bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterising diabetes in Kazakhstan: a cluster analysis
Authors: Taurbekova B , Sarsenov R , Fazli S , Salimzhanov A , Mun V , Atageldiyeva K , Zhumambayeva S , Sarria-Santamera A
Published: October 2023

Background

Diabetes is a global pandemic, affecting 537 million adults worldwide in 2021. Diabetes is much more complex than the classification into type 1 diabetes and type 2 diabetes suggests. We aimed to identify homogeneous groups of patients with diabetes based on routinely collected measurements using unsupervised, data-driven cluster analysis.

Methods

We analyzed the data from Electronic Medical Records of 558 patients with newly diagnosed diabetes from 4 outpatient clinics in Astana. We performed a k-means cluster analysis of 9 routinely measured variables using the KMeans function (iterations=3 million) from the Scikit-Learn Python library.

Results

Cluster 1, consisting of 176 (31,5%) patients, was defined by late-onset diabetes, relatively low blood pressure (BP) and body mass index (BMI), moderate metabolic derangements, and comparably low glomerular filtration rate (GFR). The 83 (14,9%) patients in cluster 2 were characterized by a late manifestation of diabetes, high BP and BMI, relatively poor glycemic control, moderate dyslipidemia, and comparably low GFR. Cluster 3, including 98 (17,6%) patients, was represented by a low age at onset, comparably low BP and BMI, moderately poor glycemic and lipid controls, and high GFR. The 110 (19,7%) patients in cluster 4 had late-onset diabetes, high BP and BMI, subcompensated diabetes, poor lipid control, and relatively low GFR. Cluster 5, which involved 91 (16,3%) patients, was characterized by comparably low BP and BMI, poor glycemic control, modest dyslipidemia, and high GFR.

Conclusions

We intend to continue the project for further conducting a prospective study with dynamic monitoring of study participants, tracking specific patterns in the development of diabetic complications in each cluster. The results of this work will contribute to the development of a model for identifying patients with an initially predictable course of diabetes and a high risk of its complications at the time of diagnosis.

Key messages

• We identified five clusters of patients with diabetes with clinically significant characteristics in each cluster.

• Identification of subgroups of patients with an initially predictable course can be useful for recognizing those at highest risk of complications and applying personalized treatment strategies.
Incidence and persistence of post-COVID-19 condition in adults– a matched cohort study in Germany
Authors: Tesch F , Wende D , Loser F , Vivirito A , Menzer S , Batram M , Buschmann T , Sarganas G , Scheidt-Nave C , Schmitt J
Published: October 2023

Introduction

It is still unknown what proportion of persons suffer from long-term consequences of COVID-19. In October 2021, the World Health Organization (WHO) proposed a definition of post COVID-19 condition (PCC) as symptoms that last at least 3 month after onset of SARS-CoV-2 infection and frequently include fatigue, respiratory symptoms and cognitive dysfunction.

Methods

The WHO definition of PCC was translated into ICD-10-GM Codes and investigated in a cohort of patients with laboratory-confirmed COVID-19 during 2020 and matched to controls in German routine healthcare data. Incidence rates were calculated and incidence rate ratios (IRRs) were estimated for developing any of the predefined diagnoses conditional on a preceding diagnosis of COVID-19. Within the COVID-19 cohort the persistence of PCC was followed up to one year after infection.

Results

A cohort of COVID-19 patients in the year 2020 was followed up to 2021-09-30 in routine healthcare data. The incidence in the COVID-19 group compared to matched controls for any investigated symptoms and conditions after three months was accessed. Main contributions were dyspnea (R06.0) and malaise/fatigue (R53). The highest IRR was observed for chronic fatigue syndrome (CFS; G93.3) the lowest for cognitive impairment (F06.7, U51). After one year a minority of the patients still had at least one specific diagnosis. The longest persistence of the symptoms was observed for CFS, cognitive impairment (F06.7, U51) and memory loss/disorientation (R41).

Conclusions

The more specific and serious diagnoses had a higher likelihood to occur in the COVID group compared to the matched control group and also these diagnoses persisted longer in the COVID group compared to less serious diagnoses. Due to the high number of infected people during the first two waves of the pandemic this result translates into considerable burden for the medical system.

Key messages

• In routine healthcare data of adults more serious ICD-10 diagnoses had a higher likelihood to occur in the COVID-19 cohort compared to the matched control cohort.

• Within the COVID-19 cohort more serious ICD-10 diagnoses persisted longer than less serious diagnoses.
Increasing incidence of non-Hodgkin lymphoma in England, 1985–2019
Authors: Bawa M , Salari Y , Taylor-Gallardo E , Memon A
Published: October 2023

Background

In the UK, non-Hodgkin lymphoma (NHL) is the most common hematological malignancy and 6th most common cancer overall - accounting for about 14,200 new cases and 4,900 deaths each year. After rising rapidly from the 1980s onwards, the incidence rates of NHL have broadly stabilised in several European and North American countries since the late 1990s. We conducted a retrospective population-based cohort study to examine whether similar changes in the incidence of NHL have also occurred in England from 1985-2019.

