bluuebunny/crossref_metadata_2025 huggingface dataset:
A selective diesel vehicle ban’s impact on NO2 concentrations in Munich: a quasi-experimental study
Authors: Leibinger A , Rehfuess E , Burns J
Published: October 2024

Background

The European Union’s current NO2 concentration limit of 40 μg/m³ is regularly exceeded in Munich, Germany. This limit is likely to be reduced towards the WHO recommended target of 10 μg/m³. In response, the city enacted a selective ban on older diesel vehicles, specifically those categorized as Euro 4 or older, within the current low-emission zone in February 2023. Our study examined how Munich’s selective ban on diesel vehicles impacted NO2 levels, concentrating on the six-month period after its introduction.

Methods

We employed a synthetic control approach in the primary analysis and a controlled interrupted time series approach in the secondary analysis. These quasi-experimental methods establish a ‘counterfactual’ no-intervention scenario, allowing for comparison with the actual observed scenario and estimation of the impact of the intervention. Historical data from monitoring stations within and outside the low-emission zone from 2014 to 2022 were utilized as controls, while potential confounders were considered.

Results

NO2 concentrations within Munich’s low-emission zone decreased across the study period. Effects of the selective diesel vehicle ban at monitoring stations within the low-emission zone were minimal, with wide confidence intervals indicating uncertainty. At Landshuter Allee, the average intervention effect was -2.67 μg/m3 (95%-CI = [-12.72; 7.38]), at Stachus it was -2.74 μg/m3 (95%-CI = [-9.91; 4.42]) and at Lothstrasse, it was -1.03 μg/m3 (95%-CI = [-7.75; 5.69]). The secondary analysis confirms these findings.

Conclusions

Munich’s selective diesel vehicle ban had limited effects in reducing NO2 concentrations. Factors such as its narrow focus on Euro 4 diesel vehicles, numerous exemptions, and unclear enforcement may explain this outcome. Comprehensive strategies and continuous monitoring and evaluation are crucial for effectively addressing urban air pollution and protecting public health.

Key messages

• Munich’s selective diesel vehicle ban had minimal effects on reducing NO2 levels, possibly due to its narrow scope, many exemptions, and unclear enforcement.

• Current guidelines and court rulings signal the need for more effective solutions beyond selective bans, emphasizing the importance of well-designed interventions and rigorous evaluation.
Physical activity promotion in Aged care: a participatory approach
Authors: Frahsa A , Hahn L S , Thiel A
Published: October 2024

Introduction

Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs.

Methods

Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20.

Results

Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated.

Conclusions

Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change.

Key messages

• Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being.

• Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.
Understanding compliance with smoke-free environments: a realist review
Authors: Jooren SJA , Garritsen H , Troelstra S , Willemsen M C , Jansen M , Bommelé J
Published: October 2024

Background

Local governments increasingly implement outdoor smoke-free environments to decrease adolescent smoking and denormalize smoking behavior. Recent research indicates that compliance with smoke-free outdoor spaces is often lacking. We examined compliance with outdoor smoke-free environments and examined the mechanisms that affect compliance in different contexts.

Methods

We performed a realist review, an exploratory approach that synthesizes existing evidence into a program theory that links elements of compliance with outdoor smoke-free environments with specific mechanisms and outcomes. A search was performed in PubMed, Web of Science, Embase, and PsycINFO, resulting in 25 relevant English language articles.

Preliminary results

Our analysis showed that the kind of enforcement (voluntary or enforcement with sanction options etc.) influences smokers’ compliance. Additionally, how implementation of the smoke-free environment was done (with supporting signs, size of the environment, attention for smoking cessation etc.) also influenced smokers’ compliance. For instance, with the implementation of an outdoor smoke-free environment (context), smokers get used to non-smoking. They are reminded they can quit smoking at any time (mechanism), leading to more compliance (outcome). If however, their social environment continues smoking (context), they are more inclined to keep smoking (mechanism), which leads to less compliance (outcome).

Conclusions

Compliance of smokers with smoke-free outdoor environments is influenced by the type of enforcement and the type of outdoor smoke-free environment. These mechanisms are important to understand so that policymakers may consider smokers’ reactions and are better able to anticipate upon them.

Key messages

• Type of enforcement and type of implementation influence compliance with smoke-free outdoor environments.

