bluuebunny/crossref_metadata_2025 huggingface dataset:
Policies and programs on children’s health promotion in the EU in the context of the JA Health4EUKids
Authors: Giusti A , Di Stefano V , Scardetta P , Zambri F , Palermo V , Di Nolfi A , Dittami A , Martelli G , Cattaneo C ,   Health4EUKids Joint Action Group
Published: October 2024

Background

Overweight and obesity prevalence are a global public health challenge. The prevalence is rapidly increasing, with significant health risks such as cardiovascular disease, type 2 diabetes, and cancer.

Objectives

To describe the state of the art of policies and programs (PPs) on children’s health promotion and responsive parenthood (children 0-12 years) in the EU, and to identify their gaps.

Methods

A cross-sectional study was carried out through an online survey, as part of the Health4EUKids Joint Action (JA) (HADEA n.101082462), between October and December 2023, targeting all EU member states (MSs) involved.

Results

The survey collected information about 74 PPs from 11 EU MSs of the JA. The PPs are primarily focused on healthcare (62.1%), education (24.1%), and social sectors (10.3%), with a focus on children aged 6-11 years. The settings for PPs include primary schools, communities, secondary schools, and healthcare services. The PPs are characterized by different degrees of innovation, controversy, equity, transferability, and sustainability, although the structural or systemic impact and public visibility appear to be lower among other characteristics. The formulation and design of PPs include problem analysis (73%), based on national or local data and on stakeholder consultation. As for implementation, most PPs are implemented upon release, but recommended action and allocated human resources are not fully adequate. Regular monitoring and evaluation (47.3%) are based on defined outcomes, standards, and indicators (63.5%). The results are disseminated to decision-makers and stakeholders (37.8%), through media, and to the general population (32.4%).

Conclusions

Most PPs are variable and context-dependent. It is necessary to align the policies with the implementation, in all its aspects, and to strengthen monitoring, evaluation, and communication with the relevant stakeholders, which currently appear to be the most lacking aspects.

Key messages

• Most European policies and programs are context-dependent, mainly in healthcare. Yet, a cross-sectoral trend involving health, education, and social sectors emerges.

• The study stresses the need for better alignment between policy formulation and implementation to enhance the effectiveness of EU children’s health programs.
Exercise interventions for Long COVID: a systematic review of randomised controlled trials
Authors: McDowell C , Tyner B , Shrestha S , McManus L , Comaskey F , Harrington P , Walsh K , O’Neill M , Ryan M
Published: October 2024

Background

Long COVID is prevalent and costly. There is much debate around the effectiveness and tolerance of exercise among people with Long COVID due to the potential to exacerbate symptoms. Therefore, this systematic review aimed to examine the effectiveness and tolerance of exercise interventions among people with Long COVID as part of a wider project to inform updates to the Irish Health Service Executive’s Long COVID interim model of care.

Methods

Medline via EBSCOhost, Embase, and CENTRAL were systematically searched on 28 February 2023. Inclusion criteria were: (1) participants with Long COVID; (2) random assignment to either an exercise intervention or a comparison group; (3) a quantitative measure of at least one of 12 core Long COVID outcomes. Two reviewers independently extracted data and assessed study risk of bias using the Cochrane Risk of Bias tool.

Results

In total, 4,394 studies were identified, 569 full texts were screened, and eight studies were included. Follow up periods ranged from two to 28 weeks (mean=8.5 weeks). Sample sizes ranged from 39 to 119 (mean=56). All studies were in adults (mean age=49.9 years) and both sexes (mean female proportion=53.9%). Four studies were at low risk of bias, two unclear, and two high. The evidence suggests that exercise interventions led to short-term improvements in dyspnoea, fatigue, physical function and the physical domain of quality of life. Of the five studies that reported adverse events, rates were low and, when reported, mild. Of the seven studies that reported sufficient information, one of 252 participants who received exercise discontinued the intervention due to tolerance-related issues.

Conclusions

Available evidence suggests that exercise interventions may have short-term benefits and be tolerable among some people with Long COVID. However, the evidence base consists of a limited number of studies with small sample sizes and short follow-up periods.

Key messages

• There is much debate around the effectiveness and safety of exercise among people with Long COVID due to the potential to exacerbate symptoms.

