This disruption of past dynamical equilibrium raises important questions regarding the factors that modulate them, particularly in a context of climate change.

Key messages

• We took advantage of the disruption caused by COVID-19 to study dynamics of other respiratory viruses and to disentangle the effects of weather from those of human behavior.

• While before 2020 cold temperatures were highly correlated with incidence, afterwards cold weather was no longer a necessary condition and human mobility became central.
Video consultations among registered nurses in public sector and associated factors
Authors: Kainiemi E , Virtanen L , Heponiemi T , Vehko T , Kaihlanen A-M
Published: October 2024

Background

In digital health services, including services for older people, video consultations can enhance access to care while enabling interaction through audio and visual means. Registered nurses are pivotal in digital care delivery and there is a need for more understanding regarding the use of video consultations in nursing. This study aims to examine factors associated with nurses’ video consultations in the public sector.

Methods

The Finnish ‘Survey on information systems for registered nurses’ was delivered for registered nurses in March 2023. The respondents were asked whether their work had included video consultations in the past six months. Binary logistic regression was used to examine if career stage and digital skills (basic IT-skills, proficiency in data security, skills in digital working environments) were associated with nurses’ video consultations, adjusted for working unit and location of employment.

Results

The study included 2,525 public sector nurses (92.7% female, mean age 47.34, SD 10.47). Of them, twelve percent had used video consultations with patients. Most nurses used video consultations in outpatient units (63.3%), whereas they were less used among those working in acute care (3.3%), housing services (3.3%) and home-based services (8.2%). Early-career nurses had lower odds (OR .38, 95% CI .19-.73) of video consultations compared to mid-career nurses. Nurses who had good skills in working in digital environments (OR 2.07, 95% CI 1.26-3.39) had greater odds of video consultations than those with poorer skills.

Conclusions

The study suggests a limited adoption of video consultations among public sector nurses, particularly among early-career professionals. Increasing targeted support and training, and the availability of tools for various patient service needs in video consultations, are needed. By recognizing the importance of nurses’ digital skills, digital care delivery could be enhanced and potential public health benefits promoted.

Key messages

• Relatively few registered nurses used video consultations in the public sector. More research is needed to explore if their usage could be increased safely for patients, also in early nursing careers.

• Proficiency in digital work environments is imperative for ensuring the quality of care in video consultations. Therefore, collaborative efforts are required to enhance professionals’ digital skills.
Exploring Meditron-7b performance on a small-scale purpose made dataset in human nutrition queries
Authors: Scarsi N , Büsser B
Published: October 2024

The interest in Large Languages Models (LLMs) has been rapidly evolving over the last years, boosting concerns about their potential to improve the efficiency and effectiveness of clinical, educational and research work in medicine. In this study, we aimed to test the performance of MEDITRON, a recently released suite of open-source LLMs with 7B parameters adapted to the medical domain, on a small sample of human nutrition queries. To facilitate our assessment, we curated a specialized dataset comprising a diverse range of human nutrition-related queries, which have been manually collected from various medical databases and nutrition exams. The dataset was adapted for the scope of our analysis to encompass variations in language complexity, query types, and semantic nuances commonly encountered in real-world settings. Additionally, to ensure a standardized and clinically relevant context for our evaluations, we engineered a specialized prompt designed to mimic interactions with a highly esteemed physician specializing in nutrition, food science, and diet-related disorders. The prompt guided the generation of nutrition-related queries in a structured format, enabling MEDITRON to provide responses consistent with the latest advancements in medical research. Our preliminary findings revealed promising capabilities of MEDITRON in understanding medical language, providing contextually appropriate responses to several human nutrition related questions. Through this study, we add valuable insights to the ongoing discussion around the deployment of LLMs in public health, highlighting their potential to improve access to essential human nutrition literacy.

Key messages

• Design of LLMs tools holds the potential to improve healthcare in clinical, research and education applications.

