bluuebunny/crossref_metadata_2025 huggingface dataset:
Land of Shadow: Perceived maternal self-efficacy
Authors: Capitani E , Prosperi G , Alaimo L , Nante N
Published: October 2024

Background

In our society, often women arrive at the motherhood without community and family models, and without an effective support network from the services. The aim of the study is to investigate mothers’ perceived maternal competence (self -efficacy) and its possible correlations with pregnancy, birth and breastfeeding outcomes.

Methods

A retrospective observational study was conducted on a sample of mothers from all over Italy, using an online survey conducted from August to October2023.The questionnaire consisted of 26 questions including the Brief Parental Self-Efficacy Scale.The instrument used a score from 5 to 25; we used a score of 15 as cut-off for perceived low or high self-efficacy.Statistical analysis was performed with the chi-square test and subsequently, the Odds Ratio was calculated to define how statistically strong the association is between the BPSE score obtained and specific variables studied.

Results

The sample consisted of 4553 mothers.56.6% were women between the ages of 31 and 40 and 28.7% were women over 40 years old.20% of the women in our sample suffered from postpartum depression. The women in our sample report having received help in caring for their first child in 42% of the cases from their partner and in 30% of the cases from other family members.The mean BPSE score was 19.45.Women who obtained a BPSE Score >15 were more likely to have received support from their partner(O.R:1.4;C.I:1.1-2.0). Women who scored a BPSE Score<15 were less likely to have had support from partners/family members (OR:1.5;C.I:1.1-2.0).Women with a BPSE Score<15 were more likely to have experienced postpartum depression (OR:1.4;C.I:1.1-1.8).

Conclusions

Our study shows that the woman in particular who becomes a mother, cannot be left alone; she needs emotional and environmental support so that she can rediscover within herself the value, competence and power of motherhood.

Key messages

• Action must be taken so that, along with improved health care, the network of social interventions for new mothers and couples is strengthened.

• The woman, in particular who becomes a mother, cannot be left alone.
Using the innovative tool to prepare a quality national cancer control programme
Authors: Jelenc M , Albreht T
Published: October 2024

Issue

National cancer control programmes (NCCPs) are key documents in European Member States (MSs) used for the management of cancer policy. While some countries still have not prepared their NCCPs, there are several others, whose NCCP is not of high quality or not implemented.

Description of the problem

There is frequently a lack of knowledge in countries on how to prepare a quality NCCP or how to improve the existing one. Our objectives were: 1. To provide help in the preparation of an NCCPs and in cancer control to EU MSs 2. To enhance the availability of all the documents needed and provide best practices from other MSs. The development of an innovative tool was therefore the main objective of iPAAC Joint Action (JA). Streamlining of all NCCP-related documents prepared by the three JAs in cancer policy (EPAAC, CanCon, iPAAC) was central to the deliverables.

Results

The solution lied in the preparation of the interactive innovative tool called Roadmap on the Implementation and Sustainability of Cancer Control Actions (Roadmap). It was developed in a joint effort and collaboration between EU MSs and the European Commission. It is available online and can be used by all countries, including countries that are not part of EU, and who aim at preparing a high quality NCCP. The extensive content of the tool covers primary prevention, health promotion, screening, diagnosis, treatment, and health care, as well as a number of sub-areas with important contents, and over a hundred one-pagers, which include national and regional experiences. Among the latter, the European Guide for Quality NCCPs with instructions how to prepare a quality NCCP is presented as one pager.

Lessons

As the result of over 10 years of joint work in cancer control at EU level MSs have now both, the opportunity to learn from each other and the opportunity to access all key information they need for controlling cancer, including the instructions on the preparation of the key document, their NCCP.

Key messages

• Using the Roadmap countries have access to instructions and guidance for the preparation of a quality NCCP.

• The Roadmap enables the access to all key documents for the management of cancer control in one place to all countries.
Introducing innovative policy instrument to reduce antibiotics use. Relevant evidence from Bulgaria
Authors: Vankova D , Veleva N , Mihaylova S , Boncheva P , Vladimirova M , Vankov P , Radkova Z H , Radkov R , Micheva I , Kerekovska A
Published: October 2024

Background of the public health challenge

Excessive individual consumption of antibiotics (ABs) increases global antimicrobial resistance (AMR). Therefore, shaping consumers’ behaviors towards responsible ABs use is an essential strategy in the battle with the silent pandemic of AMR. The EU One Health (OH) Action Plan against AMR targets making Europe a best-practice region. Overall consumption of ABs in the EU decreased significantly, especially during the COVID-19 pandemic. Bulgaria is the only EU country that has reported an annual increase in ABs use during this period (ECDC data). A growing part of Bulgarians, believe that ‘ABs kill viruses’ and is unaware that ‘unnecessary use of ABs makes them ineffective’ (Eurobarometer 2022). This limited understanding of adequate ABs use resulted in counterproductive behaviors that demand change. Introducing innovative policy instrument as a tool for behavioral change: Undeniably, drug prescription monitoring has the potential to change consumers’ behaviors. In October 2023 mandatory electronic prescribing (e-Rx) for ABs was introduced in Bulgaria at a primary healthcare level. Consequently, there was an observed decline exceeding 30% in ABs sales (IQVIA Bulgaria data), evidencing a reduction in ABs consumption. However, there were negative reactions by the stakeholders, due to time-consuming procedures, nonoptimal IT infrastructure, etc., and that led to e-Rx-moratorium. Finally, in April 2024, the e-Rx is sustainably introduced.