• The available evidence suggests that appropriate exercise interventions may have short-term benefits and be tolerable. However, there are notable limitations among the evidence.
Investigating the Mental Health Outcomes and Treatment Gap Among Sexual Minorities in Czechia: A National Cross-Sectional Study
Authors: Pitonak M , Formánek T , Potočár L
Published: October 2024

Aims

This study aims to (1) estimate the prevalence and relative risk of mental disorders, (2) assess the severity of mental health symptoms, and (3) investigate the treatment gap for mental disorders within SM.

Methods

Data from a cross-sectional, nationally representative survey of 3,063 Czech adults (response rate = 58.6%) were utilized. The Mini-International Neuropsychiatric Interview was employed to screen for mental disorders. In those identified with mental disorders, help-seeking behaviors over the past 12 months were examined. The severity of mental health symptoms was evaluated using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Prevalence rates of mental disorders associated treatment gaps, and relative risks of mental disorders were calculated.

Results

The prevalence of mental disorders among heterosexual, gay or lesbian, bisexual, and more sexually diverse individuals was 18.9% (17.4-20.3), 52.3% (36.9-67.6), 33.3% (19.5-47.2), and 25.9% (13.9-38), respectively. Suicidal thoughts and behaviors were reported in 5.7% (4.9-6.6) of heterosexual individuals compared with 25.0% (11.7-38.3) in gay or lesbian, 22.9% (10.6-35.3) in bisexual, and 11.1% (2.5-19.8) in more sexually diverse individuals. After adjusting for confounders, gay or lesbian individuals demonstrated an increased risk of having at least one current mental disorder compared with heterosexual people (OR = 3.5 95% CI(1.8-6.8)). Bisexual and more sexually diverse individuals demonstrated risks consistent with a null effect. No substantial differences in treatment gap were detected between heterosexuals and SM who scored positively for at least one current mental disorder.

Conclusions

The findings underscore the urgent need for systemic changes to improve the mental health outcomes of Czech SM. Addressing structural stigma and ensuring sensitive care are imperative to mitigate the health disparities faced by Czech SM.
Calculating potential impact fractions to assess the impact of tobacco control policies
Authors: Mons U
Published: October 2024

This presentation will provide a straightforward and accessible method for evaluating the effectiveness of various tobacco control policies in reducing the smoking-associated disease burden. To estimate numbers and proportions of potentially avoidable disease cases under different policy intervention scenarios (such as cigarette tax/price increases, comprehensive marketing ban, and plain packaging), this approach entails the calculation of age- and sex-specific potential impact fractions, representing the percentage change in disease risk following changes in exposure to smoking. The approach can account for lag and latency periods between reductions in smoking prevalence and declines in disease excess risks. The future disease burden is estimated by combining data on the incidence or mortality of the disease of interest, published effect sizes of tobacco control policies, and national smoking prevalence data. Intervention scenarios are compared against a status quo scenario that assumes the continuation of recent smoking trends. The presentation will outline the approach, using the example of smoking-associated cancer, and discuss model assumptions, required data, and sensitivity analyses. This straightforward modelling framework enables the comparison of different health policy measures’ impacts, providing valuable insights for policymakers and public health officials regarding the potential public health impact of tobacco control policy measures.
The status of health information systems and digital transformation in the European Region
Authors: Verschuuren M , Novillo Ortiz D
Published: October 2024

Although there have been investments in health information systems (HIS) and digitalization, WHO/Europe’s work with Member States (MS) shows that much can be improved still. Typically, there is a strong focus on data collection, but less on analysis and knowledge translation, resulting in available data not being optimally used to support decision making. Standards for data exchange and interoperability have not yet been fully implemented. Efforts are underway to train healthcare professionals, yet only half of MS have developed policies for digital health literacy. Fewer still have implemented a comprehensive digital inclusion plan, leaving disadvantaged populations at risk of falling behind. In line with the traditionally strong focus on HIS strengthening in WHO’s work, the European Programme of Work 2020-2025 (EPW) emphasises the need for MS to improve and modernise their HIS to ensure that decisions are data driven. One of the EPW flagship initiatives is Empowerment through Digital Health, promoting the leveraging and scaling up of digital transformation for better health. The Regional digital health action plan for the WHO European Region 2023-2030 outlines the strategic actions needed to achieve this, while fully respecting the values of equity, solidarity and human rights. Collaboration with MS and international partners is vital in this work. WHO/Europe has established several MS-driven health information networks in the past, most notably the European Health Information Initiative (the EHII). The EHII in 2023 has made a restart in the form of the European Health Information Network (HIN). The HIN will guide the work under the EU-funded action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’, which will be implemented by WHO/Europe. This strong European Commission and WHO/Europe partnership will be a main catalyst for HIS improvement in the Region the coming years.
Experiences from the European Region: case studies and scenarios to inform ways forward in digital health
Authors: Davtyan K
Published: October 2024

