bluuebunny/crossref_metadata_2025 huggingface dataset:
The Welsh Health Equity Solutions Platform – a mechanism for health equity solutions
Authors: Stewart D , Couzens L
Published: October 2024

Health inequities are a longstanding issue in Wales, as they are across the globe. They disproportionately affect the health and wellbeing outcomes of disadvantaged groups, restricting opportunities to live full and prosperous lives. Post COVID-19 new groups are emerging with disproportionately higher risk of poor health and premature death and disease, especially those with unmet needs and vulnerabilities, with the rising cost of living amplifying health inequities. Despite their prevalence, health inequities are avoidable. Efforts to reduce health inequities require action on all the social determinants of health across the life course. Improved understanding of the key drivers of health gaps is needed to address the problem and provide support for solutions-driven action to break down the barriers to health equity. The Welsh Health Equity Solutions Platform (WHESP) launched on 22nd June 2023, a collaboration between Public Health Wales, Welsh Government and WHO European Office for Investment in Health and Development. The WHESP is an innovative digital tool developed around the WHO Health Equity Status Report initiative framework of the ‘five essential conditions’ for healthy, prosperous lives for all. It is a mechanism for health equity solutions and aims to inform and facilitate policy and decision making to improve population health and address the increasing health gap through an online gateway to data, health economics, policies, and innovative health equity tools. Emerging evidence is highlighted to identify solutions for achieving healthy equity, which informs evidence-based decision making to reduce the health gap, improve overall population health and wellbeing, and achieve inclusive and sustainable economic growth and prosperity for all. Collating and sharing health equity solutions, evidence, data and best practice both across Wales and globally supports equitable, long-term action to improve the health and wellbeing of the population.

Key messages

• Highlighting health equity solutions informs best practice on tackling health inequalities.

• WHESP provides extensive evidence to facilitate cross-sectoral action and policy change.
Factor Influencing Unmet Healthcare Needs among the disabled
Authors: Park B H , Kim S Y , Park J H
Published: October 2024

Background

The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled.

Methods

We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs.

Results

Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs.

Conclusions

Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642)

Key messages

• The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation.

• Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.
We are wales: taking the hospital to the community - an engagement experiment
Authors: Hopkins J , Abdul Waheed M , Parry B , Bromwelll J , Blakeborough N
Published: October 2024

In Wales we are facing two major barriers to public health engagement. The first is describing our communities as ‘hard to reach’ when in public service we make little effort to reach them, and second, we do not consider in population level research or practice how we are perpetuating the sense of, and real, inequality in our communities that our work on social determinants of health and health inequalities seeks to address. In Wales we want to take the ‘hospital to the community’; to meet people where they are at, where they live and work and where they experience barriers to inclusion, discrimination, lack of trust and fear. ‘We are Wales’ is is built on the Museum of the United Nations concept of a global we - except we will start small with a small nation that as yet has not worked out how to include and involve everyone in our communities in the policy and practice decisions that may help, or hinder us all from leading a healthier, happier life. ‘We are Wales’ is a simple concept; it is about amplifying and connecting people who would not normally do so, because they do not have the resources or capacity to travel or take time out. It is about equal power in a connection to find solutions to adversity and trauma caused by structural inequality; it is about relationships, inclusion, kindness and compassion - and listening, sharing and taking action without judgement. We have taken a dome to communities in economically deprived areas of Wales and stimulated conversation between politicians, young people and communities around the concept of home. Using a virtual reality dome to project images to encourage discussion we have provided a safe space to amplify and include the voices of those who want to be heard and deserve to be listened to.

Key messages

• ‘Take the hospital to the community’ - meet people where they are at and feel safe.

• power sharing and an equal place at the table stimulates ideas and knowledge change in a trauma-informed way.
Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil
Authors: Araujo MCA , Souza A A , Fraga PVR , Dantas ACMTV , Marinho R A , Martins ALJ , Junior HMM , Sousa R P
Published: October 2024

Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people.

Key messages

• Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care.

• Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.
Implementing a pilot primary care program: Armenia’s steps toward universal health coverage
Authors: Dayal S , Libaridian L
Published: October 2024

Problem

Armenia has struggled to transform its ineffective primary healthcare (PHC) system into one that can address the non-communicable disease burden, which causes 93% of mortality. To address this issue, Armenia aims to establish universal health coverage and invest in high-quality primary care.