Conclusions

Legislative measures, like e-Rx, can hinder the chaotic use of ABs. Moreover, Bulgarians need to reflect on their behaviors and values of solidarity which OH offers. Herewith, a multidisciplinary team of academic educators unite their OH efforts in raising awareness related to AMR and the rational use of ABs. Years of national endeavors toward healthcare digitalisation led to the introduction of e-Rx for ABs in Bulgaria. Research will prove its relevance for the rest of Europe.

Key messages

• To the European community: The introduction of the innovative policy tool (e-Rx for antibiotics) in Bulgaria is a significant national effort in making Europe a best-practice region regarding AMR.

• To the Bulgarian society: Antibiotics are not bonbons! Responsible ABs use of every one of us can contribute to the EU efforts to manage AMR. In the context of AMR, every person is a stakeholder.
Future Finland – A nationwide Finnish multidisciplinary birth cohort initiative
Authors: Simell B , Lonna M , Valtokari M , Kajantie E , Lundqvist A
Published: October 2024

Increasing evidence suggests that early-life conditions may have substantial consequences on individual health and wellbeing throughout the lifecycle. Development of complex social and health issues may be best understood through longitudinal studies that combine the perspectives of social and health sciences. Future Finland aims to collect a nationwide lifelong data resource that through collaborative multidisciplinary research will strengthen future population welfare. Future Finland will be based on index children born in Finland (43.000/year) during a specific time period. National registers and other administrative data sources will provide data for the age cohort (children), their parents and siblings, with special effort on data from more rarely used sources (e.g., electronic health records, school records). Subsets of cohort members will be recruited in early pregnancy (consent) to undergo deeper data collection through questionnaires, biological and environmental samples and measurements, and digital monitoring data (e.g., physical activity, citizens digital footprint). The Future Finland preparatory phase started in 2023 at the Finnish Institute for Health and Welfare (THL). The Future Finland design and focus areas are currently being planned based on identified information gaps and with consultations of experts from other birth cohort studies. Data collection is planned to start in 2025 by piloting and foreseen to expand to full-scale in 2027-2028. The Future Finland data resource will be made available for the entire research community as openly as possible, at the same time maintaining the highest possible data security standards to protect privacy now and in the future. Future Finland enables novel interdisciplinary research and intervention setups, which will strengthen the knowledge base for societal decision-making and promote the future population welfare. Future Finland is funded by the Finnish Cultural Foundation.

Key messages

• Future Finland initiative will collect a nationwide lifelong data resource enabling novel cross-disciplinary research designs to produce groundbreaking and impactful scientific results.

• A larger-scale use of data enables novel interdisciplinary research and intervention setups strengthening the knowledge base for societal decision-making and promoting the future population welfare.
Co-planning as a public health tool: the Milan Health Protection Agencies’s Local Gambling Plan
Authors: Farchi E , Calloni L , Capriulo A P , Carraro S , Dodaro G , Albani R , Lamberti A , Celata C
Published: October 2024

Issue/problem

Gambling represents a public health, social, and economic problem. Lombardy Region, according with national and regional law, has approved the Regional Plan for the prevention and contrast of Pathological Gambling. The Health Protection Agencies (HPA) of the Metropolitan City of Milan, as the other HPAs, implemented the Local Gambling Plan, based on a context analysis and in synergy with all the actors involved.

Description of the problem

Since 2019, the Milan HPA’s Local Gambling Plan has been implemented through collaboration with non-profit entities (TSEs), which are involved via public tendering. The implementation of the new Italian ‘Code of the Third Sector’ changed the TSEs engagement modalities. For this reason, a complex co-planning process has been initiated in order to increase the level of active citizenship and to enhance public health, in line with horizontal subsidiarity principle.

Results

The Co-planning procedure promoted the integration among local health services, non-profit entities and municipalities with the aim of gambling prevention and contrast, ensuring the continuity of prevention programs and the involvement of local stakeholders in addressing a public health issue. During the co-planning, 9 working groups were established to define objectives, project actions, monitoring and evaluation methods, ensuring the common interest of all actors involved.