Member States in the WHO European Region face similar challenges when it comes to strengthening their HIS and implementing digital health solutions. From WHO/Europe’s work with its Member States, several important preconditions have become apparent for successful and sustainable digital transformation. Firstly, the importance of recognising that implementing digital tools is not a one-off investment, but that this takes a long-term vision including long-term budgeting. Having business continuity plans also is a key element of sustainable implementation of digital tools, that is often not adequately addressed in practice. Secondly, the importance of comprehensive strategic planning. Implementing digital tools is not only about software and hardware, but also about people and processes. Here it is also crucial for policymakers to understand that, to be able to harvest the benefits of data that are gathered by means of digital tools, resources for data processing and analysis also need to be made available. Last but not least, an important precondition for successful digital transformation is stakeholder involvement. Often, new software is developed without adequately involving the end-user, resulting in for example apps that do not meet patients’ needs. Or in electronic health record systems that are not user-friendly for the healthcare staff that need to enter the data, with incomplete and low quality information as a consequence. Stakeholder involvement is essential in strategic planning for digital health as well. Think for example about standardization and accreditation agencies, and institutes that will be secondary users of data for statistics and research. In this presentation, several case studies from across the European Region will be presented, illustrating how digital transformation in health can be successfully and sustainably implemented.
Integrating social inequalities in the burden of environmental stressors
Authors: Gorasso V , Mogin G , Idavain J , Priem F , Assunção R , Delaunay-Havard S , Castro A , Charalampous P , Baravelli C
Published: October 2024

In the process of designing equitable policies to reduce the burden of environmental stressors, it needs to be taken into consideration that socially disadvantaged communities are disproportionately exposed to environmental pollutants. These environmental health inequalities are currently however not routinely taken into account when designing mitigation measures, amongst others because of the absence of a coherent methodological framework. Within the BEST-COST project, an innovative framework for assessing social inequalities in the socioeconomic impact of environmental stressors will be developed and implemented. In particular, a novel index of multiple deprivation was developed. This includes indicators that are considered to be temporally and culturally valid for assessing social and material deprivation in Europe. In particular the new index was developed to make comparison across different European countries and to be used at a small geographical level. Within the workshop we will discuss the stepwise framework developed, starting from the results of a scoping review conducted to gather information methodological approaches used in the currently existing MDIs developed in Europe. The results of the scoping review were used to make informative decisions about the selection of indicators and other relevant methods (e.g. weighting). The construction of the composite score for the use within BEST-COST was evaluated also considering the data availability of the selected indicators at a small geographical level (i.e. LAU2) for the case-study countries: Belgium, Estonia, France, Norway and Portugal. Initial results of the quantification of social inequalities in the burden of environmental will be presented. Participants to the workshop will be able to understand the advantages and challenges of this kind of exercises with specific examples.
Mapping Long COVID across the EU: definitions, guidelines and surveillance systems in EU Member States
Authors: Van Der Heide I , Hansen J
Published: October 2024

A mapping study had been conducted to provide insight into 1) Long COVID definitions, 2) guidelines and intelligence on diagnosis and treatment, and 3) surveillance systems, as used/implemented in EU Member States plus Iceland, Norway, the United States, Canada, New Zealand, and Australia. Findings show that most Long COVID definitions align with WHO or NICE criteria, although there are also notable differences between definitions. The study also found Long COVID guidelines for diagnosis and treatment in 21 out of 34 selected countries. Common elements include advocating a multidisciplinary approach, a central role for primary care, and the focus on rehabilitation. Some guidelines include recommendations for referral to specialised care and follow-up procedures. Guidelines also differ in their target audience and in terms of their focus specific symptoms or organ systems that are affected by Long COVID. When it comes to Long COVID surveillance systems only a limited number of (nine) registries were found. Five of the Long COVID registries are based on self-registration. As limited information is available for most registries, a detailed understanding of their structures and goals in comparison to others is hindered. In conclusion, the study underlines the interconnectedness of Long COVID definitions, the development of guidelines, and surveillance systems. Given the variability in definitions and the voluntary entry of patients into the existing registries, there are no good estimates yet of the total numbers of patients and the severity of their disease in EU Member States. Linking information from cohort studies and clinical trials may be necessary to provide the full picture of the burden of disease of Long COVID. Still, preliminary estimates indicate that a significant proportion of those infected with COVID-19 experience long lasting symptoms, leading to impaired quality of life, also placing a significant burden on national health systems in the future.
Developing a set of core items for assessing preparedness in Italy: a Delphi approach
Authors: Amicosante AMV , Baccolini V , Vacchio M R , Baglio G , Eugeni E , De Vito C , Migliara G
Published: October 2024