Methods

Individual-level data for patients diagnosed with NHL, and the corresponding national population (denominator) data were obtained from ONS/PHE. Average annual incidence rates (AAIR) were calculated by sex, three age categories (0-34, 35-64 and 65+ years) and seven five-year time periods (1985-89 to 2015-19).

Results

During the 35-year study period, a total of 304,994 new cases of NHL were registered in England (54% males, 46% females). In young people aged 0-34 years, the AAIRs increased by 33% in males and 60% in females (from 1.8/100,000 in 1985-89 to 2.4/100,000 in 2015-19 in males, and from 1.0/100,000 in 1985-89 to 1.6/100,000 in 2015-19 in females). In middle age (35-64 years), the AAIRs increased by 54% in males and 57% in females (from 13.3 to 20.5 in males, and from 9.6 to 15.1 in females). At older ages (65+ years), the AAIRs increased by 108% in males and 102% in females (from 47.6 to 99.1 in males, and from 34.1 to 68.7 in females). In both sexes and all age categories, the disease was most frequently diagnosed at the advanced Stage 4. With regards to the socioeconomic status, the disease was relatively more commonly diagnosed in the most deprived groups.

Conclusions

In contrast with many European and North American countries, there has been a steady and substantial increase in the incidence of NHL in England over the past four decades. Overall, the highest increase was observed in males (115%) and those aged 65+ years (109%).

Key messages

• The reasons behind this continued increase in incidence in England, which is in contrast with most European/North American populations, remain elusive and need further etiological investigation.

• Considering that the large majority of cases were diagnosed at the advanced Stage 4, there is an urgent need for clinical guidance to facilitate early diagnosis of NHL.
Cancer risk factors and access to cancer screening for people experiencing homelessness
Authors: Jeleff M , Haider S , Schiffler T , Gil-Salmerón A , Yang L , Barreto Schuch F , Grabovac I
Published: October 2023

Background

People experiencing homelessness (PEH) are significantly more likely to develop and die from cancer than the housed population. Major factors influencing outcome are timely detection and treatment, which especially populations with complex needs lack access to. This scoping review outlines cancer risk factors among PEH and their facilitators and barriers to access cancer prevention.

Methods

Databases were searched in Embase, Global Index Medicus, PubMed, Scopus, and Web of Science in February 2023. OpenGrey and Google were searched for grey literature. Peer-reviewed and grey literature on cancer risk factors among PEH and factors facilitating or hampering access to cancer prevention services were eligible and synthesized narratively.

Results

We included 40 articles published between 1998 and 2023. Most eligible studies were conducted in the US (n = 34; 85%), indicating a paucity of data from other regions. More than one-third of the studies were published between 2018 and 2023, suggesting a recent increase in research interest. Access to cancer screening was associated with factors on the individual level (e.g., psychological and physical factors), interpersonal level (e.g., practical support), system level (e.g., continuous care), policy level (e.g., interventions to facilitate access). Most eligible studies reported high tobacco use among PEH. Overall, cancer risk factors among PEH have been less studied and require further research.

Conclusions

Mapping the evidence on cancer risk factors as well as barriers to accessing preventive services in this underserved population is a necessary step to create evidence-based public health recommendations: (a) Due to higher cancer risk factors among PEH, preventive strategies tailored to this population are necessary; (b) innovative strategies such as patient navigation may be viable to increase participation in screening programs; (c) investment in research within the European context is necessary.

Key messages

• Findings suggest that a system-wide approach is needed to address the increased risks and facilitate timely uptake of cancer screening to ensure sustainable use of cancer prevention services in PEH.

• Evidence suggests policymakers need to be aware of inequity in access to cancer preventive services among PEH.
Impact of covid-19 on obesity and abdominal obesity: focusing on differences by age group
Authors: Lee G H , Lee J A
Published: October 2023

Backgrounds

During the COVID-19 pandemic, the implementation of social-distancing policies has led to escalating the prevalence of obesity. Especially, social changes caused by COVID-19 would have had different effects depending on age. Therefore, this study aims to analyze the prevalence of obesity that has increased during the pandemic according to age group.

Methods

The study subjects were Korean adults aged 19 to 64 years who participated in the 2019 to 2020 Korean National Health and Nutrition Examination Survey (KNHNES). The definition of obesity, morbid obesity, and abdominal obesity were defined using Asian-Pacific guidelines. The age group was divided into under 40 years old and over 40 years old. We analyzed the odds ratio (ORs) (95% confidence intervals (CIs)) to compare the variants between before (2019) and after (2020) COVID-19.

Results

The prevalence of obesity, morbid obesity, and abdominal obesity increased in 2020 compared to 2019 among the Korean population. In multivariable analysis, the rate of obesity and abdominal obesity increased in both groups whom under 40 years old and over 40 by OR of 1.23 (95% CI, 1.09-1.40) and 1.23 (95% CI 1.07-1.40). However, the rate of morbid obesity only increased in adults younger than 40 years old by an OR of 1.45 (95% CI, 1.05-2.01). The achievement rate of aerobic physical activity decreased in 2020 for both age groups(<40: from 55.8% to 52.7%, ≥40: from 42.7% to 41.3%). Notably, men showed a decrease in the achievement rate of aerobic physical activity in 2020 (OR 0.82, 95% CI, 0.69-0.97) compared to 2019.