Lessons

For the health and social system, the co-planning procedure becomes an opportunity to translate what is foreseen by the regulations into local actions. It allow the active participation of local stakeholders involved into the co-construction and achievement of public health objectives and the promotion of communities’ empowerment.

Key messages

• Co-planning is both a process and a tool for local welfare.

• Co-planning involved multiple actors, among which the public institution that ensures satisfaction of health needs through governance actions.
Study tours as strategy in building multi-level public health system transformation in Ukraine (UA)
Authors: Levkovich N , Lasky C , Lieberman L , Melnyk M , Kolker J , Aaronson W
Published: October 2024

With 14 million Ukrainians in need of psychological aid (UNDP) and a strained health system, UA urgently requires mental health and psychological support services (MHPSS). As a TA partner on the USAID funded Public Health System Recovery and Resilience project in UA, the Philadelphia (PHL) team supports capacity building for population-based MHPSS at the community level with a study tour strategy. Such approaches apply to other countries interested in remodeling public health systems. The strategy aims to advance community based MHPSS through in person tours in PHL with remote follow up to stimulate vision, exchange ideas and accelerate action among governmental, community, and academic partners. The study tours presented overviews on health policy, system development, program services delivered to children and adults, community interventions, and workforce development of professionals and paraprofessionals. All included the foundational principles of trauma-informed practice. The June 2023 tour hosted 11 decision makers and regional officials who embraced the vision for system development and endorsed further engagement. The December 2023 tour hosted 13 practitioners and coordinators of health and social services to observe community programs. Results include development of PHL NGOs and UA social service hub partnerships to implement train the trainer programs for peers/people with lived experience and for mural arts programs to promote community engagement and empowerment. The September 2024 tour involves university partners from nursing, social work and psychology and PHL counterparts to strengthen curricula to include mental health competencies, support faculty development with potential for collaborative research and student exchange, and design post-graduate continuing education courses for upskilling the incumbent workforce. Study tours and direct exchange are an effective strategy for capacity building for MHPSS in Ukraine to address population health needs.

Key messages

• The sequenced study tour strategy affects distinct levels of change makers in UA. The results are governmental buy-in, partnerships for programmatic development, and academic advancement.

• The study tour model promotes systematic change and offers solutions to MHPSS workforce shortages through information exchange, relationship building, and capacity development.
Navigating complexity: an evaluation framework for assessing co-creation in public health
Authors: Agnello D M , Smith N , Steiner A , Vogelsang M , Chastin S
Published: October 2024

Background

Co-creation aims to democratize research and bridge the gap between research and practice. Key characteristics like empowerment and meaningful participation shape sustainable outcomes. However, existing frameworks like Arnstein’s Ladder of Citizen Participation broadly overlook individual method contributions. This study aims to address this gap by creating and validating a framework for intrinsic evaluation, guiding stakeholders and researchers in genuine co-creation of public health interventions.

Methods

We systematically screened and extracted frameworks aligned with five key co-creation characteristics to identify and evaluate methods. Through iterative testing, we identified key features for distinguishing methods and integrated them into a novel framework. Co-creation experts validated and refined this framework using the closed card sort method, qualitative assessment, and group discussions.

Results

The Co-Creation Rainbow framework includes key features from 20 existing frameworks, with an Individual-to-Collective Continuum, five sections (Informing, Understanding, Stimulating, Collaborating, and Collective Decision-making), and three overarching themes (Engage, Participate, and Empower). Analysis showed successful categorization of 436 methods and revealed a significant disparity in co-creation practices between researchers and practitioners.

Conclusions

The Co-Creation Rainbow framework provides a structured approach to evaluating and reporting co-creation processes. Acknowledging co-creation’s diversity, the framework aids in tailoring approaches for meaningful participation. By offering a unified language for diverse co-creation methods, the framework also facilitates transparent evaluation, enhancing the reliability and reproducibility of co-created public health interventions.

Key messages

• Employing a universal language across diverse co-creation methods is pivotal in fostering transparent evaluation, thereby bolstering the reliability of co-created public health interventions.

• Effective collaboration of key stakeholders necessitates the use of suitable methods. By integrating diverse perspectives, public health interventions gain relevance, efficacy, and sustainability.
Validated translation of telehealth and health app usability questionnaires to 8 European languages
Authors: Burski M , Castaldo V , Romano O , Kiricsi D , Genre F , Vandamme T , Holeva V , Grašič Kuhar C , Turlinskienė M , Rosińska M
Published: October 2024

