bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic differences in contact reduction in the first COVID-19-wave in Germany (CoMoLo-study)
Authors: Beese F , Wachtler B , Haller S , Koschollek C , Pfoertner T-K , Hoebel J
Published: October 2022

Background

The COVID-19 pandemic has led to physical distancing measures across a range of countries to control the spread of the virus. Evidence referring to contact dynamics in different socioeconomic populations is still sparse and may contribute to the explaining of socioeconomic inequality of infections.

Methods

Data came from two early COVID-19 hotspots in Germany using the CORONA-MONITORING-lokal study (CoMoLo). The sample (n = 3,637) was restricted to working age (18-67 years). We calculated the association of individual education and occupation status (low, middle, high) and self-reported private and professional contact reductions. Using weighting factors (adaptation to local age, gender and education distribution), we performed multivariate Poisson regressions (prevalence ratios; PR) with different sets of covariates: hotspot, age, sex, country of birth, household size, contact level before physical distancing measures and home office.

Results

The descriptive analyses show a clear socioeconomic gradient in private (low education: 70,0%; middle: 79,1%; high: 86,2%) and professional contact reductions (low education: 54,6%; middle: 61,3; high: 77,2%). The multivariate analyses confirm these associations, with a stronger gradient for professional contacts (private contact reduction: PR low vs. high education = 0,83 [KI:0.74-0.93]; professional contact reduction: PR low vs. high education = 0,75 [KI:0.64-0.89]) as well as for professional contact reduction when occupational status is considered instead of education.

Conclusions

Our results show disadvantages in groups with lower educational or occupational status in private and professional contact reductions in the first pandemic wave. This might result in a higher risk of infection. Preventive measures that a) adequately explain the importance of contact restrictions and b) facilitate the implementation of these reductions seem necessary to better protect structurally disadvantaged people during epidemics.

Key messages

• Groups with lower educational or occupational status were less likely of being able to reduce their private and professional contacts in the first wave of the pandemic.

• Socioeconomic differences were more pronounced in professional contact reduction compared to private contact reduction.
Prevalence of blood-borne viral and sexually transmitted infections among homeless people in Berlin
Authors: Steffen G , Weber C , Cawley C , Leicht A , Sarma N , Jansen K , Kröger S , Kajikhina K , Zimmermann R , Bremer V
Published: October 2022

Background

Risk factors associated with precarious living conditions make people experiencing homelessness (PEH) also highly vulnerable for blood-borne viral and sexually transmitted infections (BBVSTI) and tuberculosis (TB). The number of PEH in Germany is rising, yet little data is available on the infectious burden among this population. A pilot study assessed the prevalence of BBVSTI, TB, behaviours and access to medical services among PEH.

Methods

We recruited PEH from April-June 2021 in five low-threshold medical services in Berlin. Behavioural data was collected via questionnaire-based interviews. Serological/molecular testing from venous blood samples was performed for Hepatitis B (HBV), Hepatitis C (HCV), HIV, syphilis and TB and from urine for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT).

Results

Of 216 participants, 88% (191/216) were male and 73% (158/215) were born abroad. Mean age was 41 years (range 19-68). No health insurance was reported by 57% (123/216) and previous incarceration by 71% (153/214). Of all, 53% (114/216) injected drugs in the last 30 days, and 41% (89/216) reported unprotected sex in the last 12 months. Prevalence of active HBV was 1.9% (4/212), of active HCV 15.9% (34/213), and of HIV 2.8% (6/213). No active TB was diagnosed, while 14.4% (31/216) tested positive for latent TB infection. Active syphilis was found in 1.4% (3/212), NG in 2.0% (4/197), CT in 3.0% (6/197), and serological evidence of HBV vaccination in 26% (56/212). While 44% (96/216) of participants were ever tested for HCV, 71% (36/51) of those with HCV antibodies knew about their infection, 36% (13/36) of them reported previous/current treatment.

Conclusions

Burden of HCV and HIV was high among PEH in Berlin, and risk behaviours were frequently reported. There is a need to improve access to regular health care, accompanied by low-threshold prevention offers in cooperation with drug and homeless services. A nationwide expansion of the study is planned.

Key messages

• High burden of Hepatitis C and HIV among people experiencing homelessness in Berlin, Germany.

• Access of people experiencing homelessness to regular health care needs improvement, accompanied by low-threshold prevention offers in cooperation with drug and homeless services.
Oral Contraceptive Use and Breast Cancer Risk According to Molecular Subtypes Status: A Meta-Analysis
Authors: van Weers S , Hrzic R , Elands RJJ
Published: October 2022

Background

Breast cancer is a heterogeneous disease with distinct molecular signatures of disease etiology, evidenced by the joint expression of molecular tumor markers. Differential effects of oral contraceptive use on breast cancer risk by molecular subtypes have been reported. This is the first meta-analysis to investigate associations between oral contraceptive use and subsequent breast cancer risk stratified by combined estrogen receptor (ER) and progesterone receptor (PR) status alongside the Luminal A and B subtypes, which additionally consider the human epidermal growth factor receptor 2 (HER2) status.

