bluuebunny/crossref_metadata_2025 huggingface dataset:
The physician-AI relationship: partnering for precision medicine via clinical decision support
Authors: Samuel H , Norman T , Vaknin S , Saban M
Published: October 2024

Background

Clinical decision support systems (CDSSs) can enhance physician decision-making, but successful adoption depends on positive user attitudes. Understanding Israeli physicians’ attitudes toward CDSSs is crucial for overcoming implementation barriers and refining training.

Methods

Semi-structured interviews explored knowledge, experiences, perceived benefits/drawbacks, and potential barriers/facilitators to CDSS use among 25 Israeli physicians across specialties, roles, settings, and experience levels selected via stratified sampling. Individual 45-minute video interviews were conducted in January-July 2023.

Results

Familiarity and CDSS experience varied substantially across medical specialties. While risk calculators, information systems, and expert systems disseminating contemporary research insights are widespread, AI-based system adoption is relatively low outside radiology. Physicians expressed positive attitudes, recognizing CDSSs’ potential to enhance clinical work, reduce errors, and alleviate burdens. However, concerns included AI systems’ impact on workload, patient relationships, skill erosion, and overreliance. Key implementation barriers involved technological infrastructure, organizational processes, physician perceptions, and system features. Facilitating factors included tailored design, focused training, continuous accuracy/reliability validation, and clear autonomy/liability guidelines.

Conclusions

Addressing key concerns around transparency, trustworthiness and responsible use is crucial for AI-CDSS to fulfill its promise of enhancing quality and outcomes. Insights from Israeli clinicians provide guidance on priorities like transparency of data and algorithms as well as ensuring AI behaves ethically. Collaboration among technology designers, healthcare professionals and stakeholders can help develop systems that physicians trust to improve care while safeguarding patients. Ongoing evaluation is also needed to optimize AI-CDSS over time.

Key messages

• Understanding physician attitudes is key to overcoming barriers to clinical decision support system adoption and optimizing training protocols.

• Addressing transparency, trustworthiness, and ethical considerations around AI clinical decision support systems is crucial for enhancing quality care.
Guidelines to practice in hospitals at home: penicillin infusion pumps in erysipelas treatment
Authors: Metsä-Simola N , Saarenketo J , Lehtonen H , Broman N , Häggblom T , Björklöf P , Sariola S , Valta M
Published: October 2024

Background

Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favor broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIP), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings.

Methods

We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use, and to compare clinical outcomes between patients with and without eCIPs.

Results

Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and three months after it. Patient and nurse satisfaction regarding eCIPs was very high.

Conclusions

Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation.

Key messages

• Continuous infusion of benzyl penicillin via elastomeric infusors substantially decreases broad-spectrum antibiotic use among erysipelas patients treated at home.

• When erysipelas patients can be treated with outpatient parenteral antibiotic therapy, the use of elastomeric benzyl penicillin infusors is safe and effective and should thus be increasingly promoted.
A global adoption of cryptocurrency and blockchain technology into the healthcare system
Authors: Johnson J , Berkshire B
Published: October 2024

Background/Objectives

Blockchain technology is revolutionizing various industries by enhancing security, transparency, and efficiency. In healthcare, its small-scale application demonstrates the potential to transform healthcare. This study explores how cryptocurrency and blockchain technology enhance healthcare financial stability, secure medical information exchange, increase payment recovery and interoperability.

Methods

Guided by the Diffusion of Innovations (DOI) Theory, this study reviews 34 articles on blockchain and cryptocurrency adoption in healthcare. We performed a thematic analysis focusing on empirical data, theoretical analyses, and existing implementations. Data were categorized by DOI elements: relative advantage, compatibility, complexity, trialability, observability, and social system. The findings were synthesized into a detailed framework for adopting these technologies in healthcare.

Results

Our analysis shows that cryptocurrency offers a secure, decentralized payment platform, eliminating the need for third-party intermediaries. Blockchain adoption enhances payment and patient record protection. Cryptographic methods ensure data integrity, transparency, and security, preventing modifications once recorded. Altering data requires consensus from the network majority, protecting healthcare providers from ransomware attacks.