Conclusions

Our study shows the increase in the prevalence of obesity during the COVID-19 pandemic and morbid obesity among those under the age of 40. We found a decrease in aerobic physical activity in 2020 compared to that in 2019. In Korean men, further evaluation might be necessary to determine the associated factors affecting the increased prevalence of obesity during the COVID-19 pandemic period.

Key messages

• The prevalence of obesity increased during the COVID-19 pandemic in Korea, with a rise in the incidence of morbid obesity among those under the age of 40.

• The achievement rate of aerobic physical activity decreased in 2020 compared to that in 2019.
A multispecies coexistence based on rewilding and degrowth for the sake of global health
Authors: Moyano-Fernández C
Published: October 2023

The climate emergency is closely linked to biodiversity loss, both in its (anthropogenic) causes (anthropogenic) and possible (nature-based) solutions. Both crises are a major threat to global health because zoonoses, global warming and other climate impacts make present and future generations vulnerable, and aggravate social inequalities. Indeed, this has led some authors to start talking about ecological determinants of health. However, based on a narrative review of recent academic literature, I will argue that trophic rewilding strategies, framed within conservation biology, can ensure global health by stopping the spread of zoonoses and animating the carbon cycle. A first aim of my contribution will be to defend this correlation. Then, my next purpose will be to address how rewilding could favor coexistence with protected or reintroduced keystone species. The recent UN Biodiversity Conference (COP15) in Montreal agreed to extend the care of wilderness areas and restore 30% of degraded ecosystems by 2030, but this is a political as well as a social challenge. The current development model in Europe, based on fossil-dependent economic growth, is a stumbling block for wildlife to flourish. I will therefore argue that degrowth could be a complementary development alternative to rewilding in order to make a more serious commitment to global health.

Key messages

• The ecological restoration of trophic rewilding can contribute to global health by mitigating climate change and zoonoses.

• The development of European societies is based on economic growth, and as this is a threat for wildlife flourishing, a shift towards degrowh could complement rewilding and strengthen global health.
CHH: Health community accessing environmental information from the Copernicus Programme
Authors: Letertre J , Ananasso C , Peuch V H
Published: October 2023

Copernicus is the Earth observation component of the European Union's Space programme, looking at our planet and its environment to benefit all European citizens. The Copernicus services transform wealth of satellite and ground-based measurements into value-added information by processing and analysing the products. All the information is provided with an open and free data policy to help public national and European authorities, policy makers, international organisations and service providers to improve European citizens’ quality of life. There are six operational Copernicus Services covering the whole Earth System including ocean, land, atmosphere and more horizontal domains such as climate change, emergency and security. To facilitate the use of these information by the different user communities, some Thematic Hubs have been created and are under development. One of the first hubs is the Copernicus Health Hub (CHH) and it is focusing on the health community. The CHH collects and provides all the Copernicus environmental information that are pertinent to Health, following WHO definition: Physical, Mental and Well-being. The health Hub is also supporting the users in better exploiting and uptake Copernicus data and products (via documentation, access to catalogues, inspirational use case stories, ...). In addition, the CHH should collect new requirements for the evolution of the Copernicus programme. In this presentation, the CHH will be introduced in more details, the different types of environmental information will be presented accompanied by some use cases to inspire further developments and new applications for the health community.

Key messages

• The Copernicus Health Hub is a facilitator between the Health community and the Earth Observation and environmental science community.

• The Copernicus Health Hub provide all environmental data at Globale and European scale.
Developing Population Health Management in Ireland-Challenges and Opportunities
Authors: Hayes C , O'Reilly O
Published: October 2023

Population Health Management (PHM) is the concept of aggregating population data with data from multiple care and service settings, the analysis of that data into a single, actionable patient record, and using the insights gained to identify that population's specific healthcare needs and develop a tailored response to them. This is achieved through the use of data analytics, artificial intelligence, and digital technologies, by stratifying populations according to the risk of deterioration in health. This stratification allows the development of early personalised interventions with an emphasis on prevention, which are key to better outcomes. The overall aims of PHM are to improve the health and well-being of the population, and the patient experience of care, to reduce healthcare costs, to improve workforce well-being and engagement, and to address inequalities in health and care. This discussion paper will cover the core building blocks for PHN, the tools required to carry out population health needs assessment; population segmentation, and risk stratification. The development of PHM and its use internationally will be discussed together with developments and opportunities provided in the context of the Irish healthcare system. It will discuss the current status of PHM development in Ireland using a population health maturity matrix. Evidence and examples of impact will be provided and recommendations to advance its progression within the Irish healthcare system. Challenges for the future advancement of PHM include a better definition of the content of the segmentation analysis and the intervention steps, demonstration of its added value, in particular its cost-effectiveness, and aligning the rationale for action that underpins current customization efforts. Regarding programme implementation, those programmes that are well-supported, funded, and given sufficient time to develop are most likely to demonstrate impact.