Methods

A systematic review and meta-analysis of case-control and cohort studies was conducted in PubMed and Web of Science. The odds ratios (ORs) were summarized using a random-effects model.

Results

Eleven studies met the inclusion criteria for qualitative and quantitative analysis. Random effects meta-analyses revealed significant risk increasing effects for ever-users of oral contraception on ER-PR- breast cancer compared to never-users (OR = 1.30, 95% CI; 1.07 to 1.56, p < 0.01). Ever-use of oral contraception was not associated with breast cancer risk when stratified by the ER+PR+ breast cancer subtype (OR = 1.00, 95% CI; 0.86 to 1.16, p = 0.99). Data on Luminal A and B subtypes was limited and not suggestive for associations with breast cancer risk in ever-users of OCs compared to never-users. Furthermore, a significant increased risk of ER-PR- breast cancer was observed for OC use duration of > 4 years compared to never-users (OR = 1.74, 95% CI: 1.15 to 2.63, p < 0.01).

Conclusions

The current state of the evidence suggests that OC use longer than 4 years is associated with an increased breast cancer risk, pertaining to the estrogen and progesterone double negative breast cancer subtype. Large-scale prospective observational studies including more comprehensive molecular signature of breast cancer aetiology, including HER2 status, are needed.

Key messages

• The use of oral contraception was associated with estrogen and progesterone receptor double negative breast cancer, but not hormone receptive positive cancer.

• This is the first meta-analysis to investigate oral contraceptive use and associations with breast cancer risk by combined estrogen and progesterone receptor status.
Work outcomes of breast cancer survivors who returned to work after treatment: CANTO cohort
Authors: Ruiz-de-Azua G , Kousignian I , Vaz-Luis I , Caumette E , Di Meglio A , Havas J , Martin E , Martin AL , Dumas A , Menvielle G
Published: October 2022

Background

As survival rates among breast cancer patients improve there is an increasing need to address breast cancer survivors’ (BCS) issues, professional life being a key aspect. Return to work (RTW) of BCS has been largely studied, but studies on job maintenance and its determinants are scarce. We aim to study job maintenance after RTW and the associated factors among BCS.

Methods

We used data from the CANTO cohort, a French prospective cohort of BCS. We included 1643 BCS aged <57 at diagnosis (dx) who returned to work two years after dx. We excluded self-employed BCS. Using multinomial logistic models, we assessed the association between activity status one year after they return to work. (i.e. active, sick leave, or unemployed, retired or invalidity) and sociodemographic, clinical, health status and work-related factors.

Results

Overall, 87% of BCS were active, 10% were on sick leave and 3% were on unemployment, retirement or invalidity one year after they return to work. In the fully adjusted model being on sick leave was associated with stage III at dx (OR: 1.89, 95% CI: 1.11-3.22), being severely fatigued at the moment of returning to work (OR: 1.53, 1.04-2.27), and having workplace accommodations (OR: 1.79, 1.14-2.81). The unemployed, retired, invalidity status was negatively associated with professional life being more than or as important as one’s personal life (OR: 0.51, 0.26-0.98) and being <50 years old (OR: 0.51, 0.27-0.96), and positively associated with having a fixed-term contract (OR: 2.69, 1.39-5.18) and working for a small company (OR: 2.73, 1.24-6.02).

Conclusions

A non-negligible proportion of BCS are non-active one year after they return to work. While clinical factors are associated with sick leave, work related factors are associated with the unemployed, retired, and invalidity status. RTW should not be regarded as the ultimate goal and future policies should focus on ensuring people are ready to return to work and maintain their jobs.

Key messages

• A non-negligible proportion of breast cancer survivors are non-active one year after they return to work.

• Future policies should ensure job maintenance along with return to work.
Social inequality in health behaviours in cohabitating individuals with CVD
Authors: Sørensen JB , Friis K , Nissen NK , Maribo T , Nielsen BK , Mejdahl CT , Thomsen AML
Published: October 2022

Background

Despite a decrease in mortality rates CVD remains the leading cause of morbidity and mortality in Europe. Health behavioural risk factors, low socioeconomic status and cohabitation status are all associated with CVD. However, little is known about social inequality in health behaviour among cohabitating individuals with CVD. Thus, the aim of this study was to examine social inequality in health behaviour among cohabitating individuals with CVD.

Methods

Register data on CVD were linked with self-reported health behaviour from the Danish 2017 population-based health survey ‘How are you?'. In total, 2,443 survey participants aged 45 years and above were registered with CVD. Daily smoking was assessed using a single question about smoking habits. Physical inactivity was categorised as less than 30 minutes of physical activity at least six days per week. Respondents with a BMI ≥ 30 were considered obese. Unhealthy diet was assessed using the Diet Quality Score. Moderate risk alcohol consumption was categorised as exceeding the Danish Health Authority’s recommendations. Self-reported educational attainment was used as a marker of social position and was categorised as low (0-10 years), medium (11-15 years) or high (≥ 15 years). Sociodemographic differences in health behaviour were compared using adjusted logistic regression models with health behaviours as dependent variables and adjusted for sex, age, ethnic background, time since initial CVD diagnosis and multimorbidity.