Conclusions

Evidence suggests that cryptocurrency and blockchain will disrupt healthcare payments, data management, and accommodate interoperability within the next decade. These technologies promise improved security, improved public health research, and increased trust in the healthcare system.

Key messages

• Our research will be assessing the challenges of integrating digital coins and blockchain technology into the healthcare system.

• Examine the potential benefits and risks of implementing blockchain technology in healthcare settings.
Assessing Academic Perspectives on Infodemic Management and Health Security: A Needs-Based Approach
Authors: Mandić-Rajčević S , Stevanović A , Rowland A , Zdujić M , Vidojević J , Sotirović I , Zelić P , Martin R
Published: October 2024

Background

The information environment significantly impacts public health decisions, behaviors, and health security. Misinformation and disinformation can compromise health interventions and undermine public trust, and this phenomenon, known as the infodemic, is increasingly challenging to address and requires innovation and transformation of public health and education of the health workforce. This study aimed to assess the relevance of infodemic management (IM) to different academic fields and training needs to create a competent workforce.

Methods

As part of the US Federal Assistance Award within the University Partnership Program between Emory University and the University of Belgrade, a mixed-methods study was conducted to evaluate the curricula of all 31 faculties at the University of Belgrade. An online survey was distributed to faculty deans to assess the current educational framework and opinions on IM in various academic fields. This approach provided a multidimensional view of how IM is perceived and integrated across diverse disciplines.

Results

The survey received 33 responses from different departments at the University of Belgrade. Over 75% of participants identified misinformation as prevalent in their respective fields. More than half of the respondents believe that students are not sufficiently familiar with the concept of the infodemic and its potential consequences, only 9% believe these topics are well covered in the current curriculum, and over 90% agree that additional content on IM is required to update study programs, indicating a gap in our current educational approach.

Conclusions

Academic circles have acknowledged the issue of misinformation and its negative impact on public health. Current gaps in academic curricula indicate the critical necessity of integrating IM into educational programs. This innovative approach will provide future specialists with the necessary skills to navigate the complexities of the modern information ecosystem.

Key messages

• Over 75% of surveyed professors identify misinformation and disinformation as prevalent in their professional fields, indicating a widespread impact.

• Over half of professors feel academic programs do not sufficiently equip students to navigate the information ecosystem, with over 90% calling for additional infodemiology content.
Future of nicotine pouches – users’ perspective
Authors: Balwicki L , Kalinowska-Beszczynska O , Wojtecka A , Basinska M
Published: October 2024

Background

Nicotine pouches (NPs) are gaining popularity. They are a rapidly developing category with little research or regulatory oversight. Studies have shown that the descriptor ‘tobacco-free’ may impact risk perceptions and the appeal of nicotine pouches among young adults and thus shape their position on the market. The aim of the study was to broaden the knowledge on NP users’ perspective about the future of this products.

Methods

Qualitative approach was utilized. In December 2022 there were seventeen structured In-depth Interviews (IDIs) conducted. The sample included of adults aged 18-22, both male and female. The respondents were asked how they see NPs in the context of aim group and competition with other nicotine products.

Results

We found that from NPs users’ perspective, these products are aimed at those who want give up smoking, do not want to play with electronic devices (such us e-cigarettes of heated tobacco products) or just seek for discretion (such as office workers who do want to go outside for a smoke or vape). Special aim group are children who want to hide their nicotine product use. Respondents believe that they will not force traditional cigarettes out of the market but will be a popular alternative for young people. Some suggest they need popularization to help exclude products that produce smelly smoke or vape.

Conclusions

Nicotine pouches as smokeless products will probably fill the market space with product aimed at young people who seek discretion of their nicotine addiction as well as those who do not want to inhale smoke.

Key messages

• Nicotine pouches users see value of these products.

