bluuebunny/crossref_metadata_2025 huggingface dataset:
Discrepancies in breast cancer screening and hypothesis of artificial intelligence support
Authors: Riccardi M T , Rosca V , Forestiero F , Rudniki T , Testa A , Cerone G , Rossi E , Trinito M O
Published: October 2024

In Italy,the National Breast Screening Programme offers mammography as the 1st level examination, blindly assessed by two radiologists.In the context of continuous quality control,discrepancies in the assessment of mammograms between the 1st and 2nd reader have been studied,focusing on the most significant ones.The aims of the present study are:to evaluate the outcome of women sent to the 2nd level of review;to evaluate the possibility of using artificial intelligence (AI) software to assist radiologists in case of discrepancies. In the Local Health Authority Roma2,radiologists use a standardised classification that rates radiographs on a five-level scale from R1 to R5:R1=no abnormalities,R2=benign findings,R3=equivocal findings,R4=suspected cancer,R5=strongly suspected cancer.Data were extracted from the mammograms performed in 2023 that showed discrepancies (R1/R2 vs. R4/R5).2nd level mammography≥R4 and 2nd level histology≥B4 were considered positive. For the second aim,”IA Lunit INSIGHT” software was used to create specific target groups using the following cut-offs:G1<10%, G2 11-29%; G3 30-59%; G4 60-85%; G5 86-100%(groups ≥G3 were considered positive). Of the 36,339 mammograms,524(1.5%) were discordant:347(66.2%) were considered suspicious by the second radiologist.49(9.4%) were confirmed positive by Level II mammography and 23(4.4%) reported histology≥B4. The AI red a random sample of 247 mammograms and classified 34 women as positive (1 G5, 6 G4, 9 G3), of whom 11 (4.5%) were confirmed positive by Level II mammography and 6 (2.4%) were histologically positive. Of the negative women, 2 had histology≥B4. Discrepancies may be one of the factors leading to inappropriate referral to second level investigation. In such cases, the use of AI may improve the appropriateness of further investigation, although this hypothesis needs to be tested in larger numbers, with additional comparisons with experienced radiologists and consideration of retraining.

Key messages

• Continuous monitoring in cancer screening programs are vital to assure a sustainability of the process.

• Artificial Intelligence software are promising in aiding health care professionals in case of discrepancies.
AI-Powered Post-Discharge Monitoring to Prevent Patients Readmissions and Reduce Workforce Burden
Authors: Santos M , Peyroteo M , Lapão L
Published: October 2024

Background

Patient readmission poses a significant burden on healthcare systems, straining resources, negatively impacting patient treatment, and it is often a Public Health problem. Traditional post-discharge follow-up methods, such as phone calls, often lack efficiency and personalization. Artificial intelligence (e.g., Machine Learning (ML)) offers a transformative approach that can potentially improve post-discharge care.

Methods

This scoping review aimed to map existing research on AI-powered solutions for post-discharge monitoring, focusing on their application in risk stratification and their potential for reducing hospital readmissions within a public health framework. Following PRISMA-ScR guidelines, a search was conducted across four databases using keywords related to AI, post-discharge, and risk stratification.

Results

Studies published between 2018 and January 2024 were included if they described the development and application of an ML model in a post-discharge setting for risk stratification. Sixteen studies met the inclusion criteria. Tree-based algorithms, particularly XGBoost, were the predominant ML approach, with promising performance metrics for readmission risk prediction.

Conclusions

However, limitations were identified, including restricted generalizability due to data source limitations and a lack of real-time implementation in many studies. This review highlights the potential of AI in post-discharge monitoring, particularly the use of ML for risk stratification, as a promising tool for public health contact tracing. While challenges remain regarding generalizability and real-world implementation, the findings suggest AI holds immense promise for improving post-discharge care, potentially reducing readmissions, and optimizing resource allocation. Future research with broader datasets and real-time applications can further solidify the role of AI in revolutionizing post-discharge care within public health systems.

Key messages

• This study shows the potential of AI and risk stratification in post-discharge monitoring, improving public health outcomes by reducing hospital readmissions and optimizing the healthcare workforce.

