bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine learning methods for diagnostic disease prediction and treatment decisions in parvovirus B19 positive viral cardiomyopathy
Authors: Baumeier C , Starlinger J , Aleshcheva G , Escher F , Schultheiss H P
Published: October 2024

Background

Parvovirus B19 (B19V) is the most common type of virus found in endomyocardial biopsies (EMB) from patients with inflammatory heart disease. However, the detection of genomic B19V-DNA appears to have little clinical significance and is often considered an incidental finding. Recent analyses of a large cohort of B19V-positive patients revealed that the detection of RNA transcripts rather than DNA is of clinical importance, as B19V-RNA-positive patients have a significantly worse cardiovascular outcome. Here, we applied machine learning (ML) methods to assess the impact of B19V transcriptional activity on cardiac inflammation and patient clinical outcome.

Methods and results

A total of 305 patients with a known clinical course and a positive endomyocardial B19V-DNA test were included in this study. Follow-up measurements of the B19V-specific transcripts VP1/2 and NS1 revealed significantly worse clinical courses than in patients without B19V-RNA detection (P=0.019, hazard ratio (95% CI)=1.62 (1.10-2.57)). LVEF at follow-up was significantly lower in patients with detected B19V-RNA (P=0.007), and adverse events such as worsening LV function (P=0.003) or stable systolic dysfunction (P=0.013) were more frequent in this group. Importantly, analysis of inflammatory markers in EMB showed no difference in patients with and without RNA detection (P=0.432), suggesting that the deterioration in clinical outcome was related to B19V transcriptional activity rather than an increase in inflammation. The analysis of area under the receiver operating characteristic curve (AUROC) of B19V-RNA-negative patients revealed that the macrophage marker MAC-1 (AUROC=0.66, P=0.002) was the single most prognostically relevant parameter, while the T cell marker CD3 (AUROC=0.73, P<0.001) was identified as the most prognostically relevant marker in B19V-RNA-positive patients. The linear combination of several inflammatory markers increased the AUROC value to 0.67 in B19V-RNA-negative patients and to 0.74 in B19V-RNA-positive patients. To further increase prognostic accuracy, we trained ML models on features derived from EMB inflammatory markers. For the prediction of major adverse cardiac events within 60 months, the best ML-models achieved an AUROC of 0.87 in B19V-RNA-positive and of 0.86 in B19V-RNA-negative patients, while models that neglect the differentiation of patients with regard to the presence of B19V RNA transcripts only achieved an AUROC of up to 0.76.

Conclusions

These results show that B19V transcriptional activity is an independent risk marker for adverse cardiac events in patients with viral cardiomyopathy and thus confirm the clinical-therapeutic importance of myocardial biopsy. Furthermore, we present an ML-based algorithm that accurately indicates disease progression in B19V-positive cardiomyopathy patients and is thus helpful for appropriate therapy recommendation.
Racism in health care: systemic changes and institutional policies to advance health equity
Authors: Khan-Gökkaya S
Published: October 2024

Globally, the COVID-19 pandemic has amplified inequalities in health care. Racism is one cause of such inequalities that disadvantage Black, Indigenous, and people of color around the world, but particularly in Germany, European countries, and the United States. To advance health equity and ensure an equitable health care system for marginalized groups, it is necessary to implement systemic change, but international studies indicate there is little evidence of antiracist interventions in organizations and through policies, as well as limited data on their effectiveness. This presentation will present novel research that identifies antiracist interventions on a systemic level, meaning interventions within organizations will be analyzed. The results from this research will be used to derive recommendations and inspire policymakers and providers toward equity-oriented health care. The overarching goal of the proposed research is to contribute to a paradigm shift in Germany and Europe more broadly and enrich a previously deficit-oriented perspective on the topic with important approaches and solutions. It will also increase the geopolitical relevance of the interventions in the US and enable cross-border exchange and partnerships.
Exploring racial inequalities in maternal mental health outcomes
Authors: Wilson C
Published: October 2024

Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.
How ambient NO2 impacts the mortality burden of ischemic heart disease in Portugal (2011-2021)?
Authors: Clemente M , Corda M , Martins C
Published: October 2024

Background

Air pollution is a major environmental risk to human health, contributing to premature death and disease. Nitrogen dioxide (NO2) is a pollutant of significant public health concern, associated with increased risks of all-cause mortality, particularly in cardiovascular and respiratory deaths. In 2021, NO2 exposure exceeding the World Health Organization Air Quality Guidelines resulted in 69,000 deaths in the European Union. This study aims to estimate the impact of ambient NO2 exposure on ischemic heart disease (IHD) in Portugal, from 2011 to 2021, estimated in years of life lost (YLL).