International projects such as the Joint Action on strengthening eHealth including telemedicine and remote monitoring for health care systems for cancer prevention and care (eCAN) are implemented in countries with different languages, requiring validation of translations of standardized tools. Evaluation frameworks for telemedicine services necessarily include the patient’s perspective, i.a. on the service usability. Due to the lack of validated questionnaires in multiple European languages we sought to develop translation for the languages of the eCAN pilot countries. Based on literature review, we selected mHealth App Usability Questionnaire (MAUQ) and Telehealth Usability Questionnaire (TUQ) and developed a conceptual definition for each item. Next, we performed forward and back translation from English into the target languages, expert review, cognitive interview (CI) with 5-10 cancer or chronic disease patients per language/per questionnaire. Qualitative CI results were scored by 2 independent researchers for consistence of each item with conceptual definitions for final review by native speaker expert. We chose 8 languages (ES, GR, HU, IT, LT, NL, PT, SI) for validation. CI involved 48 respondents (29 females, 60%; 18 aged>60, 38%;23 higher education, 48%) for TUQ and 48 (22 females, 46%; 16 aged>60, 33%; 23 higher education, 48%) for MAUQ. Overall 872 (87%) of TUQ and 728 (84%) of MAUQ item answers were classified as consistent. In more than one language we identified concepts difficult to understand: consistent navigation when moving between screens, distinction between easy to use/learn, social settings. The validation process allowed us to identify opportunities to improve translation and highlighted concepts generally more difficult to understand. We provided validated translation of MAUQ and TUQ in 8 European languages for use in eCAN pilots and future telemedicine evaluation studies.

Key messages

• eCAN successfully validated translations of telemedicine usability questionnaires for 8 languages.

• Multilingual translation validation can provide insights into concepts difficult across languages.
Syndemic vulnerability in Dutch urban cities: investigating health disparities and intersectionality
Authors: Dubbeldeman E M , Vos HMM , Bussemaker M , Slagboom M N , Mook-Kanamori D O , Crone M R
Published: October 2024

Background

Syndemics, the clustering of health and social issues, disproportionately affect marginalized communities. While prior research indicates sex-specific variations in syndemic vulnerability, current research often overlooks other sociodemographic characteristics and their interaction. An intersectionality-informed syndemic approach could offer more insights into the mechanisms in syndemic suffering, providing a deeper understanding and identifying groups most affected by structural inequalities.

Methods

Our study focused on adult residents in Leiden and The Hague, the Netherlands, registered at different general practices. Using existing routine health data linked with Central Bureau for Statistics information, we included adults who were registered with a general practitioner in 2018 and 2019, had a minimum of two registered health conditions documented by their general practitioner, lived in Leiden or The Hague, and were at least 18 years old in 2018.

Results

A total of 43340 adults were included for analyses. Distinct health condition clusters were observed within sex and age groups. Women experiences a broader range of health issues, often characterized by mental and psychosomatic symptoms like mood/anxiety disorders and abdominal complaints. Conversely, men exhibited a higher prevalence of specific physical conditions, including hypertension, diabetes, and cardiovascular diseases.

Conclusions

The findings align with previous research, suggesting the importance of further exploration into the role of intersectionality in syndemics. Currently, we are investigating the foundations of these disparities, including interaction analyses and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Using MAIHDA, we will examine the relationship between intersectionality and syndemic vulnerability, quantifying intersecting factors (sex, ethnicity, SES) and exploring their impact at individual and group levels.

Key messages

• Understanding intersectionality in health disparities is crucial for addressing syndemic vulnerabilities.

• Tailored interventions informed by intersectionality may promote equitable health outcomes.
Cross-cutting integration of equity and diversity lens in public health: a novel approach of JACARDI
Authors: Armocida B , Spadea T , Formenti B , Osborne R , Zaletel J , Di Girolamo C , Musta L , Onder G , Skogberg N
Published: October 2024

Issue/Problem

Health inequities persist across European countries, impacting the distribution, prevention, and management of non-communicable diseases. With increasing population diversity and improved understanding of the intersectional nature of drivers of health inequities, narrowing inequities calls for systematic integration of diversity perspectives into equity-driven policy and practice.

Description of the problem

The EU-co-funded Joint Action on CVDs and diabetes (JACARDI, 11/2023-10/2027) project with 76 partners from 21 countries and 142 national-level projects (later pilots), applies a structured approach for integrating equity and diversity perspectives within all project structures. This is achieved through design of a common methodological framework and terminology glossary for all thematic work packages (WPs) and their pilots, which are further supported through capacity building sessions and consultations.

Results

The “4Cs” framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications) for integrating equity and diversity principles in JACARDI was developed based on results of focus group interviews with WP leaders (n = 24) and review of previous literature. This framework was applied as a lens to be applied in the planned activities by WPs and pilots, elaborated in an equity and diversity maturity matrix aligned with the XV methodological steps for pilot implementation. Additionally, equity and diversity indicators were integrated into harmonized context analysis questionnaires for national focal points of each partner country, as well as into the methodology for pilot assessment and reporting.

Lessons

Equity and diversity perspectives should be integrated into the core structures of project implementation, supported by practical tools, trainings and practical consultations to improve adherence and collaborative understanding across project partners.