Results

Cohabitating individuals with CVD and low educational attainment had higher adjusted odds for daily smoking (3.31), physical inactivity (2.10), unhealthy diet (6.37) and obesity (2.55) than cohabitating individuals with CVD and high educational attainment. However, they also had lower adjusted odds for moderate risk alcohol intake (0.35).

Conclusions

Social inequality in daily smoking, physical inactivity, unhealthy diet and obesity was found among cohabitating individuals with CVD.

Key messages

• Social inequality in health behaviour was found among cohabitating individuals with CVD. Thus, low educational attainment affects CVD risk profile regardless of cohabitation status.

• Social inequality in health behaviour among cohabitating individuals with CVD should be addressed in public health strategies, targeted secondary prevention, treatment and rehabilitation.
A review of European and international phthalates regulation: focus on daily use products
Authors: Monti M , Fasano M , Palandri L , Righi E
Published: October 2022

Background

Phthalates are known endocrine disruptors used in a wide range of industrial and household products. With globalization and interdependency of the supply chain, the control of toxic substances in daily use products has become more challenging. Many countries have implemented laws and policies to limit their use, although these regulations are neither unified nor seem adequate, as studies suggest that more vulnerable populations (children, pregnant women) are exposed to phthalates that should be restricted.

Methods

For seven of the most used phthalates - bis(2-Ethylhexyl) phthalate (DEHP), Butylbenzyl phthalate (BBP), Dibutyl phthalate (DBP), Diisobutyl phthalate (DIBP), diisononyl phthalate (DINP), diisodecyl phthalate (DIDP), Di-n-octyl phthalate (DNOP) - we performed an online research on institutional sites and dedicated Agencies of the three largest world economies (European Union (EU), United States of America (USA), China) to analyze their uses and bans, focusing on Food Contacts Materials (FCM), cosmetics, toys and childcare articles.

Results

In the EU area DEHP, BBP, DBP and DIBP are not allowed in toys and childcare articles above 0,1% by weight. All the seven phthalates are also severely restricted in FCM, and mostly banned as cosmetic components. In the USA, there is no formal prohibition to their use in cosmetics but phthalates are mostly limited in FCM. In China, the limit for DBP, BBP, DEHP, DNOP, DINP, DIDP in plastic toys is 0,1% of the material composition; regarding cosmetics DEHP, BBP and DBP are prohibited.

Conclusions

We found substantial differences in the international legislation. Though there is essential agreement on toys and childcare articles legislation, there are many discrepancies about FCM and cosmetics. Further research is needed to compare the regulation with data about concentrations of these ubiquitous elements, to underline the real exposure and risk in different populations and to improve knowledge and safety on this matter.

Key messages

• Phthalates, known endocrine disruptors, in daily use products are a matter of concern.

• Coordinated international laws to prevent exposure, especially in vulnerable populations, are needed.
Guidelines for outsourcing collective catering services in the Friuli Venezia Giulia region
Authors: Barocco G , Palei M , Croci E , Savoia A , Mauro M , Stuto F
Published: October 2022

Issue

Many stakeholders involved in collective catering services (CCS) of schools, hospitals, elderly care homes, and workplaces of the autonomous region of Friuli Venezia Giulia (ARFVG) have reported some non-compliance with the nutritional, environmental or social standards required by public administrations (PA) procurement contracts (PC), which included the recommendations of the WHO, EU, Ministry of Health, and Ministry of the Environment (MHE).

Description of the problem

The ARFVG prevention plans have set the goal to overcome the critical issues of the regional CCS which serve over 10% of the population (130,000 meals a day). Between 2019 and 2021, a multidisciplinary group of experts from health services and from the association of 215 regional municipalities developed the guidelines (GL) for outsourcing of CCS. The aim was to support PA in the drafting of PC, evaluation of offers and verification of contractual performance. Reference was made to Dir. 2014/24/EU, EU green public procurement criteria for food, catering services and vending machines, the national lines for CCS of MHE. The GL are characterized by the integration between the tender document models and the 8 qualification areas detailed in: restructuring; supplies; environmental impact and sustainability; production processes; personnel qualification and training; nutritional standards; customer satisfaction; and verification and research of quality.

Results

Two regional central purchasing bodies have already used the GL to draft the PC for school CCS of 26 municipalities and for the whole hospital CCS of RAFVG. The application of guidelines in PC has introduced homogeneous high level qualification and verification standards for the CCS of the RAFVG.

Lessons

To ensure the application of food, nutritional, environmental and social policies in CCS, it is essential to activate networks between professionals from different sectors in order to share tools to achieve the common sustainable development goals.

Key messages

• To integrate food, nutritional, environmental and social regional policies into collective catering services, it is essential to apply systemic tools shared by all Public Administrations.