• This realist review helps policymakers consider smokers’ reactions while implementing smoke-free environments.
Students’ attitudes towards and willingness to intervene in partner violence against women in Sweden
Authors: Svalin K , Wemrell M , Ivert A-K
Published: October 2024

Intimate partner violence against women (IPVAW) is a global public health problem, shown to be related to gender equality and to attitudes towards IPVAW. In Sweden, however, the reported prevalence of IPVAW is high, despite high levels of gender equality and a clear condemnation of such violence on the societal level. This phenomenon has been referred to as The Nordic paradox. One potential explanation for this paradox is that gender equality measures at the public level are not necessarily comparable to gender equality at a private level. One way to find out more about this is to investigate attitudes towards IPVAW at an individual level, which has so far been done to a limited extent in a Swedish context. In the current study, the aim was to investigate different aspects of attitudes to IPVAW (perceived acceptability, perceived severity, victim-blaming and ambivalent sexism) among university students in Sweden, and whether those attitudes were related to studentś willingness to intervene in cases of IPVAW. Any gender differences related to IPVAW attitudes and willingness to intervene were also examined. The respondents (n = 656, ≥18 years old) were recruited from three different universities and represented different scientific fields (e.g. social, behavioral, and technical sciences). Most of the respondents were undergraduate students and the majority were women (81%). The results showed that the students had rather non-accepting attitudes towards IPVAW overall, but viewed victims as to some extent responsible of the violence they are subjected to. There were no gender differences regarding willingness to intervene in cases of IPVAW, and attitudes to IPVAW were related to willingness to intervene. There were both similarities and differences between male and female students, in terms of how attitudes were linked to willingness to intervene. The presentation will discuss the results and their implications for future research, policy and practice.

Key messages

• Increased knowledge on attitudes towards IPVAW in Sweden may shed light on the Nordic paradox.

• While non-accepting attitudes were found overall, gender differences and tendencies towards victim-blaming were identified.
Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium
Authors: Vermote M , Debognies P , Demarest S , Braekman E
Published: October 2024

Background

Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders.

Methods

Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities.

Results

Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%).

Conclusions

Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities.

Key messages

• Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support.

• Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.
Non-health-targeted promotions and step counts of smartphone-based mall walking program users
Authors: Matsuoka Y , Yoshida H , Hanazato M
Published: October 2024

Background

The COVID-19 pandemic changed lifestyles and raised concerns regarding physical inactivity among adults. Mobile health interventions for physical activity may be a potential solution. However, the effects may diminish over time. This study investigated whether incorporating non-health-targeted promotions into an existing mobile health-walking program could stimulate users to walk.

Methods

We used nationwide cohort data of smartphone users participating in a shopping mall walking program in Japan. We focused on existing users registered in the program until October 31, 2022. A Japanese anime tie-in promotion was conducted by the shopping mall company from December 3 to 25, 2022, offering additional rewards alongside the regular program. We collected step count records of existing users 1 month before and after (November 1 to December 2, 2022, and December 26, 2022 to January 31, 2023, respectively), and during the promotion period. Propensity score matching was applied to ensure balance in the baseline characteristics of existing users in terms of gender, age, and pre-promotion program participation frequency. Next, we analyzed the association between participation in the promotion program and the average daily step counts during and after the promotional period using mixed effects models for repeated measures, while adjusting for the same covariates.

Results

Among the 18,156 users included in the study, 13,386 (73.7%) were women, with a mean (SD) age of 45.2 (12.7) years, and a mean (SD) pre-promotion program participation frequency of 9.7 (9.6) per month. During the promotion period, the participants walked 87 (95% CI: 50-125) more steps per day than non-participants, after adjusting for covariates. No clear association was observed 1 month post-promotion.

Conclusions

These findings indicate that non-health-targeted promotions may be short-term motivators for existing app users to walk. Ongoing monitoring is necessary to assess the long-term impact.

Key messages

• Mobile health intervention effects may diminish over time.