• Nicotine pouches future seems to be bright unless regulations disrupt their market development.
An Artificial Intelligence approach to monitor infectious diseases: lessons learned from COVID-19
Authors: Antinozzi M , del Re D , Palla L , Meridiani P , Soffi L , Loiudice M T , Cattaruzza M S
Published: October 2024

Background

The World Health Organization declared the start (March 11th 2020) and the end (May 5th 2023) of COVID19 pandemic, while in Italy it has been present since February 2020. Indicators such as number of new positive cases, deaths and hospitalizations are used to monitor epidemiological trends, but they suffer from biases limiting their effectiveness.

Methods

We used data from the Emergency Medical Services Activities as an alternative and studied three types of contributions: COVID19, flu and baseline during three time frames: -period 1 (July 1st-Oct 11th 2016; Feb 10th-May 20th 2017) used to model the baseline, when flu contribution should be negligible. -Period 2: (Dec 15th-Feb 14th 2017), when flu in 2017 is very evident. -Period 3: (March 11th-31st 2020), when the first COVID19 wave is dominant. To extract the pure contribution from flu and COVID19, the baseline contribution was properly subtracted.

Results

From these data we developed a machine learning approach (MLA) that offers a simple and powerful tool to monitor COVID19 or future infectious diseases. To maximize the identification power of COVID19, we used the Toolkit for multivariate analysis package. An artificial neural network, multilayer perceptron, deep neural network and boosted decision tree methods have been trained, considering the events in period 3 as signal and period 1 as background. To avoid overtraining, the samples were divided in two: one half to train the algorithm, and the other to check the performance. The results are stable over time and able to efficiently discriminate COVID19. With 50% efficiency of accepting COVID19 patients, roughly 95% of baseline patients can be rejected.

Conclusions

MLA can be used to early assign a probability of COVID19 without specific test, only relying on standard triage and emergency call details. This tool could be very useful to early detect the presence of new pandemics and tag positive patients before the official healthcare reporting system.

Key messages

• AI model using data from Emergency Medical Services Activities can be a useful tool to early detect new pandemics and tag positive patients before the official healthcare reporting system.

• Covid19 pandemic gave us the possibility to develop new digital tools to use in the analysis of epidemiological trends.
Public Perceptions and Engagement in mHealth Across Eight European Countries
Authors: Tona D M , Causio F A , Beccia F , Cristiano A , Verduchi A , Porcelli M , Van El C , Calabrò G E , Pastorino R , Boccia S
Published: October 2024

Background

Mobile health technologies have the potential to revolutionize healthcare delivery and patient engagement. This study explores public attitudes toward health app usage and data sharing across eight European countries, addressing a significant gap in understanding the public’s perspective on mHealth adoption.

Methods

A cross-sectional survey was conducted involving 6,581 participants from Italy, the Netherlands, France, Germany, Spain, Poland, Romania, and Hungary. The survey assessed current health app usage, future interest, willingness to share health data, and concerns about data privacy and security.

Results

21.87% of respondents currently use health apps, with 42.71% expressing interest in future use. Regarding data sharing, 52.82% are willing to share health data with healthcare providers, and 25.48% would share data with research institutions. However, 53.18% fear unauthorized use or hacking of their health data. Significant generational and geographical differences in mHealth engagement were observed, with older generations showing higher willingness to adopt health apps OR 1.22 (CI 1.03 - 1.46) for Baby Boomers, OR 1.45 (CI 0.97 - 2.16) for Silent Generation. Education level emerged as a crucial factor, with tertiary-educated individuals more likely to use health apps (OR 1.41 CI 1.24 - 1.58) and demand transparency (OR 1.61 CI 1.45 -1.78).

Conclusions

The findings underscore the need for targeted strategies to enhance digital literacy, ensure data privacy, and promote equitable access to mHealth technologies across Europe. Policymakers and healthcare stakeholders should prioritize these areas to foster greater public trust and engagement in mHealth, ultimately improving health outcomes and patient care.

Key messages

• Public attitudes toward mHealth vary significantly across generations, countries, and education levels in Europe.

