bluuebunny/crossref_metadata_2025 huggingface dataset:
14 EXAMINING THE IMPACT OF SAFETY MONITORING DEVICES ON CARE WORK AND PROCESSES IN JAPANESE NURSING HOMES
Authors: Obayashi K , Kodate N , Kondo H , Okamoto Y , Kaneko H , Ishii Y , Nonoda T , Masuyama S
Published: October 2022

Background

Although the impact of new technology on the workplace has been discussed for many years, little has been reported regarding the effect of new technology in nursing homes. The aim of the research was to test the effect of a safety monitoring device on night-time work patterns.

Methods

A monitoring sensor with an infrared camera was installed in Tokyo-based residential nursing homes in April 2020. A pre/post intervention and observation study was conducted before and after the introduction of the device. Four care professionals worked each night in pairs (one person providing care, and the other observing and keeping minute-by-minute records of task and time allocated to each task. The tasks were divided into 33 items). The data were collected by two pairs at three different nights for pre-intervention and from two pairs at two nights for post-intervention. Ten care professionals participated in the study, and they were looking after 30 older adults (86.8 +/- 6.8 years old).

Results

The total time for executing various tasks marginally increased from 978 mins to 1033 mins. However, statistically significant changes were found mainly among items related to medical care and safety. While nurse call response time decreased significantly, the proportion of time allocated to personal care such as vital checks (from 1 to 2 percent) and mobility (from 4 to 9 percent) assistance doubled. Break time also increased significantly.

Conclusion

While the introduction of a safety monitoring system did not radically reduce the workload, it changed the patterns of caregiving during the night shift. Some behavioural changes were directly caused by functions of the system, while others were by-products. Staff’s break length also increased. The findings suggest that the introduction of Information and Communication Technology (ICT) in nursing homes has the potential to release time to care.
51 VITAMIN D DEFICIENCY IS ASSOCIATED WITH INCREASED RISK OF ATRIAL FIBRILLATION: A CROSS-SECTIONAL ANALYSIS
Authors: Kavanagh M , Bradley E , Hoey L , Hughes C , McNulty H , Ward M , Strain JJ , Tracey F , Molloy A , Laird E , Cunningham C , McCarroll K
Published: October 2022

Background

Atrial Fibrillation (AF) is prevalent (up to 10.9%) in Irish adults aged over 65 and significantly increases stroke risk, as well as being associated with greater stroke severity. Identifying potential contributing factors to development of AF offers opportunity for AF prevention and reduction in associated morbidity. Low vitamin D status has been associated with AF but studies are inconsistent. We aimed to assess the potential relationship between vitamin D deficiency and self-reported AF in older Irish adults.

Methods

Participants were from a large cross-sectional study of Irish adults aged >60 years, recruited from hospital outpatient services and GP practises. The diagnosis of AF was based on self-report so those with a Mini Mental State Examination (MMSE) <25 were excluded. Vitamin D deficiency was defined as a 25(OH)D <30 nmol/l. The relationship between deficiency and AF was explored in regression models.

Results

4264 participants, mean age 73.1± 8.0 years, female (67.4%) and 11.9% had AF. There was a higher prevalence of AF in those who were deficient vs non-deficient (17.2% vs 10.9%, P<0.0001). In a subsample (n = 4043), increased risk remained after adjusting for age, gender, season, vitamin D supplement use, body mass index, timed up and go, alcohol intake, smoking status, hypertension, diabetes, and heart disease (coronary artery disease and/or heart failure) (OR: 1.3, 1.1- 1.7 , P =0.023).

Conclusion

We identified that vitamin D deficiency was independently associated with a 30% increased likelihood of self-reported AF in older adults. Vitamin D is known to inhibit the renin angiotensin, aldosterone system which may play a role in both structural and electrical remodelling of the atrium. It may also have anti-inflammatory properties which could protect against AF. We were not able to distinguish between valvular and non-valvular AF though findings offer an interesting insight for potential further investigation.
172 WHAT IS THE KNOWLEDGE OF CARE STAFF AND THE USE OF HEARING AIDS IN IRISH NURSING HOMES? A PILOT STUDY
Authors: Sheehy L
Published: October 2022

Background

Residents of nursing homes can be dependent on care staff for the insertion and maintenance of their hearing aids. There is no current research carried out in Irish nursing homes on this topic.

Methods

Using a quantitative study design participants were recruited from two Irish publicly-funded Nursing Homes. 58 Care staff participated in this study. Care staff completed a validated paper-based questionnaire. Descriptive statistics were applied. Kruskal Wallis H tests were used to examine if there was a statistically significant difference in questionnaire answers between three occupations: Healthcare Assistants, Nurses and Nurse Managers

Results

15% of care staff agreed that they had received training in the use and care of hearing aids. 20% of care staff agreed that they knew the approximate lifetime of a hearing aid battery.100% of care staff agreed they need more information on the different types of hearing aids. 95% agreed that there is a need for information on hearing aid maintenance, and 88% of care staff agreed that they need more information on hearing loss among the older population.