• This review highlights the value of AI in public health, particularly for improving post-discharge care through effective prediction of high-risk readmissions.
Development of an assessment process for digital medical devices in Austria
Authors: Laschkolnig A , Tanriverdi E , Dick D , Herzog A
Published: October 2024

Issue/problem

Digital medical devices have experienced a rapid development in recent years and are playing an increasingly important role in healthcare. These devices offer numerous benefits and can improve patient care. However, despite their potential benefits, the use of digital medical devices also poses risks and regulation from governmental side is needed from a Public Health Perspective. This is why some countries already implemented assessment processes for Digital Medical Devices (e.g. Germany and France) leading to the question how such a process could be established in Austria too.

Description of the problem

While digital medical devices must fulfil requirements set by the medical device regulation to enter market, several other aspects are of interests when offering digital medical devices in routine care. These include e.g. medical effectiveness, data security and interoperability. The objective of the ongoing pilot project is to develop a process for the assessment of quality-assured digital medical devices in Austria in 2024. For this, a combination of literature research, interviews and workshops with relevant stakeholders is used in order to gain all necessary information. Process and assessment criteria will be tested and revised in a pilot phase with several digital medical devices.

Results

At the end of the project, an assessment framework as well as a potential evaluation process will be designed in accordance with relevant stakeholders. Moreover, legals aspects and the potential integration into the austrian health telematics infrastrucutur will be assessed. This will form a basis for implementing digital medical devices within the austrian healthcare system.

Key messages

• The result of this project aims to build the basis for implementing an evaluation process for digital medical devices in Austria.

• The establishment of an evaluation process for digital medical devices supports the integration of quality assured digital medical devices in healthcare.
Global health resource distribution during COVID-19 and in future pandemics: Here’s what people say
Authors: Trutzenberg F , Hagel M L , Eid M
Published: October 2024

During the COVID-19 pandemic, countless individuals across the world needed novel and sophisticated health care resources simultaneously, leading to dramatic global shortages. How to distribute resources in such situations? This dilemma is neither new nor understudied: Its complexity is well known to medical ethicists, public health scientists and philosophers. Building on this knowledge, powerful global distribution frameworks were proposed already early into the pandemic. Despite this knowledge, no globally consensual regulations existed (and exist) on the political sphere. Worse still, numerous countries hoarded resources for themselves, increasing global inequalities and prolonging the pandemic for everyone. For future emergencies, it is thus necessary to develop immediately applicable strategies. Because public acceptance is key for such interventions, evidence on the public opinion towards allocation principles is strongly needed. In 2021, we asked representative samples of N = 2694 adults in England and Germany to rate seven COVID-19-specific global allocation principles. In line with literature on justice attitudes in general, extensions of bifactor(S-1) models showed that participants would have preferred a more equity- or equality-based global resource distribution during the pandemic, presenting themselves as more cosmopolitan than global leaders. Trying to understand these attitudes better, we tested preregistered hypotheses on relations with other constructs and found positive associations between equity- and equality-directed preferences and global human identification, among others. To ensure generalisability on future pandemics, we collected data from a second cohort in spring 2024. All results will be presented in detail. With their responses, European citizens call upon the development of fairer and more efficient global distribution mechanisms. This global public health perspective could inform preparations for future global emergencies.

Key messages

• European citizens would have preferred a more equity- or equality-based global distribution of scarce health care resources during the COVID-19 pandemic than global leaders organised.

• Citizens’ global perspective on public health and their strong emphasis on global fairness should inform preparations for future pandemics and other global emergencies.
Sailing along the global tobacco supply chain: public health insights of innovative database project
Authors: Hiscock R , Dunwoodie Stirton F , Matthes B K , Mehegan J , Alaouie H , Gallagher AWA , Bloomfield M J
Published: October 2024

Background

Tobacco control commonly focuses on reducing tobacco demand rather than tobacco supply. This paper presents findings from a major four-year project on the tobacco supply chain. Transnational Tobacco and Leaf Companies (TTLCs) and other tobacco supply chain companies argue that provision of livelihoods, exports and corporate social responsibility (CSR) exonerates tobacco. Our objective was to consider these claims.

Methods

This paper presents the results of three studies: a literature review and two analyses of data from the innovative Tobacco Supply Chain Database (TSCD). Study 1: A scoping review of academic literature (n = 124 papers) reviewing how the tobacco supply chain embeds the tobacco industry as a development actor. Study 2: The statistical association between countries hosting TTLC subsidiaries (TSCD) and TTLC interference in health policy (Global Tobacco Industry Interference Index) was analysed (n = 76 countries). Study 3: Document and website analysis of TSCD non-TTLC tobacco supply chain companies comparing descriptions of CSR and tobacco supply chain involvement (n = 80 companies).

