bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Citizen Science to examine health and access to health care of uninsured patients in Germany
Authors: Warth J , Köllges R , Böckenholt L , Kriegsmann-Rabe M
Published: October 2022

Background

Estimates suggest that numerous people live without health insurance in Germany. Existing evidence on uninsured patients’ health and care use is scarce, specifically in Germany. The present study involves citizens’ engagement to identify community perceptions of factors associated with health and medical care and to generate community-driven policy recommendations.

Methods

Representatives of civil society, affected patients and citizens (‘co-researchers') participate in a participatory health research project (MoveCitizenS) located in Bonn, Germany, using Photovoice and Community-based Mapping. The study is composed of five work packages over a 24-month period: (1) Photovoice workshops for co-researchers to produce, select and analyse photographs; (2) a series of workshops to conduct community-based mapping to identify barriers and facilitators of health care utilization; (3) workshops to co-design a cross-sectional survey of uninsured patients (n = 300); (4) project evaluation by co-researchers; (5) a dissemination strategy (e.g. advocacy event, exhibition) will be developed.

Results

Procedures to facilitate the active engagement of citizens and patients are discussed. Preliminary results on community perceptions of uninsured patients’ health and medical care and factors influencing health outcomes and care utilization are presented at the conference.

Conclusions

This is the first citizen science study which facilitates the understanding of barriers and enabling factors of good health and access to medical care for patients who lack health insurance coverage in Germany. This case study of a participatory project can be adapted to a range of settings to integrate local perspectives to improve population health for all.

Key messages

• Numerous patients in Germany are uninsured but evidence on their health and medical care is lacking.

• Using participatory methods to address these key questions is an important approach to generate suitable policy recommendations to meet the needs of the community and improve population health.
Short and long-term inequity in outpatient medical use by the type of medical institutions in Korea
Authors: Yang JY , Lee JH
Published: October 2022

Background

Many countries agree with the horizontal equity that medical resources should be allocated according to medical needs, regardless of income. Although the short-term equity index calculated through cross-sectional data doesn't reflect the dynamics of individual income and medical use, it can be supplemented by the long-term equity index using panel data. Koreans tend to choose expensive but highly specialized services without considering their medical needs because they are free to choose service providers. This study aims to empirically examine how the patterns of outpatient medical use that are not based on medical needs differ in terms of short- and long-term equity for each type of medical institution.

Methods

Using Korea Health Panel Survey(2014-2018), the equity of outpatient medical use(number of visits, medical expenses) of 10,244 people was measured by type of medical institution (tertiary general hospital, general hospital, hospital, clinic, and dentist). Wagstaff&van Doorslaer(2000)’s tool and Jones & Lopez-Nicolas(2004)’s tool were used to calculate the short and long-term horizontal equity index(HI), and mobility index(MI) to compare short and long-term inequity.

Results

In tertiary general hospitals and dentists, there were short and long-term pro-rich inequalities(HI > 0, p < 0.05). As a result of comparison, long-term inequality was greater in the number of visits (MI < 0), while inequality was easing in the long-term in medical expenses(MI > 0) in tertiary general hospitals. In dentists, long-term inequality was less than short-term inequality in both the number of visits and medical expenses (MI > 0).

Conclusions

The short-term equity index is likely to underestimate or overestimate inequity in our society, so a long-term perspective is needed. Inequality patterns for each type of medical institution should be considered in healthcare reforms for fair distribution of medical resources.

Key messages

• Short-term equity index differs from the long-term equity index in outpatient medical use.

• The pattern of short and long-term equity indices may differ by type of medical institutions.
The role of income in the lives of people with long-term disabilities: A multi-country analysis
Authors: Oña A , Pacheco Barzallo D
Published: October 2022

Background

Health is a fundamental human right. Yet, people become ill and die because they do not have enough money to access the necessary healthcare. Studies confirm that on average, more income translates to better health status. The magnitude of this relationship and its consequences beyond health like reintegration or spillovers are not widely understood but are expected to be significantly different among countries. This is especially the case in vulnerable populations like those with a spinal cord injury (SCI). This study aims to better understand the role that income plays in promoting health in people with SCI and their differences across countries.

Methods

The research focus on three aspects, one, the estimation of the health income gap using years after the injury and a comorbidity index, two, the decomposition of different factors of this inequality with a special interest in the unmet healthcare needs, and three, their consequences in their social participation measured by the reasons of unemployment.

Results

There are significant differences in health status by income and between countries. On average, the poorest income groups with SCI are up to 40 times more likely to be ill than people in the richest groups and live 4-6 years less after the injury. The working conditions and the unmet health care needs are important factors that explain that differences. In addition, the health status, the lack of sustainable employment opportunities, and workplace accessibility issues are the main issues to reintegrating into the labor market.