• Further evidence is needed to foster their actual integration in real world settings.
Multi-objective Symbolic Regression for Clinician-in-the-loop Machine Learning algorithms
Authors: Ferrari D , Wang Y , Edgeworth J , Curcin V
Published: October 2024

Background

The power of machine learning (ML) in medicine is further enhanced by input from clinical experts with detailed knowledge of phenomena explored and the organization in which the ML models will be deployed. This input is needed not only in the problem conception and evaluation, but also in the training itself using the clinician-in-the-loop approach. We explore the applicability of such an approach to Multi-objective Symbolic Regression (MOSR) and compare it with state-of-the-art methodologies.

Methods

This is a retrospective study based on the admission data of 22576 patients routinely collected by the intensive care units (ICU) of Guy’s and St. Thomas’ NHS Foundation Trust in central London between April 1st, 2008, and December 31st, 2022. Patient-level data was used, including blood tests, urine tests, medical history, signs, symptoms, and common clinical scores. The outcome was modelled as a binary classification; four experiments were executed predicting mortality at 7 days (4.5% of patients), 30 days (10.2%), 6 months (17.4%) and 12 months (21.2%). A random train-test split of 80/20% ratio was performed. Clinician-in-the-loop approach used a Multi-objective Symbolic Regression algorithm bespoke designed to also optimize for the F1-score.

Results

For all four experiments, MOSR outperformed all other available ML algorithms providing significantly higher F1-scores and AUC. This makes MOSR the most competitive algorithm, particularly for imbalanced datasets such as typical ICU admission data.

Conclusions

We have demonstrated how ML algorithms designed for a clinician-in-the-loop approach outperform standard off-the-shelf alternatives and note the role of the application environment and clinical knowledge in the training itself enhancing the model performance. We therefore champion the adoption of approaches that, like MOSR, enable clinical input also in shaping the training behaviour.

Key messages

• The input of clinical knowledge and understanding of the application domain dynamics are crucial for ML development in healthcare.

• In Health Data Science we need ML algorithms like MOSR capable of receiving clinical input also in shaping the training behaviour.
GPT models classify free text from emergency department accesses in children with medical complexity
Authors: Brigiari G , Franzoi M , La Piana C , Zanin A , Benini F , Gregori D
Published: October 2024

Background

Emergency Department (ED) management software often collects clinical information as free text, but its unstructured nature limits routine use. While Machine Learning (ML) techniques have been employed to classify such information, they demand substantial data and computational resources. GPT-based models, using direct text prompts, offer a solution without requiring retraining, potentially simplifying clinical practice.

Aims

To assess OpenAI GPT’s performance in automating data extraction from ED medical records of complex pediatric patients.

Methods

Electronic admission records of children and young adults referring to the pediatric ED of Padova University Hospital (2007-2023) were analyzed. Principal variables of interest were discharge diagnosis, reason for ED access, required medical procedures, color code at triage, color code at discharge/hospitalization, outcome of the access. GPT-4 classification, via OpenAI API, was compared with manual classification by an expert pediatrician on sample of 791 records.

Results

Preliminary results of this study analyzed 107 records, showing a correct classification of discharge diagnosis in 95% of records. The reason for access to the ED was correctly identified in 97% of cases, while outcome of admission and color code, both at triage and discharge/hospitalization, were correctly classified in all given cases. Misclassification occurred mainly in cases where classification made by the model was incomplete (e.g., in the case of a trauma, abbreviated site of lesion was not identified by the model).

Conclusions

GPT-based models demonstrate feasibility, accuracy, and efficiency in transforming unstructured data into structured formats. Ultimately, GPT-based models could provide aid to the medical personnel in decision-making processes.

Key messages

• Emergency departments often collect clinical data in unstructured free text format, resulting in usability limitations.