• Addressing data privacy concerns and enhancing digital literacy are crucial for widespread mHealth adoption.
Trust in sources of information about digital health technologies: The User’s Perspective
Authors: Hannemann N , Babitsch B
Published: October 2024

Background

Trust is key to healthcare, including all types of health information. This applies not only to the process of healthcare delivery, but also to health-related behaviors and the utilization of healthcare services. Trust in health information sources has been shown to vary by social and health characteristics. Therefore, the research question is: Are there social and health-related differences in perceptions of trust in sources of information (government agencies or physicians) about digital health technologies?

Methods

The analysis is based on a cross-sectional online survey (STELLAR) conducted in 2022 (N = 1,200), Participants were asked whether they perceive trust (1= fully agree- 4= not at all) in information about digital health technologies provided by government agencies (institutional trust) or physicians (interpersonal trust). For the analysis, binary logistic regressions (references: traditionalists, low education level, poor self-perceived health) were used.

Results

Institutional Trust. Overall, 43.9% of the participants perceived trust in this information source. Baby Boomers (OR 2.022), Generation Y (OR 2.544), and Generation Z (OR 2.566), as well as medium (OR 2.526) and high (OR 3.823) educational level, increased the odds of perceived trust; the same was found for better self-perceived health (OR 1.569). Interpersonal Trust. In general, 94.8 % of the participants expressed trust physicians. Belonging to Generation Z decreased the chance (OR 0.097) and a better subjective health status increased the chance (OR 4.250) of perceiving trust. Education did not emerge as a significant determinant.

Conclusions

The study confirmed that interpersonal and institutional trust varies by social and health characteristics. There seems to be a need to strengthen efforts to explain the process of trust building in different population groups., e.g. to find explanations for why educational level was only relevant for institutional trust but not for interpersonal trust.

Key messages

• Trust in sources of information about digital health technologies differ by generation, educational level, and subjective health status.

• Given the existing differences in perceptions of trust, it is worthwhile to explore the unknown mechanisms of the trust-building process among different population groups.
Evaluating healthcare inequalities using ChatGPT4 – The case of potentially inappropriate medication
Authors: Öberg J , Khalaf K , Midlöv P , Perez R , Merlo J
Published: October 2024

Issue/problem

Regular and standardized monitoring of healthcare is necessary to inform decision makers and clinicians about healthcare quality. Equity is a fundamental dimension in such evaluations. We aimed to investigate if artificial intelligence (AI) large language models (LLM), such as ChatGPT4, may facilitate routine monitoring of healthcare inequalities using an established framework for healthcare quality and equity evaluation, analysis of individual heterogeneity and discriminatory accuracy (AIHDA).

Description of the problem

We have previously demonstrated that compared to traditional methods, AIHDA improves the evaluation of healthcare inequity. We asked ourselves if ChatGPT4 could facilitate the standardized application of the AIHDA approach in routine monitoring of healthcare.

Results

Using strict guidelines, we instructed a GPT model, based on ChatGPT 4, to utilize the AIHDA framework for evaluating healthcare inequalities. To demonstrate the analysis, we used the quality indicator potentially inappropriate medication among elderly and analyzed simulated data of individuals >75-year-old belonging to 36 socioeconomic strata and residing in 21 Swedish regions. The GPT performed an accurate analysis, correctly interpretated the results and formulated an informative short rapport with illustrative tables and figures.

Lessons

AI appears to facilitate routine monitoring of health care inequity using the AIHDA approach. AI also allows a constructive interaction with the user but, so far, it needs be closely supervised.

Key messages

• ChatGPT 4 can improve the standardized evaluation of healthcare inequity.

• Although the technology is under development and must be used with caution.
Two decades of electronic nicotine delivery systems discussions in Türkiye: AI-driven text analysis
Authors: Doğan Jamil S , Jamil H , Ay P
Published: October 2024

Background

As Turkiye ranks second in cigarette consumption in Europe, the increasing shift to Electronic Nicotine Delivery Systems (ENDS) presents emerging public health concerns. This study aims to introduce a hybrid approach by combining AI-driven large language models (LLM) with traditional thematic analysis to explore 20 years of ENDS discourse on Eksisozluk, a popular Turkish social media platform, using the Health Belief Model (HBM).