Key messages

• Future advancement of PHM requires a better definition of the content of the segmentation analysis and the intervention steps, and demonstration of its effectiveness and cost-effectiveness.

• Programmes that are well-supported, funded, and given sufficient time to develop are most likely to demonstrate impact.
Evaluating preconception health and behaviour change following a digital intervention: OptimalMe
Authors: Brammall B R , Garad R M , Teede H J , Harrison C L
Published: October 2023

Background

Reproductive-aged women are a high-risk group for accelerated weight gain and obesity development. The objective of the current study was to assess the impact of a digital healthy lifestyle intervention for women planning a pregnancy, in optimising preconception health and lifestyle behaviours.

Methods

Australian women with the intention to conceive were invited to participate in OptimalMe. To be eligible women must be aged 18-44 years, not pregnant but wanting to conceive within 12 months of recruitment and have internet access. All participants receive the same digital lifestyle intervention, supported by health coaching and text messages during preconception. A parallel 2-arm design with sequential randomisation to compare telephone with videoconference delivery methods for health coaching was adopted.

Results

Overall, 298 women enrolled, with a mean ± (SD) age of 31.7 (4.6) years and BMI 25.5 (6.3) kg/m2. Suboptimal preconception behaviours were reported at baseline including alcohol consumption (57.0%), infrequent weighing (37.2%), and incomplete cervical cancer screening (15.8%) and prenatal supplementation (38.6%). The OptimalMe evaluation was completed by 217 women, 72.8% of the study population, an average of 4.5 months after commencing the intervention. At follow-up, a significant shift towards desired behaviours was reported for alcohol consumption (non-drinker) (z = 2.727, p = 0.00634), prenatal supplementation (taking supplement) (z=-11.082, p < 0.00001) and weighing behaviour (frequent weigher) (z=-5.291, p < 0.00001).

Conclusions

Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy. Post intervention outcomes suggest that remotely delivered preconception interventions improve lifestyle behaviours and engagement with clinical preconception care objectives.

Key messages

• Digital health interventions show positive change to important lifestyle behaviours.

• Women planning a pregnancy demonstrate sub optional health and lifestyle behaviours therefore interventions are needed to improve this.
The impact of socioeconomic vulnerability on the incidence of COVID-19 in school students
Authors: Olivella-Cirici M , Forcadell-Díez L , Montemayor Cejas P , Sánchez-Valdivia N , Fernández Barres S , Pila Valero M , Reyes Segura A , Pasarín Rua M I , Pérez Albarracín G
Published: October 2023

Inequalities have been observed in the spread of COVID-19 due to higher incidence rates in environments with greater socioeconomic deprivation. The objective of this study was to analyse the relationship between socioeconomic level and the incidence of COVID-19 in students of schools in the city of Barcelona, in different epidemic waves. Cross-sectional ecological study on compulsory education students (N = 176,390). Unit of analysis: the 780 schools in the city. Study period: second (autumn 2020), third (winter 2020-21) and sixth epidemic waves (winter 2021-22). Dependent variable: Cumulative Incidence (CI) of COVID-19 among school students. Independent variables: complexity and ownership of the school, indexes in quartiles (being Q4 the most disadvantaged) of vulnerable students of the school and the Available Family Income (AFI) of the neighbourhood of the school. Stratified by sex and educational stage (Primary/Secondary). A bivariate and multivariate analysis was performed using Poisson regression to calculate crude Relative Risks and adjusted (aRR). As an impact measure, the Population Attributable Risk was calculated. In the second wave, 41% of the CI in primary boys was attributed to the vulnerability of the school (Q4: aRR=1.96 [1.10-3.50]), and 36% to a lower AFI in the neighbourhood of the school in secondary boys (Q4: aRR=3.18 [1.25-8.13]). Instead, in the sixth wave, taking Q4 as a reference, 35% of the CI in primary girls was attributed to lower vulnerability indices of the school (Q1: aRR=1.82 [1.52-2.20]), and 38% higher AFI from the neighbourhood of the school in secondary girls (Q1: aRR=1.99 [1.33-2.98]). In the third wave, the results are mixed and less significant in the models. The results obtained show that there was an inversion of the impact of social inequalities in the CI of COVID-19 in the second wave compared to the sixth. This reflects the need to delve into the contextual factors that favour the spread of communicable diseases.

Key messages

• The socioeconomic vulnerability of school students has been associated with a higher Cumulative Incidence of COVID-19 in the second wave, but this pattern has been reversed in the sixth wave.