Conclusion

This extensive data, the first of its kind in Ireland, shows us that care staff are very candid about the issues they confront and have demonstrated a willingness and openness to learning. It confirms the skills and information gap of care staff and there is great scope for training, and this will have a very positive impact on residents and care staff.
282 SELF-REPORTED QUALITY OF LIFE IN PATIENTS COMPLETING A GERIATRIC REHABILITATION PROGRAM
Authors: Lynch A , Flood E , Mello S
Published: October 2022

Background

Geriatric Rehabilitation (GR) delivers person-centered care focused on achieving self-determined goals. While there is evidence for significant physical gain during GR, there is a paucity of articles describing its effect on self-reported Quality-of-Life (QoL). This study aims to ascertain the effect of GR on QoL and to assess whether positive effects persist even if patients do not achieve functional independence.

Methods

A retrospective review was conducted using Microsoft Excel spreadsheet data that is routinely collected for service evaluation purposes. All patients with complete data sets in 2021 were included. Barthel Index (BI) which quantifies functional independence and EQ5D which measures QoL were collected on admission and discharge. Both measures are scored out of one hundred, with higher scores indicating more positive results. Patients were divided into two groups based on BI at discharge (BI>90 and BI<90) and outcomes were analysed using t-tests.

Results

Among 122 patients, the mean age was 80 (range 64-96) and 50 (41%) were male. 68 patients (56%) had a BI>90 at discharge and 54 (44%) had a BI<90. Those with a BI<90 reported an overall improvement in QoL after GR (45 vs 68, p<0.0001), similar to those who achieved a BI>90 (55 vs 80, p<0.0001). However, those with BI>90 rated their QOL higher than those with a BI<90 (80 vs 68, p=0.008). Higher pre-morbid frailty level, fear of falling, and having delirium during GR were all significantly associated with worse outcomes (BI<90) at discharge.

Conclusion

This study demonstrates that GR improves self-reported QOL regardless of improvement in functional independence. Positive effects of GR have potential to extend beyond physical function, addressing other issues such as sarcopenia and fear of falling which improve QOL. Individually tailored GR programs should be considered for all older persons experiencing functional decline after hospitalisation or in the community.
294 INTEGRATION OF MUSIC THERAPY WITHIN A MULTIDISCIPLINARY TEAM FOR OLDER ADULTS IN AN ACUTE HOSPITAL
Authors: Hayes R , Cassidy M , Nevin R , Walsh K , Griffin A , Mealy B , Herbst J , Carroll KM
Published: October 2022

Background

Music Therapy (MT) is an evidence-based intervention in which a music therapist uses music within a therapeutic relationship to achieve targeted goals. Studies show that MT may improve patient communication, cognition and mood, and facilitate rehabilitation by improving motor skills, particularly in those with stroke and Parkinson’s disease. We aimed to integrate MT within our geriatric multidisciplinary team (MDT) by: (1) promoting knowledge of MT among MDT staff; and (2) developing and implementing a MT referral pathway for patients. Furthermore, we aimed to assess its overall impact.

Methods

Music therapists delivered oral presentations and experiential learning through creative workshops, collaboration and feedback to allied health therapists in our geriatric MDT. Criteria for referrals for MT and a referral pathway were developed. Data on patients who received MT was collated.

Results

There were 70 referrals for MT from our MDT. 61% were female, mean age 77 years. Referral sources were occupational therapists (45%), speech therapists (34%), medical social workers (13%), physiotherapists (8%). Patients included those with stroke (41%), general medical conditions (23%), dementia (16%), Parkinson's (11%) and mental health concerns (9%). There were 16 joint MDT sessions and a mean of 5 MT sessions per patient (about 40 minutes in duration). Interventions included: Melodic Intonation Therapy (MIT), singing and vocal exercises, Rhythmic Auditory Stimulation (RAS), Musical Neglect Training (MNT), Therapeutic Instrumental Musical Performance (TIMP), reminiscence and song-writing. Overall, we identified better engagement with rehabilitation and improvements in mood, speech (voice strength and verbal fluency) and upper and lower limb co-ordination.

Conclusion

MT was successfully integrated into a geriatric MDT and had beneficial effects on patient mood, speech, communication and motor function. Education of MDT members was crucial in achieving appropriate MT referrals. Joint MDT’s also facilitated individualised MT interventions. Findings strongly support our model that incorporates MT within an MDT.
334 FASTTRAX - A FRACTURE RESPONSE SERVICE FOR NURSING HOME RESIDENTS
Authors: Noonan C , Coveney S , Coughlan T , Kennelly S
Published: October 2022

Background

Nursing Home Residents (NHR) are the frailest group of older people and require a gerontologically attuned approach to care. The new FastTrax fracture response service has been developed as a result of a Quality Improvement (QI) project to evaluate the need for this service. The data leading to the development of this pathway is presented here. FastTraX ensures NHR receive optimal orthopaedic and gerontological care without necessity for emergency department (ED) presentation.