Results

Study 1: Although there are instances of advantages of involvement in the tobacco supply chain, TTLCs tends to be associated with declines in tobacco workers’ income, equality, quality of life (cultural and health and wellbeing) and nations’ environment and economy. Study 2: Countries that hosted more TTLCs had more policy interference (farming subsidiaries p=.046, tobacco product manufacturing subsidiaries p=.008). Study 3: Non-TTLC companies often lack transparency regarding their connection to tobacco. For example, 68% linked to CSR activity on their homepage whereas only 16% linked to involvement in the tobacco supply chain.

Conclusions

Tobacco supply chain involvement is detrimental to public health, the environment and governance. Countries and companies should seek to extricate themselves from the tobacco supply chain.

Key messages

• Tobacco supply chain involvement weakens public health governance despite CSR activities. Lack of transparency on supply chain involvement by companies is thus a concern.

• The new Tobacco Supply Chain Database illuminates previously hidden areas of the tobacco supply chain: the location of tobacco industry subsidiaries and presence of independent companies.
Nationwide prevalence and trends in high-risk drinking among adult men the disabled and non-disabled
Authors: Park B H , Kim S Y , Park J H
Published: October 2024

Background

Excessive drinking is an important public issue that causes various levels of physical, psychological, behavioral problems. Especially for the disabled, it matters in that it could lead to poor health and secondary health conditions.

Methods

This study analyzed high-risk drinking (HRD) behaviors over a 9-year period in adult South Korean men according to disability presence, severity, type. We linked national disability registration data with the National Health Insurance claims data. Age-standardized prevalence of HRD were analyzed for each year and the odds of current HRD were determined by multivariate logistic regression after adjusting for income level, residence, insurance type, Charlson comorbidity index.

Results

The age-standardized HRD prevalence of the mildly disabled was higher than that among the non-disabled. Among the mildly disabled and physically disabled, younger aged group showed higher prevalence of HRD than that of non-disabled. In multivariate logistic regression analysis, the mildly (aOR=1.26, 95% CI = 1.24-1.29), physically (aOR=1.31, 95% CI = 1.28-1.33), communication disabled (aOR=1.12, 95% CI = 1.07-1.17) had higher prevalence of HRD than the non-disabled.

Conclusions

The prevalence of HRD was higher among the young mildly disabled than the non-disabled, this was more evident in young men physically disabled, communication disabled. This may be a result of the physical and social limitations of severely disabled and should be interpreted with caution. Social activities should be supported, and health policies on alcohol consumption should be implemented to prevent secondary conditions and reduce health disparities. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165).

Key messages

• The prevalence of high-risk drinking was highest among the mild disabled, especially the mild, physical, communication disabled in younger aged men.

• Health policies and efforts to improve health disparities aimed at reducing alcohol consumption among people with disabilities are needed.
Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model
Authors: Belogianni K , Kouvari M , Gawronska J , Schiffler T , Knapp M , Gómez Trenado R , Tabaki I , Moudatsou M , González Peña P , Grabovac I
Published: October 2024

Background

The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings.

Methods

A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study.

Results

More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators.

Conclusions

Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services.

Key messages

• The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach.

• Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.
Deafness and Inclusion: Perceived Communicative Barriers in the Area of Rehabilitation in Italy
Authors: Sabato M , Sandroni S , Marceca M
Published: October 2024

Introduction

Deafness can create a communication deficit/barrier between the Deaf or Hard of Hearing patient and the Healthcare Workers (HWs), with negative outcomes for diagnostic and therapeutic success. As underlined by the COVID-19 pandemic, there is a need to train HWs in effective communication strategies in order to avoid marginalising or excluding the Deaf Community by denying them access to healthcare services. This study highlights the urgent need and desire of Healthcare staff for training in effective communication strategies, such as sign language, to help the Deaf community gain equal access to Healthcare.

Materials and methods

A cross-sectional survey was carried out between May and July 2022 using the Google Forms platform. An anonymous questionnaire was given to Rehabilitation HWs (RHWs) at a national level to collect information from the HWs of the various areas of rehabilitation, identifying their knowledge, training, and experience with regard to deafness. Data analysis was then carried out using the Google Forms program, SPSS program Windows7 Excel Spreadsheet.

Results

252 RHWs belonging to 8 different profiles answered this survey. 89% were women. 46% were younger than 30. 57% of these 252 had deaf patients, but 54.6% of these had no prior training. 33% of the RHWs had followed courses or seminars on deafness at least once. When asked, 94% were interested in courses or training in communication with deaf people.