• GPT-powered models efficiently convert unstructured data to structured formats, offering potential support for medical decision-making.
National implementation of telehealth in Denmark: A case study
Authors: Bollerup S , Jensen L G , Jacobsen C B , Nielsen C P
Published: October 2024

Background

With a growing number of chronic patients and a shortage of healthcare professionals, modern health systems face mounting economic pressures. Telehealth has emerged as a promising solution to address these challenges and is considered a critical component of future healthcare provision. However, implementing telehealth on a large scale is complex and challenging. To fully grasp these challenges, it is essential to look beyond the technology and delve into the processes and actors involved in its implementation. Actors on a political-administrative level are pivotal in large-scale implementation, yet this level remains understudied. Thus, this study investigates the dynamics of large-scale implementation at a political-administrative level through a case study of the national implementation of TeleCOPD in Denmark - a home-monitoring intervention targeting patients with Chronic Obstructive Pulmonary Disease (COPD).

Methods

An in-depth qualitative study of the implementation process at the political-administrative level was undertaken. Data consisted of comprehensive documentary material, including policy documents and meeting minutes and 12 semi-structured interviews with 16 key stakeholders across all levels of the implementation process. Data was analysed in accordance with thematic analysis using an abductive strategy.

Results

The analysis shows that large-scale implementation of telehealth is a profoundly complex process, necessitating the collaboration of various stakeholders across organisational hierarchies. Substantial translational work is required at the political-administrative level to implement telehealth across diverse organisational contexts. Moreover, understanding the role of context in this translation process is essential.

Conclusions

This study generates valuable knowledge about large-scale implementation of telemedicine in addition to insights into the role of the political-administrative level in the implementation process.

Key messages

• Implementing telehealth nationally involves intricate translation processes at multiple levels.

• Balancing local adjustments with degrees of fidelity is crucial in large-scale implementation.
Inferring diagnoses from prescription data: a machine-learning approach
Authors: Pinto A S , Perfeito L , Miranda T , Mesquita S , Pereira N , Gonçalves-Sá J
Published: October 2024

Estimating disease prevalence is a fundamental while challenging public-health goal: in the absence of solid diagnostic data, it typically requires expensive and time intensive studies. Analyzing existing medical records is an alternative, complementary approach. In particular, prescription records offer a glimpse into the health status of populations, prescribing patterns, and operational dynamics. We asked whether these could be used to infer diagnostics and, therefore, estimate disease prevalence. We used the Portuguese electronic medical prescriptions dataset (ADD NUMBERS) and trained a machine learning model that captures the probability that specific drugs are prescribed for the same or related medical conditions. We 1) constructed a manually-curated dataset of diseases and associated medications; 2) used this dataset to train embeddings models; 3) tested these models against human-classified data; 4) used the trained/tested model to uncover comorbidities associated with a) antibiotic prescription (to validate the model), and b) the impact of COVID-19 in prescription patterns of chronic-diseases. The model was able to accurately identify drugs used for targeting ten specific diseases, with few false positives and false negatives. Our analysis showed that the COVID-19 pandemic had almost no effect on the number of prescriptions for some chronic diseases (such as diabetes and depression), but, importantly, had a strong impact on the number of new diagnoses, with new users of diabetes medication in 2019 dropping by more than 16.8% in 2020. Medical prescriptions offer a promising tool to quickly assess disease prevalence, underdiagnosis, and allow a broad overview of the medical status of the population, especially in the face of health emergencies that strongly pressure the medical system.

Key messages

• We propose a new approach to infer diagnostics from prescription data with several promising applications.

• We propose a new approach to infer diagnostics from prescription data with several promising applications.
What works in global health partnerships? Reflections on a Nigerian-German project collaboration
Authors: Okoroafor C , Haderer F , Terpase Dooga J , Zocher U , Okafor O , Okwor T
Published: October 2024

Background

Global health partnerships for project implementation is a frequent way to address health challenges. Bringing stakeholders from different disciplines, professions, settings and countries together provides opportunity to look at health challenges from different perspectives, develop suitable ideas to tackle them and leverage diverse capacities.

Problem

In such diverse partnerships, cultural norms, practical realities and institutional practices create challenges for the development of good and equitable relationships.