Methods

A retrospective, medical chart review was completed on all NHRs who presented over12-months to a level-4 hospital ED following a fall/injury. Included patients were nursing home residents with suspected fracture discussed with the on-call orthopaedic service. Patients who required more complex imaging other than plain film or with known/suspected head trauma were excluded. Data collected included demographics, clinical and imaging details, and care outcomes.

Results

In 2021, there were sixty-nine (mean age 80.3, 82.6% female) NHR presentations to the ED with fracture/ injury where orthopaedic opinion was sought following x-ray. Just-under half, 49.2 % (34/69) of patients were admitted, all of whom had confirmed fractures. However, 32.3% (11/34) of admitted NHRs were conservatively treated with an average length-of-stay of 3.6 days before discharge to NH. 6/34 (17.6%) of admitted NHRs died, and 5 of those deaths occurred post-operatively. Of the 50.7% (35/69) discharged directly back to NH from ED, 45.7% (16/35) of those had no fracture, whereas 54.2% (19/35) were discharged for conservative management. Therefore, potentially only 29/69 (33%) ED presentations required definitive orthopaedic/gerontological intervention necessitating admission and two-thirds are potentially avoidable.

Conclusion

The new FastTraX fracture response service is an Advanced-Nurse Practitioner (rANP) co-ordinated integrated service combining use of on-site mobile radiological diagnostics in the NH, a fast-track ambulatory orthopaedic-consult clinic, and specialist gerontological care delivered in timely response to support NH staff in avoiding ED transfer where appropriate.
3-D reconstruction of rice leaf tissue for proper estimation of surface area of mesophyll cells and chloroplasts facing intercellular airspaces from 2-D section images
Authors: Ouk Rachana , Oi Takao , Sugiura Daisuke , Taniguchi Mitsutaka
Published: October 2022

Background and Aims

The surface area of mesophyll cells (Smes) and chloroplasts (Sc) facing the intercellular airspace (IAS) are important parameters for estimating photosynthetic activity from leaf anatomy. Although Smes and Sc are estimated based on the shape assumption of mesophyll cells (MCs), it is questionable if the assumption is correct for rice MCs with concave–convex surfaces. Therefore, in this study, we establish a reconstruction method for the 3-D representation of the IAS in rice leaf tissue to calculate the actual Smes and Sc with 3-D images and to determine the correct shape assumption for the estimation of Smes and Sc based on 2-D section images.

Methods

We used serial section light microscopy to reconstruct 3-D representations of the IAS, MCs and chloroplasts in rice leaf tissue. Actual Smes and Sc values obtained from the 3-D representation were compared with those estimated from the 2-D images to find the correct shape-specific assumption (oblate or prolate spheroid) in different orientations (longitudinal and transverse sections) using the same leaf sample.

Key Results

The 3-D representation method revealed that volumes of the IAS and MCs accounted for 30 and 70 % of rice leaf tissue excluding epidermis, respectively, and the volume of chloroplasts accounted for 44 % of MCs. The shape-specific assumption on the sectioning orientation affected the estimation of Smes and Sc using 2-D section images with discrepancies of 10–38 %.

Conclusions

The 3-D representation of rice leaf tissue was successfully reconstructed using serial section light microscopy and suggested that estimation of Smes and Sc of the rice leaf is more accurate using longitudinal sections with MCs assumed as oblate spheroids than using transverse sections with MCs as prolate spheroids.
Identifying the critical state of complex biological systems by the directed-network rank score method
Authors: Zhong Jiayuan , Han Chongyin , Wang Yangkai , Chen Pei , Liu Rui
Published: October 2022

Motivation

Catastrophic transitions are ubiquitous in the dynamic progression of complex biological systems; that is, a critical transition at which complex systems suddenly shift from one stable state to another occurs. Identifying such a critical point or tipping point is essential for revealing the underlying mechanism of complex biological systems. However, it is difficult to identify the tipping point since few significant differences in the critical state are detected in terms of traditional static measurements.

Results

In this study, by exploring the dynamic changes in gene cooperative effects between the before-transition and critical states, we presented a model-free approach, the directed-network rank score (DNRS), to detect the early-warning signal of critical transition in complex biological systems. The proposed method is applicable to both bulk and single-cell RNA-sequencing (scRNA-seq) data. This computational method was validated by the successful identification of the critical or pre-transition state for both simulated and six real datasets, including three scRNA-seq datasets of embryonic development and three tumor datasets. In addition, the functional and pathway enrichment analyses suggested that the corresponding DNRS signaling biomarkers were involved in key biological processes.