• Central purchasing bodies have the potential to introduce homogeneous and shared high level qualification and verification standards for collective catering services.
The effect of Kefir consumption on blood pressure some blood parameters in hypertensive individuals
Authors: Ozyazgan Tokay A , Pehlivan E
Published: October 2022

Aim

In this study is to examine the effect of kefir consumption on blood pressure, some blood parameters and anthropometric measurements in hypertensive individuals.

Methods

The study is a randomized controlled clinical trial. The mean systolic blood pressure in hypertensive individuals was taken as 145.2±19.2. The minimum sample size was determined as 30 for each group with a 95% CI and 80% power. The study was conducted by face-to-face interviews with a total of 100 volunteers, 35 male, 65 female, aged 18 and over, who were hypertensive and volunteered to participate in the study and applied to the internal medicine outpatient clinics of Akçadag Public Hospital between September 2020 and May 2021. The experimental (n = 42) and control (n = 58) groups that the patients are randomly assigned into, the experimental group was ensured to consume 250 ml/day kefir for 28 days. During the study, The study was completed with 56 volunteers. At the beginning of the study and the end of 4 weeks, blood samples, blood pressure, pulse and anthropometric measurements of the individuals were taken.

Results

When the anthropometric measurements were compared, the body weight, body mass index, waist circumference, and hip circumference of the individuals in the experimental group decreased significantly at the end of the study. There was no significant difference between the experimental and control groups in terms of glycemic parameters. While no significant change was observed in the lipid profile in the experimental group, total and LDL cholesterol levels decreased in the control group. There was no statistically significant difference in kidney function parameters in both groups. In addition, at the end of the study, there was no significant change in diastolic blood pressure and pulse in the experimental group, but systolic blood pressure decreased significantly.

Conclusions

Regularly kefir consumption has positive effects on systolic hypertension and weight control.

Key messages

• Regular daily consumption of kefir reduces systolic blood pressure and provides weight control.

• Regular daily consumption of kefir did not lead to an effective result on blood and kidney parameters.
HTA supporting clinical practice: the case of surgical repair of thoracoabdominal aortic aneurysms
Authors: Vigezzi GP , Guddemi A , Bucci D , Colucci S , La Fauci D , Calsolaro R , Foglia E , Chiesa R , Bertoglio L , Odone A
Published: October 2022

Background

Thoracoabdominal aortic aneurysms (TAAAs) are defined as those aortic aneurysms involving renovisceral arteries. They account for around 10% of aortic aneurysms, and their treatment is burdened by considerable mortality and morbidity. Open surgical repair has been practised as the standard of care since the 1950s. In 2001 endovascular repair was introduced to reduce treatment invasiveness, and the technology is still evolving. The potential benefits of endovascular repair over open surgery should be carefully weighed in a multidimensional framework.

Methods

We applied the Health Technology Assessment (HTA) framework (EUnetHTA core model with 9 dimensions) to conduct a report comparing the two technologies. A multidisciplinary working group was established. We derived and pooled: i) secondary data derived from systematic literature reviews, and ii) original data from IRCCS San Raffaele Hospital, Milan, a national referral centre for TAAA (qualitative and economic data).

Results

Endovascular repair resulted superior to the traditional open surgery in terms of efficacy and safety, as justified by the meta-analysis we performed. Despite the higher costs, a significant impact on budget and slightly lower cost-effectiveness, the endovascular protheses’ adoption could provide conspicuous benefits in terms of social and ethical dimensions without affecting long-term organisational and legal aspects.

Conclusions

The multi-criteria decision analysis carried out from a hospital point of view shows that there is no significant difference (final score endovascular repair 0.68 vs open surgery 0.63) between the two procedures considering all the dimensions. Still, the endovascular repair is slightly superior to the open surgery in terms of safety, effectiveness, social, ethical, legal, and organisational impact. From the policy maker’s point of view, technologies with a score superior to 0.6 are equally valuable, and the final decision should be left to the clinicians.

Key messages

• Further research is needed to compare endovascular prostheses and open surgery’s long-term population benefits, balancing clinical, economic, organisational and patient-related outcomes.

• HTA methodology offers substantial support to compare in-use technologies, informing clinicians’ and decision-makers’ choices to strengthen healthcare provision equity and preparedness.
Atypical working hours are associated with tobacco, cannabis and alcohol use
Authors: Hamieh N , Airagnes G , Descatha A , Goldberg M , Limosin F , Roquelaure Y , Lemogne C , Zins M , Matta J
Published: October 2022

Background

We examined prospective associations between atypical working hours, substance use and sugar and fat consumption.

Methods

In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use; among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use if appropriate.

Results

Working at night was associated with increased tobacco use in women [odds ratios ranging from 1.45 to 1.48], with increased cannabis use in men [from 1.40 to 1.54] and with increased alcohol use in both men and women [from 1.12 to 1.14]. Weekend work and non-fixed working hours were associated with increased tobacco and alcohol use in both men and women [from 1.15 to 1.54 and 1.12 to 1.14, respectively]. Dose-dependent relationships were found regarding the association between working at night and tobacco use in women as well as regarding non-fixed working hours and tobacco use in both men and women (P for trends <0.001).