Methods

Data on ambient NO2 levels were obtained from the Portuguese Environment Agency’s online database QualAr. Only monitoring stations that reported valid data for at least 75% of the time in a year were considered. The number of IHD mortality cases from 2011 to 2021 was sourced from Statistics Portugal. The burden of IHD attributed to NO2 exposure was estimated in YLL for the Portuguese population aged 25 years and older, categorized by five-years age groups, regions of mainland Portugal and sex, using the population attributable fraction (PAF).

Results

Between 2011 and 2021, mainland Portugal experienced a declining trend in NO2 mean levels, with occasional fluctuations. Regarding IHD YLL attributed to NO2 exposure, the same trend was followed with an overall decline over the study period. In total, 94,843.75 (95% CI 53,408.35-134,766.17) IHD YLL were attributed to NO2 exposure, with an estimated number of IHD YLLs higher for males than for females.

Conclusions

These findings underscore the significant impact of air pollution on human health. Despite an overall reduction in YLL across mainland Portugal, persistent health effects emphasize the need to reduce NO2 concentrations, with informed decision-making being crucial to mitigate these impacts and protect public health.

Key messages

• Ambient NO2 exposure significantly impacts ischemic heart disease mortality in Portugal.

• These estimates underscore the necessity of well-informed decision-making to safeguard public health.
Exploring the relationship between energy poverty and mental wellbeing: a qualitative study
Authors: Stevens M M , Ambrosio-Albala P , van Ooij C , Searle B A , Garcia N , Rocher E , Middlemiss L , van Grieken A
Published: October 2024

Background

Rising rates of energy poverty in Europe, affecting 11% of households, are a serious public health concern. The inability to meet energy needs impacts mental wellbeing, preventing people from productively engaging in society. Our objective was to explore this relationship within the context of three European cities, each characterized by distinct climatic conditions, cultural and societal characteristics and governance arrangements. This work is part of the European funded research project WELLBASED, grant no. 945097.

Methods

Semi-structured interviews (n = 34) were conducted with people experiencing energy poverty in the United Kingdom, the Netherlands and Spain. Purposive sampling ensured the representation of a diverse range of family and household types, gender and experiences with energy poverty. Thematic analysis was conducted using MaxQDA software.

Preliminary results

The analysis resulted in six themes: (1) worries and fear (2) stress (3) value of the home and neighborhood, (4) caring for others, (5) engaging with daily life and (6) autonomy in managing the situation and seeking for and receiving support. Participants were worried and stressed about the rising energy bills, the thermal discomfort, and health impacts of their poor housing conditions. In relation to caring responsibilities, participants were especially concerned about the impact on their children and prioritized children’s needs. Participants also expressed a strong will for independence and having control over their lives, but at the same time valued being seen and supported.

Conclusions

The persistent worries, fear and stress highlight implications of failure to meet energy needs for mental wellbeing. Caring responsibilities, engaging with daily life and autonomy proved important for mental wellbeing among people living in energy poverty. Our findings call for addressing energy poverty challenges in public health programs to improve mental wellbeing of vulnerable citizens.

Key messages

• People experiencing energy poverty in the United Kingdom, Spain and the Netherlands recognize the impact of their energy poverty situation on their mental wellbeing.

• The public health community needs to be informed and engaged about the impact of energy poverty on mental wellbeing in order to take action.
Inequities in child health in Luxembourg
Authors: Seuring T , Ducomble T , Berthet F
Published: October 2024

Background

In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve.

Methods

We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles.

Results

We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits.

Conclusions

Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours.

Key messages

• Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health.

• Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.
The Africa CDC Guidance for Strengthening NCDI-MH Surveillance Systems: The role of HIS assessments
Authors: Kakunze A , Zobi M , Kabarega B , Moser F , Njobo Mamba D , Sarganas Margolis G , Alinon K , Abdulaziz M , Fehr A
Published: October 2024