Conclusions

HWs recognize the gap in communication and are willing to learn more in the matter for effective communication with their patients to gain a better therapeutic success. They also consider a program that imparts such knowledge and training to be highly important.

Key messages

• Therapeutic success is increased if there are effective communication strategies, such as sign language, between the Deaf and Healthcare provider.

• This study shows the importance of training all health workers in effective communication strategies with deaf people to allow an all-inclusive healthcare.
Refining current methods: Including comorbidity adjustment in burden of disease estimates
Authors: Porst M , Yessimova D , von der Lippe E
Published: October 2024

When quantifying years lost due to disability (YLD), a correction for multimorbidity (or comorbidity, COMO for short, in the Global Burden of Disease study) is necessary to avoid overestimating the morbidity-related burden of disease. Such an overestimation occurs if the calculation of disease frequencies does not consider that persons are counted more than once in a cross-sectional year. In such cases, the time spent with illness at an individual level can add up to a value of more than 1 year. To avoid this, a microsimulation is used that corrects the YLD to a maximum value of 1. A standard approach is to generate a synthetic data set by age, gender and region. Using prevalence estimates and based on (independent) Bernoulli experiments, a vector of diseases is randomly assigned to these (pseudo) individuals. The assignment is usually independent, which means that the presence of one disease has no influence on the presence of another disease. At this level, the individual YLD are then proportionally corrected (the maximum value is 1) and extrapolated to the population. However, there is evidence that disease clusters exist at the individual level. As part of the further development of such multimorbidity correction methods, a new approach will be tested and applied to generate a more realistic population of interest. This considers correlation patterns (1st step) between diseases when generating the synthetic data (2nd step) on the basis of Bernoulli experiments. For this purpose, the existing approaches need to be enriched by (pairwise) correlations between diseases, which requires the inclusion of additional epidemiological data sources. It is assumed that this will lead to an additional correction of the YLD, as they are still overestimated under an independent assignment.
Promoting ownership in local community health promotion interventions
Authors: Lund Holm Thomsen L , Andersen C G , Overgaard C
Published: October 2024

Background

A prerequisite for successful and sustainable implementation of local community health interventions is strong community ownership. Ownership is related to the level of perceived control of an intervention and its program components. Facilitation of community ownership involves engagement of the stakeholders within the community, e.g. in deciding what the problem is to whom and how to solve it. Much is known about methods to facilitate community engagement at a continuum between informing the community and community control. However, less is known about how different methods for community engagement work to foster and sustain ownership among local stakeholders.

Aim

To generate knowledge about how ownership is fostered or hindered among stakeholders across three different communities in a local community intervention with whole-of-community characteristics implemented to reduce overweight among children. The study also explores how synergies of ownership between various types of stakeholders at different organizational levels influence overall ownership and implementation of the intervention.

Methods

The study is designed as a multiple case study based on Robert K. Yin’s principles for case study evaluation. The study takes place in three different Danish Municipalities with different local contextual conditions. Various data sources are collected including sources of qualitative data comprising document analysis, observations, and interviews with key stakeholders.

Preliminary results

An influential contextual factor on local ownership is that implementation of the intervention and commitment to this in 10 years is a top-down decision at the policy level. Local stakeholders find the goals of the intervention meaningful to their day-to-day practices. However, they also experience a shortage of resources for participating and lack trust in higher management stakeholders to take shared leadership when the implementation phase ends.

Key messages

• Ownership is influenced by the degree of engagement.

• Ownership is influence by the synergy of ownership between different stakeholders.
Association of physical activity with health-related quality of life in rectal cancer survivors
Authors: Gazibara T , Grubor N , Pavic N , Grubor I , Ceranic M
Published: October 2024

Background

Health-related quality of life (HRQoL) in rectal cancer survivors after completion of surgical treatment may be influenced by various factors including physical activity. The purpose of this study was to examine the association between regular exercise and physical and mental health in rectal cancer survivors.

Methods

People who underwent surgical resection of rectal cancer with temporary ileostomy from 2018 to 2021 were invited to participate. Participants were drawn from the Clinic for Digestive Surgery and the Clinic for Emergency Surgery of the University Clinical Center of Serbia, as well as the nationwide laparoscopic program - LapSerb consortium. Data were collected through interviews in late 2022 and early 2023. The HRQoL was evaluated using the physical composite score (PCS) and mental composite score (MCS) of the Short Form-36 (SF-36) questionnaire. Socio-demographic, clinical and behavioral characteristics including the frequency of exercise were analyzed in multiple linear regression models.