Description

In 2023, the Armenian Ministry of Health signed a multisectoral policy to implement a pilot primary care program to trial a multitude of reforms related to diabetes (DM) and hypertension (HTN). Pilot interventions include pathways for screening/diagnosis, provider training, free medications and diagnostics, and new provider financial incentives. The key question to be answered is if these pilot interventions cause DM and HTN health outcomes to improve. Beginning in 2024, the program is being piloted in a primary care clinic in Dsegh.

Results

As a result of the 2023 Ministerial policy, multisectoral stakeholders designed and implemented this pilot program. Baseline focus groups found that the pilot addresses the financial barriers that community members noted lead to delays in seeking care and that providers perceive the pilot to be beneficial to their patients. Although final results are not yet available, the pilot has already positively changed features in the national EMR and brought together stakeholders in a way never done before.

Lessons

The pilot’s innovation comes from it being the first time that hypertension and cholesterol medications are provided by the government for free, provider bonuses are based on outcome indicators, indicator targets are set this high, a point-of-care A1c machine is utilized, and a robust monitoring and evaluation (M&E) plan is implemented, all of which are currently shaping discussions on national policy. For countries similarly working on strengthening primary care, it is recommended to pilot specific reforms and establish mechanisms through M&E systems that allow pilots to inform evidence-based decision making.

Key messages

• To move towards universal health coverage, pilot programs designed with multi-sectoral stakeholders are needed to trial suggested healthcare reforms.

• It is essential to invest in monitoring and evaluations systems to generate the data necessary to develop evidence-based policies.
Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)
Authors: Leitao S , Robinson L , O’Donoghue K
Published: October 2024

Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs 75% of white women, p < 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p < 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p < 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities.

Key messages

• Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues.

• Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.
Strategies to improve recruitment to multimodal group programmes for obesity: a systematic review
Authors: Reinsperger I , Wolf S , Zechmeister-Koss I
Published: October 2024

Background

The World Health Organization describes obesity as one of the greatest public health challenges in the 21st century. Possible therapies include multimodal (group) programmes with nutrition, exercise, and behavioural therapy elements. However, programme providers often have difficulties recruiting the target groups and motivating them to participate. This systematic review aimed to identify barriers and facilitators as well as strategies to improve recruitment.

Methods

We systematically searched five databases (Medline, CINAHL, Cochrane, PsycInfo, Web of Science). Based on predefined inclusion criteria, we selected primary studies of different study designs (e.g. [randomised] controlled trials, qualitative studies). We extracted barriers and facilitators as well as recruitment strategies into predefined tables, assessed the quality of the studies and summarised the results narratively.

Results

Of the 1,082 articles identified, 16 met the inclusion criteria. The main active recruitment strategies were writing directly to potential participants and referrals from health professionals. The most frequently reported passive strategies included media adverts, websites, flyers, social media, and word of mouth. The information on how many people approached actually participated was heterogeneous, which illustrates that recruitment depends on the setting/context and the people involved. Some studies came to contradictory results, e.g., regarding whether passive or active methods are more successful. In most cases, a combination of strategies was recommended. The studies reported numerous recruitment barriers, e.g., lack of staff time, lack of motivation, or fear of discrimination.

Conclusions

The review provides a broad overview of recruitment methods that can be applied depending on the framework conditions and target groups. The summary of possible barriers can serve as an overview of which aspects could be considered when designing or adapting a programme.

Key messages

• To improve recruitment to obesity programmes, a combination of several recruitment strategies, including active and passive methods, should be applied.

• Results on the “effectiveness” of the strategies were inconclusive, which indicates that the success of methods depends on the context, setting and the people involved.
Housing items and amenities a non-traditional risk factors for all-cause and cardiovascular mortality
Authors: Luksiene D , Tamosiunas A , Aukstakalniene G , Radisauskas R , Bobak M
Published: October 2024

Background

Higher satisfaction levels are associated with improved psychological well-being (PWB), such as housing amenities being a determinant of health. However, their potentially influencing effect on mortality risk at this moment is not enough. For this reason, searching for non-traditional risk factors that could reduce all-cause and cardiovascular disease (CVD) mortality risk is our primary objective of this study.

Methods

The cohort study was based on the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Data from the Official Lithuanian Mortality Register were used to evaluate mortality from the baseline survey (2006- 2008) to 31 December 2022. The 20 housing items and amenities were used. The items were categorized into three groups: basic needs, socially oriented needs, and luxury.