Methods

This mixed-methods study, analyzed 5,907 comments about ENDS from 2003 to 2023, sourced from a renowned online user-generated forum in Turkiye. Utilizing an LLM, comments were first categorized according to the HBM. Subsequently, the LLM’s generative capabilities were employed to identify sub-themes through thematic analysis. A temporal analysis was then conducted to examine the evolving trends over the 20-year span.

Results

ENDS popularity peaked in 2017, dipped during the COVID-19 pandemic, and later rebounded. Using an LLM with 70% accuracy, validated by a manually labeled sample, we discerned two main themes: perceived benefits (40.5%) - primarily using ENDS as for harm reduction (32.8%) and smoking cessation tools (21.6%)- and perceived barriers (27.7%), with cost and accessibility (21.9%) being the most significant throughout the period. Initially, the focus was on cessation, but shifted to harm reduction post-pandemic.

Conclusions

Our study indicates that consumers in Turkiye initially used ENDS for cessation but recognized their ineffectiveness over time. During the COVID-19 pandemic, usage shifted towards harm reduction, likely influenced by the rhetoric of the Tobacco Industry. Despite a national ban, ENDS remain widely used in Turkiye.

Key messages

• Turkiye should develop a social marketing strategy to raise awareness that ENDS is not a valid tool for harm reduction.

• Although the sale of ENDS is prohibited in Turkiye, enforcement of bans should be strengthened as part of an effective control strategy.
Exploring the Impacts of Artificial Intelligence Interventions on Provider Practice practice
Authors: Lintz J
Published: October 2024

Background

Despite the growing prevalence of AI in healthcare, there has been a lack of recent studies exploring its impact on providers’ practices and patient outcomes. This study investigates healthcare providers’ perceptions of AI interventions’ influence on their practice efficiency and patient outcomes, as well as the correlation between providers’ perceptions of AI and its effects on patient outcomes.

Methods

A self-administered questionnaire was mailed to 38 healthcare providers at a rural medical center in north Texas, with a 70% percent response rate (n = 27). In addition to descriptive statistics, multivariable logistic regression test was conducted to discern the relationship between their perceptions of AI and its impact on patient outcomes.

Results

The findings revealed that a majority of providers perceived AI to still be in its early stages, posing challenges for practice and having a limited impact on patient outcomes. Additionally, various factors such as age, gender, a user-centered design approach, AI experience, along with perceptions of workplace support and stress, significantly shape providers’ attitudes toward AI and ultimately affecting patient outcomes.

Conclusions

Before AI technology can fulfill its promise of transforming healthcare through integration with other technologies, the healthcare sector must address numerous hurdles. It is crucial to approach the development and testing of intricate systems like AI-integrated electronic health record (EHR) systems with caution to ensure their reliability and dependability in clinical decision-making. Additionally, navigating medico-legal responsibilities and pursuing fair distribution of benefits are equally crucial.

Key messages

• This study offers insights into the extent of AI interventions’ impact on healthcare.

• This study specifically focuses on enhancing patient care, reducing costs, and improving the efficiency of the healthcare system.
Using marketing strategies to promote maternal health: an international students’ collaboration
Authors: Nazaruk D , Pardo L , Palacios A , Chopak-Foss J
Published: October 2024

Purpose

About 1 in 8 birth parents experience symptoms of perinatal mood and anxiety disorders (PMADs). The purpose of this collaborative project was to create a social media deliverable to lower the risk of postpartum depression in pregnant and postpartum parents in Georgia, USA.

Methods

Using the SM 10-step model, Master of Public Health Students from Georgia Southern University (GSU), Georgia in collaboration with Creative Business students from Breda University of Applied Science (BUas), the Netherlands, designed an evidence-based SM product. They were mentored by public health and media faculty from both institutions. Roles and responsibilities according to the skill sets were divided, but briefly: students 1) identified a target audience; 2) conducted tertiary data collection; 3) set goals and objectives; 4) developed 4 P’s (product, price, place, and promotion) 5) developed marketing strategies.; 6) and used the strategy to create a specific social media deliverable.