• A non-health-related promotion could stimulate existing mall walking program app users to increase their daily step count temporarily.
Cost per kilogram weight-lost - Lifestyle change program at the Public Health Institute in Croatia
Authors: Kovačević J , Zombori D
Published: October 2024

According to the 2019 European Health Survey, 42% and 23% of the Croatian adult population were affected by overweight or obesity, respectively. Counselling services are available in some Public Health Institutes for free or paid out-of-pocket. The estimated cost per kilogram lost in programs in Europe and the USA ranges from 100-340€, with a justifiable cost estimation for a weight loss intervention being 120-210€. Aim was to demonstrate the cost of losing one kilogram by analysing necessary initial material and human resources, including equipping counselling centres, and estimating the cost of continuous implementation. In the year 2023, 47 participants (31F,10M) with a BMI higher than 30 kg/m2 enrolled in the three-month free Program in the County Public Health Institute in Pozega. The program consisted of personalized assessment, habit change plan, education, counselling and follow-up. An analysis of the minimal required equipment and working hours of physician and a nurse (contracted gross hourly wage rates) was conducted. The main outcome measure was the cost of one kilogram lost by participants at the end of the Program. Program was completed by 41 (22F, 9M) participants (87.2%). Their initial BMI ranged from 30.3 to 47.4 kg/m2. Collectively, they lost 323.2 kg (1.3-24.4kg), with an average of 7.9 kg or 7.4% (1.7-19.8%) of their initial weight lost. The estimated total cost of medical, IT and office equipment, was 9363€. The human resources cost was 9509€, with a specialist and nurse spending 249 and 116 hours, respectively (27.6€/hour and 13€/hour). The initial cost per kilogram lost, including the prerequisites for the work of the counselling centre, was 58.4€. The continuous program cost with equipment already in place is estimated at 27.9€ per kilogram lost. We have shown that the lifestyle management program in the Croatia without extra cost to patients delivers results with a cost of 27.9€ per kilogram weight-lost in continuous implementation.

Key messages

• The significant impact of obesity on premature mortality and healthcare systems calls for the systematic implementation of effective weight management programs that are available to patients for free.

• It is possible to implement effective weight management program in Croatia without extra cost to patients for 27.9 € per kilogram weight-lost.
Cost-effectiveness of respiratory syncytial virus adjuvanted vaccine in Portuguese aged ≥ 60 years
Authors: Zarkadoulas L , Bota P , Silva F , Coelho A , Castanheira R
Published: October 2024

Background

Respiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract disease among adults aged ≥60 years in Europe. This study aims to assess the potential public health impact of the RSVPreF3 OA adjuvanted vaccine, the first approved preventive intervention for the older adult population in Portugal.

Methods

A monthly-cycle static Markov model was developed to assess RSVPreF3 OA adjuvanted vaccine impact on adults aged 60 years and older in Portugal. A single dose of RSVPreF3 OA adjuvanted vaccine was compared to no-vaccination over a three-year time-horizon. The model captures lower respiratory tract disease (LRTD) RSV cases, hospitalizations, deaths, and healthcare resource utilization. Data inputs were based on local published literature, supplemented by the best available data when local information was lacking.

Results

Based on preliminary analysis considering 75% vaccine coverage, model outputs estimate that RSVPreF3 OA adjuvanted vaccine can prevent 71,433 LRTD cases requiring medical attendance, 11,067 hospitalizations, 1,793 intensive care unit admissions and 1,003 deaths. The model estimates that 32 adults need to be vaccinated to avoid one RSV LRTD case, 207 adults need to be vaccinated to avoid one hospitalization and 2,283 adults need to be vaccinated to avoid one death. The incremental cost-effectiveness ratio was estimated at 9,541€, hence the RSVPreF3 OA adjuvanted vaccine is cost-effective compared to no vaccination.

Conclusions

The results demonstrate a strong preventive impact of the RSVPreF3 OA adjuvanted vaccine on health outcomes and healthcare resource utilization in adults ≥60 years, leading to a significant public health benefit. This result emphasizes the importance of preventing RSV to preserve the health and well-being of Portugal’s older adults. In addition, data from ongoing studies may enhance precision and extensive sensitivity analyses validate the robustness of the model’s input assumptions.

Key messages

• This study shows the robust evidence of RSVPreF3 OA adjuvanted vaccine to improve public health by preventing thousands of hospitalizations and deaths among ≥60 years, in Portugal.

• Vaccinating adults aged ≥ 60 years with RSVPreF3 OA adjuvanted vaccine in Portugal is a cost-effective strategy.
Decision-analytic modelling of costs & benefits of adding sigmoidoscopy to CRC screening in Germany
Authors: Krueger K , Schaubert K , Brinkmann M , Schramm W , Dreier M , Krauth C
Published: October 2024

Background

In Germany, a colorectal cancer (CRC) screening programme is in place that entitles individuals to a stool test or colonoscopy. However, less than half of those eligible participate. The inclusion of an additional screening option, such as the evidence-based sigmoidoscopy, could lead to a higher overall participation rate, but also to individuals preferring the additional option to the more effective colonoscopy. The objective of this modelling study is to estimate the impact of offering sigmoidoscopy as an additional option for CRC screening in Germany.