Conclusions

Health inequalities are a global problem that affects people with long-term health conditions disproportionately to others without. Even in more equal and high-income countries with a universal health system, there are different realities for the people according to their income, where the estimations and solutions for the ‘average’ individual do not target the needs of people in the extremes.

Key messages

• This study generates evidence about the role of income in health, lack of health services, and consequences in people with SCI across and within countries.

• To achieve the goal of health equity, it is important to target the different realities focusing on the needs of people who most need which goes beyond the health system and changes by income level.
Inequality in access to COVID-19 vaccines: an annual experience in Verona (Italy)
Authors: Sartorello A , Paiola E , Moretti F , Accordini L , Postiglione C , Tardivo S , Benoni R
Published: October 2022

COVID-19 vaccination campaigns involved massive resources worldwide. However, the disparity in vaccine accessibility is a global issue. The study evaluated whether birthplace is a barrier to healthcare access in a high-income country (HIC). The retrospective cohort study included fully vaccinated adults in the Verona district between 27/12/2020 and 31/12/2021. In Italy, the vaccination was opened at different times according to the risk category. Two multiple linear regression models explored the relationship between (1) days before getting the first shot (IV) and (2) the distance between the municipality of residence and the vaccination point, and age, sex, and Income Group (IG, as defined by the World Bank). Distance (km) was estimated with Q-GIS. Results are reported as Marginal Effect at the Mean (MEM) with a confidence interval of 0.95. 500,001 first doses were included, with a mean age of 47 years (SD = 21) and a mean IV of 47.5 days. 6% of the sample was UpperMiddle (UMIC), 6% Lower-Middle (LMIC), and 0.3% Low-Income Countries (LIC). The mean age was higher for HIC (p < 0.05). Male outnumbered females in LMIC (61%) and LIC (69%), but not in HIC and UMIC (p < 0.001). LMIC and LIC were vaccinated at local facilities (5.8%) and pharmacies (4.2%) more than other groups (3%) and at hub centers less (p < 0.05). The IV was lower for subjects from HIC (p < 0.05) with a MEM of 24 [22; 26] for LIC, 21 [21; 22] for LMIC and 27 [26; 27] for UMIC. Men from UMIC (9 [4; 14]), LMIC (7 [6; 8]) and LIC (4 [3; 5]) had a higher IV than women. All variables being equal, IV decreased with age (MEM -0.48 [-0.49; -0.47]). Distance was shorter for LMIC and LIC than for HIC (p < 0.05). The MEM on the distance of the Income group was -2.8 [-3.5; -2.2] for LIC and -2.0 [-2.1; -1.8] for LMIC (p < 0.05). The Income Group of one’s birth country is a barrier to vaccine accessibility in Italy, a HIC. Hence, we address public health workers to improve access to vaccination in community settings to narrow this gap.

Key messages

• Birthplace Income Group could be linked to vaccine accessibility in High Income Countries.

• Public Health stakeholders should consider community and social barriers to healthcare access when planning health interventions.
The paid sick leave and sickness benefits for universal health coverage: a scoping review
Authors: Lee H , Kwon Y , Ryu K , Sohn M , Chung H
Published: October 2022

Background

The countries with paid sick leave (PSL) and sickness benefits (SB) mostly provide the benefit coverage to specific categories of workers, which results in health inequalities among employees in COVID-19. The PSL and SB are key factors to achieve universal health coverage (UHC) in that they protect access to healthcare and improve population health. This study attempted to investigate whether the policies helped achieve the UHC when they were expanded.

Methods

This review followed the scoping review protocol of PRISMA-ScR. On April 6, 2021, we extracted the literature using the keywords ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ from PubMed and Web of Science and added two studies through hand-search. All articles were written in English. We did not limit the publication date.

Results

Forty-four selected studies were based in four single countries and the European Union. Most of the studies were published after 2010 (84.1%) and were conducted as cross-sectional (72.7%) studies. Not only workers who use PSL and SB but also children whose parents use PSL and SB increased their use of healthcare services and getting flu shots. Also, using PSL and SB decreased their unmet healthcare needs and emergency use. The various health status factors, such as infectious disease incidence, mortality, and presenteeism, also decreased.

Conclusions

The provisions of PSL and SB offer individual and public health benefits by allowing employees and their families to use healthcare services. Group of employees, we can expect similar public health impacts on newly covered groups, thus contributing to achieving the UHC. Since more than 90% of articles are published from the United States, future studies need to evaluate the outcomes of health effects in various European or Asian countries.

Key messages

• The provision of PSL and SB positively affects employees and their families by allowing them to use healthcare services.