Deaths due to NCDs, injuries and mental health conditions are expected to at least triple by 2063 in the region of the African Union. Population-based data for NCDI/MH and their determinants remain scarce in many AU MS; therefore, NCDI/MH surveillance is a flagship initiative in the Africa CDC NCDI/MH Strategy. In a survey conducted by Africa CDC and RKI in 2022 on the impact of COVID-19 on NCDI/MH in 10 AU MS, countries signaled the need for a continental guidance document. In 2023, Africa CDC and RKI performed desk reviews and facilitated peer-to-peer multi-country HIS assessment workshops, based on modified WHO and IANPHI tools. The first workshop took place in Zambia with experts from Botswana, Democratic Republic of Congo/DRC, Kenya and Zambia. The second workshop was hosted in Ghana and included DRC, Ghana, Morocco, Nigeria, Senegal and Sierra Leone. Participants came i.a. from ministries of health, national public health institutes or academia. The process included a virtual introductory meeting as well as half-day training sessions at the physical meeting for participants to familiarize themselves with the tools. Peer-to-peer assessment sessions took place on days 2 and 3. Day 4 was reserved for site visits to (public) health institutions of the hosting countries. On day 5, participants presented their findings to the plenary, which included high-level representations from host countries. The combined results from the survey, desk reviews and workshops informed the development of the continental Africa CDC Guidance for strengthening surveillance for NCDI/MH, launched at the 3rd Conference on Public Health in Africa. In four chapters, the Guidance covers recommendations on indicators, data sources and data types; surveillance system capacities; surveillance integration with existing systems; and data use. Implementation of the Guidance, including development of core health indicators, has been initiated by Africa CDC in 2024.
The EU project VAXaction: tacking effectively vaccine hesitancy in Europe
Authors: Signorelli C , Odone A , Barbati C , Cuciniello R , Lunetti C , Pennisi F , Viviani L , Correia T
Published: October 2024

The main objective of VAX-ACTION is to support EU Member States and relevant stakeholders to implement the results of tailored, evidence-based interventions aimed to reduce vaccine hesitancy. Based on the evaluation of effectiveness of these interventions, which will be conducted in selected target regions in EU member states, recommendations will be drawn through diverse dissemination strategies to allow scaling up good practices to other member States, but also to the USA and Canada, where gaps in implementation strategies also have prevented effective, evidence-based interventions aimed to better deal with vaccine hesitancy.

The first phase of the research involved some relevant systematic reviews with the aim of:

1. to map public health evidence and research results on large-scale vaccination programs in Europe and north America;

2. to map interventions aimed to address vaccine hesitancy regarding new and well-stablished vaccines and vaccination programs (Covid-19, mpox, national immunizations programs for children) in Europe and north America;

3. to identify successful and unsuccessful interventions designs aimed to address vaccine hesitancy, including challenges in the implementation, evaluation designs, and the feasibility of scaling-up solutions that are context-sensitive;

4. to identify significant similarities or dissimilarities in the designs and outcomes of interventions aimed to address vaccine hesitancy in northern countries where political and academic concern towards this phenomenon is growing;

5. to identify the extent to which ‘grounding’ (bottom-up) experiences aimed to address vaccine hesitancy are evidence-based, build on current international knowledge and guidelines, and whether they are internationally reported;

6. to systematize the mapping of interventions aimed to address vaccine hesitancy in the northern hemisphere in a way that can be shared and used by third parties.

This contribution will illustrate the results of the first phase of the project.
Unravelling COVID-19 social mortality patterns using conditional inference tree algorithm
Authors: Cavillot L , Van den Borre L , Vanthomme K , Scohy A , Deboosere P , Devleesschauwer B , Speybroeck N , Gadeyne S
Published: October 2024

Background

The COVID-19 pandemic led to significant excess mortality in 2020 in Belgium. By using microlevel cause-specific mortality data for the total Belgian adult population in 2020, three outcomes were considered in this study aiming at predicting sociodemographic (SD) and socioeconomic (SE) patterns of 1) COVID-19 specific death compared to survival; 2) all other causes of death (OCOD) compared to survival; 3) COVID-19 specific deaths compared to all OCOD.

Methods

Multivariable logistic regression models were fitted for the three outcomes. In addition, we computed conditional inference tree (CIT) algorithms, complementing regression models, to identify and rank the strongest SD and SE predictors of the three outcomes.

Results

Older people, males, people living in collectivities, first-generation migrants, and deprived SE groups experienced higher odds of dying from COVID-19 compared to survival; living in collectivities was identified by the CIT as the strongest predictor followed by age and sex. Education emerged as one of the strongest predictors for people not living in collectivities. Overall, similar patterns were observed for all OCOD except for first- and second-generation migrants having lower odds of all OCOD compared to survival; age group was identified by the CIT as the strongest predictor. Older people, males, people living in collectivities, first- and second-generation migrants, and people with lower levels of education had higher odds of COVID-19 death compared to all OCOD; living in collectivities was identified by the CIT as the strongest predictor followed by age, sex, and migration status. Education and income emerged as the strongest predictors among people not living in collectivities.