Conclusions

The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

Key messages

• Night shifts were associated with increased smoking in women with dose-dependent relationships, cannabis use in men and alcohol use in both.

• Weekend work and non-fixed working hours were associated with increased alcohol and tobacco use with dose-dependent relationships in men and women.
Impact of occupational SARS-CoV-2 risk on the mental distress of non-healthcare employees in Germany
Authors: Casjens S , Taeger D , Brüning T , Behrens T
Published: October 2022

Background

The SARS-CoV-2 pandemic posed major challenges to employees and companies. Differences between industries and professions in occupational SARS-CoV-2 infection risk (OSIR) became apparent early on. This study examines the mental distress in terms of depression and anxiety symptoms of non-healthcare workers during the first and second Corona waves in Germany.

Methods

We conducted an online survey from December 2020 to June 2021 among employees from industrial enterprises, local public transport, the public and the financial sector. High and potential OSIR was defined based on job information. Depression and anxiety symptoms were rated with the 4-item Patient Health Questionnaire (PHQ-4). Categorized PHQ-4 scores were modeled with ordinal random-intercept logistic multinomial regression models and presented with odds ratios (OR) and 95% confidence intervals (95% CI).

Results

Overall, 516 of 1,545 participants (33.4%) were determined to be at increased OSIR. Anxiety and depression symptoms worsened during the pandemic in all OSIR groups. Risks for more severe depressive and anxiety symptoms were higher among employees with high (OR 2.35; 95% CI 1.33-4.16) and potential OSIR (OR 1.70; 95% CI 1.19-2.43) compared to employees without OSIR. Severity of mental distress differed also by the extent of perceived job protection, interactions with colleagues, work-privacy conflicts, and overcommitment.

Conclusions

OSIR had a negative impact on employee’s depressive symptoms and anxiety. Reducing SARS-CoV-2 exposure through workplace protective measures, strengthening interactions among colleagues, and supporting employees with work-privacy conflicts could help better protect employees’ mental health.

Key messages

• The risk for more severe depressive and anxiety symptoms increases with higher occupational SARS-CoV-2 infection risk.

• Improvements in SARS-CoV-2 exposure at work, colleague interactions, and work-privacy conflicts could help better protect mental health.
Methodologies for determining staffing needs in healthcare: systematic literature review
Authors: Pirrotta L , Da Ros A , Cantarelli P , Bellè N
Published: October 2022

The determination of staffing needs in healthcare is not just calculating the optimal number of professionals but is defining how the professional contingent accompanies the development of the healthcare organisation and of the population’s care needs. This research investigates the existence of a gold standard for determining health personnel requirements. We perform a systematic literature review to explore several approaches worldwide, examining a wide range of contextual variables, useful for the definition of an omni-comprehensive approach. A total of 557 articles was initially detected, then reduced to 57 after excluding everything not related to healthcare context and staff planning models. Results do not reveal a recognized standard for determining staffing needs. Approaches to the definition of staffing standards are mainly ex-ante (31%), based on the characteristics of specific models and organisational needs, or ex-post (62%), based on production analysis and historical trends. Most of these refer to the medical and nursing category (68.4%), while the minority proposes a multi-professional approach (17.5%). This review highlights innovative approaches based on algorithms which, starting from historical data, are adjusted by moderating key variables such as contextual factors, healthcare organisation models and professional attributes.

The review suggests:

1. Develop and share a unique tool for defining standards based on several variables that identify the characteristics of the context

2. Use up-to-date information flows and quality data

3. Consider a multi-professional approach

4. Adopt a long-term vision and continuous dialogue with the training process

It is clear the need to develop a tool for the definition of personnel requirements in line with internal and external changes in the health system. Therefore, such models need to account for an adequate number of variables, useful to identify the characteristics of the overall context.

Key messages

• The development of staffing needs estimates must necessarily rely on a certain level of standardisation, but at the same time must take into account the variability characterising different contexts.

• In order to respond to recent demographic and epidemiological trends, it is crucial to include in the model skill mix and task shifting strategies involving health professionals as a whole.
Managerial preventions of common mental disorders and the association with stigmatizing attitudes
Authors: Hultqvist J , Zhang P , Staland-Nyman C , Bertilsson M
Published: October 2022

Background

Common mental disorders (CMDs) are an extensive problem in the society and attributed to stigma. Prevention of CMD at work is advocated but few studies have investigated what kind of preventive actions managers take. We investigated managers’ attitudes to depression and two managerial preventive actions (MPA): ‘reviewing assignments and the work situation’ (MPA-review) and ‘taking initiative to talk about depression and anxiety at the workplace’ (MPA-talk). We hypothesized that managers’ negative attitudes towards depression would be negatively associated with both MPAs.