Background

Effective pandemic management relies on preparedness and several tools are available for evaluation. However, due to differences in regional healthcare organization and structures, these may not accurately evaluate Italy’s capacities. This study, part of a project funded by the Italian Ministry of Health, report on the development of an assessment tool capable of evaluating the preparedness to confront pandemics at the regional level based on the actions outlined by the Italian influenza pandemic plan.

Methods

A desk research was carried out for preparedness evaluation tools, consulting Public Health Agencies, and Google Scholar and Search. Tools evaluation items were extracted, associated with the Italian plan, and screened for relevance and data availability. Selected items were then subjected to a two-round Delphi procedure involving 18 stakeholders from academia, local health services, and national agencies. The agreement was assessed using a 10-point Likert scale, and defined as a mean score ≥8, and consensus as a score standard deviation (SD) ≤1.5. Items with mean score ≥ 8 and SD > 1.5 after the first round were sent to the second round.

Results

A total of 6 tools were included in the study, from which 303 evaluation items matched the actions of the plan. After the screening phase, 122 indicators were deemed relevant and potentially available and sent to the Delphi procedure. Eighteen (14.8%) items reached both agreement and consensus in the first round, while another fifteen (12.3%) after the second. The 33 items covered all the domains of the national plan, especially Research and Development (21.1%) and Clinical Governance (15.2%).

Conclusions

The development of a set of core items that are agile, relevant, and readily available was facilitated by the involvement of stakeholders from different sectors. Moreover, adherence to the Italian pandemic plan should ensure that these items are deeply integrated into the unique context of the Italian regions.

Key messages

• The Delphi process identified a narrow number of evaluation items with great consensus.

• Consensus was searched involving stakeholders from central authorities, local units, and academia.
Excess mortality in individuals with and without COVID-19 vaccination in the Netherlands in 2021
Authors: Rijpkema C , Heins M , Bos I , Ramerman L , Verheij R A , Hek K
Published: October 2024

Background

The COVID-19 pandemic greatly affected public health, evident in higher mortality rates in 2020-2022. COVID-19 vaccinations reduced global mortality, though this may vary across subpopulations. We aimed to study the role of COVID-19 vaccination in excess mortality by examining individuals with and without COVID-19 vaccine while accounting for characteristics such as income and frailty.

Methods

In this observational study, electronic health record data from general practitioners participating in the Nivel Primary Care Database were linked to demographic data and COVID-19 vaccination data. Patients were categorized in age groups, based on vaccination invitation dates, with the index date set as vaccination date for vaccinated individuals and the expected vaccination date for nonvaccinated ones. Expected mortality rates were calculated using 2015-2018 data, accounting for season, sex, income, migration background, palliative care, and frailty. We compared expected mortality to observed mortality in 2021 to determine excess mortality.

Results

Preliminary results show that nonvaccinated individuals (n = 160.253) were younger, and less frail, but more often received palliative care than vaccinated individuals (n = 819.363). In nonvaccinated individuals, excess mortality in the three months after expected vaccination ranged from 22-61% for 36-60 year olds to 209-233% for the 81+ year olds. In vaccinated individuals, excess mortality ranged from -64- -61% in 36-60 year olds to 2-4% in 81+ year olds. When not correcting for palliative care, excess mortality estimations increased significantly in nonvaccinated individuals (e.g. for 81+ year olds: 504%-514%).

Conclusions

Excess mortality was hardly present in vaccinated subgroups, while it was high in all nonvaccinated subgroups. Our study shed light on characteristics of nonvaccinated individuals, who require special attention during future vaccination programs to prevent excess mortality.

Key messages

• Excess mortality in the three months after (expected) COVID-19 vaccination was high among nonvaccinated individuals and hardly observed amongst vaccinated individuals.

• Routine care data could help identify terminally ill individuals, who are overrepresented amongst nonvaccinated individuals, and mitigate the so called healthy vaccinee bias in vaccination research.
Systematic review of the literature about immunogenity and antibodies persistance of Tdap vaccination
Authors: Bartucciotto L , Genovese C , La Spada G , Saia I , Rizzo C , Squeri R
Published: October 2024

Introduction

In industrialized countries, routine use of pertussis vaccines has shifted the burden of pertussis disease from children to infants, adolescents and adults, leading to the necessity of booster doses.