• The expansion of PSL and SB contributes to the UHC by guaranteeing indirect medical costs that enable universal access to essential healthcare services.
Involving YOUNG people with Type 1 Diabetes in reSearch and the development of healTh cARe activities
Authors: Ganahl K , Paldán K , Bernhard A
Published: October 2022

Background

Typ1 Diabetes (T1D) us a complicated condition that requires constant monitoring and making many decisions. Living with T1D means to check blood sugar levels, inject oneself insulin, and be careful what you eat. In the life of a young adult there are a lot of things going on and youngsters don't want to control themselves all day and night. They want to rebel and feel free.

Methods

Teenagers living with T1D are actively involved in the research process from data collection to data interpretation. Following the photo voice method the teenagers documented their everyday life with T1D by photographs and recordings (Summer 2021), and discussed their need and resources in group discussions. The visual and audio-data was structured on a muti-touchscreen for which a software was developed during the project. From the inductively formed categories, measures were derived together with the young people and transferred into an action plan, which was presented and discussed with decision-makers.

Results

During the photo voice process, the teenagers identified 26 categories (i.e. nutrition, coping strategies, autonomy, etc.) that were important for describing their life with diabetes and there categories were categorized into 4 dimension: psycho-social, time, subject and space. The project-team used a systematic action planning process to develop 9 goals for an action plan to improve their life with T1D. They presented their action plan to local political leaders and stakeholders from different setting, such as health care and youth work. The responses during the stakeholder dialog were positively and there was agreement to achieve the defined goals.

Conclusions

The photo-voice method was helpful in immersing the participants in the lives of young people with type 1 diabetes. Structuring and organizing the visual- and audio-data together was beneficial for the participatory process. Together, an action plan could be developed and discussed with decision makers.

Key messages

• The photo voive method using digital tools (like smartphones and multitouchscreen) is a route to empower young people and give them a voice.

• The participating patients are experts for their bodies and the disease and should be perceived and taken seriously as such.
Breast cancer trends in women in Cyprus: a population-based study between 2004-2017
Authors: Quattrocchi A , Demetriou CA , Cory OA , Saad B , Constantinou C , Marcou Y , Demetriou A , Scoutellas V , Kolokotroni O
Published: October 2022

Background

In Cyprus, breast cancer (BC) is the first in incidence and second in mortality cancer in women. A national screening programme (NSP), targeting women 50-69 years, was introduced in 2007. The aim of this study is to provide a better understanding of cancer trends.

Methods

Data from the national population-based Cyprus Cancer Registry on adult women diagnosed with BC between 2004-2017 with follow-up until 2019 were analysed as follows: Joinpoint regression for age-adjusted (overall and by tumor stage at diagnosis - TSD) and age-specific rates (<50, 50-59, 60-69, 70-79, ≥ 80) incidence and mortality rates; 5-year age-adjusted Net Survival (NS) rates, overall and by TSD. TSD was categorised as localised, regional, and distant.

Results

Age-adjusted incidence rate increased from 135.3 (2004) to 153.2 (2017) per 100,000, with an annual percentage change (APC) of 1.1% (95%CI: 0.4-1.9). The greatest increase was in the age groups ≥70 years. A positive time trend was found for localized cancers between 2006-2017, while for all other stages nonsignificant trends were detected. Age-adjusted mortality rate increased from 37.0 (2004) to 50.0 (2019) per 100,000 (APC: 2.7%; 95%CI: 1.9-9.4). Significant increases in mortality rates were detected in the age groups ≥70 years. By TSD, increased rates were found at localised and regional stages, however smaller increases were detected since 2007. NS rates for the most recent period (2014-2017) was 93% for localized, 81% for regional, and 32% for distant and did not significantly improve compared to the previous years.

Conclusions

Trends in BC incidence continues to increase, especially in the older age groups and for early-stage cancers. As expected, since the introduction of the NSP, the incidence of localised cancers increased whilst the incidence of advanced stage cancer decreased, albeit non-significantly. Survival trends did not change but mortality rates for localised and regional cancers increased at a slower pace.

Key messages

• The introduction of the national screening programme may have played an important role in the increasing BC incidence trends.

• Despite survival rates not improving since the introduction of the national screening programme, mortality rates for early-stage cancers show a less steep increase.
Impact of a Cancer Diagnosis on Quality of Life among Cancer Survivors and their Partners
Authors: Bessa F , Morais S , Lopes-Conceição L , Costa AR
Published: October 2022

Background

Cancer survivors (CS) often experience physical, psychological and socioeconomic problems, which may have a negative effect on their quality of life (QoL). Additionally, cancer may also have a significant impact on patientś families, particularly their partners (PCS), who are typically the main informal caregiver.