Methods

In our project collaboration between the Nigerian Centre for Disease Control and Prevention and the German Robert Koch Institute on developing and implementing trainings in infection prevention and control, we demonstrated how a partnership can function. The collaboration followed a participatory approach and was informed by the following principles: - Plan, revise, adapt and implement all project activities as well as its contents participatorily; - A well-coordinated teamwork is key to facilitate operational performance; - Consider everyone as expert in its own domain of influence; - Constant and inclusive communication: maintaining transparency on all aspects and steps both in contents and organization and applying non-violent communication and active listening; - Provide space for reflection on roles and functions and for open discussion on needs and misunderstandings; - Appreciate team work as constantly evolving process of interaction and learning.

Results

We built a strong resilient team and could leverage team diversity to deliver on project objectives with exceptional quality, adaptability in a highly complex and frequently changing implementation setting.

Lessons

Working across cultures, disciplines, professions and countries means to develop a joint communication language and an understanding of the other. It is challenging and dynamic, requires additional space/time and attention, but offers personal growth and self-realization.

Key messages

• Using a participatory approach in teams can leverage team diversity to deliver on project objectives and bring about a high professional and personal self-realization.

• There are concrete implementable ways of teamwork in international interdisciplinary global health collaborations that enhance quality of results in complex implementation settings.
A monitoring framework for reinforcing policies against antimicrobial resistance in Europe
Authors: Dates M , Davies M
Published: October 2024

In an attempt to overcome barriers to the effective implementation of policies against antimicrobial resistance (AMR) in the EU Member States, Norway and Iceland, One Health national action plans (NAPs) need to show improvements in both their formulation and their implementation. Research conducted by Tetra Tech, funded by the EU4Health Programme, has identified shortcomings to One Health national policies across all countries, such as limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; and lack of harmonised indicators and inadequate information systems for monitoring the implementation of plans. On this last issue, subsequent reseach by Tetra Tech has supported the design and development of monitoring indicators for reinforcing the expected improvements of NAPs and the implementation of policies aimed at EU Member States in the 2023 “Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach”. While drawing on existing data sources at EU and global level, the study has also worked with Member States representatives in identifying indicators for the monitoring framework and proposed new data collection activities at the national level.

Key messages

• EU countries face common barriers to the effective implementation of One health policies against AMR, and need to reinforce their national action plans.

• Stepping up the fight against AMR in the EU requires a strong monitoring framework for following up on EU recommendations.
2.Q. Skills building seminar: Publishing and disseminating your research: How to get published, and what then?
Authors:   Organised by: EUPHA,   Chair persons: Monica Brînzac (EUPHAnxt)
Published: October 2024

Getting your public health research published can be a real challenge, and the publishing process is not always clear. Often it takes a lot of time, effort and perseverance. In this skills building workshop, participants will be able to learn the ropes from the Editor-in-Chief and the Publisher (OUP) of the European Journal of Public Health (EJPH), EUPHA’s scientific Journal. The EJPH is a well-established multidisciplinary, Open Access journal that covers a broad scope of public health topics. It’s current impact factor is 4.4. The workshop will have the format of an interactive clinic and will start with short presentations by the Editor-in-Chief of the EJPH and the Publisher on how to write, how to disseminate your findings, and tools the publisher has for helping promote your research for the best impact. The Editor-in-Chief will focus on what makes manuscripts attractive to editors and reviewers, while the publisher will give an overview of the publishing process, important aspects of the wider publishing industry (including how to publish your work Open Access) and give authors tips of how to promote their articles post-publication. After that, there will be ample time for participants to ask their questions to the panellists. This skills-building workshop will be of interest to anyone who would like to increase their chances of getting published and who would like to learn more about creating impact with their publications. The session should in particular be helpful for young researchers who do not have a lot of publishing experience yet.

Key messages

• Think about relevance to public health, and what your research adds to science and policy.

• Think about what tools you can use to disseminate your findings.