Results

A total of 134 rectal cancer survivors were tested. Few participants (18.7%) exercised regularly, while most of the study population occasionally (41.8%) or never engaged (39.5%) in physical activity. Rectal cancer survivors who exercised regularly had significantly higher scores of physical (75.5 vs. 62.8, p = 0.019) and mental quality of life (78.9 vs. 63.8, p = 0.008). Regular exercise remained associated with better physical and mental health after the adjustment for demographic, clinical and behavioral characteristics.

Conclusions

Consistent physical exercise seems to be significant contributor of better physical and mental quality of life in rectal cancer survivors after completion of surgical treatment.

Key messages

• Physical exercise may help rectal cancer survivors improve their physical and mental health.

• Promotion of physcial activity in rectal cancer survivors could optimize recovery after surgery.
Thirty-five years of personalized promotion. The contribution of medicine in the workplace
Authors: Magnavita N , Iannaccone U , Di Stasio E , Meraglia I , Viti G , Borghese L
Published: October 2024

Issue/problem

Occupational medicine has always had the task of identifying and solving problems caused by exposure to occupational risks and improving the health conditions of workers. This traditional prevention task can be advantageously associated with promotional activities to reduce the incidence of non-communicable diseases.

Description of the problem

Since the end of the 1980s we have conducted health promotion interventions in the workplace, integrated into the company’s occupational prevention plan. The results, discussed internationally, have allowed the improvement of projects such as the one presented here, aimed at the prevention of cardiovascular and metabolic risks.

Results

Workers carry out a clinical check integrated with blood chemistry tests, actigraphic measurement of physical activity and sleep, bioimpedance measurement and plicometry, to objectify the data of interest. Furthermore, they keep a food diary and answer questionnaires on lifestyle, stress, and sleep. They receive personalized non-pharmacological treatment aimed at making salutogenic changes to diet, sleep, physical activity, and relaxation methods. They are monitored monthly and carry out a follow-up after six months. The pilot study, conducted on 20 healthcare workers with previously undiagnosed metabolic problems, indicates a significant improvement in abdominal circumference, systolic blood pressure and sleep duration in the third month. Workers report a high level of satisfaction with the initiative, a lower level of occupational stress and a higher quality of sleep.

Lessons

Accumulated experience demonstrates that projects of this type are feasible, sustainable, and advantageous and can be applied to companies of all sizes, regardless of the quantity of resources available.

Key messages

• Health promotion in the workplace can contribute to the reduction of chronic non-communicable diseases.

• The active participation of workers in health promotion activities contributes to improving job engagement and satisfaction derived from work.
Impact of Multiple Sclerosis on different life dimensions among working women in Sweden
Authors: Machado A , Teni F S , Friberg E
Published: October 2024

Introduction

Multiple sclerosis (MS), like many other chronic diseases, may impact the whole life situation. MS is more common among women than men, in addition, women tend to report worse health status. We aimed to explore the self-reported impact of MS on different dimensions of life such as work, family, leisure activities and, contact with friends and acquaintances.

Methods

All individuals 20-50 years of age listed in the Swedish MS Registry were invited to answer a survey in 2021. Responses from 2659 working women regarding impact of MS in different dimensions (1, not at all; 2-3, occasionally; 4-5, frequently; 6-7 to a high extend) were explored with descriptive statistics.

Results

Reported impact of MS varied across the different life dimensions. Working women reported that MS had a greater impact on their leisure activities (20.7% - responding to ‘to a high extent’), followed by contact with friends and acquaintances (15.8%), work (15.5%) and family (11.7%). This despite the fact that 77.1% had mild levels of disability. Further, the MS diagnosis was reported to have contributed to reduced working time (31.4%), refrained from changing job (28.8%), changed jobs (20.5%) or changed career track (20.4%). When questioned about positive life-changing experiences due to MS diagnosis, a majority of the women stated that it had contributed to learning how to adapt to things one cannot change (59.2%) and being grateful for everyday (51.7%).

Conclusions

An MS diagnosis can significantly impact various aspects of life. While work is notably affected, leisure activities also undergo substantial changes after MS diagnosis. However, acceptance, adaptability and finding meaning, among other, can be important parts of the journey.