Methods

A life-time mathematical model (Markov model) is developed to analyse the long-term effects of the additional offer of sigmoidoscopy on benefits (prevalence, mortality, health-related quality of life (HRQoL)), costs, and cost-effectiveness. The model is based on systematic literature reviews and real-world healthcare data. It incorporates disease development, sensitivity and specificity of the options, compliance rates, survival probabilities and background mortality. A discrete choice experiment (DCE) was conducted to estimate the future uptake of the options (stool test, colonoscopy, sigmoidoscopy, no screening) based on stated preferences of n = 666 individuals.

Results

Adding sigmoidoscopy leads to greater effectiveness of the CRC screening programme in terms of increased screening participation, increased adenoma detection, decreased disease-specific mortality, and improved discounted HRQoL. However, it also incurs higher costs. The incremental cost-effectiveness ratios (ICER) for men and women are €507 per quality-adjusted life year gained (QALYg) and €74 per QALYg, respectively.

Conclusions

The results indicate that the inclusion of sigmoidoscopy in the German CRC screening programme would be cost-effective and that sigmoidoscopy should be piloted in practice. The expanded programme has the potential to enhance the program’s effectiveness, improve health outcomes, and reduce the burden of CRC.

Key messages

• Expanding the CRC screening programme may increase overall participation, resulting in higher costs, but also greater effectiveness in detecting more adenomas, reducing mortality, improving HRQoL.

• Introducing sigmoidoscopy in Germany appears cost-effective and justifies practical piloting to enhance CRC screening efficacy and health outcomes.
Polish midwives’ experiences of providing maternity care to Ukrainian women in Poland
Authors: Nenko I , Baranowska B , Szlendak B , Sahraoui N , Węgrzynowska M
Published: October 2024

Background

Migrants’ health has attracted the attention of researchers for many years, particularly from the perspective of barriers in access to healthcare systems. Providing high quality care to migrants and refugees, especially in contexts of significant and sudden arrivals, may be particularly challenging.

Aim

The aim of our research was to learn about the experiences and strategies of midwives providing maternity care for Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine.

Methods

Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed.

Results

Healthcare personnel experiences a number of barriers to the provision of high-quality care to the migrant population. Polish midwives expressed mainly experience of two groups of barriers on: (1) individual and interpersonal, (2) management and organization levels. Firstly, at the individual and interpersonal level midwives experienced: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for woman fleeing the war. Secondly, at the management and organizational level midwives experienced: lack of organizational support, interpreting services and documentation in any other language than Polish. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units.

Conclusions

The Polish health care services need systemic solutions prepared jointly by state and local authorities and considering the voices of midwives to support the provision of high-quality care to migrant population.

Key messages

• Midwives were left to their own devices.

• Midwives need better preparation for providing high-quality care to migrant population.
Patients’ experiences of racism in German inpatient healthcare
Authors: Brunnett R , Meshkova K
Published: October 2024

Background

Racism is recognised as a social determinant of health. An evolving concern in research and policymaking has been the impact of racism in the healthcare system, particularly regarding the quality of healthcare and barriers for healthcare. Little is known about patients’ experiences of racism in hospitals and rehabilitation facilities in Germany and their coping strategies in dealing with racism.

Methods

As part of a joint project on racism in healthcare (RiGeV) funded by the Federal Ministry of Education and Research, twenty qualitative interviews and two group discussions with patients and their next of kin about their experiences in hospitals and rehabilitation facilities were conducted and analysed using the documentary method. Ethical approval for this study was obtained from the Ethics Committee of Fulda University of Applied Sciences.

Results

Interviews with patients and their next of kin revealed that the most significant experiences of racism in hospitals are attributions of dramatisation and exaggeration of pain, embedded in a general perception of not being taken seriously and/or being ignored. Patients try to avoid such experiences that compromise their trust and sense of security, as well as the quality of treatment they receive. Healthcare for refugees is impacted by structural barriers (AsylBLg) which jeopardise the healing process and represent a considerable psychosocial burden.