Conclusions

This study identified important SD and SE disparities in COVID-19 mortality underlying the importance of implementing preventive measures, particularly within the most vulnerable populations, in infectious disease pandemic preparedness.

Key messages

• Living in collectivities appeared to be the strongest predictor of COVID-19 death across all age groups, highlighting the importance of preventive measures in reducing the transmission of the virus.

• Poor education plays a crucial role in predicting COVID-19 death among people not living in collectivities, highlighting the importance of targeting preventive measures towards low educated groups.
COVID-19 vaccine effectiveness and hybrid immunity in the respiratory season of 2022-23 in Hungary
Authors: Oroszi B , Horváth J K , Túri G , Krisztalovics K , Kristóf K
Published: October 2024

Background

There has been an increase in COVID-19 vaccine hesitancy among the general population, accompanied by a decline in confidence that vaccines provide adequate protection. We estimated the effectiveness of the COVID-19 vaccines (CVE) and hybrid immunity against medically attended COVID-19 during the 2022-2023 respiratory season in Hungary.

Methods

We conducted a test-negative design study involving 68 GPs. Patients aged ≥18 years presenting with acute respiratory infection were swabbed. Cases and controls were patients testing positive and negative for SARS-CoV-2 by RT-PCR, respectively. Exposure was defined as having received at least one COVID-19 booster dose, taking into account the time since the last vaccination. CVE was estimated using logistic regression, adjusted for symptom onset date, age, chronic condition and sex.

Results

We included 247 cases and 1073 controls in the analysis. 196 samples were sequenced, and Omicron BA.5, BQ.1 and XBB.1 were the most frequent sub-variants. The CVE was 52.9% (95% CI: 15.2-73.9%), and 72.3% (95% CI: 32.0-88.7%) in the 18-59, and 60+-year-old population who received the final dose within the past year, respectively. Self-reported COVID-19 in the previous 60-365 days did not confer protection against reinfection, however, when combined with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: −28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively.

Conclusions

Booster vaccination within one year after the last dose confers significant protection against symptomatic infection, particularly among the elderly. Those who have previously been infected with SARS-CoV-2 may also benefit from booster vaccinations.

Key messages

• COVID-19 booster campaigns must be intensified, focusing mainly on the elderly.

• Providing clear guidance on the timing and target groups of vaccination and emphasising the benefits of vaccination can help to achieve higher coverage.
Sex differences at different ages in 30-day survival of COVID-19 hospitalized patients in Israel
Authors: Magid A , Niv Y , Green M S
Published: October 2024

Background

Sex differences in mortality from COVID-19 have been described. It is not clear to what extent sex is an independent risk factor for mortality or is confounded by co-morbidities and whether it varies by age. It is also not clear whether it is constant over time since diagnosis. We studied sex differences in 30-day mortality rates in patients hospitalized with COVID-19, after controlling for co-morbidities.

Methods

Data on patients hospitalized with COVID-19 were extracted from the majority of general hospitals in Israel during 2020 to 2022. The outcome variables were death during 30 days from onset of hospitalization. Sex differences in survival rates were assessed using Cox proportional hazards models controlling for age, heart disease, cancer, respiratory disease, diabetes and hypertension.

Results

Mortality rates in women were significantly lower than in men in all age groups. There was an approximate 5-6 year lag in the mortality rates between men and women.

Conclusions

Sex was an independent predictor of 30 day mortality from COVID-19 with women experiencing better survival. This advantage was not explained by differences in co-morbidities or the magnitude of the differences in survival by age. The sex differences in the 30-day mortality of hospitalized patients are compatible with the male dominance in the incidence rates of many infectious diseases. Poorer survival of men hospitalized for COVID-19 is likely to be part of the disease mechanism and should be explored further.

Key messages

• Poorer survival of male COVID-19 patients seems to be part of the disease mechanism and should be explored further.

• Sex differences in disease should be included in personalized management of disease.
Molecular Tumor Boards impact on patients’ health: towards a policy brief in the Can.Heal project
Authors: Giacobini E , Russo L , Osti T , Cacciuttolo M G , Lentini N , Pastorino R , Specchia M L , Kamal M , Boccia S
Published: October 2024

Background

Molecular Tumor Boards (MTBs) are pivotal in the current management of oncological patients, integrating molecular diagnostics with clinical expertise to tailor precise treatments. Within the framework of EU-funded ‘Building EU Cancer and Public Health Genomics platform’ (Can.Heal) project that aims at streamlining genomics implementation in public health, we are developing a policy brief to promote MTBs’ adoption across the EU.