Methods

An on-line survey was sent in 2017 to 4737 managers, answer rate 71% (n = 3358), of which 2 899 were included in this study. Negative attitudes were measured through the 12-item instrument “Managerial stigma towards employee depression” (scores 12-72), a cut-off at the 3rd quartile was used as an indicator for having negative attitudes. MPAs were measured with two single questions. Negative attitudes to depression were analyzed in relation to MPA-review and MPA-talk using binary logistic regression analysis with adjustments for sex, education, managerial experience and training, lived experiences of CMD, work organizational context and general preventive actions in the organization towards CMD.

Results

The proportion of managers with negative attitudes to depression was 20%, performing MPA-review and MPA-talk was 50% and 57% respectively. Adjusted for all co-variates, managers with negative attitudes towards employees with depression were less likely to do both MPA-review (OR 0.71; 95% CI, 0.57-0.89) and MPA-talk (OR 0.53; 95% CI, 0.42-0.66).

Conclusions

Managers with negative attitudes to depression were less likely to take actions to prevent CMD among their employees which confirmed the study hypotheses. The study suggests that initiatives to reduce stigma among managers could be a way forward to prevent CMD at work.

Key messages

• Stigma to depression hampers managers’ prevention of CMD and needs to be addressed.

• To increase managers prevention of CMD, managerial training to reduce stigma towards depression is essential.
Does sickness absence history affect work participation after vocational labour market training?
Authors: Salonen L , Solovieva S , Kauhanen A , Hartikainen E , Viikari-Juntura E , Leinonen T
Published: October 2022

Background

Active labour market programmes, such as vocational training, have become widely adopted measures to increase job seekers’ employment opportunities, but evidence of their effectiveness in later employment is mixed. Individuals who enter training differ greatly in their socioeconomic background, health, and labour market history, which can affect the effectiveness of these programmes. There is still uncertainty, for example, on how vocational labour market training works for individuals with prior health problems.

Methods

We use nationally representative Finnish register data on 88,283 individuals aged 25-59 who participated in vocational labour market training in 2008-2013, 23,715 of whom had sickness absence lasting at least 10 weekdays (including Saturday) three years prior to the training and 64,568 of whom did not. To adjust for the differences in sociodemographic and work-related factors between these groups, we will conduct propensity score matching. We will analyze work participation three years before and after the training among those with sickness absence and those without using a difference-in-difference analysis.

Results

Our preliminary results show that before training the work participation rate was similar in those with sickness absence history (58.5 %) and those without (58.1 %). After training, those with a sickness absence history had slightly lower work participation than those without (54.6% versus 59.6 %). The differences in work participation between these groups increased slightly over time after training.

Conclusions

Vocational labour market training does not necessarily work equally well for everyone in terms of enhancing employment, and job seekers with work disability history should be offered either extra support or another type of unemployment service. However, these are our pre-matching results, and they cannot be causally interpreted. Next, we will conduct the propensity score matching and difference-in-difference analysis.

Key messages

• Having a sickness absence history prior to vocational labour market training is associated with lower work participation after training compared to participants without a sickness absence history.

• The main advantage of the study is the use of a quasi-experimental study design to test the effectiveness of vocational training, using rich nationally representative register data with long follow-up.
Discrimination and sexual harassment – Results from the largest German medical university
Authors: Ludwig S , Jenner S , Berger R , Tappert S , Kurmeyer C , Oertelt-Prigione S , Petzold M
Published: October 2022

Background

Discrimination and sexual harassment in the workplace and in higher education institutions are important public health issues. Here we aim at analyzing the prevalence of discrimination and sexual harassment of lecturers and students at one of the largest teaching hospitals in Europe. We assess whether there are differences between lecturers and students, women and men, and different study programs.

Methods

An online questionnaire was sent to N = 7095 students of all study programs and N = 2528 lecturers at Charité - Universitätsmedizin Berlin. The survey was conducted from November 2018 to February 2019. We investigated experienced or observed discrimination or sexual harassment at the medical faculty. Furthermore, we analyzed frequency, perpetrators, situational factors, attributed reasons and forms of harassment encountered.

Results

A total of 964 (14%) students (S) and 275 (11%) of lecturers (L) participated in the survey. Discriminatory behavior was witnessed and/or experienced by 49,6% of students (L: 31%), sexual harassment by 23,6% of students (L: 19,2%). Students state lecturers (85,9%) as main source of discriminatory behavior (L: directors/supervisors: 47,4%; students 41,0%). Sex/Gender (S: 71%; L: 60,3%) is cited most frequently as reason for discriminatory experiences. Female students and faculty experience more discrimination and sexual harassment.

Conclusions

Discrimination and sexual harassment are prevalent in academic medicine. There are differences in the reasons and sources of discrimination and sexual harassment between students and lecturers. Specific programs for lecturers and students are necessary to educate the faculty on how to prevent and respond to it and whom to address.

Key messages

• National preventive strategies should be implemented to tackle issues of discrimination and harassment in higher education institutions.