Availability and implementation

The source code is freely available at https://github.com/zhongjiayuan/DNRS.

Supplementary information

Supplementary data are available at Bioinformatics online.
EvAM-Tools: tools for evolutionary accumulation and cancer progression models
Authors: Diaz-Uriarte Ramon , Herrera-Nieto Pablo
Published: October 2022

EvAM-Tools is an R package and web application that provides a unified interface to state-of-the-art cancer progression models and, more generally, evolutionary models of event accumulation. The output includes, in addition to the fitted models, the transition (and transition rate) matrices between genotypes and the probabilities of evolutionary paths. Generation of random cancer progression models is also available. Using the GUI in the web application, users can easily construct models (modifying directed acyclic graphs of restrictions, matrices of mutual hazards or specifying genotype composition), generate data from them (with user-specified observational/genotyping error) and analyze the data.

Availability and implementation

Implemented in R and C; open source code available under the GNU Affero General Public License v3.0 at https://github.com/rdiaz02/EvAM-Tools. Docker images freely available from https://hub.docker.com/u/rdiaz02. Web app freely accessible at https://iib.uam.es/evamtools.

Supplementary information

Supplementary data are available at Bioinformatics online.
Through Thick and Thin: Unpacking the Association between Role Stress and Job Performance by a Nationally Representative Sample of Chinese Child Welfare Workers
Authors: Jiang Shan , Jiang Chaoxin
Published: October 2022

Role stress is considered a risk factor for child welfare workers’ job performance, but little is known about its influencing paths. This study examines the mediating effects of two dimensions of collective psychological ownership in the association between role stress and job performance and reveals how Chinese culture shapes child welfare workers’ thoughts and behaviours. A sample of 2,943 Chinese child welfare workers is obtained from the data-set of the 2019 China Social Work Longitudinal Study. Findings illustrate that the association between role stress and job performance is partially mediated by shared decision-making and shared hardship endurance. The mediating effect of shared hardship endurance is much stronger than that of shared decision-making. This study clarifies the underlying mechanisms between role stress and job performance, enriching the limited knowledge of the child welfare profession. Practical implications for improving the job performance of child welfare workers are provided.
A Wealth Tax at Work
Authors: Thoresen Thor O , Ring Marius A K , Nygård Odd E , Epland Jon
Published: October 2022

Over the past decade, the question of whether and, in the event, how to tax household wealth has risen to the forefront of policy debates across the world. As Norway belongs to only a handful of countries that (still) levy an annual net wealth tax, we use the Norwegian example to review the case for annual taxation of wealth. Our discussion benefits from the use of rich administrative data, enabling us to provide a comprehensive set of empirical facts that are useful in assessing the merits of wealth taxation. We consider some of the central issues in the wealth tax debate: how the taxation of wealth fits in with personal income tax, distortionary effects, redistributional effects, and the extent to which wealth taxation may cause adverse liquidity effects for private firms. Taken together, we consider that the evidence presented here does not weaken the case for maintaining the tax in the Norwegian case: we find favorable distributional effects and efficiency losses appear to be limited (JEL codes: H21, H23, H25, and H31).
Costs Attributable to Clostridioides difficile Infection Based on the Setting of Onset
Authors: Sahrmann John M , Olsen Margaret A , Stwalley Dustin , Yu Holly , Dubberke Erik R
Published: October 2022

Background

Although hospital-onset Clostridioides difficile infection (CDI) is associated with significant healthcare costs, the economic burden of CDI with onset in other facilities or the community has not been well studied.

Methods

Incident CDI cases were identified using 2011–2017 Medicare fee-for-service data. Controls were randomly selected in a 4:1 ratio matching to the CDI case surveillance definition. Inverse probability of exposure weights were used to balance on measured confounders. One-, 3-, and 5-year cumulative costs attributable to CDI were computed using a 3-part estimator (parametric survival model and pair of 2-part models predicting costs separately in intervals where death did and did not occur).

Results

A total of 60 492 CDI cases were frequency-matched to 241 968 controls. One-, 3-, and 5-year adjusted attributable costs were highest for hospital-onset CDI at $14 257, $18 953, and $21 792, respectively, compared with hospitalized controls and lowest for community-associated CDI compared with community controls at $1013, $3161, and $6454, respectively. Adjusted 1-, 3-, and 5-year costs attributable to community-onset healthcare facility–associated CDI were $8222, $13 066, and $16 329 and for other healthcare facility-onset CDI were $5345, $6764, and $7125, respectively.