Conclusions

Recommendations for policies and practice include a mission statement for non-discriminatory treatment and the sanctioning of racism within healthcare institutions. A complaints office should manage implementation and offer support for affected patients. The topic of racism must be addressed in the training and further education of doctors and healthcare professionals. Patient trust in a safe and high-quality form of healthcare should be strengthened by addressing their complaints. Health care for refugees has to be improved.

Key messages

• Racism in German inpatient healthcare represents a considerable psychosocial burden for patients and impairs the quality of treatment they receive.

• Policies for reducing racism inpatient healthcare have to be implemented.
Educational and employment for adults with a history of migration and foster care in Finland
Authors: Malin M , Miettinen J , Anand J , Joubert N , Batbaatar E
Published: October 2024

Several studies document the adverse educational prospects for both immigrant-origin as well as out of home placed children and youth. Few studies have examined the educational and employment outcomes of migrant-origin young adults with a history of out-of-home care (OHC), which is the aim of our study. Methods. We studied all subjects born in 1976 to 1995 abroad and immigrated to Finland as underage persons prior to 2010 (N = 20 037), comparing them to children born in Finland to foreign born parents (N = 3198) and a matched random sample of host population (N = 23 187) according to register data 1991 to 2015. We formed OHC alumni and non-OHC alumni groups among refugee-origin born abroad and in Finland, non-refugee-origin born abroad and in Finland as well as native Finns group. Logistic regression analysis was used in which age of the child in the first placement, number of placements and the type of the first place were adjusted. Results.Minors both with refugee and non-refugee background born in Finland were more likely than native Finns to be placed in OHC. A history of OHC predicted less chance of degrees completed and being employed compared to non-OHC peers in all study groups. Refugee background born abroad having history in OHC had lower educational and employment outcomes as young adults compared to other OHC groups. Education made difference since immigrant background having OHC history and post-compulsory degree had two times higher likelihood of being employed. The first OHC during teenage years decreased odds for post-compulsory education but increased odds for employment. Multiple placements in OHC decreased a youth’s chances of completing degrees and employment

Key messages

• Education made difference since persons with OHC history and degrees done had two times higher likelihood of being employed.

• Refugee origin OHC alumni were in the most vulnerable position with less degrees and less employment, and thus they need any support in their studies.
Prevalence of Mental health and Receipt of Services in Latino Immigrants Living in Philadelphia
Authors: Guariglia B , Yamasaki Y , Perez C , Zumaeta-Castillo C , Lazo M , Bakely L , Martinez-Donate A
Published: October 2024

Background and Purpose

Research shows that Latino populations are less likely to seek formal mental health services, these attitudes combined with difficulty finding affordable services impact the ability to receive a mental health diagnosis. This project examines mental health symptoms, utilization of mental health services, and socio-ecological barriers to receive mental health services among Latino immigrants, including region of origin, health insurance, immigration status, and English proficiency.

Methods

Data was collected between 2021-2022 by Drexel University’s CRISOL lab using a cross-sectional respondent-driven sample survey of Latinos born outside the U.S. mainland and residing in Philadelphia. The final sample included 420 Latino/a/e immigrants. Descriptive statistics and bivariate associations using Chi-square analyses were computed.

Outcomes

The findings revealed that 29.1% of the surveyed individuals exhibited signs of Depression, 36.1% experienced symptoms of Anxiety, 8.7% showed signs of PTSD, and 43.4% possessed one or more mental health conditions. The findings show that country of origin (p<.01), health insurance (p<.05), immigration status (p<.01), and language proficiency (p<.001) are significantly associated with whether an individual has received mental health services in the past year or in their lifetime. Of the survey population, only 39.5% of individuals with one or more mental issues had received mental health services in their lifetime.

Conclusions

Interventions to increase access to mental health services for Latino communities are needed. Solutions addressing disparities in access to mental health services must address systemic, cultural, and language barriers.

Key messages

• Region of origin, health insurance, immigration status, and English proficiency impact the utilization of mental health services.

• Immigrant populations face stressors that increase the risk for mental health disease and experience multiple barriers to access mental health services.
Gender stereotypes in Ukrainian healthcare: results of the mixed methods study
Authors: Boiko A , Peresada M , Duda M , Pavlenko P , Hinchey B , Avaliani N , Polomoshnova E , Elkins D , Samko M , Tokar A
Published: October 2024

Background

A good interpersonal patient-provider relationship is crucial for quality care, still patients frequently perceive interface as discriminatory and marginalizing, reinforcing societal gender roles and hindering healthcare quality. This becomes even more critical for healthcare systems with limited resources and prolonged emergencies, such as Ukraine during the COVID-19 pandemic and full-scale war. We explore gender stereotypes of healthcare workers in Ukraine.