• Special attention should be paid to female students and lecturers.
Sickness absence among 299484 blue-collar workers in the trade industry during the Covid-19 pandemic
Authors: Farrants K , Alexanderson K
Published: October 2022

Background

Many blue-collar workers in the trade and retail industries have jobs that make it hard to avoid contacts with other people, which may have increased their risk for sickness absence (SA) during the Covid-19 pandemic. The aim was to investigate rates of SA and sociodemographic and occupational differences in risk of SA during the Covid-19 pandemic.

Methods

A prospective cohort study of all blue-collar workers in Sweden in the trade and retail industry aged 18-67 in 2018 (n = 299 484), followed 5 years (2016-2020) using linked microdata from nationwide registers. Descriptive statistics of rate of workers having had at least one SA-spell >14 days were calculated, and logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) of having SA due to Covid-19 or related diagnoses (some infectious, respiratory, and symptom-based diagnoses).

Results

Their SA rates increased from fluctuating between 7.6%-8.2% in 2016-2019 to 10.0% in 2020. 0.05% had SA due to Covid-19 and 2.2% had SA due to Covid-19 or related diagnoses. Factors associated with having SA due to Covid-19 or related diagnoses were older age (OR age 55-64: 3.41, CI 3.04-3.82 compared to 18-25) and only elementary education (OR 1.50, CI 1.37-1.64 compared to university/college). Warehouse and terminal staff (reference category) was the occupational group with the highest risk of SA/DP due to Covid-19 or related diagnoses. Cashiers had the second highest risk, with CIs that overlapped 1 (OR 0.91, CI 0.77-1.06). All other occupational groups had significantly lower ORs (0.48-0.78).

Conclusions

The SA rates increased slightly during the Covid-19 pandemic. Within the trade and retail industry, the warehouse and terminal staff was the occupational group with the highest risk of SA due to Covid-19 or related diagnoses.

Key messages

• The rates of SA among blue-collar workers in the trade and retail industry increased slightly during the first year of the Covid-19 pandemic.

• Warehouse and terminal staff and cashiers were the occupational groups with the highest risk of SA due to Covid-19 or related diagnoses among blue-collar workers in the trade and retail industry.
Determinants of regulatory compliance in health and social care services: a systematic review
Authors: Dunbar P , Barry F , Browne J , O'Connor L
Published: October 2022

Background

The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Quality is variable in services and settings. One response to variation in quality is a regulatory framework that looks to set minimum standards that are enforced by an independent public authority. This systematic review seeks to identify and describe determinants of regulatory compliance in health and social care services.

Methods

Systematic searches were carried out on five electronic databases and grey literature sources. Titles and abstracts were screened by two reviewers independently. Determinants evaluated in studies were identified, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The included studies were quality appraised by two reviewers independently. The results were synthesised narratively under each CFIR domain.

Results

The search yielded 6,515 articles for screening, of which 148 were included. Most studies were quantitative designs focused on specific exposures (e.g. staffing levels, size, for-profit status). Qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Most of the determinants identified fit within the inner and outer setting domains of the CFIR, many with mixed findings in terms of an association with compliance. There were fewer determinants identified in the intervention characteristics, characteristics of individuals, and process domains of the CFIR.

Conclusions

The literature in this field focuses on the broader concept of quality and appears to neglect the more nuanced issues surrounding the successful implementation of regulatory standards i.e. compliance. A number of gaps, particularly in terms of qualitative work focussed on the mechanism involved in implementing regulations, remain in the literature and further research in this area is needed to provide a clearer picture.

Key messages

• No clear determinants of regulatory compliance were identified, suggesting it is complex and context specific.

• There are gaps in the literature around the underlying processes which contribute to the achievement of compliance that warrant research attention.
Results of the requirement analysis as part of the Austrian research project linked care
Authors: Salomon G , Sturm N
Published: October 2022

Sufficient information is the foundation for efficient and high-quality health care services. In the field of extramural health care, this challenge is particularly evident: missing or insufficient information can lead to underuse, overuse, or misuse of health care, e.g. due to the necessity of multiple assessments or lack of relevant information. The noticeable shortage of health care professionals further underscores the urgent need for efficient and quality-assured health care services. The aim of the project LICA - linked care - is to provide a platform for better coordination and information exchange between health professionals involved in home care, with a focus on ICT in nursing in Austria. The project is funded by the Austrian Research Promotion agency (FFG) as part of the “benefit - demografischer Wandel als Chance” program (April 2020-March 2025). The requirement analysis was conducted from April to December 2021. In light of the user-centered approach a mix of methods was chosen, consisting of: literature analysis, 5 guideline-based focus group interviews, guideline-based expert interviews n = 44 (people in need of care n = 23, health professionals n = 21), documentation-analysis (4 care documentation systems - from participating project partners) and working diaries: n = 5 on 5 consecutive working days (=25 diaries). Therefore, three main target groups were identified: i) people in need of care, ii) healthcare professionals and iii) healthcare providers. The data were analyzed using a qualitative content analysis based on Kuckartz. The main results regarding the status quo are: i) different documentation systems are utilized, ii) lack of digitized documents, iii) currently no standardized documentation system is in use. Thus, following requirements could be identified: i) interoperability with existing systems, ii) setting comprehensive function, iii) usability, iv) interdisciplinary readability, v) error-management, and vi) proper data protection measures.