Methods

A two-step approach was employed to delineate strategies for MTB implementation. Firstly, we conducted a systematic review and meta-analyses (if feasible) up to November 2023, on studies assessing the MTBs’ clinical impact. Secondly, based on the results of the review, we conducted an expert consultation to identify key areas to improve MTBs implementation and impact.

Results

48 studies were included, whose results were heterogeneous in terms of organizational aspects and number of experts involved (mean n: 6, range: 2-19). Average implementation rate of the recommendations issued by the MTB was 43.1% (3.2%-92%), with a turnaround time from testing to recommendation of 36 days (15-58). By pooling data from 12 studies (n = 1623), a favorable overall survival [HR = 0.63 (95% CI 0.53-0.76), I2 42.0%] was reported for patients managed in hospitals with MTBs versus not. Similar estimates were reported when the outcome was progression free survival [HR = 0.63 (95% CI 0.54-0.72), I2 = 0.0%], based on 8 studies (n = 1106). The subsequent expert consultation identified 5 key areas for MTB implementation: genetic data sharing, standards for results’ interpretation, equitable access to MTB, optimization of the testing process, and funding and reimbursement.

Conclusions

The policy brief underscores the significant clinical benefits of MTB-recommended therapy, improving patients’ outcomes. Nevertheless, addressing resource allocation and infrastructure development is essential to optimize MTB utilization and enhance patient outcomes.

Key messages

• Our results highlight that MTBs-recommended therapy translates into tangible clinical benefits.

• More fundings and resources are needed to optimize and fully implement MTBs in clinical practice.
Improving data quality by implementing an electronic medical record seems to depend on the context
Authors: Wurster F , Hansen T , Jaschke J , Köberlein-Neu J , Okumu M R , Pfaff H , Rusniok C , Karbach U
Published: October 2024

Background

The European healthcare system is reliant on its digital transformation to deal with challenges like rising expenditures or workforce shortage. The digital transformation is inevitably accompanied by the implementation of electronic medical records (EMR) and the ongoing adaptation of existing ones. Systematic reviews indicate that this process can have an impact on medical records data quality (DQ) [1]. At micro level, DQ is essential to ensure high quality of care. At macro level, sufficient DQ is a prerequisite for big data analyzability. In this field, completeness is a commonly analyzed dimension of DQ and empirical results indicate that completeness can improve but also deteriorate as a result of the described implementation or adoption of EMRs [2]. The aim of this work was to investigate the implementation of EMRs in comparable settings and to observe and discuss possible differences in the change in DQ.

Methods

Data was collected on three surgical clinics of a German academic teaching hospital before and after the implementation of an EMR. Paper-based and electronic medical records were compared. Analysis focused on ten items that were commonly documented in both record types (e.g. pain). T-tests and χ²-tests were used to compare average completeness per record type and percentage of completeness per item.

Results

A total of N = 659 records was analyzed. Overall, results show a significant improvement in completeness from an average of 6.0/10 items in the paper-based record type to 7.2/10 in the EMR (p<.05). At clinic level, improvement rates vary from 0.9 to 1.4. At the level of the specific items, significant deteriorations are visible in certain clinics.

Conclusions

Results suggest that DQs variability is context-dependent (e.g. on the clinic’s turnover rate or its patient’s length of stay). Due to the unavoidable digital transformation, a detailed context and needs analysis involving all stakeholders should be carried out before any changes are made.

Key messages

• The application of advanced analytics such as big data or AI training is reliant on the availability of high-quality datasets.

• Electronic medical records have been demonstrated to enhance data quality, but it remains uncertain how and why improvements appear to be context-dependent.
Safety in Teletriage by Nurses and Physicians in the US and Israel - a Tale of 2 Systems
Authors: Haimi M , Wheeler S Q
Published: October 2024

Background

The safety of telemedicine in general and telephone triage (teletriage), in particular, have been a focus of concern since the 1970s. Inadequate telehealth systems may compromise patient safety.

Objectives

Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions.

Methods

We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems’ respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach.

Results

The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering non-medical factors and patient preferences (Shared Decision-Making).

Conclusions

Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. There is a need identifying safe systems to guide developers and clinicians about needed improvements.

Key messages

• Patient safety and safe professional practice are extremely important in the field of teletriage.