• Between 18 and 41% - depending on gender, educational level and epidemic wave- of the Cumulative Incidence of COVID-19 in Barcelona schools can be attributed to factors of socioeconomic deprivation.
Diet quality and risk of SARS-CoV-2 infection or COVID-19 disease: a systematic review
Authors: Sharma S , Di Castelnuovo A , Cerletti C , Donati M B , de Gaetano G , Iacoviello L , Bonaccio M
Published: October 2023

Background

The COVID-19 disease pandemic highlighted the importance of healthy diets in the management of SARS-CoV-2 infection and COVID-19 disease. Evidence suggests the influence of the diet and dietary patterns during post-COVID-19 disease, and the impact of the COVID-19 disease pandemic on dietary habits and quality. However, limited evidence exists on the association between a healthy diet, and risk of SARS-CoV-2 infection and COVID-19 disease.

Methods

5072 research articles from Scopus, EMBASE, PubMed and MEDLINE databases were identified for eligibility. Only studies that had prospective and cross-sectional study designs were included. Eight studies were extracted and were included in the current systematic review that explored Mediterranean diet and dietary components as dietary exposures, and SARS-CoV2 infection and COVID-19 disease as study outcomes.

Results

Amongst cross-sectional studies, a higher adherence to Mediterranean diet lowered the odds of COVID-19 disease between 12% (OR: 0.88; 95% CI: 0.81-0.97) and 84% (OR: 0.16; 95% CI: 0.08-0.32). Amongst prospective studies, a higher diet quality and adherence to a Mediterranean diet was associated with lower hazard ratio of 9% (HR: 0.91; 95% CI: 0.88-0.94), and the odds of COVID-19 diseases by 36% (OR: 0.64, 95% CI: 0.42-0.98) to 50% (OR: 0.50, 95% CI: 0.34-0.73), respectively.

Conclusions

Overall findings of the studies in this review support the concept that Mediterranean diet and other nutritious diets might lower the risk of COVID-19 disease. Awareness could be created by promoting nutrition education programmes. Finally, this review highlights the limited evidence, and requirement of further studies to explore the longitudinal associations between diet, and SARS-CoV2 infection and COVID-19 disease in order to make the findings more generalisable.

Key messages

• A nutritious diet is associated with lower risk of COVID-19 disease.

• Longitudinal studies and nutritional awareness is required to promote the importance of diet quality to cautiously prevent the risk of SARS-CoV2 infection and COVID-19 disease.
Long-term study using of short stems with ceramic-on-metal bearing in hip replacement
Authors: Saracco M , Logroscino G , Maccauro G , Fidanza A , Goderecci R , Falez F , Nasi G
Published: October 2023

Background

Osteoarthritis is a disease that affects about 300 million people in the world. Surgery is indicated in cases where all other treatments have failed, in economic terms expenses are between 1 and 2.5% of the GDP of the most industrialized countries in the world. Hip prosthetic replacement surgery is the gold standard for patients affected by symptomatic osteoarthritis. The ceramic-on-metal (C-M) hybrid hard-on-hard bearing was initially launched on the market with the purpose of reducing adhesive and corrosion wear, loss of metal debris and ions and risk of fracture and squeaking. However, this bearing was withdrawn from the market, in the apprehension of local and systemic toxicity. The aim of this study is to evaluate the reliability and safety of ceramic-on-metal bearing at long term follow-up.

Methods

From 2 cohorts of patients suffering of hip osteoarthritis who underwent total hip arthroplasty using ceramic-on-metal bearing with two different short stems, 19 of the GROUP A and 25 of the GROUP B were suitable for this study. All compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12P/M), and radiographically. The two groups were compared in terms of metal ions blood levels (chromium and cobalt), and finally all the implanted prostheses were compared with a healthy control group.

Results

All the implanted stems were well osseointegrated at a mean follow-up of 114 months. Radiographical and clinical scores performed well. Chromium and cobalt ion analysis revealed values below the safety threshold except for 3. No revision occurred.

Conclusions

Ceramic-on-metal bearing is safe and reliable at long term follow-up in association to short stems arthroplasty, if the implant is correctly positioned. Chromium and cobalt metal ions blood levels evaluation should be performed annually.

Key messages

• Metal ions evaluations is mandatory in patients with ceramic-on-metal bearing.

• Ceramic-on-metal bearing is safe and reliable at long term follow-up, if the implant is correctly positioned.
Prior morbidity and sickness absence with Covid-19 among wholesale and retail blue-collar workers
Authors: Farrants K , Alexanderson K
Published: October 2023

Background

Cancer, cardiovascular disease, hypertension, diabetes, chronic kidney disorders, chronic lung disorders, neurological disorders, obesity, immunocompromisation, and schizophrenia or bipolar disorders were found to be risk factors for severe Covid-19. The aim was to determine associations between having such diagnoses and future sickness absence (SA) due to Covid-19 or related diagnoses in 2020.

Methods

A prospective population-based cohort study of all 299,268 blue-collar workers (48% women) in Sweden in 2018, using linked microdata from four nationwide registers covering 2018-2020. People with any of the above diagnoses in 2018 or 2019 were identified using microdata from specialised in- and outpatient healthcare and prescribed drugs. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of a new SA spell >14 days due to diagnosed Covid-19 or one of the diagnoses used by the Social Insurance Agency for suspected Covid-19 in 2020, separately for each diagnosis group and a global estimate for all risk factors together, adjusted for sociodemographic characteristics.