Objective

To estimate the association between a cancer diagnosis and a poor QoL among both members of the couples, according to sociodemographic, health-related and cancer characteristics.

Methods

This cross-sectional study was based on data from the Sixth Wave of the Survey of Health, Ageing and Retirement in Europe - SHARE, conducted in 2015, in 18 countries. All cancer survivors (n = 2,040) who lived with a partner in the same household, as well as PCS (n = 2,040) were selected, and were country-, sex-, age- and education-matched (1:1) to non-cancer individuals (NC) and their partners (PNC), respectively. QoL was assessed using the Control, Autonomy, Self-Realization and Pleasure scale (CASP-12). The association between a cancer diagnosis and a poor QoL among both members of the couple was estimated through odds ratios (ORs) and 95% confidence intervals (95%CIs).

Results

In nearly one-fifth of couples, both members reported a poor QoL (17.0%); this outcome was more frequently observed among CS than NC (OR = 1.31, 95%CI: 1.10-1.56). A tendency towards stronger odds of poor QoL among both couples’ members was observed among CS who lived in urban areas (OR = 1.91, 95%CI: 1.30-2.80), with no multimorbidity (OR = 2.07, 95%CI: 1.14-3.76), as well as among those diagnosed <5 years (OR = 1.65, 95%CI: 1.21-2.24) and with cancers with a usually poor prognosis (OR = 1.82, 95%CI: 1.04-3.18), when compared with respective NC.

Conclusions

A poor QoL among both couples’ members was more frequent among couples dealing with cancer than those without cancer, which highlights the importance of closely monitoring CS and their partners, throughout the cancer survivorship course.

Key messages

• Couples dealing with cancer more frequently reported a worse quality of life among both members, when compared with couples without cancer.

• The findings of this study highlights the importance of family-focused care from an early phase after the cancer diagnosis and throughout the cancer survivorship trajectory.
Temperature and cardiovascular diseases: exploring associations in India and public health insights
Authors: Shrikhande S , Pedder H , Roosli M , Dalvie MA , Ravivarman L , Gasparrini A , Utzinger J , Cisse G
Published: October 2022

Background

Climate change has far-reaching consequences on human health globally. Cardiovascular diseases (CVDs), the global leading cause of death, are climate sensitive, mainly to temperature. The temperature-CVD association is region-specific, with several studies from Europe but relatively few from low-and-middle-income countries (LMICs).

Methods

We used a binomial regression model to analyze the association between apparent temperature and in-hospital CVD mortality in Puducherry city. A distributed lag non-linear model was used to capture the delayed and non-linear trends over a 21 day lag period to estimate the burden of in-hospital CVD mortalities attributable to non-optimal temperature between 2010 and 2020.

Results

Tapp in Puducherry ranges from 23°C to 40°C. We found that the optimal temperature range for Puducherry is between 33°C and 35°C with respect to CVDs. Temperatures both above and below the optimal temperature range were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Up to 20% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to cold (11.2%) than heat (9.12%). We also found that males above 60 years of age were more vulnerable to colder temperatures while females above 60 years were more vulnerable to the heat. Mortality with cerebrovascular accidents was associated more with heat compared to cold, and ischemic heart diseases did not seem to be affected by temperature.

Conclusions

Both cold and heat is associated with CVD mortality in Puducherry. The comparison of the results of this exploratory Indian study with those from European contexts show that the associations differ based on several factors. There are also age, gender and CVD type differences in Tapp attributable CVD mortalities. More region specific studies on Tapp- CVD mortality are needed from LMICs to better understand this association and build capacity.

Key messages

• The regional burden of cold attributable CVD deaths needs to be considered along with heat. Age and gender specific differences in the association need to be further studied globally.

• The development regional and contextual climate-health action plans, as seen in some European countries, could be enhanced by such studies and reduce the burden of temperature attributable CVD deaths.
Digital phenotyping for monitoring and prediction of physical activity level during pregnancy
Authors: Shojaa M , Schmitz N
Published: October 2022

Background

Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. Physical activity (PA) during pregnancy may reduce the adverse pregnancy outcomes. Digital phenotyping can develop interactive risk profiles to better reflect a person’s daily mobility than traditional retrospective self-assessment questionnaires. Therefore, the aims of the proposed research are to 1) test the acceptability and applicability of the BEIWE app during pregnancy, 2) characterize daily physical mobility during pregnancy, and 3) describe differences in physical mobility in women with and without diabetes.