• We need to guide developers and clinicians about needed improvements in teletriage systems.
Trustworthiness of EHRs: Key Factors from a User-Centered Study in Germany
Authors: von Kalckreuth N , Kopka M , Schmid C , Kratzer C , Reptuschenko A , Feufel M
Published: October 2024

Background

The integration of digital technologies, particularly Electronic Health Records (EHRs), promises substantial improvements in patient care and cost reductions. However, the success of EHRs depends heavily on patient trust and usage, which are influenced by their control over data visibility, storage, and sharing. Identifying the factors that enhance the perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings.

Methods

Participants (N = 30) first interacted with an interactive EHR prototype, then evaluated its trustworthiness and suggested improvements during semi-structured interviews. These interviews were transcribed and analyzed using thematic analysis to identify key themes affecting perceptions of the EHR’s trustworthiness.

Results

Through thematic analysis, we developed a categorical system encompassing five principal themes: provider reputation, information quality, system characteristics, user control, and user feedback. The analysis revealed that deficiencies in design and usability indirectly affect perceptions of privacy and data security.

Conclusions

Our study underscores the critical role of contextual factors-including provider reputation, strategic IT partnerships, and user feedback-in cultivating trust in Electronic Health Record (EHR) systems. Addressing privacy concerns and bolstering user trust necessitates not only a professional approach to design and usability but also clear communication about adherence to rigorous data privacy and security standards. In Germany’s tightly regulated environment, clearly communicating EHR security standards is crucial. Enhancing trust also involves robust customer support, user control over their data, and leveraging social proof like high download rates or positive reviews. These approaches could significantly improve EHR acceptance and trust in digital health across the country.

Key messages

• The perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings.

• Effective communication and design are critical for building trust in digital health technologies. Trust in EHRs grows with transparent data policies and empowering user controls.
Mental health of Finnish cis- and transgender youth before, during and after the COVID-19 pandemic
Authors: Kiviruusu O , Sares-Jäske L , Therman S , Lehtonen J , Suvisaari J
Published: October 2024

Background

Transgender youth report more mental health problems than their cisgender peers, but little is known about their mental health during and after the COVID-19 pandemic. We studied symptoms of anxiety and depression among cis- and transgender youth before, during, and after the pandemic using large nationwide samples.

Methods

Data from the Finnish School Health Promotion survey from years 2019, 2021 and 2023 (461,249 students in total; mean age 15.7, SD 1.3) were used. Self-reports covered official gender, gender identity, symptoms of anxiety (Generalized Anxiety Disorder Scale-7 ≥10) and depression (Patient Health Questionnaire-2 ≥3). Categories of cisgender boy (officially boy; gender identity boy; N = 214,423), transfeminine youth (officially boy; gender identity girl, both, neither, or it varies; N = 5,069), cisgender girl (officially girl; gender identity girl; N = 224,753), and transmasculine youth (officially girl; gender identity boy, both, neither, or it varies; N = 14,508) were formed.

Results

In all timepoints, proportion of those with anxiety or depression was higher among transfeminine youth compared with cisgender boys and among transmasculine youth compared with cisgender girls. In all groups anxiety and depression increased significantly from 2019 to 2021 (ORs 1.4-1.8, p < 0.0001), with no significant differences in these changes between cis- and transgender groups. From 2021 to 2023, anxiety (OR 0.91, p = 0.015) and depression (OR 0.77, p < 0.0001) decreased among transmasculine youth but increased among cisgender girls (ORs 1.11 [p < 0.0001] and 1.07 [p < 0.0001], interactions p < 0.0001). Among transfeminine youth, generalized anxiety symptoms decreased from 2021 to 2023, whereas they remained at the level observed in 2021 among cisgender boys (interaction p = 0.0025).

Conclusions

In Spring 2023, we found still increasing mental health problems among cisgender girls, while among transgender youth the post-pandemic developments were more positive.

Key messages

• Post-pandemic, we found further increases in mental health symptoms in cisgender youth, while among transgender youth the development seemed more promising.

• Transgender youth experience more anxiety and depression than their cisgender peers, thus gender diversity deserves still more attention in educational, social, and health care services.
How can healthcare providers reduce the adverse effects of endometriosis on women’s life course?
Authors: Zarecki C , Satran C , Kaldawy A , Klaitman V , Tesler R , Bord S
Published: October 2024

Background

Endometriosis is a chronic gynecological disease that affects about 10% of women of reproductive age. Its symptoms vary in severity and manifestation. Diagnosis is often delayed by an average of 10 years, which may significantly affect women’s lives. This study explores how endometriosis morbidity affects women’s relationships, intimacy, and employment over their lifetime.