Results

In total, 38,422 individuals had at least one of the diagnoses that was a risk factor for severe Covid-19. Of them, 284 individuals had SA due to Covid-19 or related diagnoses (0.7%) in 2020, while 1210 of those with no such risk factor for Covid-19 had SA due to Covid-19 or related diagnoses (0.5%). The adjusted OR of SA due to Covid-19 or related diagnoses was 1.37 (95% CI 1.20-1.56) for those who had any risk factors for severe Covid-19. The group of diagnoses with the highest adjusted OR for SA in Covid-19-related diagnoses was lung disease (2.23; 95% CI 1.93-2.56).

Conclusions

While only a few of those with prior morbidity that was a risk factor for severe Covid-19 had SA due to Covid-19 or related diagnoses in 2020, they had a higher risk than those without such prior morbidity.

Key messages

• Having prior morbidity with a diagnosis identified as a risk factor for severe Covid-19 was associated with a higher risk of having SA due to Covid-19 or related diagnoses in 2020.

• Prior lung disease was the diagnosis group with the highest risk of SA due to Covid-19 or related diagnoses.
Regional public health staff workplace psychosocial risk assessment and health promotion initiative
Authors: Ryan L , Edwards D , Lee J , Connor D O , Kane G O , Smith L , Cooney F
Published: October 2023

Psychosocial work conditions can be detrimental to worker wellbeing with 70% of healthcare workers reporting work related stress, which may lead to burnout. Despite European health and safety legislation, managers rarely assess and manage workplace psychosocial risks. The Public Health workforce in Ireland, already impacted by the pandemic, is currently experiencing major organisational change as a result of the ongoing Public Health Reform Process. This paper describes the structures, processes and outcomes involved in a Public Health staff (n = 56) workplace psychosocial risk assessment, guided by the European Framework for Psychosocial risk Management: PRIMA-EF, using the HSE Work Positive CI psychosocial risk assessment survey. The establishment of a multidisciplinary Health & Wellbeing (H&W) group, under the governance of the Area Senior Management Team, was key to guide the process, including a workplace health promotion initiative, influenced by Positive Psychology framework (PERMA). The response rate to the survey was 70% (n = 40), with half of staff reporting psychological distress. Work stressors included role clarity, demand, change and control, scoring below average compared to Irish organisational norms. Relationships and manager support scored highly. The H&W group shared results promptly with all staff and formulated iterative mitigation measures, including HSE Change Management and HSE Health & Wellbeing consultants, based on the survey action plan and staff feedback. Five months later a repeat survey revealed continuing issues around role clarity and demands, with change and control showing an improvement. Further exploration of these results, and an evaluation, informed by staff feedback is ongoing and iterative. Lessons learnt include the importance of embedding a dedicated H&W multidisciplinary group to lead the continuous process; senior management support; employee involvement and effective utilisation of existing organisational tools and supports.

Key messages

• It is a public health imperative to promote risk assessment and mitigation of healthcare workplace stressors to safeguard employee wellbeing and ensure health service resilience and patient safety.

• Effective workplace psychosocial risk assessment and implementation of targeted mitigation measures requires management support and a continuous iterative collaborative quality improvement process.
The scope of psychosocial factors among resident physicians and their links to occupational burnout
Authors: Kaliniene G , Žutautienė R
Published: October 2023

Background

High work demand, low authority and decision-making latitude and constantly changing situations put residents’ physicians under increased pressure, causing burnout resulting in reduced workability and wellness. The awareness of the most critical factors is crucial for the development of preventive occupational interventions to reduce burnout and stress.

Methods

A cross-sectional study was conducted. Data were collected with the Job Content Questionnaire (JCQ) and Copenhagen Burnout Inventory (CBI) from 233 hospital resident physicians.

Results

The descriptive analysis showed that the psychosocial work environment was negative in the resident physicians’ population - about a third (35.5%) of respondents had low job skill discretion and 40% complained about weak decision-making authority therefore 45% were classified as having low job control. More than one-third (39.1%) of respondents had high job demands and about a quarter had weak co-worker and supervisor support (24.9% and 24.5% respectively) and 37% felt insecure at work. The statistical analysis showed a high frequency of personal (PB), work-related (WB) and client-related burnout (CB) - 53.6%, 62.2%, and 33% respectively. The multiple stepwise regression models for each burnout dimension revealed that job skill discretion was found to have a buffering effect and reduced personal and work-related burnout odds by an average of 12% and 16% respectively. Each one-unit increase in job demands score increased the probability of all burnout dimensions by an average of 9% (PB), 13% (WB) and 18% (CB). The increase in scores of insecurity at work increased the probability of PB (B = 1.2) and CB (B = 1.3). The co-workers’ support reduced the probability of CB by 20%.

Conclusions

The result of this study indicated that promoting job skills discretion and co-workers’ support and reducing job demands and insecurity at work could be the most effective way to reduce occupational burnout among young physicians.

Key messages

• Physicians residents are particularly vulnerable to occupational burnout.