Methods

This mixed-methods study was conducted in August-September 2022, and included: 1)16 online focus group discussions with 93 healthcare workers; 2)survey conducted face-to-face with 1,529 physicians and 502 nurses; modified Nijmegen Gender Awareness in Medicine Scale questionnaire was used. Qualitative data was transcribed and inductively analyzed. Survey results were analyzed in SPSS using descriptive statistics and correlation analyses.

Results

Healthcare workers perceived women patients as ‘more demanding’ and ‘less accommodating’ compared to men. Thus, 64% of healthcare workers perceived female patients as overusing health services; 44%-believed women have higher expectations than male patients; 61%-thought they expected excessive empathy; and 58%-noticed women veering off-topic during consultations. Also, respondents who supported the belief that male patients better understand doctors’ recommendations were more likely to also support the statement that female patients, compared to male patients, more often have higher expectations from doctors (rs = 0.4, p < 0.001). With age prevalence of gender stereotypes increased among healthcare workers; there were no significant differences by sex of healthcare workers, healthcare facility type, position, or geographical location.

Conclusions

It is crucial to develop and implement gender-sensitive approaches in Ukrainian health facilities, rooted in comprehensive training and continuous professional development targeting prevalent gender stereotypes.

Key messages

• Gender stereotypes are prevalent among healthcare workers in Ukraine.

• Gender-sensitive approaches and comprehensive training should target prevalent gender stereotypes.
Association between all-cause mortality and diabetic avoidable hospitalization among older patients
Authors: Lee W-R , Chun S-Y , Son N , Son Y , Yoo K-B
Published: October 2024

Background

In South Korea, the prognosis of avoidable hospitalization in diabetes has not been evaluated, even though the incidence rate is considerably high compared to the Organization for Economic Co-operation and Development average. This study investigated the association between diabetic avoidable hospitalization after the diagnosis of type 2 diabetes mellitus and short- and long-term all-cause mortality.

Methods

Participants were type 2 diabetes mellitus patients aged 60 years and older and gathered through the National Health Insurance Services Senior cohort data from 2008 to 2019. The outcome measures included five-year and overall period all-cause mortality. The main independent variable was the first-year experience of diabetic avoidable hospitalization after type 2 diabetes mellitus diagnosis. Regression analysis was performed using the Cox proportional hazard model. To enhance the robustness of the study results, a sensitivity analysis and inverse probability of treatment weighting method were conducted.

Results

Among 31 222 participants, 2343 (7.5%) died within 5 years of type 2 diabetes mellitus diagnosis and 5314 (17.0%) died in the overall study period after type 2 diabetes mellitus diagnosis. Participants who experienced diabetic avoidable hospitalization one year after being diagnosed with type 2 diabetes mellitus had a higher risk of all-cause mortality compared to those who did not (Five-year: hazard ratio 1.84, 95% confidence interval 1.54-2.21; Overall period: hazard ratio 1.81, 95% confidence interval 1.60-2.06).

Conclusions

Enhancing accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary.

Key messages

• Older patients with T2DM who experienced avoidable hospitalization exhibited higher all-cause mortality rates in both the short and long terms.

• Enhancing the accessibility and quality of primary care to prevent avoidable hospitalization in older patients with type 2 diabetes mellitus is necessary.
Associations of per- and polyfluoroalkyl substances with human milk metabolomic profiles in a rural North American cohort
Authors: Criswell Rachel L. , Bauer Julia A. , Christensen Brock C. , Meijer Jennifer , Peterson Lisa A. , Huset Carin A. , Walker Douglas I. , Karagas Margaret R. , Romano Megan E.
Published: October 2024

Background:

Per- and polyfluoroalkyl substances (PFAS) are a class of persistent synthetic chemicals that are found in human milk and are associated with negative health effects. Research suggests that PFAS affect both lactation and the human metabolome.