Speakers/Panelists

Peter Allebeck

Karolinska Institute, Department of Global Public Health, Stockholm, Sweden

Rachel Moriarty

Oxford University Press, Oxford, UK
Developing an infodemic management toolkit for immunization: An iterative consultation process
Authors: White B , Menning L , Orbina J R , Abeyesekera S , Purnat T , Von Harbou K , Emiroglu N , Varaidzo Machiri S , Yau B
Published: October 2024

Issue

An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform an emergency response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights and contextualize these insights in relation to other programme data.

Description

The WHO and UNICEF ‘how to build an infodemic insights report in 6 steps’ document provides general guidance. A more immunization specific document, with practical and specific tools in standalone short focus areas was developed to guide infodemic managers or those working on vaccine demand and acceptance, and by vaccination field workers. The toolkit is intended for vaccines across the life course, including for children, adolescents, pregnant people, adults, and people with pre-existing conditions or have other vulnerabilities.

Results

Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels.

Lessons

The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives.

Key messages

• For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake, and manage vaccine-related events.

• Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox.
Temporal Analysis of Sanitation and Water Development Indicators in Tunisia: 2012-2023
Authors: Fitouri S , Harizi C , Ayedi Y , Skhiri A , Besbes K , Fakhfakh R
Published: October 2024

Background

Access to sanitation and water resources is a cornerstone of the ‘One Health’ approach, which encompasses the holistic integration of human, animal and environmental health considerations. We aimed to elucidate the temporal trajectory of sanitation and water resource development in Tunisia across successive years.

Methods

Data from the Multiple Indicator Cluster Survey in Tunisia, a UNICEF-conducted repeated cross-sectional survey, was used to compare trends in access to improved water sources, utilization of improved sanitation facilities, and handwashing practices across 2012, 2018, and 2023.

Results

In 2023, we observed that 20.9% of households did not have access to drinking water on site, compared with 12.7% in 2018 (p = 0.15). The availability of drinking water in sufficient quantity was 69.8% in 2023 and 80.6% in 2018 (p = 0.37). In 2023, 78.1% of the population had access to an improved water source, compared with 86.3% in 2018 and 95.7% in 2012 (p = 0.4), 80% in urban areas and 73% in rural areas (p = 0.57). In 2023, 12.5% of the population consumed water from sources contaminated with Escherichia coli, compared with 20.5% in 2018 (p = 0.16). Disparities in Escherichia coli detection were observed between rural (21%) and urban (8.3%) areas (p = 0.01). In 2023, 92.1% of households had access to handwashing facilities equipped with soap and water, compared with 89.9% in 2018 and 91.5% in 2012 (p = 0.98). The breakdown between urban and rural areas was 95.1% and 86.4% respectively (p = 0.51).

Conclusions

Access to improved water sources, sanitation, and handwashing practices remains high over time, but regional disparities persist. Improved water quality directly reduces the transmission of waterborne pathogens, emphasizing the need to address regional disparities and socio-economic inequalities to promote public health nationwide.

Key messages

• Challenges persist in tunisia regarding sanitation and access to water.

• Regional disparities threaten public health.
Health literacy of pregnant women in Hungary
Authors: Molnárné Grestyák A , Ratkó T , Barabás Á , Takács P , Jávorné Erdei R
Published: October 2024

Health literacy determines our state of health and through this our quality of life. The health behavior of women of reproductive age should be treated with priority, since the lifestyle of pregnant women shows a correlation with the occurrence of premature birth and intrauterine development, and also between fetal development and the occurrence of chronic diseases in adulthood. The aim of our research is to explore the factors influencing the health behavior of pregnant women, to analyze regional differences, and to identify the causes of regional differences and inequalities. During a prospective, cross-sectional study, the health behavior of pregnant women living in Hungary was assessed using a questionnaire. In the course of our research, we examined health literacy using two measuring instruments, the Chew questionnaire and The Newest Vital Sign test. A total of 2,000 questionnaires were distributed of which 1,655 evaluable questionnaires were returned, the willingness to answer was 75%. The most people considered their own health to be good or very good (59.7%). 59.5% of the respondents changed their health behavior because of their pregnancy, mainly for the sake of the health of the fetus. 18.1% of pregnant women most likely have insufficient, 15.0% probably limited and 48.1% most likely have adequate functional health literacy. Age, education, place of residence and financial situation of pregnant women show a significant correlation with health literacy. Our results confirmed that sociodemographic factors, especially age and education, significantly influence the health literacy, perceived health status and health behavior of pregnant women. The two health literacy questionnaires we use can be combined well with each other and complement each other. The results greatly contribute to the development of health literacy, and thus to the development of individual and community-level strategies for improving health behavior in the field of pregnant women’s care.