Methods

An online survey was conducted in February 2024 among Jewish Israeli women aged 18 to 50. Out of the 573 women, 270 were diagnosed with endometriosis. The survey collected information on the women’s diagnostic status, pain severity, social support, negative interactions, life-course impact, and distance from the doctor’s clinic.

Results

Women with endometriosis experience a negative impact on their life course compared to women without the disease, particularly in relationships and intimacy (39.41 vs. 18.44, p<.001) and employment (19.39 vs. 19.11, p<.001). A multivariate regression model was used to predict the effect of endometriosis on the women’s life course and revealed that a negative impact on relationships and intimacy (R2=.385, n = 505) might be predicted by longer travel distance to the doctor’s clinic, higher reported pain level, less reported social support level, and higher reported negative interactions. Furthermore, a negative effect on employment (R2 = .270, n = 513) was predicted by a longer distance to the clinic, a higher reported pain level, less reported social support level, and higher reported negative interactions.

Conclusions

Enencing supportive environments and increasing accessibility to health services is vital to improving the negative impact of endometriosis on women’s lives.

Key messages

• Endometriosis treatment requires a multi-faceted approach, including supportive frameworks, reducing negative interactions, and addressing gaps in health service accessibility.

• Awareness must be raised among employers regarding endometriosis, creating a supportive environment and making necessary adjustments for employees to openly communicate their needs and struggles.
Mixed-methods systematic review of shared decision-making tools for cancer screening
Authors: Herrera D J , van de Veerdonk W , Berhe N M , Talboom S , van Loo M , Ruiz-Alejos A , Ferrari A , Van Hal G
Published: October 2024

Shared decision-making (SDM) tools hold promise for guiding informed choices in cancer screening. However, their effectiveness among underserved people, as well as the specific characteristics of these tools preferred by this group and clinicians, remains unclear. This review aimed to synthesize evidence on the effectiveness of SDM tools for cancer screening and explored the preferences of underserved people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analyses showed that SDM tools for cancer screening are effective in reducing decisional conflict for both the general population and the underserved, and in increasing cancer screening knowledge and intention for underserved people only. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes, measured over a six-month period. Insights from the qualitative findings revealed that underserved people highly preferred SDM tools with relevant information about cancer risk, culturally tailored content, and high accessibility, both during clinical encounters and beyond. Meanwhile, clinicians highly preferred tools that can be easily integrated into medical systems, and can effectively guide SDM, while considering their patients’ values and the limited time for consultation. There is strong evidence on the effectiveness of SDM tools in facilitating informed choice in cancer screening, especially among underserved people. However, evidence on long-term outcomes remains insufficient. Additionally, considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.

Key messages

• Shared decision-making tools are effective in increasing screening knowledge and intention among underserved people.

• Considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.
Human-forest proximity and the risk infectious diseases in a changing world
Authors: Fanelli A , Cescatti A , Riccetti N , Debois G , Robuchon M , Szewczy W , Ibarreta D , Ciscar J C
Published: October 2024

Background

Emerging Infectious Diseases (EIDs) pose a significant threat to global human health; they can lead to epidemics and pandemics with severe repercussions on human life, economic performance, and societal well-being. Despite the recognized negative impact of the EIDs, current research lacks a comprehensive global framework to assess the significance and interaction of various environmental and anthropogenic factors driving emergence of these diseases.

Methods

In this study, we examine both environmental and anthropogenic factors and their relation to the emergence of EIDs, focusing on historical trends from 1975 to 2020. We focus on 10 diseases with pandemic and epidemic potential. Spatial data on outbreaks in humans and animals from 1975 to 2020 were retrieved from the GIDEON database. Using Bayesian statistical models, we pinpoint regions at increased risk, and we focus on a new indicator based on the human-forest proximity.

Conclusions

Our results show that human-forest proximity together with biodiversity loss, and high population density increase the likelihood of diseases being transmitted from animals to humans, influencing where outbreaks occur among human populations. Lastly, we introduce a country vulnerability index that combines our risk assessment with the IHRC3 indicator from the WHO, which gauges a country’s capability to handle zoonotic diseases. These combined indices help us to assess each country’s ability to respond to an outbreak. The study also addresses data limitations and proposes directions for future research, emphasizing the importance of our findings in shaping public health policies and decision-making.

Key messages

• Anthropogenic drivers shape the distribution of outbreaks in human populations.