Results

Utilizing the 10-step model social marketing strategy used state-of-the-art marketing and digital media techniques and evidence-based strategies to create a digital electronic booklet that focused on reducing the stigma associated with help seeking behaviors with the ultimate goal to reduce the incidence and prevalence of PMADs. The digital interactive booklet will be pilot tested in selected OBGYN offices and health departments in Southeast Georgia in July 2024.

Conclusions

This collaborative project demonstrates effective collaboration between disciplines from different world regions utilizing strengths from both teams: public health and digital media skills to create an SM product that will be utilized to promote social engagement among postpartum parents.

Key messages

• Students utilized social marketing strategies to create an electronic booklet to address postpartum depression using state-of-the-art digital media techniques and evidence-based strategies.

• This collaborative project demonstrates effective collaboration between disciplines from different world regions and utilizes strengths from both teams.
A mixed-methods evaluation of a virtual coach for smoking cessation and physical activity in adults
Authors: van Vliet MHM , Versluis A , Chavannes N H , Scheltinga B L , Albers N , Penfornis K M , Baccinelli W , Meijer E ,   on behalf of the Perfect Fit consortium
Published: October 2024

Background

Mobile health (mHealth) interventions with virtual coaches (i.e. AI conversational agents) offer scalable and cost-effective solutions for health behavior change. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to promote smoking cessation and physical activity simultaneously. Through innovative techniques (e.g. sensor technology) and iterative development involving end-users, we aim to overcome challenges faced by mHealth interventions, like insufficient personalization. This study examines Perfect Fit’s feasibility and acceptability.

Methods

A single-arm, mixed-method, real-world evaluation study was conducted with 100 adult smokers in the Netherlands. The intervention lasted approximately 16 weeks. Data were collected at baseline and post-intervention. Quantitative data included usage data and self-report questionnaires on feasibility, acceptability and participant characteristics (e.g. eHealth literacy). Qualitative data included semi-structured post-intervention interviews with a subsample of 12 participants. Descriptive analyses (quantitative) and the Framework Approach (qualitative) were used for data analysis, and quantitative and qualitative data were integrated during interpretation.

Preliminary results

Participants adapted the use of Perfect Fit to their preferences. Many participants were satisfied with the content but missed variations in conversations with the virtual coach. The coach offered anonymity, positively experienced by some (e.g. non-judgemental), but negatively by others (e.g. lower accountability). Many participants liked the combination of smoking cessation and physical activity enhancement.

Conclusions

Findings show the potential of interventions like Perfect Fit as a multiple health behavior change strategy in promoting public health and preventing chronic disease. Findings can inform intervention development and identify methods to foster feasibility and acceptability.

Key messages

• mHealth interventions with virtual coaches, like Perfect Fit, could promote public health.

• Targeting multiple behaviors, like low physical activity and smoking, simultaneously seems beneficial.
Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness
Authors: Malešević A , Čartolovni A
Published: October 2024

Background

According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context.

Methods

To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022.

Results

Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods.

Conclusions

The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media.

Key messages

• It’s crucial to align digital health implementation with the social & cultural context and capabilities.

• The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.
Knowledge and attitudes of the Italian population on sharing health data: a cross-sectional study
Authors: Toffanin C , Scaioli G , Lo Moro G , Mara A , Varì M G , Butnaru A M , Cataldo A , Lodin M , Bert F , Siliquini R
Published: October 2024

Background

Healthcare digitization enhances data accessibility but faces data management and privacy challenges. The study sought to explore the Italian public’s understanding and views on storing and sharing health data for treatment and research purposes, as well as factors influencing their attitudes toward health data management and sharing.

Methods

A cross-sectional questionnaire assessed socio-demographic information, knowledge about health data sharing, and attitudes toward sharing data for treatment and scientific purposes. Descriptive analyses and multivariable logistic regressions were performed to examine the associations between sociodemographic factors and knowledge/attitudes about data storage and sharing.