Conclusions

Economic costs attributable to CDI in elderly persons were highest for hospital-onset and community-onset healthcare facility–associated CDI. Although lower, attributable costs due to CDI were significantly higher in cases with CDI onset in the community or other healthcare facility than for comparable persons without CDI. Additional strategies to prevent CDI in the elderly are needed to reduce morbidity and healthcare expenditures.
Intake of Ultra-processed Foods Is Associated with an Increased Risk of Crohn’s Disease: A Cross-sectional and Prospective Analysis of 187 154 Participants in the UK Biobank
Authors: Chen Jie , Wellens Judith , Kalla Rahul , Fu Tian , Deng Minzi , Zhang Han , Yuan Shuai , Wang Xiaoyan , Theodoratou Evropi , Li Xue , Satsangi Jack
Published: October 2022

Background and Aims

Ultra-processed food [UPF] consumption has been linked to globally increasing incidence and prevalence of chronic diseases, including inflammatory bowel diseases [IBD]. We aimed to investigate the association between UPF consumption and IBD incidence, prevalence, and IBD-relevant outcomes.

Methods

We performed a cross-sectional and prospective cohort study in 187 854 individuals included in the national UK Biobank, using 24-h dietary recall questionnaires. Multivariable logistic regression and Cox proportional hazard regression were used to examine the association between UPFs and the prevalence and incidence risk of IBD, respectively.

Results

A total of 185 849 participants with a mean age of 56.2 were included, with a mean follow-up of 9.84 years. During follow-up, 841 developed IBD (251 Crohn’s disease [CD], and 590 ulcerative colitis [UC]). UPF intake in IBD patients was significantly higher: CD: odds ratio [OR] 1.94 (95% confidence interval [CI]: 1.52, 2.49, p <0.001); UC: OR 1.39 [95% CI: 1.17, 1.65, p <0.001]. Compared with low consumption, higher UPF consumption was significantly associated with incident CD: hazard ration [HR] 2.00 [95% CI: 1.32, 3.03, p = 0.001], but not UC. We also found a significant association between UPF intake and need of IBD-related surgery: HR 4.06 [95% CI: 1.52, 10.86, p = 0.005].

Conclusion

Higher intake of UPFs was associated with higher incidence of CD, but not UC. In individuals with a pre-existing diagnosis of IBD, consumption of UPFs was significantly higher compared with controls, and was associated with an increased need for IBD-related surgery. Further studies are needed to address the impact of UPF intake on disease pathogenesis and outcomes.
Multi-Dimensional Skills and Gender Differences in STEM Majors
Authors: Saltiel Fernando
Published: October 2022

This paper studies the relationship between pre-college skills and gender differences in STEM majors. I use longitudinal data to estimate a generalised Roy model of initial major choices and subsequent graduation outcomes. I recover students’ latent math ability, non-cognitive skills and math self-efficacy. High–math-ability women have lower math self-efficacy than men. Mathematical ability and self-efficacy shape the likelihood of STEM enrolment. A lack of math self-efficacy drives women’s drop out from STEM majors. I find large returns to STEM enrolment for high–math-ability women. Well-focused math self-efficacy interventions could improve women’s STEM graduation rates and labour market outcomes.
Whole-body Magnetic Resonance Imaging in the German National Cohort (NAKO): Design & Current Status
Authors: Bamberg F
Published: October 2022

Background

Whole-body magnetic resonance imaging (MRI) permits non-invasive, non-ionizing phenotyping of the human body and ideally complements the epidemiological assessment of the NAKO participants. As such, it allows for the detection of morphologic or functional predisposition, early disease stages prior to overt clinical events as well as evident pathological changes. The assessment of progression and regression of imaging phenotypes over time will provide the basis to identify and understand the relevance of imaging-based risk factor profiles for disease development.

Methods

Integrated in the general NAKO study program and managed by a central Imaging Core, study participants underwent whole-body imaging at five dedicated MR imaging sites. Imaging was performed on five identical 3 Tesla scanners (Magnetom Skyra, Siemens Healthineers, Erlangen, Germany) applying a one hour protocol, including sequences for the brain, the cardiovascular and musculoskeletal system as well as for the thorax and abdomen. Comprehensive measures to assure high image quality and management of incidental findings were established.

Results

As part of the baseline examination program, a total of 30,861 participants successfully underwent the MR imaging program. All measures of quality assurance and incidental findings management were successfully employed throughout the study period and obtained image quality and completeness of all MR sequences was excellent (>94.2% completeness). While MR imaging as part of the first re-examination is ongoing, baseline MRI data is currently accessible for scientific analyses.

Conclusions

The MRI-Study of the NAKO will provide a comprehensive imaging phenotypic biobank covering different organ systems with highest morphological and functional detail. MRI data analysis will gain novel insights into the natural history of disease development, the role of subclinical disease burden, and revolutionize our understanding of imaging biomarkers of risk.
The Berlin index of health and social deprivation: a data based tool to tackle health inequality
Authors: Zeiher J , Häßler K , Finger JD , Haase A , Hermann S
Published: October 2022

Background

Reducing socially induced health inequalities is a key task of urban and regional public health authorities. The Berlin index of health and social deprivation (BIHSD) 2022 aims to show regional differences in health and social situation in sub-areas of the city, to observe developments over time and to identify socially deprived sub-areas of the city.