Methods

This prospective cohort study will include 20 pregnant women with GDM and 20 without GDM from the Diabetes Center of the Medical Clinic or outpatient clinics of the Tübingen Women’s Clinic, Tuebingen, Germany. The study was approved by the Ethics Committee of the University Hospital Tuebingen (004/2022BO1). At baseline (22 weeks gestation), participants will be instructed to download the app. Passive data (phenotypic information) is collected automatically during the observation period. The follow-up assessment will be conducted three weeks after delivery. The acceptance of the app and comparison of the groups with and without diabetes will be conducted through Statistical analysis.

Results

Recruitment of participants has started and follow-up assessment is estimated to be finalized in fall 2022. Study design and results will be presented at the conference.

Conclusions

PA during pregnancy has been associated with minimum risk of a pregnancy, and self-monitoring of PA via an app may play a role in improving pregnancy outcomes. However, the success of Apps depends on their validity and reliability, which lack evidence.

Key messages

• The result of the study will develop a qualification measure for PA with no intervention.

• It also provides information for planning and conducting subsequent intervention studies.
Attitudes of doctors of medicine and dental medicine towards contacting patients via social networks
Authors: Relic D , Marelic M , Machala Poplasen L , Viskic J , Sedak K , Majer M , Vukusic Rukavina T
Published: October 2022

Background

As the use of social networking sites (SNSs) has greatly increased among health professionals, it is necessary to investigate their use of SNSs. The aim of this study was to identify the patterns of SNS use for contact with patients between medical doctors (MD) and doctors of dental medicine (DMD) in Croatia.

Methods

In collaboration with the Croatian Medical Chamber and the Croatian Chamber of Dental Medicine, a quantitative cross-sectional study was conducted on the use of SNSs and the attitudes of MDs and DMDs towards e-professionalism. Data were collected using online questionnaires. The data were analyzed using descriptive statistics.

Results

A total of 753 responses were processed, 507 (67,3%) MDs and 246 (32,7%) DMDs. DMDs were significantly more likely to visit patients or their family members’ profiles on SNSs (60,6% vs 33,3%, P < 0.001). The main reason for visiting a patient’s or family member’s profile is social communication, which is significantly more common among DMDs (46,3% vs 29,0%, P < 0.002). DMDs are significantly more likely to send friend requests from private SNS profiles to patients or their family members (15,0% DMDs vs 3,4% MDs, P < 0.001). Patients are much more likely to send friendship and connection requests on SNS to DMDs (91,1% DMDs vs 62,7% MDs, P < 0.001) who are also significantly more likely to accept these requests (76,8% DMDs vs 41,5% MDs, P < 0.001). MDs and DMDs would find the presence of e-professionalism guidelines useful (72,2% MDS vs 78,0% DMDs, P = 0.103).

Conclusions

The results show that DMDs are more open to communicating with patients via SNSs. Results showed a difference between MDs and DMDs in both directions - in sending requests to patients or their family members and in positive responses to their requests for connection. The findings point to the need to develop guidelines for health professionals regarding e-professionalism.

Key messages

• There are differences between MDs and DMDs toward communicating with patients using SNSs, DMDs being more open to the communication with patients.

• There is a need to develop guidelines for health professionals on e-professionalism with emphasis regarding how to professionally communicate with patients on SNSs.
Mapping core characteristics of internet-based tools to maintain and improve population health
Authors: Maass L , Freye M , Pan CC
Published: October 2022

Rapid developments and implementation of digital technologies in public health domains throughout the last decades have changed the landscape of health delivery and disease prevention globally. Many countries introduce digital interventions to their health systems to improve their populations’ health and make access to health care more accessible. Despite multiple definitions for digital public health and the development of different digital interventions, no study has analysed whether the used technologies fit the definition and the core characteristics of digital public health interventions. Digital public health for us means using digital tools to achieve public health goals. We conducted a scoping review to map the characteristics of digital public health interventions, see how the understanding of specific interventions differs between countries, and how they fit in the theoretical framework of digital public health definitions. Our review is the first to display the landscape of worldwide existing digital public health interventions that use information- and communication technologies. The study’s protocol was published in March 2022 in JMIR Research Protocols (DOI 10.2196/33404). We searched five databases (PubMed, Web of Science, CENTRAL, Ieee, and ACM) for publications. Given the broad search string, we retrieved 13,869 results screened for eligibility. A total of 1,429 publications were included for full-text screening. The study showed that the terms for specific interventions are related to the context in which they are used. Scandinavian countries displayed a different understanding of electronic health records (EHRs) than South American countries. We also identified that the separation between digital health and digital public health is blurry in praxis. Although interventions such as EHRs target individuals to improve their health, the collected data can also be pooled to allow research and the development of interventions on a public health level.

Key messages

• When comparing interventions internationally, it’s best to compare based on the characteristics of the intervention rather than on the name.