Results

A total of 6472 participants aged 45-72 years were examined in the baseline survey. Cox proportional hazards regression analysis results show that increasing the number of housing items per 1 unit decreased the risk of all-cause mortality by 8% (Hazard ratio (HR)=0.92;95%CI 0.90-0.94) in males and by 7% (HR = 0.93;95%CI 0.91-0.96) in females. Increasing the number of housing items per 1 unit decreased the risk of mortality from CVD by 10% (HR = 0.90;95%CI 0.87-0.93) in males and by 9% (HR = 0.91;95% CI 0.87-0.95) in females (data adjusted by age, education, smoking, metabolic syndrome, PWB, CVD at baseline survey). Once more, the increased number of items from the luxury group (4-7 vs. 0-1) significantly decreased all-cause and CVD mortality risk (respectively in males HR = 0.74(95%CI 0.60-0.91) and HR = 0.71(95%CI 0.52-0.96); in females HR = 0.66(95%CI 0.48-0.91) and HR = 0.57(95%CI 0.33-0.96).

Conclusions

These data suggest that the increasing number of household items and amenities, as an essential aspect of people’s lives, may be used as non-traditional risk factors in assessing the risk of all-cause mortality and CVD.

Key messages

• Household items and amenities may be used as non-traditional risk factors in assessing the risk of all-cause mortality and CVD.

• Increasing the number of housing items decreased the risk of all-cause and CVD mortality.
Educational inequalities in cervical cancer mortality: A systematic review and meta-analysis
Authors: Machado M , Eikemo T A , Mohammad T , Balaj M
Published: October 2024

Background

Educational inequalities in mortality continue to persist. We aimed to systematically analyse the association between level of education and cervical cancer mortality.

Methods

We conducted a systematic review and meta-analysis. We systematically searched Pub-Med, Web of Science, Scopus, EMBASE and Global Health (CAB), EconLit and Sociology Source Ultimate databases. A protocol has been registered with PROSPERO (CRD42023411757). We included studies that measured the association between level of education and cervical cancer mortality using individual level data. Included articles were assessed for study quality and risk of bias using the Joanna Briggs Institute critical appraisal checklists. A random-effects meta-analysis was conducted to evaluate the overall and stratified effects of education on mortality.

Findings

Our literature search resulted in over 47,000 articles. 30 studies mentioned cervical cancer as a cause of death, and of these, 11 were eligible for the meta-analysis. Results showed an overall risk ratio of 2.41 (95% CI 1.81-3.20) for low education (ISCED 0-2) and 1.62 (95% CI 1.18-2.24) for medium education (ISCED 3-4). Those aged 25-64 with low education had more than twice the risk of cervical cancer (RR = 5.73; 95% CI 5.04-6.51) compared to those aged 25 and above (RR = 2.11; 95% CI 1.82-2.45). Besides, the impact of an additional level of education on reducing risk of cervical cancer mortality was higher in Northern Europe, compared to the South.

Interpretation

Lower educational attainment is associated with an increase in the risk of cervical cancer mortality, with an additional level of education greatly reducing this risk in Northern Europe. Younger cohorts with low education have a higher risk of cervical cancer mortality. This study provides important information for evidence-based policy seeking to reduce health inequities and inequalities in both the health and education sector.

Key messages

• Lower educational attainment is linked to a higher risk of cervical cancer mortality.

• Younger cohorts (aged 25-64) with low education are at a particularly heightened risk compared to those aged 25 and above.
Cardiovascular diseases risk assessment: the Italian Health Examination Survey 2023 - CUORE Project
Authors: Donfrancesco C , Lo Noce C , Di Lonardo A , Marcozzi B , Vannucchi S , Morello M , Bernardini S , Galeone D , Bellisario P , Palmieri L
Published: October 2024

Background

The reduction of NCDs premature mortality is pursued by the WHO; risk conditions targets are recommended as well as population-level monitoring of cardiovascular disease (CVD) risk. The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported periodic CVD risk assessment through national health examination surveys (HESs), funded by the MoH-CCM and conducted within the CUORE Project.