Results

A total of 1,389 citizens participated. Most respondents (65.4%) thought that healthcare providers could access personal health data nationwide, while 94% expressed willingness to share personal health data nationwide. A high percentage of respondents (73%) fully agreed that storing and sharing personal health-related data could improve research and quality of care. Males and younger individuals (<41 years) were likelier to have higher data-sharing knowledge (adjusted Odds Ratio [adjOR] 1.50, 95% Confidence Interval (CI) 1.03 - 2.18, and adjOR 1.99, 95% CI 1.29 - 3.08 respectively). Lower educational-level respondents exhibited lower positive attitudes towards sharing health data for treatment and research purposes (adjOR 0.18, 95% CI 0.05-0.58 for high school, and adjOR 0.11, 95% CI 0.03-0.41 for middle school or lower, compared to those with a university degree).

Conclusions

The findings offer valuable perspectives for European policymakers, healthcare practitioners, and researchers who aim to enhance data handling, foster cooperation, and maximize the benefits of health data for tailored care and scientific progress.

Key messages

• Italian citizens show strong willingness to share health data nationwide for treatment and research, suggesting a favorable environment for collaborative healthcare initiatives.

• Sociodemographic factors such as age and education level influence attitudes towards health data sharing, stressing interventions to ensure equitable access and participation in data-driven healthcare.
Different approaches to regulate digital health applications in seven European countries
Authors: Riedel M , Koisser L , Czypionka T
Published: October 2024

Background

Demographic ageing, shortages in health workforce and increased use of digital tools in daily life kindle decision makers’ interest to utilize digital health applications (DHA). While there are several reviews that provide an overview across remuneration frameworks, no synthesis between additional regulatory aspects and frequency of remuneration approval has been conducted.

Methods

European countries with either strong status in digital health in general or regulation for health apps in particular were chosen for analysis (BE, DK, DE, EE, EN, FR, NL). Country specific information was collected from scientific and grey literature, legal and stakeholder webpages. Semi-structured interviews were conducted with country experts via video call or e-mail and analyzed using Mayring’s structured, qualitative content analysis.

Preliminary results

We find three approaches concerning DHT-definitions: For BE, DE, FR, specific regulations define national remuneration requirements. EN and NL define only minimum requirements while decentralized payors make financing decisions. DK and EE fit DHTs into existing financing schemes. Among countries with a national financing framework, DE achieved the largest number of approvals, followed by FR, while BE has not yet issued a (lasting) financing approval. Evaluation requirements focus on clinical and economic outcomes, largely ignoring non-clinical improvements for patients.

Conclusions

The German regulation stands out with a peculiar definition that might help clarify evaluation criteria, increase the number of financing approvals but also empower patients while reducing the role of health workforce in their application. BE and NL regulations necessitate involvement of health workers, thus addressing structurally different applications.

Key messages

• Drawing lessons for DHT regulations across countries needs to address differences in national definitions and evaluation criteria.

• A standardization system for DHT may help to speed utilization of effective tools and clarify evaluation requirements.
Developing an mpox risk assessment matrix for social listening and infodemic insights generation
Authors: Pereira Ibrahim A , Machiri S , Ishizumi A , Nguyen T , Latinovic L , Bezbaruah S , Purnat T , Von Harbou K , Emiroglu N , Varaidzo Machiri S
Published: October 2024

Issue

Any effective response to an infodemic, requires prioritizing public health response on identified narrative themes that pose highest risk to health and well-being of populations. High-risk narratives often require more swift and far-reaching action and low-risk narratives require little or no response.

Description of the problem

Different countries are assigned different levels of risk to specific narratives or concerns, recognizing that for some issues there may be a large gap between the true public health threat and what is generating lots of conversations, concerns and press coverage that indicate a high degree of risk perception that may be unwarranted. WHO developed a risk matrix to apply to global analysis of questions, concerns and narratives about mpox, which resulted in biweekly infodemic intelligence reports that risk-assessed identified infodemic themes and corresponding recommendations for action.