• Although, in theory, the distinguishment between digital health, digital public health, and public health became more precise in recent years, the practical reality between them remains still blurry.
Online information seeking and attitudes towards COVID-19 vaccination in Germany
Authors: Schmidt L , Babitsch B
Published: October 2022

Background

A large proportion of the European population seeks information about the COVID-19 vaccination on the internet. The population seems to split into those with positive stance on the vaccination and those with negative stance, but there are still individuals who do not have a final position yet. By now, there is a lack of understanding about the online information seeking behavior in these three groups. The current analysis sheds light on differences in internet usage and requested qualities of online information regarding the COVID-19 vaccination.

Methods

An online survey with N = 1,000 people (18-74 years) living in Germany was conducted between November 26 and December 8, 2021. The questionnaire included closed questions about frequency, information channels, formats and reasons of online information seeking, as well as one open question about requested qualities of online content. We conducted bivariate analysis for differences in information seeking behavior and content analysis for the requests.

Results

Information seeking behavior differed significantly by attitude towards the vaccination regarding frequency, almost all types of formats, three of ten listed information channels, and three of six reasons for online information seeking. Undecided participants and those who support COVID-19 vaccination used the internet more often than participants who are against the vaccination. Individuals supporting vaccination preferred reading text contributions (e.g. online articles). Informative videos were more often consumed by those who are undecided or against vaccination. Those who have not decided yet preferred online resources providing full information about side-effects and showing reliable facts by credible sources.

Conclusions

Our findings support an online vaccination communication that is tailored to target groups with different attitudes towards the vaccination. Overall, online campaigns should focus on transparent, reliable and complete information.

Key messages

• Online information seeking behavior regarding COVID-19 vaccination varies between individuals with different attitudes towards the vaccination.

• Online information about the COVID-19 vaccination should focus on transparency and reliable information.
The usage of DiGA, stratified by sociodemographic/socioeconomic characteristics
Authors: Hannemann N , Babitsch B
Published: October 2022

Background

The German government undertakes efforts to implement DiGA into the statutory health insurance to improve its quality. DiGA are physician-prescribed applications for patients with certain diagnosed diseases, whose costs are covered by the statutory health insurers. DiGA have the potential to improve healthcare, but it is also possible, that the usage of these applications perpetuates existing health inequalities, summarized by the term Digital Divide; meaning that socially deprived populations are less able to benefit from digital technologies. The aim of this analysis is to determine whether differences exist in DiGA use by sociodemographic/socioeconomic characteristics.

Methods

The results based upon the analysis of an online survey involving 1,200 people (18-74 years) living in Germany between March 10 and March 18, 2022. The sample composition reflects the current distribution of age, gender, and place of residence in the federal states (uncrossed). The questionnaire focused, among other aspects, on the use of DiGA. A binary logistic regression was used for the analysis.

Results

Compared to the lowest subjective social status (SSS), probands with a medium (OR 2.865) or a high SSS (OR 4.085) are more likely to use DiGA. Compared to the reference group (60 years and older), the 18-29-year- (OR 2.044) and the 30-39-year-olds (OR 1.952) tend to have a higher likelihood of using DiGA. The likelihood of the use decreases among probands with medium (OR 0.632) and high educational degree (OR 0.580) compared to the reference group (low education).

Conclusions

In accordance with the results of existing studies, social differences could be identified regarding known determinants of health inequalities, like age and SSS. In this analysis, the highest degree of education does not appear as a predictor for an increased likelihood of use. Thus, further analyses are needed to address the influence of education, especially to develop a broader understanding of the DiGA use.

Key messages

• It appears that DiGA are not equally accessible or used across different population groups, and thus indicating an already existing or emerging Digital Divide regarding the use of DiGA.

• Contrary to the broad assumption that higher expressions of health determinants are related to a higher likelihood of using DiGA, a higher degree of education decreases the likelihood of using DiGA.
Knowledge, attitude and practice about the Personal Health Record among general population in Italy
Authors: Prinzivalli A , Scaioli G , Guastavigna L , Scacchi A , Lo Moro G , Bert F , Siliquini R
Published: October 2022

Background

The Personal Health Record (PHR) is an online tool containing a person’s health-related data, which can be shared with health professionals. This tool is widely used throughout Europe but is not very popular in Italy, despite its implementation being mandatory. This study aims to investigate knowledge, attitudes and practices (KAP) associated with the PHR among the general population in Italy, to identify the main obstacles in the usage of PHR and to establish strategies that lead to their resolution.

Methods

A cross-sectional survey was designed and shared both online and on paper (in the waiting rooms of the outpatient clinics) to an opportunistic sample of people aged ≥18 years. Factors associated with a higher knowledge and willingness to activate the PHR were investigated through multivariable logistic regression analyses.