Key messages

• Healthcare systems are under great pressure worldwide. Innovative solutions can help maintain and improve the quality and efficacy of healthcare services.

• Gapless and efficient information provision is a key essential to high quality healthcare. The project offers a user-centric approach to develop a platform for connectivity of existing systems.
How to improve the rehabilitation outcome after total knee replacement?
Authors: Dionisi L , De Gironimo G , Praino F , Abinova G , Averame C , Gentile AM , Nante N
Published: October 2022

Background

Even if total knee replacement has revolutionized the treatment of degenerative knee diseases, the definition of an ideal rehabilitation protocol is still in progress. The aim of this study is to identify the factors that influence the outcomes after early, intensive, hospitalized treatment.

Methods

A retrospective study was conducted in 2019 on 545 patients admitted to a northern Italy private clinic specialized in post-surgery rehabilitation, which applies a bio-psycho-social-environmental model and individual rehabilitation plans. Data regarding each patient were collected from medical records: age, numeric pain rating scale (NPRS) at admission, days between surgery and the beginning of rehabilitation (DBS). The outcomes were measured as the difference (Δ) between the values at discharge and admission of the Barthel scale (ΔBS), Tinetti scale (ΔTS), passive flexion (ΔPF) and active flexion (ΔAF). We performed a univariate linear regression through STATA, to determine which factors influence the outcomes. A p < 0.05 was considered statistically significant.

Results

Our sample (69.17% female) was 69.8 ± 9.4 years old. ΔBS was significantly influenced by age (Coef. 0.270, CI [0.173 - 0.367]) and NPRS (Coef. 1.434, CI [0.979 - 1.890]). ΔTS was significantly influenced by age (Coef. 0.024, CI [0.011 - 0.037]) and NPRS (Coef. 0.130, CI [0.067 - 0.191]). ΔPF was significantly influenced by age (Coef. - 0.158, CI [- 0.266 - - 0.050]), DBS (Coef. - 1.047, CI [- 1.401 - - 0.687]) and NPRS (Coef. 1.825, CI [1.333 - 2.318]). ΔAF was significantly influenced by age (Coef. - 0.171, CI [- 0.300 - - 0.042]), DBS (Coef. - 1.150, CI [- 1.580 - - 0.721]) and NPRS (Coef. 2.504, CI [1.928 - 3.080]).

Conclusions

Older patients obtain a higher functional outcome (ΔBS, ΔTS) but lower improvement in range of motion (ΔPF, ΔAF). Patients with higher NPRS at admission obtain an overall better outcome. Higher DBS is associated to lower articular outcomes (ΔPF, ΔAF).

Key messages

• A better outcome can be achieved if rehabilitation is started immediately after knee replacement.

• Pain and age are not factors that impede effective rehabilitation.
Piloting a Health System Performance Assessment for Germany - insights from trend and equity analyses
Authors: Achstetter K , Blümel M , Hengel P , Schwarzbach V , Busse R
Published: October 2022

Background

Health System Performance Assessment (HSPA) is a tool for the evaluation of the performance and efficiency of a health system and can be used for evidence-based policymaking. For the first time, a country specific HSPA for the German health system is piloted with a focus on trend and equity analyses.

Methods

Based on the conceptual framework developed in a feasibility study, the pilot study in Germany has being conducted between 2020 and 2023. The framework includes 90 internationally compatible indicators, each of which can be assigned to one of nine dimensions (e.g., access, quality, population health, responsiveness, efficiency). The aim of this pilot study is to conduct trend analyses over the period 2000-2020 and equity analyses (e.g., age, gender, region, education). Data from 56 different national and international secondary data sources (e.g., epidemiologic registry data, claims data, and survey data) were collected, analyzed, and compiled in a report.

Results

In total, 84 of the 90 indicators could be analyzed with data for Germany. The indicators (e.g., access to acute care, 30-day mortality, amenable mortality rate) are prepared as a trend analysis for Germany for up to 20 years and with regard to various equity aspects. Most indicators can be presented in international comparison with eight selected European countries (e.g., Denmark, France). Furthermore, recommendations were derived to improve the availability and/or quality of data.

Conclusions

The first German HSPA pilot study provides valuable insights into the performance of the health system. The results based on the analysis of the 90 indicators are an important basis for identifying inequities and needs for improvement. In the future, the lessons learned from the pilot study can be helpful for a permanent implementation of a German HSPA. However, the fragmented data structure in Germany will be a future challenge.

Key messages

• The first country specific health system performance assessment for the German health system was conducted as a pilot study.

• Trends over time, inequities, and needs for improvement can be derived from the analysis of 90 indicators.