Methods

The BIHSD 2022 is based on 20 indicators, most of which come from official statistics. Principal component analyses were applied to calculate subindices for the dimensions employment (e.g. unemployment rate), social conditions (e.g. risk-of-poverty rate) and health (e.g. premature mortality). Based on these subindices the final health and social index was derived. The (sub)indices are available on different spatial levels. Relative changes compared to the BIHSD 2013 were calculated to identify regional trends in the transitions in the social structure and health of the city over time.

Results

Besides improvements for most indicators over time in most regions of Berlin, there is still significant evidence for health and social inequality across the city. For example, long-term unemployment rate varies between 0.5% and 40.4% on the lowest spatial level. Following a secular trend, there are substantial improvements in former deprived areas in the inner city while in many peripheral residential areas with an average social structure in the past a downwards trend was observed.

Conclusions

Deprivation indices are helpful tools for research and health reporting in providing evidence for regional inequality. Additionally, they can be used to tailor health promotion strategies and to promote a targeted allocation of financial resources. For example, results of the BIHSD 2022 are being used in epidemiological analyses (e.g. regional inequalities in the risk of SARS-CoV-2 infection) and for (health) policy planning (e.g. needs- and demand-based planning of healthcare).

Key messages

• The Berlin index of health and social deprivation 2022 show regional differences in health and social situation in sub-areas of the city and documents developments over time.

• The index is being used in epidemiological analyses, to tailor health promotion strategies, and to promote a targeted allocation of financial resources.
Etiologic and prognostic roles of frailty, multimorbidity and socioeconomic characteristics in the development of SARS-CoV-2 infection and related severe health outcomes: systematic reviews of population-based studies
Authors: Makovski T , Ghattas J , Devleesschauwer B , Carcaillon-Bentata L ,   PHIRI WP5.2working group
Published: October 2022

The study had 2 objectives, to: 1) evaluate the etiologic roles of frailty, multimorbidity and socioeconomic status on SARS-CoV-2 infection probability, hospitalization, intensive care unit (ICU) admission, mechanical ventilation and COVID-19 related mortality; 2) investigate the prognostic roles of mentioned risk factors on the likelihood of hospitalization, ICU admission, mechanical ventilation, COVID-19 mortality, functioning, quality of life, disability, mental health and work absence. Three systematic reviews were performed, for each risk factor. The reviews shared first screening steps relying on a common population-based approach. Initial search took place on 7 April 2021 in PubMed, Embase, PsycINFO and WHO Covid-19 database. An update was performed for frailty only, on 1 February 2022, due to the scarce literature retained initially. Prospero registration number: CRD42021249444. Initial search retrieved 10 139 records; 411 studies were read in full text. An update for frailty retrieved 565 records. Finally, the total number of included studies was: for multimorbidity, objective 1 N = 2, objective 2 N = 13; frailty, objective 1 N = 2, objective 2 N = 3; socioeconomic characteristics, objective 1 N = 57, objective 2 N = 30. The risk of severe short-term outcomes such as mortality, ICU admission or hospitalization increased with increasing disease burden and socioeconomic deprivation. Literature on long-term impacts was not identified. The evidence indicates a dose-effect association across all risk factors and outcomes. There is a lack of work conducted on population-based representative samples accounting for frailty and multimorbidity. Measures of multimorbidity and frailty were heterogeneous between studies. Most of the studies observing socioeconomic determinants were performed in the USA and the UK; hence the need for more research in different contexts. Further evidence is required in order to estimate the impact of crisis among general population.
Trans* people’s access to gender-affirming health care: A European comparison
Authors: Breckenkamp J , Thirugnanamohan J , Stern A , Razum O , Namer Y
Published: October 2022

Background

Trans* people's life satisfaction is correlated with established legal frameworks for gender recognition and access to trans*-specific health care (Transgender Europe [TGEU], 2021). TGEU's guidelines to human rights-based principles of trans*-specific health care highlight bodily integrity/autonomy, free self-determination of gender, quality, specialized and decentralized care, and the right to determine reproductive paths as important pillars of gender affirming health care. We conducted a policy comparison across Europe regarding access to gender-affirming health care to assess how adherence to human rights-based principles could be strengthened.

Methods

We compared access to health care across four main domains: legal framework (e.g., legally recognised genders), insurance coverage (e.g., out of pocket costs), access barriers (e.g., legal requirements to access gender-affirming surgery), and health care offers (e.g., hormone replacement therapy). Criteria were developed in guided brainstorming sessions. Three researchers rated 28 countries across 28 items based on available policy documents.