Key messages

• Health literacy of pregnant women in Hungary.

• Health literacy in health promotion.
Impact of spilanthol supplementation with balance training on neuromuscular performance
Authors: Mishra K G , Patnaik N , Pradhan N R
Published: October 2024

Background

Age-related reductions in muscle mass, muscle contraction power, force, and coordination contribute to an elevated risk of falls and associated consequences. Research suggests that the enhancement of neuromuscular function is attainable through a regimen of targeted exercises and the strategic inclusion of certain supplements like spilanthol. This randomized controlled trial investigated the effect of resistance exercise with either spilanthol plus coordination/ balance training (BAL) or BAL-alone on neuromuscular function (countermovement jump, multiple one-leg hopping, and sit-to-stand test).

Materials and methods

In the course of this study, a cohort of 68 healthy male participants, aged 40 to 50 years, completed a rigorous 6-month intervention, from the initial 75 recruits. In the spilanthol-plus-BAL group, participants engaged in 30 minutes of resistance exercise sessions four times a week, complemented by daily supplementation of 17.5 mg of spilanthol.

Results

The analysis of the results showed significant improvements in the spilanthol-plus-BAL group, particularly evident in the peak countermovement power (p < 0.01). The mean effect size for this parameter was a + 1.5[0.9 to 2.1] W/kg greater change in spilanthol-plus-BAL group than BAL-alone group after six months. Moreover, multiple one-leg hopping performance showed significant enhancement in the spilanthol-plus-BAL group post-intervention. The parameters of sit-to-stand duration (1.04 s vs. 1.95 s; p = 0.03) and average acceleration (1.54 g vs. 1.06 g; p = 0.04) both exhibited substantial improvements in the spilanthol-plus-BAL group compared to the BAL-alone group.

Conclusions

The findings of this investigation contribute empirical evidence supporting the proposition that spilanthol supplementation, when integrated with BAL training, can exert a more pronounced impact on select facets of neuromuscular function.

Key messages

• Spilanthol supplementation with balance training can exert a pronounced impact on neuromuscular function.

• Spilanthol supplementation with balance training demonstrates potential in mitigating sarcopenia and other degenerative conditions.
The association between trajectories of structural disadvantage and mental wellbeing for Māori youth
Authors: Neumann D , Paine S J , Yao E
Published: October 2024

Background

Youth mental health is a major global concern with substantial inequities for Indigenous and other young people from minoritised ethnic groups. In New Zealand, Māori, the Indigenous people, experience poorer mental health than other young people, especially those living in high deprivation. Cultural connectedness is related to positive mental wellbeing, however, its potential to buffer against the harms of structural disadvantage for young Māori mental health has not been investigated.

Methods

We used data from 1224 Māori young people in the longitudinal Growing Up in New Zealand study. Structural disadvantage measures included material hardship, deprivation, employment, residential mobility. We conducted Latent Class Analysis and Social Sequence Analysis to identify clusters and longitudinal patterns of structural disadvantage. Cultural connectedness and mental wellbeing (depression & anxiety symptoms, quality of life) were measured at age 12. Linear regression analysis was used to determine associations between structural disadvantage, cultural connectedness and mental health.

Results

We identified 3 trajectories of structural disadvantage for Māori youth: 21% experienced persistent high structural disadvantage, 35% intermittent high structural disadvantage and 44% persistent relatively low structural disadvantage. Few differences in mental health were found between groups. Cultural connectedness was independently associated with positive mental wellbeing, yet there was mixed evidence it might buffer the impacts of structural disadvantage on mental health.