Results

Preliminary results of the on paper survey (243 answers) showed that the median age of the participants was 45, 46% were women, 9% worked in healthcare and 68% had chronic diseases. Only 31% heard about the PHR, of which 22% showed a good knowledge of it. The 66% declared the willingness to activate the PHR and 92% agreed that the PHR is a useful tool for physicians to share information. Multivariable logistic regression models showed that those who were employed and those who were visited by a doctor in the last three months had a higher likelihood of having heard about PHR (OR 2.56, 95% CI 1.12 - 5.82 and OR 2.67, 95% CI 1.20 - 5.90 respectively). The likelihood of being willing to activate the PHR is lower for those who live alone, and is higher for those who are employed (OR 0.35, 95% CI 0.14 - 0.88 and OR 2.35, 95% CI 1.06 - 5.24).

Conclusions

The results confirm the low level of knowledge and diffusion of the PHR in Italy, although a relatively high interest in this tool was highlighted, along with a favorable perception of its usefulness. Promotional interventions are needed to increase knowledge and awareness of this tool.

Key messages

• Awareness about Personal Health Record among the Italian population is low. Despite this, a high level of willingness to activate this tool and a high perception of its usefulness were registered.

• Identifying factors that lead to lower awareness on Personal Health Record may help Public Health professionals to implement targeted promotional interventions aimed to increase the usage of this tool.
The contribution of health behaviours to waist circumference change following employment transitions
Authors: Tam ACT , Murphy RA , Zhang W , Conklin AI
Published: October 2022

Background

Mechanisms through which retirement and later-life job loss lead to subsequent weight change are poorly understood, and include changes to one’s health behaviours (HBs) after employment changes. Our study assessed the potential role of HBs in the impact of employment transitions (ET) on waist circumference (WC), by gender.

Methods

We used two waves of survey data from a Canadian sample of 45- to 85-year-olds with objectively measured WC. For 10,117 participants who were working at baseline, we categorized them into three ET statuses: stayed working, entered retirement, and stopped working. Changes in HBs [sleep, smoking, drinking, and physical activity (PA)] were coded by comparing baseline and follow-up responses. Change in WC was analyzed using multivariable linear regression and multinomial logistic regression models (≥5% gain or loss, no change).

Results

Multivariable models showed that the addition of change in HBs did not alter the effect sizes of ETs on WC change. Regardless of ET status, women who quit smoking had an increased WC compared to persistent non-smokers (1.43cm, 95% Confidence Interval 0.07 - 2.79). Women who became habitual drinkers showed more increases in WC compared to non-habitual drinkers (1.43cm, 0.16 - 2.69). Changes to sleep duration were not associated with WC change; however, women who became satisfied with their sleep had greater WC increases compared to already satisfied sleepers (0.79cm, 0.12 - 1.46). Men who increased their PA by > 1hr to 2hrs were less likely to gain ≥5% weight compared to men with no PA change (OR = 0.75, 0.57 - 0.99). Women who increased their PA by > 1hr to 2hrs were less likely to lose ≥5% weight (OR = 0.74, 0.56 - 0.99).

Conclusions

Our study of this Canadian cohort of middle-aged and older adults suggests some HBs are independent risk factors for weight change rather than mechanisms in the employment-anthropometry relationship.

Key messages

• Health behaviour changes in middle-aged and older adults have anthropometric effects that differ by sex/gender, independent of employment transitions.

• Promotion of persistently good sleep quality to women may help maintain waist size.
New proposed measures to evaluate contact tracing effectiveness
Authors: Santos JV , Fernandes Silva D , Santos Martins F ,   Espinho/Gaia Public Health Unit working group
Published: October 2022

Issue/problem

Contact tracing is an important and widely used method to control transmission of communicable diseases. The COVID-19 pandemic presented a new and big challenge with a high number of confirmed cases and contacts and subsequent high burden on contact tracing activities. Naturally, the effectiveness of such interventions needs to be assessed, and appropriate measures are still rather underdeveloped.

Description of the problem

We propose two new measures for assessing contact tracing effectiveness: “number needed to quarantine” (NNQ), which is the number of quarantined person-days needed to prevent one infectious person-day, and the proportion of infectious days prevented by the quarantined (PPID). We have applied these measures to assess COVID-19 contact tracing effectiveness in COVID-19 confirmed cases diagnosed between July and mid-September 2020 in a local Public Health Unity in the Northern region of Portugal (Espinho/Gaia). For robustness checks and accounting for the uncertainty of the infectiousness period, we used three different scenarios.