Results

The majority of European countries prescribes a medicalised gender-affirming process rather than a self-decided process. Psychiatric diagnosis is also required in most countries to access gender-affirming health care. Gender-affirming health care is partly financed by statutory health insurance in most of the countries. Not all countries authorise full gender-affirming health care. Especially where statutory health insurance-covered gender-affirming health care relied centralised on single outpatient clinics or hospitals, waiting times between 6-24 months are found.

Conclusions

Many European countries fail to fully comply with TGEU's guidelines to human rights-based principles of trans* health care. Given the negative impact of access barriers on life satisfaction, European countries should target these shortfalls in ensuring gender-affirming health care.

Key messages

• Non- or only partly covered trans* health care contributes to health inequality.

• Regarding trans* people, European countries need to strengthen human-rights based access to gender-affirming health care.
Environmental health perception by Brussels inhabitants: comparison between a top-down raising awareness and citizen science
Authors: Incourt P , Herbrich L , Bouland C
Published: October 2022

The effects of the environment on health are well documented and prove to be a real public health problem. It is therefore essential to raise public awareness of these issues to induce preventive and protective behaviours. We focused on two methods: passive information transmission (top-down approach) and citizen science (bottom-up approach). The study aims to compare both approaches while raising awareness among Brussels citizens. We created two groups: a traditional awareness group, receiving infographics by email, and a citizen science group, carrying out immersive activities with researchers. All enrolled participants filled out a questionnaire before and after. The “top-down” group (n = 137) received 3 infographics. The citizen science participants deep-dived into the environmental health body of knowledge, carried out individual measurements of air quality and noise pollution along a city walk and analysed, together, the results in groups to design actions. The citizen science sessions were finalised by a focus group. All sessions enjoyed and developed knowledge and awareness of environmental health. Accompanying citizens in developing knowledge was beneficial and required for environmental health empowerment. It showed the added value of citizen science in raising curiosity, creativity, and capacity building. The participants showed different socioeconomic statuses and demonstrated an appetite for understanding the exposures measured during the walks. Our results integrate several SDGs among those SDG4 and SDG3, since by raising awareness of participants, we enabled them to improve their capacities in becoming actors in their health. The risk of developing health problems related to the environment is higher in lower socio-economic groups, due to a greater vulnerability and the inequitable environment distribution between neighbourhoods. Pro-environmental behaviour fosters reduced exposure for now and future generations.
Whole grain intake, overall diet quality and key components of sustainable diets in Finnish adults
Authors: Tammi R , Männistö S , Reinivuo H , Tapanainen H , Rautanen J , Maukonen M , Päivärinta E , Pajari A-M , Kaartinen NE
Published: October 2022

Background and objectives

Whole grains have been deemed a core component in diets promoting human health and environmental sustainability. Yet, research is scarce on whole grain intake in relation to overall diet quality and diet sustainability. We aimed to examine the association of whole grain intake with overall diet quality and key components of sustainable diets (fruits, vegetables, legumes, red and processed meat, plant-based and animal-based proteins) in Finnish adults.

Methods

Our data comprised 3127 adults (58% women, energy underreporters excluded) aged 18 − 74 years participating in the population-based FinHealth 2017 Study. Dietary intake was assessed by a validated 134-item food frequency questionnaire. Food, nutrient, energy and whole grain intakes were calculated utilizing the Finnish Food Composition Database. Overall diet quality was examined by the modified Baltic Sea Diet Score (excluding cereals). Associations were assessed by linear regression analysis adjusted for relevant confounders.

Results

Whole grain intake was positively associated with overall diet quality and fruit consumption (p < 0.001) in women and men. A positive association also occurred with plant-based protein intake (p < 0.001, women and men). Yet, whole grain intake was inversely associated with legume consumption in women (p = 0.001), while no association was found in men (p > 0.05). The association between whole grain intake and the intake of animal-based proteins and red and processed meat was inverse (p < 0.001) in both sexes. No association was found between whole grain and vegetable intakes (p > 0.05).

Conclusions

Our results suggest that whole grain intake is associated with healthier diets and more sustainable protein intake in Finnish adults. However, challenges in furthering healthy and sustainable diets in the population may occur regarding legume consumption. Legumes are especially important in plant-based diets as they complement cereals as a source of essential amino acids.

Key messages

• Higher whole grain intake may indicate higher overall diet quality and more sustainable protein intake in Finnish adults.

• Legume consumption requires further attention among Finnish adults with high whole grain intake despite their generally higher overall diet quality and more sustainable protein intake.
Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic
Authors: Lazzerini M , Covi B , Mariani I , Drglin Z , Arendt M , Hersoug Nedberg I , Elden H , Costa R , Drandic D , Pessa Valente E
Published: October 2022

Background

Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID19 pandemic, as defined by WHO Standards, are lacking.

Methods

Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.