Materials and methods

We prepared the review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) with the aim of a) to describe the immunogenity of the main available vaccines for adolescents and adults b) to describe antibodies persistance after immunization with the main vaccines available in childhood and adults and, also, possible co-administration and c) to identify the gold standard for adolescent and adult immunizations.

Results

Of 6906 records identified, after removing duplicate records, 12 RCT were included (people aged 11-73): of these 7 studies had only 1 control group, 4 studies had 2 control group and 1 had 5 control group; moreover, of the 12 studies included only 2 regarding co-administration and all were about immunogenity. 9 out 12 studies had a Jadad score above 3 points and 10 out 12 meet the criteria of Cocrane Back Review Group Criteria List for Methodological Quality Assessment.

Discussion and conclusions

We found a limited number of good-quality RCTs investigating our object. The five component vaccines, although containing a lower dosage of antigen, are found to be more effective than one components vaccines for prevention. Evidences support the use of 5- components vaccines for booster sessions in adolescence and adulthood.

Key messages

• Although 3-component and 5-component vaccines contain a lower dose of antigen, they are more effective than 1-component vaccines in the prevention of diphtheria-tetanus and Bordetella pertussis.

• The robustness of the data and the analytical tests support the use of vaccines with reduced antigen concentration for decennial booster sessions in adolescence and adulthood.
Impact of artificial intelligence on healthcare-associated infection control: a systematic review
Authors: Barbati C , Viviani L , Vecchio R , Arzilli G , De Angelis L , Baglivo F , Rizzo C , Odone A
Published: October 2024

Background

Healthcare-associated infections (HAIs) represent a significant public health concern, correlating with increased morbidity, mortality rates and healthcare expenditures. While artificial intelligence (AI) systems offer transformative potential in enhancing HAIs detection and control practices, the actual performance effectiveness of these systems remains uncertain. This systematic review updates a previously published study from 2020 and evaluates the performance of AI-based tools for surveillance, detection, and control of HAIs.

Methods

PRISMA 2020 guidelines were applied. The study protocol has been registered in PROSPERO (ID: CRD42024513145). PubMed, Embase, Scopus and Web of Science were searched for experimental and observational studies assessing the performance of AI-based tools to detect and control HAIs, published in English.

Results

From 8,701 articles initially identified, 4,212 records were removed due to duplication. Out of 4,489 papers screened, 147 were included. Studies reported performance measures including sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve, accuracy, precision, F1 score. Significant heterogeneity was found in the types of technology, infections targeted, health care settings and data sources between studies.

Conclusions

The increase in published evidence since the previous review reflects the growing interest and use of new technologies such as Large Language Models, showing promising performance in surveillance, early diagnosis and prediction of HAIs. However, the observed heterogeneity in study designs, targeted infections, healthcare settings, and data sources underscores the need for standardised methodologies and robust validation processes to ensure the reliability and comparability of results across different studies.

Key messages

• The use of AI-based tools has the potential to enhance surveillance, detection, and control of healthcare-associated infections, offering a transformative impact on healthcare systems.

• Standardised methodologies and validation processes are needed to ensure comparable results across studies and to maximise the real-world impact of AI tools in HAI surveillance and control efforts.
How effective are eHealth literacy interventions? A meta-analysis of experimental studies
Authors: Maranesi E , Barbati C , Vigezzi G P , Bonciani M , Bailoni T , Giammarchi C , Lenge M , Dragoni M , Barbi E , Odone A
Published: October 2024