Key messages

• At early stages of MS, the disease tend to affect leisure activities more than other dimensions of life.

• Finding coping mechanisms to handle MS may contribute to compensate the impact of MS.
Work and disability benefit unraveled in chronic gastrointestinal patients
Authors: Lemlijn-Slenter AHWM , van Iperen L P , Wijnands KAP , Masclee AAM , de Rijk A E
Published: October 2024

Background

Persons with a chronic disease, such as chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disease, have a lower work participation (WP) than the healthy population. Instead, they might receive a disability benefit (DB). Positive Health (PH) is a newly developed, holistic view of health and comprises six dimensions: bodily functions, mental well-being, meaningfulness, quality of life, participation, and daily functioning. In this study we aim to determine whether the dimensions of PH relate to WP and DB in persons with GI-HPB.

Methods

GI-HPB patients attending the outpatient clinic of the Maastricht University Medical Center between 2019-2021 received validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L) and items regarding WP and DB. The relation between the six dimensions of PH, and WP and DB, were tested with univariate and multivariate statistics.

Results

448 patients (Mage = 45 years; 69% female) were included. Univariate analysis revealed that, except for meaningfulness, all dimensions were significantly associated with WP (p≤.02) and DB (p≤.005). In multivariate analyses, lower age (p=.010), better general health (p=.044) and better physical functioning (p<.001) related to WP. Higher age (p=.002) and lower physical functioning (p=.011) related to DB.

Conclusions

Among GI-HPB patients, physical functioning related to both WP and DB. The chance of working was higher among younger patients and those with better general health while those with a higher age received DB more often. The PH concept was only partially relevant to work status and DB.

Key messages

• Within the dimensions of Positive health, work participation was associated with a lower age, a better general health and a better physical functioning.

• Within the dimensions of Positive health, disability benefit was associated with higher age and lower physical functioning.
Measurability of overall health in patients with chronic gastrointestinal disorders
Authors: Lemlijn-Slenter AHWM , Wijnands KAP , van der Hamsvoort G , van Iperen L P , Wolter N , de Rijk A E , Masclee AAM
Published: October 2024

Background

Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) patients experience problems in all life areas. The Positive health (PH) concept, based on six different dimensions of health, may hold the answers for a broader understanding of the patients’ well-being.

Aim

To measure the overall health status of GI-HPB patients, according to the PH concept.

Methods

In 2019-2021, patients with GI-HPB attending the outpatient clinic of the Maastricht University Medical Center filled in questionnaires before consultation. The six dimensions of PH (bodily functions, mental well-being, meaningfulness, quality of life, participation, daily functioning) were measured by validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L). Results were compared to control groups and assessed with McDonald’s Omega, Zero-order Pearson correlations, and t-tests.

Results

The 235 participating patients scored lower on quality of life, participation, and daily functioning than healthy controls (p ≤ 0.001) but similar to those with other chronic conditions. Malnutrition (moderate-severe 45.6%) and depressive/anxious symptoms (35%/21.6%) were higher in the GI-HPB group compared to those with other chronic conditions.

Conclusions

Validated questionnaires addressing the six dimensions of PH showed a significant worse health status compared to controls, and malnutrition and depressive symptoms were higher compared to other patient groups.

Key messages

• GI-HPB patients have a lower quality of life, participate less, and have less daily functioning than healthy controls and higher malnutrition and depression than those with other chronic diseases.

• By using validated questionnaires, an impression of the overall health status of patients can be obtained through the concept of Positive Health.
The burden of psoriasis in Belgium, 2021
Authors: Claerman R , Devleesschauwer B , Nayani S , De Pauw R
Published: October 2024

Psoriasis is a common, chronic, inflammatory skin disease with a great impact on healthcare systems. Given the limitations of the currently available burden estimates, estimates of the Belgian national burden of disease study are necessary in order to guide decision-making processes within the health sector. According to the Global Psoriasis Atlas, the prevalence of psoriasis is rising globally. The current study aims to estimate the burden of psoriasis in Belgium using national data. As there is no single comprehensive data source on prevalence of psoriasis in Belgium, a critical appraisal of existing local and national data sources was conducted. We estimated the non-fatal psoriasis burden in terms of years lived with disability (YLD). Estimated prevalence data were combined with disability weights to yield YLDs imposed by psoriasis. Mortality attributable to psoriasis was assumed to be zero, in line with the Global Burden of Disease study (GBD) 2019. We assessed three data sources containing information on existing cases with psoriasis in Belgium. Based on qualitative and quantitative appraisal, a widespread network of general practitioners was identified as the best available national data source. In 2021, the prevalence of psoriasis in Belgium was 2.1%, leading to 13084 DALYs (113 DALYs per 100 000). The burden of psoriasis was in line with national disease burden estimates for bipolar disorder, multiple myeloma, and hearing loss. Our prevalence, YLD, and DALY estimates for psoriasis in Belgium were however lower than those of the GBD study. Psoriasis imposes a non-negligible burden on population health in Belgium, despite it not being a cause of death. Along progression in psoriasis management, objective evaluation of psoriasis burden is critical to track the trends at the population level.