Methods

In 2023 a new HES started including the 10-year fatal and non-fatal CVD risk assessment based on knowledge of sex, age, smoking habit, measured systolic blood pressure and fasting total and HDL serum cholesterol, and presence of diabetes (on measured fasting serum glycemia and/or treatment) and anti-hypertensive therapy. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy, aged 35-69 years, without previous CVD, are available (585 men, 617 women). Determinations were assayed by a central lab. CUORE Project functions developed on and for the Italian adults were used.

Results

Mean values of the CVD risk assessment resulted 6.9% (95% CI: 6.3-7.4) in men and 2.3% (2.1-2.5) in women. For men aged 35-44 years risk was 1.6% (1.5-1.8), for 45-54 years 3.8% (3.5-4.2), for 55-64 years 10.0% (9.0-10.9), for 65-69 years 17.6% (16.4-18.9); for women was 0.5% (0.4-0.6), 1.0% (0.9-1.1), 3.3% (2.9-3.7) and 6.0% (5.5-6.6) respectively. Prevalence of CVD risk less than 5% was 57% (49-64) in men and 88% (84-93) in women, of 10-15% risk were 22% (15-28) of men and 9% (5-14) of women, of 15-20% risk were 5% (1.6-8.0) of men and 0% of women, of over 20% risk were 2% (0-3.6) of men and 0% of women.

Conclusions

Compared to 2008, these data showed stable mean levels of CVD risk both in men and women at any age-classes and stable prevalence of CVD risk classes. CVD risk perception represents a challenge in primary prevention especially for young age groups and women.

Key messages

• In the Italian general population, CVD risk assessment remained stable compared to 15 years ago.

• CVD risk perception represents a challenge in primary prevention.
Disability-adjusted life years 19 former socialist economies in the European region, 1990-2019
Authors: Šantrić Milićević M , Stevanović A , Todorović J , Stamenković Ž , Rosic N , Anton A , Rommel A
Published: October 2024

Background

Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Enhanced Surveillance), we conducted a study to describe health progress in 19 former socialist economies (FSEs) in Europe from 1990 to 2019. Our metric of choice was age and sex-standardized rates per 100,000 population of total disability-adjusted life years (ASR-DALY).

Methods

We applied joinpoint regression with extracted ASR-DALY data from the Institute for Health Metrics and Evaluation result tool. The annual per cent change (APC) and average annual per cent change (AAPC) from 1990 to 2019 were analyzed in 19 former socialist economies (FSEs) in Europe, including Albania, Belarus, Bosnia and Herzegovina (BH), Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Montenegro, North Macedonia, Poland, Moldova, Romania, Russia, Serbia, Slovakia, Slovenia, and Ukraine.

Results

The ASR-DALY decreased in Estonia (APC1994-1997= -5.2%, p = 0.034; APC2013-2019= -0.7%, p = 0.07), Latvia (APC1994-1997= -6.3%, p = 0.03; APC1997-2007= -1%, p = 0.001; APC2007-2011= -3.9%, p = 0.01), BH (APC1995-1998= -13.3%, p = 0.041; APC1998-2019= -0.5%, p = 0.004), Bulgaria (APC1997-2000= -2.5%, p = 0.022), Lithuania (APC2007-2010= -4.9%, p = 0.018), North Macedonia (APC2007-2011= -1.9%, p = 0.023, APC2011-2019= -0.5%, p = 0.005), Czechia (APC2014-2019= -0.6%, p = 0.014), Moldavia (APC1998-2007= -0.6%, p = 0.06), and Ukraine (APC1995-2008= -0.5%, p = 0.035). Slovenia performed the best amongst the FSEs (ASR-DALY2019: 16677.51 for women, 21985.95 for men and 19134.73 for both sexes), Ukraine the worst (ASR-DALY2019: 26154.88 for women, 47983.60 for men and 35852.17 for both sexes).

Conclusions

Except for Ukraine, all FSEs in the European region achieved health improvement. The most common was a three-year decline in ASR-DALY. Health policy changes, investments in health care, and harmonization with EU regulations were among the factors contributing to improved population health in the FSEs.

Key messages

• Bosnia and Herzegovina is the only FSE in Europe with a continuous 24-year decline in total ASR-DALY.

• Reducing total ASR-DALY significantly in a three-year time frame is possible.
Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador
Authors: Puig-García M , Caicedo-Montaño C , Márquez-Figueroa M , Chilet-Rosell E , Lumbreras B , Parker L A
Published: October 2024

Background

The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context.