Key messages

• Equity and diversity integration into core structures are essential for tackling health inequities and the NCD-related social gradient in Europe.

• Encouraging critical reflection among JACARDI partners is pivotal for initiating a paradigm shift towards equity and diversity inclusion.
Pediatric tonsilitis: modern tactics against an old foe
Authors: Cachim A , Santos M M , Luz Fortes A , Paixão M M
Published: October 2024

Background

Pediatric tonsillitis (PT) impacts public health due to its widespread incidence and the prevalent overprescription of antibiotics driven by concerns over Group A β-hemolytic streptococcus (SGA) complications. Rapid antigen diagnostic tests (RADT) serve as vital tools for promptly identifying SGA infections in PT cases. However, despite their widespread availability, healthcare professionals often underutilize RADT, leading to inappropriate antibiotic prescriptions. Clinical audits and feedback to professionals emerge as solutions to this issue.

Methods

An audit was conducted on clinical cases of PT during 2023 to evaluate the correct usage of RADT and subsequent antibiotic prescription across various primary care practices in Lisbon, Portugal. Afterwards, a pilot practice was selected to assess the feasibility and utility of an online tool designed specifically to report RADT results and create a real-time surveillance system of incidence of SGA with feedback to prescribing clinicians. Following the revision of the reporting tool after the pilot, its implementation was extended to multiple practices across the Lisbon region.

Results

From the 1050 clinical cases analyzed, 992 had an indication to do a RADT according to the Portuguese guidelines, however only 282 (28.4%) tests were done. Overall, only 19.6% of PT cases were considered fully compliant. During the pilot, the introduction of the online tool led to a 3.259 increase in reporting (from 0.574 RADT/day to 1.872 RADT/day) for the same time period between February and March.

Conclusions

The implementation of an online reporting tool represents a significant advancement in SGA surveillance efforts, detecting cases promptly for public health interventions. This initiative underscores the importance of continuous quality improvement in diagnostics and shows digital tools’ potential for better disease surveillance in clinical settings.

Key messages

• Underutilization of RADT in PT cases contributes to inappropriate antibiotic prescriptions, compromising patient care.

• Introduction of an online reporting tool significantly enhances RADT usage, aiding prompt SGA detection for improved public health interventions.
Needs Assessment for Primary Care for Best Practice Implementation: The CIRCE Joint Action
Authors: Papadakis S , Petelos E , Angelaki A , Anastasaki M , Vafeiadi M , Magkanaraki E , Tornero Patricio S , Carriazo A , Lionis C
Published: October 2024

Introduction

CIRCE is a Joint Action (JA) supporting the transfer of six best practices (BPs) to new primary care settings in Europe. High-quality needs assessment can set the foundation for strong planning and implementation of the CIRCE-JA best practices in these new primary care settings.

Methods

A needs assessment tool was developed based on the TO-REACH knowledge transfer framework and learnings from a scoping review of international knowledge transfer frameworks. The needs assessment provides structured tool for local sites to self-assess the alignment of the BP with local priorities, readiness of the local site to successfully implement the BP, the availability of necessary leadership, resources and partnerships, and an examination of barriers to local BP implementation and mitigation strategies.

Results

Twenty-six CIRCE-JA teams completed the needs assessments. Local teams identified the CIRCE-JA BPs were value-adding and aligned with local priorities. Cross-cutting barriers were identified which were common among the six CIRCE-JA best practices across five thematic areas: (1) provider level, (2) intervention level, (3) health system/policy level, (4) partnership and physical resources and (5) information technology. The needs assessment supported primary care sites with a structured approach to planning for transfer of BPs to their local setting that is based on established international best practices and knowledge transfer frameworks including early identification of barriers and mitigating strategies.

Conclusions

The needs assessment has supported teams with conducting a self-assessment and informing initial planning for adoption of the BP in their local primary care practice. Given the importance of the local needs assessment to high quality implementation of BP the CIRCE-JA experience with local needs assessment may provide learnings for future BP transfer initiatives.

Key messages

• Local needs assessment supports the transfer of best practices to primary care settings, which is a critical component of service transformation during the post-COVID-19 period.

• For successful transfer of best practices in primary care, it is vital to give to examine such as provider capacity, available human resources, health policy, and information technology.
Inequities to the access to and use of telemedicine among cancer patients in Europe: A scoping review
Authors: Leclercq V , Vandervliet L , Schmitt T , Van den Bulcke M , Delnord M
Published: October 2024

Background

Over the last few years, telemedicine services (TMs) have increasingly been used in European health and care systems. TMs include remote assistance with teleconsultation and telemonitoring. The expected benefits to individuals include easier access to information and personalized care. However, while the effectiveness and utility of TMs among cancer patients are well-established in Europe, several evidences highlighted the fact that TMs may widen existing inequities in health. Therefore, the aim of this study is to identify barriers and facilitators contributing to inequities to TMs among cancer patients in Europe.