The rapid evolution of digital health emphasises the need for effective eHealth literacy (eHL) to ensure equitable access to health information and improve patient outcomes. This systematic review and meta-analysis aim to assess the effectiveness of eHL interventions, addressing the significant gap in knowledge about which strategies are most beneficial. Adhering to PRISMA guidelines, we systematically retrieved, quantitatively pooled and critically appraised available experimental evidence on the effectiveness of eHL interventions across different populations. PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies reporting original quantitative outcomes of eHL, assessed by the eHealth Literacy Scale or other validated scales. Data were pooled using a random-effects model, with critical appraisal of the included studies. From the 504 records screened, 15 studies met the inclusion criteria. They encompass interventions targeting adults with chronic diseases (6 studies), older adults (5), and young people (4) and examine either individualistic or collaborative approaches (respectively, 9 and 5 studies, and 1 assessing both). The meta-analysis revealed significant improvements in eHL, both pre- vs post-intervention (UMD 5.81, 95%CI 3.38-8.26, N = 1,025) and experimental vs control groups (OR 3.65, 95%CI 2.06-6.46, N = 1,258). Meta-regression showed a significant correlation between pre/post-intervention outcomes and baseline eHL levels (slope=-0.91, p-value=0.009). Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights (role of baseline eHL levels and intervention approach) for intervention design and implementation that are adaptable to various demographic contexts. This research was supported by the National Plan for Complementary Investments to the NRRP Hub Life Science-Digital Health (PNC-E3-2022-23683267, DHEAL-COM).
Precarious employment expectancy by history of mental-health-related sickness absence in Finland
Authors: Leinonen T , Salonen L , Hartikainen E , Bodin T , Solovieva S
Published: October 2024

Background

Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence.

Methods

We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history).

Results

Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%.

Conclusions

Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability.

Key messages

• People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market.

• Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.
Predictors of disability retirement - a prediction model for disability pension application risk
Authors: Sohlman P
Published: October 2024

Background

Regarding the objective of preventing early exits from labor market, the late life-course years present an important timeframe. It is essential to identify the employees in the greatest risk of permanently losing their work ability. In practical applications, multifactorial models are needed to evaluate the combined effect of risk factors. In this study, the disability pension risk is modeled based on large unique register data, at the same time assessing the effect of sickness absences (SA) of different lengths.

Methods

We utilize a logistic model for the risk of filing a first-time disability pension application (DPA) based on register data on 222,321 Finnish municipal sector employees. The data include employment and sickness spells, occupations, and wages in 2016-2018 as covariates. During the 3-year follow-up, 2,969 employees filed a DPA. The data include also short SA spells, a novelty in these kinds of studies. DPA is used as a follow-up to include employees who receive a rejecting decision but still carry a physician’s evaluation of diminished work ability.

Results

The resulting model can accurately predict the risk of DPA in employee groups. Age, occupation, cumulative SAs preceding the application, and the number of SA spells of all lengths, also short ones, have a significant increasing effect on the DPA risk. Proximity of the retirement age and high earnings decrease the risk of DPA. Surprisingly gender had no effect on the risk.

Conclusions

The results indicate that register-based sociodemographic data is very useful in modeling the employee DPA risk in public sector employee groups. The resulting model provides a basis for tools for predicting the risk status of employee groups for the use of employers responsible for risk management and early intervention, also allowing for the assessment of economic effects of SAs and disability risk. The presented modeling results are already utilized among public sector employers in Finland.

Key messages

• Disability pension risk can accurately be predicted in public sector employee groups based on readily available sociodemographic register data.

• All sickness absences have a significant increasing effect on the risk of disability pension application, but the effect varies greatly depending on age and occupation.
Multiple behavioural risk factors and mental health complaints among adults in Estonia
Authors: Opikova G , Reile R , Konstabel K , Kask K
Published: October 2024

Background

Behavioural risk factors are inter-related and often coincide, resulting in potentially worse mental health outcomes. This study explores the association between multiple behavioural risk factors and mental health among adults in Estonia.

Methods

We used nationally representative survey data from 2020 (n = 6404) to study the co-occurrence of lifestyle risk factors (smoking, alcohol consumption, physical inactivity, unhealthy diet, drug use, and high screen time) in relation to mental health indicators. Latent class analysis (LCA) was used to identify lifestyle risk profiles, while regression analysis was used to examine associations.

Results

Mental health outcomes were more frequent among females and younger respondents, but 54.4% of respondents reported having at least one mental health problem. Using LCA, three lifestyle classes were identified: multiple risk factors (17.9% of respondents), healthy lifestyle (76.1%), and drug use lifestyle (5.9%). Compared to individuals in healthy lifestyle class, respondents in multiple risk factors had higher odds for experiencing depressiveness (OR 1.46; CI 1.24-1.72), stress (OR 1.26; CI 1.06-1.49), and suicidal thoughts (OR 1.50; CI 1.26-1.80), as well as self-reported diagnoses of depression and insomnia, and using medications, such as antidepressants, hypnotics and sedatives. Respondents in drug use lifestyle had 1.5-2.5 times higher odds for all mental health items compared to healthy lifestyle class with largest difference found for suicidal thoughts (OR 2.46; CI 1.92-3.16) and medication use (OR 2.58; CI 1.91-3.47).