Methods

Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals.

Results

Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia.

Conclusions

The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations.

Key messages

• The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities.

• Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.
Overdiagnosis for screen-detected prostate cancer incorporating patient comorbidities
Authors: Beltran A , Parker L A , Moral-Pélaez I , Caballero-Romeu J P , Chilet-Rosell E , Hernandez-Aguado I , Alonso-Coello P , Ronda E , Gómez-Pérez L , Lumbreras B
Published: October 2024

Background

Evidence regarding the likelihood of overdiagnosis in prostate cancer (CaP) screening with PSA are mainly based on clinical trials, which include younger population with fewer comorbidities than those receiving the test in clinical practice. We aimed to assess the likelihood of overdiagnosis and associated variables using real-world data.

Methods

Retrospective cohort of men >40 years with PCa, who had been diagnosed being asymptomatic and after a positive PSA test in the previous 12 months in two hospitals (2004-2022). The probability of overdiagnosis was estimated considering the life expectancy of the Spanish male in the year 2022 and the Charlson Comorbidity Index (lead time 10 years). PSA values and Gleason score were included as independent variables.

Results

Of the 2,331 patients in the cohort, 1,070 (46%) met the inclusion criteria for this analysis. The median follow-up time was 5.7 years (IQR 3.2-8.6). The median age was 71 years (IQR 65-78) and 37% had more than one comorbidity. At diagnosis, the median life expectancy was 12 years (IQR 4-18) and the probability of overdiagnosis was 30.8% (IQR 17.6-52.4). Patients with PSA levels >10 mg/dl tended to be older and with more comorbidities than those with PSA levels 4-10 mg/dl, and thus, with shorter life expectancy. The median probability of overdiagnosis was higher in patients with PSA levels >10 mg/dl (41.4%, IQR 21.5-73.9) than in those with PSA levels 4-10 mg/dl (20.1%, IQR 12.8-30.4), p < 0.001. Correspondingly, patients with Gleason score ≥8 were more likely to be overdiagnosed (median 42.6%, IQR 23.6-68.6) than those with Gleason score ≤6 (median 20.1%, IQR 12.8-30.4) (p < 0.001).

Conclusions

In clinical practice, older patients with comorbidities showed high PSA levels and Gleason score ≥8, presenting low life expectancy at diagnosis and, therefore, high probability of overdiagnosis. This highlights the importance of considering the patient’s comorbidities when ordering a new PSA test.

Key messages

• A detailed assessment of the prevalence of comorbidities among CaP patients in real-life settings has significant implications for patient management.

• The decision to make an early diagnosis should be based on individual life expectancy, where comorbidity is at least as important as age.
Impact of Noncommunicable Diseases on Years of Life Lost in FB&H During the COVID-19 Pandemic
Authors: Cilović Lagarija Š , Skočibušić S , Rommel A , Anton A
Published: October 2024

This study aims to comprehensively investigate the impact of noncommunicable diseases (NCDs) on years of life lost (YLL) within the Federation of Bosnia and Herzegovina (FB&H) across distinct phases: pre-pandemic, pandemic, and post-pandemic periods. Given that NCDs currently represent more than half of the global disease burden, our focus lies in assessing YLL specifically for cerebral infarction (I63-I64) and diabetes mellitus (E10-E14). Conducting a retrospective data analysis, we utilized mortality data sourced from the Institute for Statistics of FB&H to quantify YLL. This assessment involved multiplying age-specific mortality figures by the remaining life expectancy at the corresponding age, utilizing the GBD 2019 life expectancy table. Examining the period between 2019 and 2022, our analysis aimed to elucidate the pandemic’s potential influence on NCD burden, through the examination of age-standardized YLL rates based on the world standard population. In 2019, YLL attributable to I63-I64 for both sexes totaled 41,244 in 2019, escalating to 44,790 in 2020, and subsequently decreasing to 39,439 and 32,055 in the pandemic years of 2021 and 2022, respectively. For diabetes mellitus (E10-E14), YLL in 2019 amounted to 23,675, with figures for 2020, 2021, and 2022 standing retrospectively at 24,329, 24,114, 19,125. The increase in 2020 may be attributed, in part, to initial healthcare hesitancy during the pandemic’s onset, leading to delayed treatment and heightened mortality rates. Furthermore, patients who died in 2020 from C-19 without being tested may have skewed mortality registration by inflating rates attributed to pre-existing conditions. The declining rates thereafter could be due to a harvesting pandemic effect, in that people who were previously ill died prematurely from C-19. These insights show the pandemic’s profound impact on NCD-related mortality, underscoring the urgent need for targeted interventions and healthcare strategies.