Methods

Medline (via Ovid) and Scopus databases were searched in March 2023 for all publications providing evidence on factors influencing the access to and use of TMs services among cancer patients aged 18 and over in Europe published between January 2018 and March 2023. The PROGRESS-plus framework was used to stratify health opportunities, patients characteristics and outcomes.

Results

A total of 1683 peer reviewed publications were identified and after screening, 26 articles were retained in our scoping review. All included studies focused on TMs used by cancer patients through mobile or web-based applications. On one hand, socioeconomic status and language were the most cited influential factors as well as having an internet connection and a (mobile) device to the access to TMs. On the other hand, factors that influence the use of TMs are the level of education with digital skills and (e-)health literacy, social support, age and presence of comorbidities.

Conclusions

Identifying and addressing factors influencing access to and use of TMs among cancer patients will enable the development and tailoring of TMs that align more effectively with the needs and expectations of cancer patients. Integration of patient-centered care in TMs is necessary to enhance equity and allow a better implementation of TMs in European health and care systems.

Key messages

• The main factors influencing the access to and use of TMs are socioeconomic status and level of education respectively.

• TMs must be developed and used to tackle inequities already present among cancer patients instead of widening the gap.
A Comparative Study of Sensor Quantity and Data Granularity in AAL Systems for Activity Recognition
Authors: Saragadam A , Morita P , Kaur J
Published: October 2024

As populations age, the demand for non-intrusive elderly care solutions increases, highlighting the need for efficient AAL systems. Current research predominantly focuses on wearable sensors at high data frequencies. There is a critical gap in research in understanding the effectiveness of model performance using ambient sensors operating at varied granularities and with varied numbers of sensors. This study addresses this gap by investigating how sensor quantity and data frequency affect an artificial intelligence model’s ability to detect various activities of daily living. The methodology employs a quantitative, experimental design to systematically assess the performance of artificial intelligence models across sensor quantity and data frequencies. This assessment will be conducted through a multi-study approach involving different populations to ensure robust and generalizable findings. Each model’s efficacy will be evaluated using 5-fold cross-validation and GridSearchCV for rigorous hyperparameter tuning, employing diverse data aggregation and imputations techniques to maintain comprehensive analysis integrity. The primary goal of this research is to determine the optimal data granularity and number of sensors that maximize AI models’ ability to detect daily living activities while minimizing resource demands, thereby enhancing the sustainability and scalability of AAL systems. This work aims to advance the field of ambient sensing in elderly care, offering significant implications for designing and implementing future AAL technologies and potentially improving the quality of life for the elderly population.

Key messages

• The study explores the optimal configuration of data granularity and sensor quantity to maximize AI model efficiency in detecting activities of daily living among older adults.

• The study investigates the impact of data frequency and sensor count on AI model performance in detecting daily activities, aiming to optimize Ambient Assisted Living systems for the elderly.
Increasing inequalities in mortality among individuals with a foreign background in Sweden
Authors: Miething A , Dunlavy A , Juárez S P
Published: October 2024

Background

Previous research indicates that migrants in high-income destination countries not only experience a mortality advantage but also demonstrate lower or absent socioeconomic inequalities in mortality compared to the general native population. Yet the extent to which an income mortality gradient may also be evident among the descendants of migrants has been largely unexamined. Existing evidence has revealed that descendants of migrants face mortality risks higher than both migrants and their native-born peers.

Methods

This study utilizes longitudinal population registries covering the entire registered population of Sweden from 2004 to 2016. The study population comprises individuals aged 25 to 64, employing an open cohort design. Using Poisson regression, we examine the relationship between income rank position and cause-specific mortality among native-origin Swedes and eight nativity groups based on individuals’ country/region of birth, age of migration or parental origin.

Results

While foreign-born individuals who migrated as adults exhibited lower inequalities in all-cause mortality compared to native-origin Swedes, descendants of immigrants, particularly those with non-European backgrounds, show larger inequalities. Examination of specific causes of mortality revealed that external causes, notably accidents and assaults, account for increased disparities among non-European foreign-born men who migrated during childhood and male descendants of immigrants with non-European backgrounds.

Conclusions

Income-related inequalities in mortality are less pronounced among migrants compared to the native-born majority population in Sweden and tend to be higher among descendants of migrants, depending on gender and parental origin. The analysis highlights the role of external causes of mortality in shaping these inequalities, indicating that income disadvantages, augmented by a migrant background during upbringing, amplify specific health risks within these groups.

Key messages

• The study reveals lower mortality inequalities among migrant adults but a higher magnitude of inequalities among male descendants of immigrants, especially with non-European backgrounds.