• In solving the issue of professional burnout among young doctors, the focus must be directed to ensuring work control and optimizing workload.
Determinants of long-term sickness absence trajectories among 19–39-year-old employees with pain
Authors: Fagerlund P , Shiri R , Rahkonen O , Lallukka T
Published: October 2023

Background

Previous studies have shown higher long-term sickness absence (LTSA) rates among employees with pain as compared to those not reporting pain. We examined distinct developmental patterns in LTSA (≥10 consecutive working days) among young and early midlife employees with pain at baseline, and factors associated with LTSA trajectories.

Methods

The study population consisted of 19-39-year-old employees (n = 1685) of the City of Helsinki who reported current pain at baseline in 2017. Data on all-cause LTSA days through March 2020 were collected from the Social Insurance Institution of Finland. Group-based trajectory modelling was used to identify distinct all-cause LTSA trajectories. Multinomial logistic regression was used to examine associations of pain characteristics, lifestyle- and occupational factors with trajectory group membership.

Results

Three distinct LTSA-trajectory groups were identified; No LTSA (74%), Decreasing (18%), and Increasing (8%). Compared to the No LTSA trajectory, employees in the Decreasing trajectory were more likely to have chronic (OR 1.34, 95% CI 1.04-1.73) or multisite (OR 1.81, 95% CI 1.36-2.41) pain, smoke (OR 1.55, 95% CI 1.18-2.03), have obesity (OR 1.70, 95% CI 1.21-2.38), manual or routine non-manual occupation (OR 1.87, 95% CI 1.31-2.67) and high physical workload (OR 1.47, 95% CI 1.14-1.90), after adjusting for age and gender. Predictors of the Increasing trajectory were not identified.

Conclusions

Distinct LTSA-trajectories were identified among young and early midlife employees with pain, of whom a majority had no LTSA during follow-up. Chronic and multisite pain, unhealthy lifestyle, lower occupational class, and higher physical workload are related to a pattern with more LTSA. Future intervention studies could examine opportunities to prevent LTSA through supporting younger employees who work with pain and have these risk factors.

Key messages

• Distinct trajectories of LTSA were identified among younger employees with pain, of whom most had no LTSA. Pain characteristics, lifestyle and occupational factors predicted trajectory membership.

• Future intervention studies could examine opportunities to prevent LTSA through support to employees who work with pain and have pain-, lifestyle- and occupation related risk factors of LTSA.
Stroke care pathways according to rural-urban residency
Authors: Grimaud O , Kerbrat S , Menant L , Olié V , Timsit S , Le Meur N
Published: October 2023

Context

There is concern in France about geographical access to health care, particularly in remote areas with scarce medical services. The objective of our study was to compare the care pathway of stroke patients according to their residence context (rural/urban) and their affiliation to the “agricultural social security” scheme (“MSA”).

Methods

The study population included ischaemic strokes occurring between 2010 and 2013 in the 79 communes covered by the Brest stroke register (BSR). State sequence analysis using BSR data linked to medico-administrative records led to the construction of a typology of care pathways encompassing a period of 12 months before and after stroke occurrence. The associations between the typology, communal density (3 levels: dense, intermediate, and sparse), and affiliation to MSA were analysed by multinomial logistic regression.

Results

The study involved 2499 strokes (men 47%, mean age 71 years) distributed equally between the three levels of density. The pathway typology identifies a 1st group of severe strokes (n = 539). Pre-stroke care consumption distinguishes the 2nd (high consumption, n = 844) and 3rd (low, n = 1117) groups. Communal density was not associated with the pathway type, although the use of post-hospitalisation care was lower in the intermediate density (e.g. use of GP services in the year: 85% versus 92%, p < 10-3). Affiliation to MSA (n = 389, 16%) was positively associated with the low care consumption group. MSA patients had a lower prevalence of diabetes (10.5 versus 14.4%, p = 0.05) but a higher prevalence of cardiac arrhythmia (29% versus 22%, p < 0.01). Stroke occurred significantly later in these patients (e.g. mean age in men: 76 versus 70, p < 10-3).

Conclusions

In the BSR territory, stroke patients’ pathway did not vary according to communal density suggesting equitable access to care. The unexpected result of higher age at stroke occurrence among MSA patients (reflecting lower incidence) requests further investigation.

Key messages

• Access to stroke care was comparable in rural and urban areas of Brittany, France.

• Affiliation to the agricultural social security scheme was associated with lower risk of stroke.
Health economic analysis of inpatient prostate cancer treatment in Austrian hospitals
Authors: Heilig D , Wienand D , Zuba M , Mitterhauser M , Simon J
Published: October 2023

Background

Prostate cancer (PrC) is the fourth most prevalent type of cancer worldwide. Its high incidence and 5-year survival rates contributing to high inpatient care costs make it an important public health issue. In Austria, surgery has been the most common inpatient procedure for PrC, despite clinical recommendations not clearly indicating its benefits over alternatives. No health economic comparison of these procedures has considered the period after treatment yet. We bridge this gap by analysing the health economic impact of treatment pathways.