Key messages

• A substantial reduction in years of life lost (YLL) related to certain noncommunicable diseases was observed during the pandemic.

• The pandemic significantly influenced mortality among individuals with noncommunicable diseases, driven partly by healthcare hesitancy and potential misregistration of causes of death.
Seasonal Variation in Vascular Dehydration Risk: Insights from the KOBE Study
Authors: Nishikawa T , Miyamatsu N , Higashiyama A , Kubota Y , Hirata T , Hirata A , Nishida Y , Kubo S , Miyazaki J , Okamura T
Published: October 2024

Objectives

Dehydration, a risk factor for ischemic cerebrovascular diseases, is common in summer; however, the incidence of ischemic diseases is not necessarily higher in summer. The phenomenon may be influenced by the differences in the susceptibility to vascular dehydration based on the season. Therefore, this study aimed to distinguish types of dehydration in colder and warmer seasons by analyzing serum osmolarity, hematocrit, and daily non-alcohol drink (NAD) intake.

Methods

Participants in the Kobe Orthopedic and Biomedical Epidemiologic (KOBE) Study, consisting of healthy individuals, were categorized into two groups based on the examination month: the warmer and colder seasons. Multivariate analyses were conducted to examine disparities in serum osmolarity, hematocrit, and NAD intake between these two groups.

Results

Participant ratios by age group and the seasons (warmer season/colder season) were as follows: Women under 50 (35/62), 50-60 (77/126), 60-70 (123/170), over 70 (58/52); Men under 50 (14/17), 50-60 (22/36), 60-70 (57/71), over 70 (55/34). The colder season was found to be negatively correlated with serum osmolarity and NAD intake, but positively correlated with hematocrit, even after adjusting for relevant factors. Age was independently associated with serum osmolarity, but not with hematocrit and NAD intake.

Conclusions

This study highlights that vascular dehydration is more likely in the colder season despite lower serum osmolarity than the warmer season. Age-related increases in serum osmolarity without a corresponding rise in water intake may contribute to this. These findings emphasize the importance of addressing dehydration in the colder season, particularly in older adults.

Key messages

• The colder season showed a negative correlation with serum osmolarity and NAD intake but a positive correlation with hematocrit.

• Raising awareness about the importance of hydration during winter may be essential.
Social inequalities in cancer incidence, survival and mortality: An umbrella review
Authors: Francis M , Peña S , von Wright T , Lindell E , Bellos I , Benetou V , Kestilä L
Published: October 2024

Background

An increasing number of systematic reviews investigating differences in cancer burden by social factors such as race, ethnicity, and socioeconomic status have been published in recent years. Our study aims to evaluate the strength and quality of evidence from systematic reviews investigating associations between social factors and cancer incidence, survival, and mortality to help policy-makers reduce existing social inequalities in the burden of cancer.

Methods

Our study is a pre-registered umbrella review (PROSPERO; CRD42024552884). We systematically searched Medline, Scopus, Web of Science, CINAHL, PsycINFO, the Cochrane Library, the JBI EBP database, and Epistemonikos without date restrictions for published systematic reviews with or without meta-analyses on June 17, 2024. The search identified 15,542 records, which were reduced to 7,421 after deduplication. We are currently screening studies to include systematic reviews of cohort or case-control studies that examined associations between one or more social factors (gender, race/ethnicity, education, occupation, socioeconomic status, place of residence, religion, social capital) and cancer outcomes. Study screening, data extraction, and quality appraisal will be done in duplicate using pre-piloted forms. The strength of evidence of reported associations between social factors and cancer outcomes will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Before data synthesis, we will assess the degree of overlap between primary studies in the eligible reviews by creating citation matrices and calculating corrected covered area indices. Following this, we will narratively summarize associations (for systematic reviews without meta-analyses) and pool the risk estimates for individual social factors and cancer outcomes (for reviews with meta-analyses) using random-effects meta-analysis models. We will have preliminary results ready by November 2024.

Key messages

• Our umbrella review aims to evaluate the strength and quality of evidence from systematic reviews which have examined social inequalities in cancer incidence, survival, and mortality.