• Income disparities, combined with migrant backgrounds, amplify health risks among descendants of migrants in Sweden, underscoring the need for tackling social inequalities.
Optimizing elderly care: a data-driven AI model for predicting polypharmacy risk using SHARE data
Authors: Elhosseiny Elsayed A , Eldawlatly S , Ramadan E , Börsch-Supan A , Salama M
Published: October 2024

Background

Polypharmacy (PP), which rises with age, is a growing public health challenge, affecting health outcomes and escalating healthcare expenditure. Leveraging the comprehensive European coverage and longitudinality of the Survey of Health, Ageing, and Retirement in Europe (SHARE) study, we aim to assess PP prevalence patterns and identify the most effective machine learning (ML) model for predicting long-term PP risk, as a foundation for a scalable predictive tool.

Methods

We used data from participants aged above 50 who were present in wave 6 and at least one of the subsequent three waves of the SHARE study, aiming to predict PP risk at 2, 4, and 6-year intervals. PP was defined as the concurrent use of five or more medications. We analyzed PP prevalence trends and selected the predictor variables from wave 6 using LASSO regression analysis. We evaluated eight ML models, namely, ANN, SVM, DT, RF, GB, XGBoost, LightGBM, and CatBoost, using a rigorous cross-validation strategy to ensure robustness and reliability.

Results

Our analysis reveals an upward trend in PP prevalence across the surveyed countries, with aggregate figures rising from 34.03% (95% CI 33.1-34.9) in wave 7 to 36.75% (95% CI 35.6-37.9) in wave 8, reaching 39.91 (95% CI 38.9-40.9) in wave 9. Additionally, using the Categorical Boosting ML model to predict PP resulted in overall accuracies of 75.08%, 73.7%, and 71.65% and recall rates of 72.83%, 70.48%, and 67.96% for the 2, 4, and 6-year intervals, respectively.

Conclusions

This study reveals a rising trend of PP across European countries and demonstrates the potential of using longitudinal data and ML to enhance PP prediction. The tool developed represents a step forward in risk stratification, which would be particularly beneficial in practical settings where family physicians or pharmacists could employ the tool to monitor elderly patients, predict and thus prevent PP, and reduce the negative health and economic impact associated with it.

Key messages

• The integration of machine learning with longitudinal data presents a significant advance in polypharmacy risk prediction.

• The tool we developed highlights the potential translational impact of our findings.
Cardio Policy Optimiser: an integrated public health approach to enhancing cardiovascular health
Authors: Lopes H , Baptista-Leite R , Simões Coelho P , Mendes J , Diogo J , Castro M
Published: October 2024

Background

Cardiovascular diseases (CVDs) remain a leading cause of mortality in Europe, with atherosclerotic-related conditions accounting for 80% of CVD deaths - a third of them premature. Despite extensive efforts over the past five decades, the decline in these deaths over the last 20-25 years has plateaued, highlighting the need for innovative approaches. Additionally, the co-occurrence of CVDs with other chronic conditions such as diabetes, hypertension, and renal and hepatic diseases, adds complexity to their management and prevention.

Methods

In Portugal, the pilot phase implemented a novel integrated approach combining a Bayesian epidemiological model - which incorporates genetic, sociodemographic, comorbidity, and lifestyle data - with an adaptive conjoint analysis model focusing on atherosclerosis policy intervention. These models are part of a comprehensive response framework that incorporates health outcomes and associated costs resulting from better prevention and diagnosis.

Results

Currently in the development and calibration stage, the model is expected to yield initial results by early September.

Conclusions

This modeling approach offers new opportunities for public health to intervene at early stages in the natural history of CVDs. It emphasizes enhancing prevention and early diagnosis to potentially reduce the incidence of acute episodes and associated mortalities. Moreover, the model facilitates rapid evaluation of the economic benefits derived from preventive policies, thereby supporting more informed public health decision-making.

Key messages

• The CPO model combines epidemiological and policy models to address cardiovascular morbidity and mortality.

• It boosts early diagnosis and prevention, and assesses economic benefits from policies.
Development of a Medical Device Lifecycle Research Database at the MFDS
Authors: Yang H S , Jeon S W , Park C H , Kim S Y , Park J H
Published: October 2024

So-called big data are potentially useful in the healthcare field and are of interest to researchers, industry, and government agencies. Over the past 10 years, Europe, the United States, and Asia have been making efforts to collect and systematically manage information on the entire process from clinical trials to follow-up management of medical devices (MD). We developed MD lifecycle research database at the Ministry of Food and Drug Safety (MFDS) of the Republic of Korea, consisting of 61 tables and 2,053 variables. The MFDS possesses statistical information on all MD, pharmaceuticals, foods, and human tissues produced and distributed. The information in the database is categorized according to four MD lifecycle phases-clinical trial, approval, production, and post-approval. For the clinical trial phase, the database contains information on planning and approval of clinical trial and non-clinical trial. The approval phase includes information on models, raw materials, quality, and changes, while the production phase stores information on production, import, export, supply and use. For the last step, follow-up management phase, provide information on post-marketing safety management, risk management, and administrative disposition. All four steps are linked based on primary key, so it is possible to understand information on the overall MD lifecycle. The MD Lifecycle Research Database will help strengthen the industry’s competitiveness in terms of cost-effectiveness in MD development and facilitate policy monitoring by improving its utilization in the public interest. This database contains information on all MD produced and distributed in Korea depending on the phases of the MD lifecycle, and data is easily accessible due to the lack risk of personal information exposure, so it can be widely used by individual researchers, industries, academia, and governments.