Methods

We use a large administrative dataset of all inpatient PrC patients in Austria who received either only surgery or only radiation therapy from 2005-2014 (n = 34,286). To assess the health economic impact, we used diagnosis-related-group (DRG) points and length of stay (LOS). Monthly DRG points and LOS for each patient ±12-months around the index procedure were analysed using the difference in difference (DID) method. We controlled for age, and physical comorbidity burden using Charlson Comorbidity Index (CCI) scores.

Results

Looking at unadjusted averages, patients in the surgery group were significantly younger and had a lower CCI compared to the radiation group. Consequently, the surgery group had lower nominal average DRG points and LOS. However, when controlling for age and CCI, we found that radiation treatment was less resource intensive. A DID estimation found a shorter average LOS and lower DRG points for the radiation group compared to surgery for the 12 months post index.

Conclusions

We found significant additional costs and LOS times for surgical pathways following risk adjustment in Austria. This implies a potential excess burden of ∼4,400 hospitalisation days and ∼4 million DRG points (€4.8m) a year for the healthcare system during the observed period. Considering international evidence on higher patient burden in surgical pathways, these findings may call for clinical reconsiderations of PrC care.

Key messages

• Patient characteristics of different inpatient treatment pathways for PrC in Austria were very heterogenous.

• Health economic outcomes in the post treatment period for PrC inpatient treatment were significantly better for radiation treatment compared to surgery.
Has cross-level clinical coordination changed in the Catalan health system after the pandemic?
Authors: Campaz D , Vargas I , Cots F , Escosa A , Perez-Castejón J M , Plaja P , Sánchez E , Banqué M , Sánchez A , Vázquez M L
Published: October 2023

Background

The COVID-19 pandemic triggered several changes in the organization of health services, such as the acceleration of the introduction of digital tools to improve cross-level clinical coordination and, therefore, the quality of care. The aim is to analyse changes in the experience, perception of cross-level clinical coordination and related factors of primary care (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.

Methods

Comparison of two cross-sectional studies based on the online surveys COORDENA-CAT (2017) and COORDENA-TICs (2022) to PC and SC doctors. Sample 2017 n = 3308 (participation: 20.9%); 2022 n = 2277 (participation: 17.5%). Outcome variables: experience and perception of cross-level clinical coordination, and related factors, knowledge, and use of digital coordination mechanisms. Descriptive and multivariate analyses were performed to detect changes between years.

Results

Compared to 2017, there was a worse experience of clinical management coordination, particularly in cross-level care consistency and accessibility, and of the perception. Regarding related factors there was a worsening in some organizational factors (time available for coordination, institutional support), attitudinal factors (satisfaction with the job) and interactional factors (knowledge between doctors). The use of some coordination mechanisms such as electronic medical records and virtual consultations between PC and SC increased, while the use of virtual joint clinical sessions was limited.

Conclusions

Results show that after the pandemic there was a worsening in some items of the experience and in the perception of cross-level clinical coordination, despite the increased use of some digital coordination mechanisms. There is a need to explore in depth the factors associated with this worsening to identify and promote more effective strategies to improve cross-level clinical coordination in Catalonia.

Key messages

• Cross-level clinical coordination in Catalonia has worsened despite the increase in implementation and use of some digital coordination mechanisms.

• It is necessary to explore in depth the factors related to this worsening to develop more effective strategies to improve cross-level clinical coordination.
Chronic disease management: Preventive care framework for migrant workers in Singapore
Authors: Karthikeyan N , Yong E , Ang P , Talib H , Lee H Y , Lam M C
Published: October 2023

Chronic diseases, if unmanaged, can contribute to significant premature mortality and morbidity. Before the COVID-19 pandemic, there was limited data on chronic disease prevalence amongst migrant workers (MWs) in Singapore. The antecedent episodic and fragmented primary care for migrant workers also affected care continuity for common chronic diseases. In April 2022, a Primary Care Plan (PCP) was developed for migrant workers to improve access and affordability which included chronic disease detection and management and risk factor reduction. In addition, chronic disease screening was also enhanced in migrant workers’ pre-employment medical screening for those with risk factors or above 40 years old. Beyond disease management, interventions to address health gaps and strengthen the healthcare resilience of MWs are incorporated into a population-health based “Management of Oral and Chronic Conditions and Ailments - MOCCA” framework, anchored on three thrusts:

1. Address knowledge gaps and inculcate healthier habits - Improve health literacy via outreach programmes and culturally nuanced health materials

2. Mitigate risk factors - Build primary care providers’ capabilities to deliver alcohol/tobacco interventions

3. Treat and control disease progression - Set up referral pathways between primary and tertiary healthcare institutions including for post-discharge case management

MOCCA was implemented in December 2022 through the collective efforts from the government, community, social service agencies and their employers.

Key messages

• Migrant workers have been receptive to interactive health programmes, regular health screening, follow up on chronic disease under the PCP and 324 workers attended basic dental screening.

• The MOCCA framework is integral to the provision of care for MWs, through risk factor identification, empowerment of health ownership, and periodic assessment of health and behavioural outcomes.