• This high-level evidence synthesis can help policy-makers better plan and target interventions to reduce the existing social inequalities in the burden of cancer.
Serum circulating liver enzymes and human diseases
Authors: Feng Q
Published: October 2024

Background

This study aimed to comprehensively investigate the observational and Mendelian randomization (MR) associations between liver enzymes (ALP, ALT, AST and GGT) with a wide spectrum of human diseases.

Methods

UK Biobank data was used for observational analysis. Cox proportional hazard models were used to quantify the observational associations between liver enzymes and risks of 1109 diseases, adjusted for covariates. A correction was applied to allow for multiple comparisons. Two-sample MR was performed to replicate the identified observational associations. We assessed the strength, consistency and pleiotropy of these MR associations.

Results

In 438571 participants with a median 12.4 years of follow-up, we found evidence linking liver enzymes and 654 diseases, 254 of which were further assessed in subsequent MR. In MR, 52 associations were replicated (10 for ALP, 14 for ALT, 10 for AST and 18 for GGT). Specifically, ALT was associated with liver conditions, diabetes, abnormal bleeding from the female genital tract, and prostate cancer. AST showed associations with prostate cancer, anxiety, diabetic neuropathy, and stroke. GGT was linked to hepatic and biliary conditions, coronary atherosclerosis, and pneumonia, while ALP displayed positive associations with vitamin D-calcium-parathyroid-bone conditions.

Conclusions

Elevated liver enzymes are risk factors for a wide range of hepatic and extrahepatic diseases, predominantly digestive, circulatory, metabolic/endocrine (including diabetes) diseases. Furthermore, the four liver enzymes demonstrated distinct patterns of disease associations.

Key messages

• Elevated liver enzymes are risk factors for a wide range of hepatic and extrahepatic diseases.

• The four liver enzymes demonstrated distinct patterns of disease associations.
Tobacco and nicotine products use among adolescents in Serbia – Latent class analysis
Authors: Kilibarda B , Gudelj Rakic J , Jovanovic V , Vasic M , Tosic M
Published: October 2024

Background

In parallel with a decline in cigarette smoking in the previous decade, other tobacco and nicotine products (TNPs), that are often used concurrently, have gained popularity among adolescents. The purpose of this study was to identify patterns of tobacco and nicotine product use among Serbian adolescents.

Methods

Data for this study were obtained from Health Behavior in School-aged Children (HBSC), a WHO collaborative cross-national study of adolescent health and well-being, that was conducted in Serbia in 2022 on a sample of 3713 students 11,13 and 15 years old. Descriptive statistics was used as well as latent class analysis to classify students based on their past-month use of cigarettes, e-cigarettes, heated tobacco products, waterpipes, and oral tobacco/nicotine products.

Results

Among students 11,13 and 15 years old, 10.2% smoke cigarettes, 13% use e-cigarettes, 11.1% waterpipes, 3.7% oral tobacco/nicotine products, and 4.5% heated tobacco products with differences by age and sex. We found high percentages of dual use of TNPs among cigarette smokers. Among students who smoke cigarettes, 61.6% also use e-cigarettes, 36.2% smoke waterpipes, 30.2% heated tobacco products, and 24.1% oral tobacco/nicotine products. Latent class analysis identified three classes as optimal solution: (1) dual e-cigarette and cigarette users (6.9%); (2) minimal/non-users (83.2%) and (3) poly tobacco and nicotine products users (9.9%). Statistically significant differences between classes were found in age and sex.

Conclusions

Dual and poly-tobacco and nicotine use is common among Serbian adolescents and presents a challenge for monitoring and public health response. Findings contribute to a better understanding of patterns and heterogeneity of TNPs use among adolescents and might have implications for prevention and cessation interventions for youth.

Key messages

• Among students 11,13 and 15 years old, tobacco and nicotine products, other than cigarettes is gaining popularity and with the e-cigarettes being the most popular product.

• Dual and poly tobacco and nicotine products use is new challenged that should be taken into account in tobacco and nicotine monitoring, cessation and prevention.
Utilization and subjective effectiveness of post-COVID-19 therapies in patients with chronic fatigue
Authors: Stolz M , Burger B , Herrmann-Lingen C , Stahmeyer J T , de Zwaan M , Krauth C
Published: October 2024

Background

A significant proportion of people who have had a SARS-CoV-2 infection suffer from persistent symptoms for more than three months, referred to as post-COVID-19 condition (PCC). Chronic fatigue syndrome (CFS) is common in people with PCC. Little is known about the use of therapeutic measures for people with CFS, and the effect of active exercise in particular is a subject of controversial debate.