Conclusions

The current data highlights the importance of preventive measures targeting multiple behavioural risk factors, given that these factors often coincide. Moreover, the study showed a high proportion of individuals with at least one mental health problem, highlighting the necessity to continue efforts in preventive and interventive methods.

Key messages

• The study highlights the significant association between multiple behavioural risk factors and mental health outcomes.

• The study also emphasizes the importance of focused interventions targeting multiple behavioural risk factors to address the increased risk of mental health problems.
HIV risks and transactional sex among Swedish-born MSM and foreign-born MSM in Sweden
Authors: Causevic S , Strömdahl S , Ekström A M , Berglund T , Ingemarsdotter Persson K , Salazar M
Published: October 2024

Background

Transactional sex, which includes exchanging sex for material goods, services, or money, is a key HIV risk factor. Risk patterns associated with transactional sex among men who have sex with men (MSM) in Sweden, where buying sexual services is illegal, have not been examined earlier. This study aims to assess whether transactional sex (both buying and selling), country of birth, and migration-related factors (described by country of origin) are associated with self-reported HIV status among MSM in Sweden.

Methods

We analyzed secondary data from the 2017 European MSM Internet Survey (EMIS-2017), including participants reporting to live in Sweden (n = 4443). Using multivariate logistic regression analysis, we aimed to understand factors related to involvement in transactional sex and risk of HIV acquisition.

Results

Among the respondents, 5.4% reported living with HIV, with 8.8% of foreign-born MSM and 4.8% of Swedish-born MSM. The multivariable analysis showed that both selling and buying sex in the past five years increased the odds of reporting a positive HIV serostatus among all participants. Stratifying by transactional sex exposure and country of birth showed an HIV prevalence increase for all groups. Foreign-born selling or buying sex ever in the last five years had the highest prevalence of all groups (ranging from 17.8 to 19.1%). Other factors associated with a positive HIV status were age, outness, sex with a woman in the past twelve months, and condom use.

Conclusions

The relatively high reported HIV prevalence supports the need for HIV prevention, including the scale-up of access to pre-exposure prophylaxis to foreign-born MSM. A transparent discussion about risk factors and socioeconomic structures contributing to risk behaviors, including transactional sex, is needed.

Key messages

• Engaging in transactional sex increases the HIV risk among MSM in Sweden, particularly among foreign-born MSM.

• HIV prevention needs to address the socioeconomic factors contributing to risky behaviors, such as transactional sex.
The impact of parenthood on well-being: a qualitative study of mothers’ and fathers’ perceptions across European countries
Authors: Maia S , Pereira M , Mamelund S E , Amaro J , Fraga S , Leão T
Published: October 2024

Background

Parenthood significantly impacts the well-being of mothers and fathers. Yet, their experiences may differ according to societal roles and expectations. Parenthood can bring joy and fulfillment, but also emotional strain, particularly for mothers. Fathers’ involvement in caregiving has been recognized as crucial for family well-being, but studies on its health impact remain scarce. This study analyzed mothers’ and fathers’ perceptions of how parenthood affected their personal and professional well-being.

Methods

We conducted 30 semi-structured interviews with Portuguese mothers and fathers living in Portugal, Sweden, Norway, Germany, the Netherlands, the UK, Spain, and Italy. Thematic content analysis was performed to analyze the interviews.

Results

After becoming parents, male interviewees reported career benefits such as higher pay and career growth due to increased workload, while female interviewees reported greater family overload that spilled over into their professional lives. In Portugal, women faced work-life conflict as they felt more competent than their male partners in providing care and maintained their full-time paid work. In countries like Germany and Spain, women assumed the role of main caregivers but reduced their work commitments, either by working fewer hours or leaving the workforce. Self-reported health declined for both after parenthood, but differently. Some fathers engaged in less healthy behaviors, resulting in weight gain. In contrast, mothers, particularly in Portugal, were more prone to express emotions such as guilt, pressure, and anxiety due to role conflicts as workers, mothers, and wives.

Conclusions

Traditional gender norms still shape parental roles in work and family life, differently affecting women’s and men’s well-being. To address gender inequalities in parenthood, equal access to supportive measures such as shared parental leave is needed, as well as flexible working arrangements and childcare services.
Are prison settings included in national preparedness plans?
Authors: Alves da Costa F
Published: October 2024

With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.
Capability of ChatGPT to support the screening process of scoping reviews: A feasibility study
Authors: Nordmann K , Fischer F
Published: October 2024

Background

The time-consuming screening phase in health-related evidence syntheses is increasingly supported by artificial intelligence (AI). However, scoping reviews have not benefited as much as systematic reviews from such AI tools as they utilize conceptual rather than keyword-specific search strategies to address broad research questions. Context-understanding chatbots based on large language models could potentially enhance the efficiency of scoping review screenings. This study evaluates the performance of ChatGPT against an open-access AI tool used for abstract screening in systematic reviews and the costs involved.