Methods:

We measured perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) in the milk of 425 participants from the New Hampshire Birth Cohort Study using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A nontargeted metabolomics assay was performed using LC with high-resolution MS, and metabolites were identified based on in-house database matching. We observed six metabolic profiles among our milk samples using self-organizing maps, and multinomial logistic regression was used to identify sociodemographic and perinatal predictors of these profiles, including infant sex, parity, participant body mass index, participant age, education, race, smoking status, gestational weight gain, and infant age at time of milk collection.

Results:

Elevated PFOA was associated with profiles containing higher amounts of triglyceride fatty acids, glycerophospholipids and sphingolipids, and carnitine metabolites, as well as lower amounts of lactose and creatine phosphate. Lower concentrations of milk PFOS were associated with lower levels of fatty acids.

Conclusion:

Our findings suggest that elevated PFOA in human milk is related to metabolomic profiles consistent with enlarged milk fat globule membranes and altered fatty acid metabolism. Further, our study supports the theory that PFAS share mammary epithelial membrane transport mechanisms with fatty acids and associate with metabolic markers of reduced milk production.
2024 Latin American Society of Hypertension guidelines on the management of arterial hypertension and related comorbidities in Latin America
Authors:   ∗LASH Guidelines Task Force Steering and Writing Committee, Sánchez Ramiro , Coca Antonio , de Salazar Dora I. Molina , Alcocer Luis , Aristizabal Dagnovar , Barbosa Eduardo , Brandao Andrea A. , Diaz-Velazco Margarita E. , Hernández-Hernández Rafael , López-Jaramillo Patricio , López-Rivera Jesús , Ortellado José , Parra-Carrillo José , Parati Gianfranco , Peñaherrera Ernesto , Ramirez Agustín J. , Sebba-Barroso Weimar K. , Valdez Osiris , Wyss Fernando , Heagerty Anthony , Mancia Giuseppe
Published: October 2024

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region.
Sense of coherence in Spanish-speaking countries during the COVID-19 pandemic: A systematic review
Authors: Escobar-Segovia Kenny , Domínguez-Salas Sara , García-Iglesias Juan Jesús , López-López Daniel , Allande-Cussó Regina , Romero Adolfo , Gómez-Salgado Juan
Published: October 2024

Background:

The aim of this study was to assess the sense of coherence (SOC) in the Spanish-speaking population during the 2019 coronavirus disease pandemic.

Methods:

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in the PubMed, Scopus, and Web of Science electronic databases in August 2024. The methodological quality of the included studies was evaluated using the critical appraisal tools developed by the Joanna Briggs Institute.

Results:

A total of 25 studies were included in the review, which demonstrated that high SOC is associated with improved coping styles, a reduced incidence of mental disorders, and greater resilience to traumatic events. The findings indicated that SOC acts as a crucial protective factor in diverse population groups, including health professionals, university students, and older adults, particularly during the 2019 coronavirus disease pandemic.

Conclusions:

The study concludes that there are significant benefits for the mental and physical health of the population, regardless of cultural context, to be gained from strengthening the SOC. It is therefore essential that interventions which enhance the SOC are implemented in order to improve public health in times of crisis. Furthermore, it is crucial that SOC measurement instruments are validated in different cultural contexts in order to ensure the reliability and validity of the results obtained.
Relationships between heart failure, depression, and anxiety: A Mendelian randomization study
Authors: Chen Xi , Liang Xing-Yu , Zhang Gui-Lin , Wei Shu-Yan , Zou Jing-Xia , Liu Hao , Zhang Hong
Published: October 2024