Results

21,027 mothers were included in the analysis. Among those who experienced labour (N = 18,063), 41.8% (26.1%- 63.5%) experienced difficulties in accessing antenatal care, 62% (12.6%-99.0%) were not allowed a companion of choice, 31.1% (16.5%-56.9%) received inadequate breastfeeding support, 34.4% (5.2%-64.8%) reported that health workers were not always using protective personal equipment, and 31.8% (17.8%-53.1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20.1% (6.1%-66.0%) of spontaneous vaginal births and fundal pressure applied in 41.2% (11.5% -100%) of instrumental vaginal births. In addition, 23.9% women felt they were not treated with dignity (12.8%-59.8%), 12.5% (7.0%-23.4%) suffered abuse, and 2.4% (0.1%-26.2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N = 2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significantly lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes.

Conclusions

Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed.

Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
Are loneliness interventions effective in reducing loneliness? A meta-analytic review of 128 studies
Authors: Lasgaard M , Løvschall C , Qualter P , Laustsen LM , Lim MH , Maindal HT , Hargaard AS , Christensen J
Published: October 2022

Loneliness is widely acknowledged as a growing public health concern, accelerated by the onset of the COVID-19 pandemic. However, our knowledge about the effectiveness of interventions to reduce loneliness across the lifespan, including knowledge of different intervention strategies, is limited. This preregistered systematic review and meta-analysis aimed to evaluate the effect of interventions to reduce loneliness. The systematic review identified 136 studies. The meta-analysis included 128 studies comprising 54 randomised controlled trials (RCTs) (n = 6,379), 23 multi-cohort studies (n = 2,882) and 48 single-cohort studies (n = 3,009). A small to moderate statistically significant effect was detected (RCTs; SMD = -0.47, multi-cohort studies; SMD = -0.24, single cohort-studies; SMD = -0.42). Using the GRADE system, confidence in the estimates was assessed as low or very low, implying that the estimates may potentially be higher or lower. No statistically significant differences were found between age groups. Psychological treatment, social support interventions, and social and emotional skills training appeared to be the most effective intervention strategies in reducing loneliness but there is currently no strong reason to prefer one intervention strategy over another. Further analyses demonstrated that the long-term effects (i.e., one to six months after the intervention) were comparable to the short-term effects (i.e., up to four weeks after the intervention). Findings from the current meta-analyses provide overall evidence of the effectiveness of loneliness interventions. Given methodological limitations, including the heterogeneity of the reviewed studies, it remains unclear who the interventions would help the most. Overall, there is a need for rigorous and high-quality development and evaluations of interventions for loneliness.

Key messages

• The findings of this meta-analytic review suggest that interventions designed to reduce loneliness are effective.

• Psychological treatment, social support interventions, and social and emotional skills training are the most promising interventions, albeit the magnitude of the effects is moderate.
Low confidence in systematic reviews of digital interventions for physical activity promotion
Authors: Matthias K , Mergenthal L , De Santis KK
Published: October 2022

Background

The field of digital public health aims to promote and improve the health of people and communities through the application of digital interventions (DIs). Systematic reviews (SRs) show that many DIs target physical activity (PA) promotion. ‘A Measurement Tool to Assess Systematic Reviews’ (AMSTAR2) is a valid and moderately reliable appraisal tool with 16 items that can be used to derive an overall confidence rating (OCR: high, moderate, low or critically low) in the results of a SR. This cross-sectional study aimed to appraise SRs of DIs for PA promotion.

Methods

This study using 30 SRs was embedded within a scoping review with a published protocol (doi:10.2196/35332). Following electronic searches in 03/2021 in MEDLINE, PsycINFO, and CINAHL two authors independently selected and appraised the SRs. AMSTAR2 appraisal outcomes were expressed as (1) OCRs according to the AMSTAR2 scoring guidelines and (2) as percentage scores (fulfilled items/16 items). Appraisal outcomes were assessed using descriptive statistics.

Results

The 30 SRs were published in 2007-2021 and included 5-60 primary studies. Most SRs (27/30) received ‘critically low’ OCR, while ‘low’ (2/30), ‘moderate’ (1/30) or ‘high’ (0/30) OCRs were seldom. The 21 SRs published after AMSTAR2 implementation in 2018 onwards received higher percentage scores (mean±SD of 53±15%) compared to 9 SRs published before 2018 (44±13%). In addition, the 11 SR with a protocol received higher percentage scores (59±13%) compared to 19 SRs without a protocol (45±15%) and had fewer critical weaknesses (median: 2 vs. 4).

Conclusions

High quality SRs are needed for making public health decisions. AMSTAR2 assigns mostly low and critically low OCR to SRs of DIs for PA promotion. These SRs should not be relied on as a source of accurate evidence. Our results show that SR reporting guidelines need to be better followed.

Key messages

• According to AMSTAR2 the overall methodological quality of systematic reviews of digital interventions for physical activity promotion needs improvement.

• Better adherence to established reporting guidelines for systematic reviews in public health context is needed.