Funding This research was supported by a grant (22063MFDS498) from ministry of food and drug safety in 2024.

Key messages

• We developed a medical device lifecycle database that enables tracking management according to the medical device lifecycle.

• This database can be used as a scientific basis to ensure the safety, effectiveness, and efficiency of medical devices.
Unmet healthcare needs in migrant population in Finland: comparative analysis between 2014 and 2022
Authors: Nykänen S , García Velázquez R , Tynkkynen L-K , Lämsä R , Kuusio H
Published: October 2024

Background

Timely access to health services is one of the cornerstones of universal health coverage. However, various individual and structural factors remain as barriers to meet this goal. Access to physician services remains a concern for migrant populations, with a substantial proportion experiencing unmet healthcare needs, surpassing rates observed in the general population of Finland. This study aims to assess temporal changes in unmet healthcare needs among migrants in Finland across the years 2014, 2018, and 2022, investigating potential disparities across population groups.

Methods

Three nationally representative datasets derived from cross-sectional surveys are used; Survey on work and well-being among people of foreign origin 2014-2015 (UTH), Survey on well-being among foreign-born population 2018-2019 (FinMonik) and National survey on health, well-being, and service use among foreign-born population 2022-2023 (MoniSuomi). We analysed data from individuals aged 20 to 64 years. Multivariate logistic regression analysis, adjusting for sociodemographic and socioeconomic factors, is employed to compare unmet healthcare needs in migrant populations with the Finnish general population.

Results

A significant increase was found in unmet healthcare needs among migrant populations in Finland from 2014 to 2022. Prevalence rates rose from 25.0% in 2014 to 24.9% in 2018 and reached 33.7% in 2022. Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs.

Conclusions

The escalating prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland is a cause for concern. This research underscores the urgent need for policymakers, healthcare providers, and community advocates to address healthcare inequities and ensure equitable access to healthcare, to ensure universal health coverage for all individuals in Finland.

Key messages

• The prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland has escalated, compared to the Finnish general population.

• Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs.
The interplay of technology anxiety and digital health literacy in determining e-health readiness
Authors: Duplaga M , Smola P , Wojcieszko M
Published: October 2024

Background

The assessment of e-health readiness (eHR) is used to assess the ability of selected groups of citizens and patients, as well as society as a whole, to adopt e-health support. This study aimed to understand the main determinants of eHR in adult Internet users in Poland.

Methods

The analysis was conducted using data from a computer-based web-based interviewing (CAWI) survey carried out in June 2023 in a representative sample of 1661 Polish Internet users. The eHR score was established based on the e-Health Readiness Scale. Uni- (ULRM) and multivariable (MLRM) models were developed for eHR. Independent variables included technology anxiety (TA), digital health literacy (DHL), Internet (IU) and social media use (SMU), self-assessed health status, and sociodemographic variables.

Results

ULRMs revealed that TA, DHL, IU, SMU, an array of sociodemographic variables, and self-assessed health status (SAHS) were significant predictors of eHL. ULRMs with TA and DHL explained, respectively, 30.1% and 23.9% of the eHR variability. In MLRM developed with all predictors confirmed in ULRMs, only TA, DHL SMU, age, and income level maintained their significant effect on eHR. MLRM explained 42.8% of TA variability. Higher TA was associated with lower eHR (B, 95% confidentiality interval (95%CI): -0.30, -0.33 - -0.27). Respondents with higher DHL demonstrated higher eHR (B, 95%CI: 0.42, 0.37 - 0.48). Older persons were more likely to accept e-health solutions (B, 95%CI: 0.03, 0.003 - 0.05). More frequent SMU was associated with higher eHR (B, 95%CI: 1.87, 0.94 - 2.80). Finally, those who refused to reveal their level of income showed significantly lower eHR than those who revealed it (B, 95%CI: -0.84, -1.58 - -0.10).

Conclusions

TA and DHL are the main predictors of eHR. SMU also accounts for eHR. Unexpectedly, older age is a positive predictor of eHR. Finally, variables reflecting health status do not exert a significant effect on eHR.

Key messages

• Technology anxiety should be treated as an important determinant of the successful implementation of e health solutions.

• The development of society’s digital health literacy may be a countermeasure to the unfavorable effect of technology anxiety on e-health readiness.