Growing evidence suggests that heart failure (HF) is associated with an increased risk of depressive disorders and anxiety. However, the existing studies were observational and may have confounded and not reflected true causal relationships. This study collected genetic instruments about HF, depression, and anxiety from publicly available genetic summary data. Two-sample Mendelian randomization (MR) analysis was performed, with inverse-variance weighted designated as the primary approach for determining causal effects. Secondary analyses included MR-Egger regression and the weighted media method. Additionally, we conducted MR pleiotropy residual sum and outlier to address horizontal pleiotropy. Cochran Q test, MR-Egger intercept test, and leave-one-out analysis were used to assess the robustness of the findings. The significance is determined by a P-value below .05. Gene prediction result revealed that HF did not exhibit a significant association with elevated incidence of depression by inverse-variance weighted method no matter HF from the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.93–1.18, P = .424 for major depressive disorder, MDD; OR = 1.01, 95% CI = 0.94–1.09, P = .782 for major depression) or the FinnGen Consortium (OR = 1.03, 95% CI = 0.92–1.15, P = .644 for MDD; OR = 1.00, 95% CI = 0.94–1.07, P = .962 for major depression). In contrast, the results of HF on anxiety exhibited inconsistency (OR = 1.60, 95% CI = 1.10–2.31, P = .013 for Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium; OR = 1.42, 95% CI = 0.91–2.21, P = .123 for FinnGen Consortium); however, a combined effect analysis indicated support causal relationship between HF and the risk of anxiety (OR = 1.52, 95% CI = 1.07–2.00, P < .001). Our findings did not reveal evidence to confirm a causal association between HF and depression. However, our results provide support for a causal effect of HF on the risk of anxiety.
The impact of integrated health Qigong and dance exercise on cardiovascular function in middle-aged and elderly women
Authors: Zeng Fan-Wen , Zhang Qian-Yi , Zong Wei-Jie , Peng Xiang-Ji , Yang Hui
Published: October 2024

Background:

The aim of this study was to evaluate the impact of health Qigong on vascular elasticity, blood lipid levels, and cardiac function in middle-aged and elderly women. By comparing various indicators preintervention and postintervention, the research provides valuable insights into the effectiveness of health Qigong in enhancing cardiovascular health within this demographic.

Methods:

A total of 40 middle-aged and elderly women were randomly assigned to 2 groups. The experimental group, consisting of 20 women, practiced health Qigong combined with Tibetan dance for 12 weeks, 3 times per week, with each session lasting 60 minutes. The control group, also consisting of 20 women, continued their regular routines without any exercise intervention. Cardiovascular function metrics were subsequently compared between the 2 groups.

Results:

(1) Pulse wave velocity: in the experimental group, significant improvements were observed, particularly in the right ankle (P =.02 for left ankle, P =.00 for right ankle). The control group showed no significant differences (P =.08 for both ankles); (2) blood lipid levels: the experimental group demonstrated significant reductions in total cholesterol and triglyceride levels (P =.00 for both), while the control group showed no significant changes (P =.59 for total cholesterol, P =.71 for triglycerides). There were significant differences in high-density lipoprotein levels between the experimental and control groups (P =.00 and .01, respectively); (3) cardiac function: significant improvements were noted in cardiac output (Teich) and stroke volume (Teich) in the experimental group (P =.00 for both), while the control group showed no significant differences (P =.71 for cardiac output, P =.06 for stroke volume).

Conclusion:

Health Qigong, integrated with dance exercise effectively enhances pulse wave velocity, blood lipid levels, and cardiac function in middle-aged and elderly women. These findings suggest that incorporating such exercises may contribute to the prevention or delay of atherosclerosis and cardiovascular disease in this population.
Insulin in aluminum phosphide poisoning: A systematic review of the current literature
Authors: Shukla Ravi , Lamichhane Kiran , Pandey Dhritee , Gupta Chandan Kumar , Shukla Sashank
Published: October 2024

Background:

Aluminum phosphide (AlP) is a commonly used fumigant in agriculture and grain preservation because of its high potency and low cost. Due to the absence of a specific antidote and promising treatment modality, poisoning with this substance is deadly. Amid multiple studies in different parts of the world, each exploring options like lavage, inotropes, antioxidants, etc, we conducted a systematic review to find the possible role of exogenous insulin in treating symptomatic cases of AlP poisoning.

Methods:

Experimental studies released before February 15, 2024, that reported the use of exogenous insulin were systematically reviewed following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The search was done on PubMed Central, Cochrane Library, and Google Scholar.

Results:

After applying the inclusion and exclusion criteria, we finalized a few scientific papers for the review. Studying data from 4 scientific papers (3 quasi-experimental studies and 1 randomized controlled trial), we could postulate the significant improvement in survivability after the inclusion of exogenous insulin in the treatment of poisoned cases of AlP. Studies showed divergent results for the blood pressure, blood gases, and need for mechanical ventilation. Hypoglycemia, hyperglycemia, and hypokalemia were the reported adverse effects of this therapy.

Conclusion:

Our review found that the use of exogenous insulin in AlP poisoning reduced mortality rates, which was consistent across all studies. With available knowledge, its inclusion as a part of therapy might be beneficial in AlP poisoning, but to put it forward confidently, we still need high-quality randomized control trials. It is indeed a subject of interest for future research.