Key messages

• Psoriasis is a common skin disease with a relatively high morbidity burden.

• Information on psoriasis prevalence and burden are crucial for disease management and appropriate health-care planning.
Cancer prevention for homeless people: Qualitative evaluation of the Health Navigator Model
Authors: Schiffler T , Jeleff M , Alhambra-Borrás T , Gawronska J , Rico Varadé M , Gómez Trenado R , Barrio Cortes J , Tabaki I , Moudatsou M , Grabovac I
Published: October 2024

Background

People experiencing homelessness (PEH) face significant barriers when accessing cancer preventive services. The Health Navigator Model (HNM) seeks to address these challenges by improving access and engagement with cancer preventive care through tailored navigation services. This study aimed to explore PEH’s and health navigators’ experiences with the HNM.

Methods

This qualitative evaluation involved semi-structured interviews with a total of 61 PEH receiving the HNM intervention and 11 health navigators across four pilot sites in Austria, Greece, Spain, and the UK. Data were analyzed thematically using a cross-national coding framework.

Results

Following overarching themes were identified: (1) State of health and perception of health of PEH; (2) Experiences and understanding of cancer prevention; (3) Perceived effects of the Health Navigation intervention; (4) Navigators’ experiences with the implementation of the Health Navigation intervention; and (5) Effects of the Health Navigation intervention from the navigator perspective and sustainability of the intervention. Participants reported a general lack of access to healthcare services and low cancer prevention literacy. The HNM intervention led to increased engagement in cancer prevention activities, such as screenings, facilitated by the personalized support from health navigators. Navigators played a crucial role in bridging the gap between PEH and healthcare systems, though challenges such as mistrust and logistical barriers persisted.

Conclusions

The HNM has shown potential in enhancing cancer preventive care access for PEH by providing personalized guidance and support. The navigators’ role was pivotal in overcoming systemic and individual barriers, suggesting the need for integrated services that cater specifically to PEH. Future implementations should consider continuous training for navigators and further integration into local health systems to expand the benefits of the intervention.

Key messages

• The Health Navigator Model effectively enhanced cancer prevention engagement among people experiencing homelessness and empowered them through tailored and person-centered support.

• Health navigators bridged healthcare gaps for people experiencing homelessness, improving their access to cancer preventive care services in their local settings.
Multidisciplinary management of gastroesophageal reflux disease: an italian retrospective study
Authors: Nasi G , Brandimarte G , Pasta A , Pellizzaro F , Marabotto E , Calabrese F , Formisano E , Manes G , Gravina A G , Savarino E V
Published: October 2024

Background

Millions of individuals are affected by gastroesophageal reflux disease (GERD) that causes significant discomfort negatively affecting patients’ overall quality of life. For a collaborative approach of continuous improvement in public health we wanted to know the real-world perspectives in the multidisciplinary and multimodal management pathway.

Methods

We aimed to interview a sample of gastroenterologists (GE), primary care physicians (GP), and otolaryngologists (ENT) to investigate the management of the intake and treatment of patients reporting symptoms of GERD. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life was explored with the GERD Impact Scale (GSI) and Reflux Symptom Index (RSI).

Results

A total of 6211 patients were analyzed of whom with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). GSI was highest in patients followed by GE (9 points) and GP (9 points) than ENT specialists (8 points), while the RSI was higher in the ENT group (14.3 ± 6.93) than in the groups of GP and GE, respectively (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the greatest negative impact on quality of life (p < 0.0001). Of the 3,025 patients who used (proton pump inhibitors) PPIs, non-responders had a lower GSI when treated with a combination of adjunctive drug treatments and bioadhesive compounds, compared with single-component drugs.