Conclusions

Our results highlight the importance of policies that uphold Indigenous rights to health and address structural disadvantage as a persistent threat to Indigenous wellbeing. Our findings call for holistic, early-life, family-centred strategies and to reduce barriers to accessing support. We highlight the need for policies that enable young people to flourish in their identity and culture.

Key messages

• Many Māori young people experience pervasive structural disadvantage starting before they are born, persisting throughout childhood and adolescence which is an omnipresent threat to their wellbeing.

• Supporting cultural connectedness for Indigenous youth is important but cannot substitute for policies addressing structural disadvantages that contribute to health inequities.
Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania
Authors: Kalediene R , Kaseliene S , Sauliune S , Mesceriakova O , Zutautiene R , Kalibatas V
Published: October 2024

Background

During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic.

Methods

Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024.

Results

22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p < 0.05).

Conclusions

Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society.

Key messages

• Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics.

• Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.
Inequalities in prevalence rate of edentulism in the European Union between 1990 and 2019
Authors: Andrade CAS , Mahrouseh N , von der Lippe E , Baravelli C M , Varga O
Published: October 2024

Background

Edentulism, characterized by tooth loss, serves as a global indicator of oral health burden, particularly affecting older and economically disadvantaged populations. We aimed to assess health inequalities in age-standardized prevalence rate (ASPR) of edentulism across 28 EU member states and EU as a whole between 1990 and 2019.

Methods

We retrieved ASPR, annual rate of change (ARC) and 95% uncertainty interval from the Global Burden of Disease (GBD) 2019 study. We calculated the ASPR ratio between 1990 and 2019 and country-paired ASPR for 2019. To estimate the inequalities between countries between 1990 and 2019, we used the Gini Coefficient (GC) and Slope Index of Inequality (SII).

Results

The EU ASPR for edentulism was 5912 (95% UI: 4751-7473) in 1990 while in 2019 it was 5048 (95% UI: 3970-6485). Sweden had the lowest ASPR in 1990, while Spain held this position in 2019. The highest rates in 1990 were observed in Poland and the Netherlands, with the Netherlands maintaining the highest ASPR in 2019. Spain exhibited the lowest ARC at -0.325 (95% UI: -0.477--0.193), while Sweden was the sole country with a positive value, at 0.034 (95% UI: -0.009-0.075). The ASPR ratio across all EU member states exhibited a range of values for males, from 1.00-2.16, and for females, from 1.00 to 1.87. The ASPR ratios ranged between 1.81 and 2.16 from 1990 to 2000. The GC was 0.097 (95% UI: 0.076-0.117) in 1990 and subsequently decreased-0.084 (95% UI: 0.063-0.105) by 2019. The SII exhibited a range from 0.062 (95% UI: 0.051-0.072) in 1990-0.046 (95% UI: 0.038-0.054) in 2019.

Conclusions

Inequalities in edentulism in the EU were similarly low when comparing 1990 and 2019. However, there was an alarming increase in inequalities between 2005 and 2010. This underscores the need for targeted interventions and policy measures-address oral health inequalities, considering socio-economic factors, healthcare policies, sex disparities, and public awareness initiatives.

Key messages

• Edentulism is a significant public health concern within the EU for approximately 30 years.

• It has demonstrated comparable disparities in prevalence at both the beginning and end of the period, with a noticeable intensification in the interim.
Determinants of willingness to vaccinate against HPV among adults: an Italian cross-sectional study
Authors: Mimmo R , Lo Moro G , Golzio F , Campi G , Scaioli G , Bert F , Siliquini R
Published: October 2024

Background

In Italy, heterosexual males over the age of 18 do not participate in the free-of-charge HPV vaccine offer, nor do women over the age of 26, with regional differences; however, they can vaccinate for a fee. This survey aims to assess the vaccination readiness of the 18-40 year old population group, their perceived need with respect to the vaccine, and the determinants of the vaccination choice.