Methods

From November 2023 to January 2024, an online survey was conducted among a random sample of statutorily-insured people with PCC (ICD10 U09.9). Patients with CFS were identified using the DSQ-PEM. The utilization of various physical, psychological and alternative medical therapies and their subjective effectiveness on a scale from 1 (significantly worsened) to 5 (significantly improved) were recorded. Mann-Whitney-U-tests were carried out.

Results

Preliminary analyses of 1,699 participants with persisting PCC revealed an indication for CFS in 310 participants. Looking at the active exercises, there is no difference in the utilization of functional training between people with and people without CFS (14.6 % vs. 14.5 %, p = 1.0), while rehabilitation sport is utilized significantly more frequently by people with CFS (26.5% vs. 18.7%, p = 0.003). While 45-48% of CFS patients benefited from active therapies, 20-30% showed a worsening of their symptoms. On average, people with CFS also showed significantly less improvement from rehabilitation sports (M 3.28 vs. 3.72, p = 0.002) and functional training (M 3.16 vs. 3.81, p = 0.002) than people without CFS.

Conclusions

People with CFS due to PCC are significantly more likely to utilize therapeutic services than people with PCC without CFS. Active therapies seemed to benefit almost half of CFS patients but led to worsening of symptoms in up to 20-30%. Further studies are needed to provide evidence-based treatment recommendations for this vulnerable population.

Key messages

• People with PCC and CFS benefit less from active therapies than people with PCC without CFS. Utilization of active therapies worsen symptoms in a relevant minority of 20-30% of CFS patients.

• Further research should focus on evidence-based treatment recommendations for people with PCC and CFS.
Advancing mammography uptake among vulnerable groups: a systematic review of intervention strategies
Authors: Ferrari A , Jael Herrera D , van de Veerdonk W , D’haenens W , Ruiz Alejos A , Van Bos L , Talboom S , Ding L , Goossens M , Van Hal G
Published: October 2024

With over 2 million cases diagnosed annually, breast cancer is a leading cause of cancer-related disability and mortality. Despite global efforts to implement mammography screening programs, uptake rates vary widely across settings due to socioeconomic factors and accessibility challenges. To improve participation, targeted interventions addressing barriers faced by underserved groups are essential for promoting inclusive screening and early detection. As part of the ENTER project, which aims to address disparities in breast cancer screening participation among women with low socioeconomic status (SES) in Flanders, Belgium, we conducted a systematic review and meta-analysis on the effectiveness of interventions to enhance mammography uptake. To explore the differential impact of interventions on mammography uptake among vulnerable groups, including individuals with low SES, underinsured, with immigrant background or part of an ethnic minority, subgroup analyses were performed. 7 databases were searched, resulting in the inclusion of 54 out of 9,366 papers for analysis. 14 types of interventions were identified. The meta-analysis showed significant pooled effects of interventions that increased mammography uptake [OR 1.8 (95%CI 1.6-2.2)], particularly among vulnerable populations [OR 2.2 (95%CI 1.7-2.8)]. The most effective interventions were educational interventions [OR 3.03 (95%CI 2.2-4.9); in vulnerable groups OR 2.7 (95%CI 1.9-3.9)]. As expected, interventions adapted to linguistic needs and culturally sensitive approaches showed a significant effect among vulnerable target groups [OR 2.9 (95%CI 1.1-7.9) and OR 2.5 (95%CI 1.1-5.6), respectively]. Reminders were also highly effective [OR 1.8 (95%CI 1.5-2.1); in vulnerable groups OR 2.5 (95%CI 1.9-3.1)]. This review underscores the critical role of targeted interventions in augmenting screening mammography uptake, particularly among vulnerable populations, where odds of participation can increase by up to 2-3 times.

Key messages

• Interventions adapted to the linguistic needs of the target population and culturally sensitive approaches, aligned with values and beliefs of a specific community, can greatly enhance screening rates.

• Considering costs, practicality and impact, reminder letters with culturally and linguistically adapted content emerged as the most promising option for implementation in the ENTER project.