Conclusions

The multidisciplinary and multimodal approach to the management pathway of GERD patients reveals variations in patient profiles by physician specialty, directing toward more appropriate and targeted treatments. In addition, the combination of adjunctive drug treatments and bioadhesive compounds appears to be effective in the management of patients refractory to PPIs.

Key messages

• The presentation of GERD symptoms is different in accordance with the physician’s speciality: the patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life.

• The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.
Digital Public Health and Digital Health: twins or Neighbors? A data protection perspective
Authors: Macedo Silva A , Ventura M
Published: October 2024

Enhancing digital public health (DiPH) terminology may foster a better understanding of the legal framework that grounds the use of personal health data within and outside public health policy and public health systems. Terminology accuracy is, therefore, relevant to understanding the data protection regulations that apply to DiPH interventions. The broader or narrower possibilities for using personal health data in digital health interventions depend on the legal basis that justifies (or not) the access to personal health data, whether inside public health policy or outside (e.g., in private health companies). In the context of digital health policy for DiPH, using personal health data is based on public law, analyzing proportionality, necessity, and the legitimacy of the interest. In contrast, for digital health interventions outside public health policy or in an individual clinical approach (like in digital health), the use of personal health data is based on informed consent. Brazilian data protection law (LGPD) and European GDPR provide the legal basis for public health systems’ use of health data in health policy. As a result, the DiPH approach highlights the relevance of using digital technologies and health data to strengthen public health systems within the platform economy and the context of surveillance capitalism. This presentation will shed light on the expansion of digital technologies and health data in health policy in the face of data science, highlighting the need to delve into the terminology of DiPH, understanding its boundaries and legal differences from its neighbors (not twins) outside health policy. Clarifying the DiPH approach, potentially leading to standards in terminology and embedding a data protection perspective, may maximize the accuracy of the legal justification for personal health data use in health policies. DiPH, therefore, may foster data protection, public health systems, and policies strengthening with health data.
Post-infection symptoms up to 24 months after COVID-19: a matched cohort study in Berlin, Germany
Authors: Meierkord A , Schulze D , Gertler M , Seybold J , Mall M A , Kurth T , Mockenhaupt F P , Theuring S
Published: October 2024

Background

Long-term health consequences after mild COVID-19 are not well described. Our aim was to estimate their prevalence and describe the time course of signs and symptoms for a period of up to 24 months after confirmed SARS-CoV-2 infection.

Methods

We conducted a cohort study matched for age, sex, and test week among individuals who had attended the public COVID-19 test center at Charité - Universitätsmedizin Berlin, Germany. In early 2022, 576 former COVID-19 patients (>95% non-hospitalised) and 302 uninfected individuals responded to a questionnaire on retrospective monthly symptoms since the test date up to 24 months after.

Results

Symptoms compatible with long COVID were present in 42.9% (247/576) of former COVID-19 patients, compared with 21.2% (64/302) in the uninfected group. In former patients, unadjusted odds ratios (OR) were highest for disturbed taste/smell (OR 9.1 [95% CI: 4.0 - 21.1]), memory difficulties (OR 5.1 [95% CI: 2.9 - 8.9]) and shortness of breath at rest (OR 4.5 [95% CI: 1.9 - 10.6]). Whilst in most former COVID-19 patients, symptoms occurred in one coherent period and resolved after a median of 6.5 months, taste/smell disturbance and neurological/cognitive symptoms showed longer times until recovery and 28.7% (31/108) still reported long COVID-compatible symptoms 18 months after initial COVID-19. Factors associated with long COVID-compatible symptoms included hospitalisation (OR 4.2 [95% CI: 1.7 - 10.8], symptomatic COVID-19 infection (OR 3.4 [95% CI: 1.9 - 6.3], low household income (OR 1.8 [95% CI: 1.2 - 2.7], and female sex (OR 1.7 [95% CI: 1.2 - 2.4]).

Conclusions

Post-infection symptoms in mild COVID-19 mostly persist for about half a year, but sometimes longer. Among uninfected individuals who never experienced COVID-19, 21.2% also reported long COVID-compatible symptoms. The current long COVID definition might require revision to prevent misclassification and over-reporting, and to improve diagnosis and prevalence estimates.

Key messages

• A more precise definition of long COVID is needed to prevent over-reporting of symptoms compatible with long COVID, and to improve diagnosis, prevalence estimates and research harmonisation.

• Post-infection symptoms after mild COVID-19 are common, mostly persist for about half a year but sometimes longer for more than 20 months.