Methods

Leveraging data from a prior scoping review, we compared the performance of ChatGPT 4.0 and 3.5 against Rayyan, using human researchers’ decisions as a benchmark. A random set of 50 included and 50 excluded abstracts was used to train Rayyan’s algorithm and to develop ChatGPT’s prompt. ChatGPT 4.0’s evaluation was repeated after 5-7 days to assess response consistency. We computed performance metrics including sensitivity, specificity, and accuracy.

Results

ChatGPT 4.0 and 3.5 achieved 68% accuracy, 11% precision, 99% negative predictive value, and 67% specificity. Sensitivity was high at 88-89% for ChatGPT 4.0 and 84% for ChatGPT 3.5. ChatGPT 4.0 showed a substantial interrater reliability between the two evaluations and moderate reliability compared to ChatGPT 3.5. The cost of deployment varied, with Rayyan being free, ChatGPT 3.5 costing $9.06 and ChatGPT 4.0 $505.72.

Conclusions

Given the exponential increase in publications, effective mechanisms to support the screening phase of scoping reviews are needed. Our feasibility study using ChatGPT to decide on abstracts’ inclusion or exclusion achieved good performance metrics. Given further positive evaluation, such chatbots might be incorporated in the standard screening process, possibly replacing a second screener, saving time and costs, and accelerating evidence synthesis.

Key messages

• ChatGPT performs well in supporting screening for scoping reviews, outperforming a traditional AI tool at reasonable costs.

• Employing chatbots like ChatGPT could potentially cut costs and time in scoping reviews.
Adverse childhood experiences and age-trajectories of depressive symptom for middle and older ages
Authors: Ren X , Li L , Demakakos P
Published: October 2024

Background

Adverse childhood experiences (ACEs) have lifelong impacts on health outcomes. Less is known about their effects on later outcomes (mental health). Moreover, associations of ACEs with age-trajectories of depressive symptoms and how they differ in different countries remain unclear. We investigated associations between ACEs and trajectories of depressive symptoms at mid-to-older ages in two distinct populations.

Methods

We used longitudinal data from English Longitudinal Study of Ageing (ELSA: n = 19602, ≥50y) and China Health and Retirement Longitudinal Study (CHARLS: n = 19561, ≥45y). Depressive symptoms were measured by Center for Epidemiologic Studies Depression scale at 10 waves (2002-2022) in ELSA and at 5 waves (2011-2020) in CHARLS. ACEs were retrospectively reported in both studies. We applied group-based trajectory modelling to identify distinct age-trajectories of depressive symptoms and multinomial regression to estimate associations between ACEs and trajectory groups.

Results

We identified three trajectory groups: in ELSA: high (12.3% in men and 14.7% in women), moderate (46.6% and 47.9%) and low (41.1% and 37.4%), and in CHARLS: high (9.3% and 13.2%), moderate (34.1% and 39.4%) and low (56.6% and 47.4%). Most ACEs were associated with increased risk of having moderate/ high trajectories of depressive symptoms after adjusting for other ACEs, sex, and childhood socioeconomic disadvantages. For example, for physical abuse, the adjusted relative risk ratio (RRRadj) for high and moderate trajectory groups was 2.09(1.99, 2.19) and 1.16(1.12, 1.20) respectively in ELSA. It was 1.34(1.23, 1.44) and 1.22(1.13, 1.32) in CHARLS. For domestic violence, the respective RRRadj was 1.90(1.65, 2.18) and 1.44(1.22, 1.70) in ELSA, and 1.33(1.22, 1.44) and 1.24(1.14, 1.35) in CHARLS.

Conclusions

ACEs have life-long effects on mental health at mid-to-older ages in both countries, highlighting the need of early intervention to improve mental health in later life.

Key messages

• Our work considered the distinct patterns of age-trajectories of depressive symptoms for adults at middle and older ages, capturing the changing process of mental health problems in later life.

• We also investigated the associations between childhood factors and trajectory of depressive symptoms, which helped to improve mental health for older people under the situation of global ageing.