Methods

A questionnaire-based cross-sectional study targeting the general population in the 18-40 age group has been ongoing since March 2024. Recruitment occurs through social media and flyers. Demographic characteristics, social determinants, deprivation index by area via HAZ (health action zone) method (SR: -15;25), risk factors, main barriers to vaccination are assessed. Our main outcome is HPV vaccination willingness. People already vaccinated were excluded from the analysis. Descriptive and logistic regression analyses were performed with Jamovi.

Results

Our preliminary results included 159 individuals of whom 57.2% would like to receive HPV vaccine. The main characteristics of the sample were: median age 30 years (IQR:26.5;34), 47.2% female gender, median deprivation index 3.7 (IQR:-0.2;7.1), 75% working, 11.9% from the LGBTQ+ community. Regarding barriers, 31.9% rated fatigue in accessing the vaccine as significant, 10.4% feared a risk in receiving the vaccine. Among the people who did not want to vaccinate or did not know, 75% would do so by paying less than the normal amount, 21.6% if free, and 3.4% would not vaccinate anyway. Vaccination willingness was positively associated with female gender (OR:3.1; p = 0.026) and belonging to the LGBTQ+ community (OR:10.0; p:0.050) and negatively associated with working status (OR:0.19; p = 0.013).

Conclusions

Socioeconomic barriers appeared to play a significant role in the choice to vaccinate. Policies to reduce economic barriers could increase vaccination in an uncovered but still potentially sexually active population.

Key messages

• Coverage of HPV vaccine is not yet at optimal thresholds, yet people excluded from free vaccination programs could benefit from vaccination incentive policies.

• Vaccination intention among heterosexual men is significantly lower than among women in the same age group, a symptom that there would still be room for awareness-raising interventions on the issue.
Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis
Authors: McCann L , Johnson L , Gkiouleka A , Pearce H , Ford J
Published: October 2024

Background

Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework.

Methods

First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis.

Results

From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability.

Conclusions

EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions.

Key messages

• PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability.

• EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.
Post-operative Mortality Trends for Complicated Appendicitis: Adults with and without Disabilities
Authors: Kim Y J , Yeob K E , Kim S Y , Park J H
Published: October 2024

Background

Even for the same complicated appendicitis, the prognosis may vary if appropriate post-operative care and follow-up are not provided. We aimed to investigate the 10-year trend of complicated appendicitis mortality among disabilities and non-disabilities peoples in Korea, recognizing potential disparities in post-surgical outcomes and the importance of adequate post-operative care.

Methods

Patients with complicated appendicitis were classified by severity using DRG codes. Causes of death were categorized into infectious, respiratory, cardiovascular, and digestive diseases using ICD-10 data. Age-adjusted mortality rates were calculated annually from 2008 to 2017 based on disability presence, severity, and type. Factors associated complicated appendicitis mortality were analyzed using multivariate logistic regression models.

Results

The mortality of complicated appendicitis was 10.2 times (40.8% vs. 413.9%) higher in people with disabilities, especially those with severe disabilities. This difference was more evident in patients with a severe disability (aOR=2.12, 95% CI:1.58-2.86), intellectual or psychological disability (aOR=2.95, 95% CI:1.49-5.85) and internal organ problems (aOR=2.05, 95% CI:1.28-3.28).

Conclusions

Our findings suggest that insufficient post-operative care among disabled peoples, especially those with severe disabilities, internal organ problems, and intellectual or psychological disabilities, may impact outcomes. This is exacerbated by poor healthcare facilities and limited disability awareness among healthcare workers. Additionally, further research is required to uncover unexplained mortality causes. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165).

Key messages

• Complicated appendicitis mortality rates show a stark 10.2-fold disparity between people with and without disabilities.

• Severe disabilities, intellectual or psychological disabilities, and internal organ problems heighten the risk, emphasizing the importance of disability-inclusive healthcare practices.