Results

Depending on the infectiousness period considered, we have found a NNQ between 19.8 and 41.8 and a PPID between 19.7% and 38.2%. Contact tracing effectiveness was higher for some specific groups such as cohabitants and symptomatic contacts. Effectiveness also decreased with the increasing time from diagnosis or symptom onset to contact isolation

Lessons

NNQ and PPID are straightforward and easy to use measures to evaluate contact tracing effectiveness in communicable diseases. Although this example focuses in the COVID-19 pandemic at a local setting, these measures can also be used for different communicable diseases and at different levels. This assessment step can be important for priority setting of transmission control activities but also on a health management perspective.

Key messages

• New measures to evaluate contact tracing effectiveness are proposed: “number needed to quarantine” and “proportion of prevented infectious days”.

• These measures allow the identification of priority groups that must be quarantined, as well as time periods of intervention, for better transmission control.
Leading causes of death in Tunisia, 2020
Authors: Rejaibi S , Zoghalami N , Silini A , Ben Slama I , Skhiri A , Mariem I , Mensi I , Bennour MA , Taibi S , Aounallah-Skhiri H
Published: October 2022

Background

Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19’s effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020.

Methods

Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization cause-of-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software.

Results

A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system.

Conclusions

The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD’s coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization.

Key messages

• Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths.

• The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.
Ethical perspectives of the involvement of vulnerable populations in health research
Authors: Lampa E , Warner G , Sarkadi A , Perez Aronsson A , Thell M , Kihlbom U
Published: October 2022

Background

Public involvement in research has potential to transform public health research processes and outcomes, as well as contribute to sustainable collaborations between academia and the civil society. However, this all relies on public involvement being conducted in an ethical and inclusive way, especially when involving representatives from vulnerable populations.

Methods

In this empirically informed theoretical reflection, ethical perspectives on involvement of vulnerable populations in health research were explored using data collected within a public involvement evaluation project. By analysing observational and longitudinal qualitative data from research projects involving public representatives from vulnerable groups, ethical aspects were identified.

Results

Responsibility and decision-making appeared as important ethical aspects, where laws and regulations conflicted with involvement ideals. Similarly, reimbursement and recognition for public contributors became an ethical issue when facing legislation and bureaucracy, especially when involving children or refugees. Another ethical aspect concerned researchers’ concerns in balancing involvement and protection of vulnerable groups, especially when involving contributors living under unstable circumstances. Finally, effectively communicating around research and involvement in an accessible way, for contributors to be involved but not burdened, was a challenge for researchers.

Conclusions

Public involvement of vulnerable populations led to ethical challenges related to conflicting ideals and practical realities, including balancing involvement and protection of contributors. This highlighted a need for ethical guidance to support ethical decision-making and practice. The findings are used to guide the development of an ethical framework for decision-making in public involvement.

Key messages

• Researchers involving public contributors from vulnerable groups face ethical challenges which causes barriers to involvement.

• There is need for guidance on ethical decision-making for researchers involving representatives from vulnerable groups in research.
Who is following me? Public attitude towards government tracing apps in the covid Era in Israel
Authors: Golan O , Bord S , Satran C
Published: October 2022

Background

In the battle to decrease coronavirus infection and mortality, Israel has employed emergency tools, e.g., tracking civilians’ locations via their cellphones or activating the HaMagen app that identifies when a person is near someone who has been diagnosed with the virus. While the aim of these tools is to ensure the public’s health, they could harm human rights.

Objective

To examine the Israeli public’s attitudes towards enhancing public health during the pandemic while preserving privacy, by examining the relationship between trust in the healthcare system, threat perceptions, cellphone tracking, and HaMagen App.

Methods

Surveys (distributed by iPanel) was completed by 741 adults, aged ≥18.

Results

About half the respondents (47.1%) perceived cellphone tracking as harmful to privacy, yet one-quarter (24.4%) reported that this increases their sense of security. About half (48.4%) agreed/greatly agreed with the item whereby the government uses the gathered data for non-coronavirus purposes. Jewish respondents had more positive attitudes towards government tracking than Arab ones, yet the latter reported higher downloading of HaMagen. The findings indicate that threat perceptions and positive attitudes towards cellphone tracking were related to greater chances of downloading the app. Moreover, attitudes towards such tracking were mediated by the relationship between trust levels/threat perceptions and downloading the app, whereby the former was association with more positive attitudes towards cellphone tracking, which in turn was related to greater app downloading.

Conclusions and Recommendations

Trust plays a central role in people’s willingness to forgo their privacy for the good of public health. To enhance trust, messages must be suited to a range of communities, presented in a suitable language by local professionals.

Key messages

• Trust plays a central role in people’s willingness to forgo their privacy for the good of public health.

• Concern for public health must include ethical considerations.