• Human-forest proximity exacerbates the likelihood of Emerging Infectious Disease.
Level of tobacco dependence and beliefs towards heated tobacco products
Authors: Gradowicz-Prajsnar B , Kozela M , Sytnik-Czetwertyński J , Polak M
Published: October 2024

Nicotine dependence affects not only behaviors related directly to smoking, quit attempts or looking for alternative products but also beliefs about smoking. We sought to assess whether the level of tobacco dependence is associated with beliefs and feelings towards heated tobacco products (HTP) and to assess the relationship between tobacco dependence and the motivators to quit HTP use. Random population sample of Polish citizens aged 18+ years, former smokers, current HTP users was recruited. Tobacco dependence was assessed using 5 question; participants were classified into two groups of tobacco dependence (low or high) using a two-stage cluster analysis. An extensive questionnaire on beliefs on HTP use was administered. The χ2 test and logistic regression were used. There were 2,500 participants (62.6% women) of median age=36 years (Q1=29, Q3=45). The median number of years of smoking was 10 (Q1=5, Q3=15) and median number of years of HTP use was 2 (Q1=1, Q3=3). High tobacco dependence was found in 958 (38,3%) participants. Compared to low dependence, high tobacco dependence was related with feeling of strong need for HTP use (69.7% vs. 47.6%, p < 0,001). High level of tobacco dependence was positively related to perceived social pressure against smoking (72.9% vs. 44.9%, p < 0,001), but it did not differentiate perceived social pressure against HTP use. Compared to low tobacco dependence, participants with high tobacco dependence more often indicated fear of illness OR = 1,73 95%CI=1,46-2,07, own resolution OR = 1,32 95%CI =1,12-1,55 and price OR = 1,34 95%CI=1,13-1,59 as possible motivators to quit HTP use. Level of tobacco dependence in former smokers shaped beliefs and feelings towards HTP use. High tobacco dependence contributed to strong need to use HTP and also increased perception of social pressure against smoking, but not against using HTP. It also increased the importance of fear of illness, price and one’s own resolution as motivators to quit HTP use.

Key messages

• High level of tobacco dependence in former smokers results in stronger perceived social pressure against smoking but not against HTP use.

• High tobacco dependence in former smokers is related with stronger need to use HTP.
CKD incidence, predictors & progression: African migrants vs. Non-Migrants (RODAM cohort study)
Authors: Mungamba M M , Chilunga F P , van der Linden E L , Beune E , Hayfron-Benjamin C F , Meeks KAC , Vogt L , van den Born B J , Nkeh-Chungag B N , Agyemang C O
Published: October 2024

Background

Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors, and progression of CKD among Ghanaians residing in rural- and urban-Ghana, and Ghanaian migrants in the Netherlands (Amsterdam).

Methods

We analysed data from 2183 participants in the transcontinental population-based prospective RODAM-cohort, followed for approximately seven years. CKD incidence and its progression to end-stage renal disease (ESRD) were defined using KDIGO criteria. CKD incidence was calculated using age-and sex-standardization for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESRD from baseline was also assessed using robust Poisson regressions.

Results

Overall age-and-sex standardized CKD incidence was 11.0% (95%CI; 9.3%-12.3%). Rural and urban-Ghanaians had higher CKD incidence (12.5%;8.5%-15.5%; 12.3%;8.2%-15.8%; respectively) than Amsterdam-Ghanaians (7.6%; 5.4%-10.6%). Residence in Amsterdam was associated with lower CKD incidence compared to rural Ghana after adjustments (Incidence Rate Ratio=0.34; 0.13-0.89), but not with urban-Ghana (IRR=1.07; 0.69-1.67). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels, and hypertension. CKD progression to ESRD was 2.5% (1.4%-3.6%) in rural- Ghana, 2.3% (1.3%-3.2%) in urban-Ghana and 0.0% in Amsterdam.

Conclusions

One-tenth of Ghanaians developed CKD over seven-years, with higher incidence in Ghana compared to Europe. Age, female sex, alcohol use, uric acid levels, and hypertension were predictive factors. CKD progression to ESRD was minimal. High CKD incidence among Ghanaians, especially among non-migrants, calls for in-depth assessment of contributing factors and targeted interventions.

Key messages

• We observed higher CKD Rates in Rural/Urban Ghana vs. Amsterdam:Indicating geographic Disparities.

• CKD Predictors: Age, Sex, Alcohol, Uric Acid, Hypertension (Minimal ESRD Progression). Interventions target: Non-Migrant Ghanaians.