Results

Risk assessment criteria were defined in the context of WHO’s global infodemic insights analysis for low, medium and high risk and positive sentiment in mpox global outbreak context before conducting the integrated analysis so that insights were reproducible and infodemic response actions were prioritized. This implemented the WHO/UNICEF training manual on 6 steps to produce an infodemic insights report, which includes tools on how to develop and apply a risk matrix for a specific public health question of concern and apply it in analysis.

Lessons

The approach resulted in rapid, systematic, reproducible and evidence-driven decision-making to respond to the infodemic accompanying the mpox global outbreak. Risk matrices must be adapted to the context of the public health event and the mandate of the health authority taking action. An mpox risk matrix for narratives included adaptation to reflect high-risk from stigmatizing narratives, as well as narratives circulating around or within LGBTQI+ communities.

Key messages

• A risk matrix must be developed and adapted to the context of each health emergency and level of health authority action.

• Prioritization for rapid infodemic response based on a risk assessment is that it facilitates more effective response in a health emergency.
Poultry farms as a One health priority for Aspergillus section Fumigati surveillance
Authors: Gomes B , Dias M , Pena P , Cervantes R , Viegas S , Viegas C
Published: October 2024

In poultry production environments, particulate matter (PM) is considered one of the harmful air pollutants [2]. Considering potential biological pathogens, the genus Aspergillus in particular, Aspergillus fumigatus, is a widely recognized human and animal pathogen [3]. Hot-humid farm environments could contribute to the proliferation of these fungi [4]. Therefore, poultry production workers, besides animals [4], may be at a higher risk of inhaling fungi spores [4,5]. This study aimed to determine particulate matter (PM) contamination and analyze the prevalence of Aspergillus section Fumigati in air samples from poultry pavilions. Indoor and outdoor air samples were taken in the 1st, 2nd and 3rd weeks of birds growth cycle (n = 58). Air was collected through the impaction method (MAS-100) onto polycarbonate filters, set at 100 L/min, for 5 min. Followed by DNA extraction, and real-time PCR detection of Aspergillus section Fumigati. For PM evaluation, portable direct-reading equipment (Lighthouse, model 3016 IAQ) was used. Particle concentrations were measured (n = 67) at five distinct fractions during 5 min. Considering particles fractions, PM10 and PM5 where prevalent in 1st (58% PM10; 28% PM5), 2nd (63% PM10; 26% PM5) and 3rd (64% PM10; 25% PM5) weeks. These results evidence that coarse particles (between 2.5 and 10 µm) are the most relevant PM present in this setting. Regarding fungal detection, Aspergillus section Fumigati was widespread inside poultry pavilions (62%, 26 out of 42), highlighting this environment has a potential reservoir of microbial pathogens [7]. Furthermore, PM can act as a host of biological fragments [6]. Overall, in addition to molecular analysis, future studies should consider using culture-based methods to assess the viability of pathogenic microorganisms and their infection potential [3]. From a One Health perspective, quantitative and qualitative research is required to fully understand this environment.

Key messages

• This study evidence that coarse particles (between 2.5 and 10 µm) are the most relevant PM present and Aspergillus section Fumigati is widespread in poultry pavilions.

• A One health intervention should be considered in future studies.
What are the health system impacts of engaging with global health activity? A qualitative study
Authors: Haywood J , Smyth J , Goldstone R
Published: October 2024

Background

Global health partnerships between high-income health systems and low- and middle-income countries (LMICs) are becoming more common as there is an appreciation of the need for collaboration to solve global health issues through knowledge and skill exchange. However, partnership evaluations largely focus on the benefits to individual participants and recipient systems, with little evidence of the impacts on the high-income system. Therefore, the aim of this study was to explore the health system-wide impacts of engaging with global health activity and consider the arguments for and against adopting these partnerships.

Methods

We carried out semi-structured interviews with individuals from three UK health systems that engage with global health activity to explore their motivations to in doing so. Transcripts were thematically analysed.

Results

We found that engagement in global health activity can contribute to workforce recruitment, retention, development, and upskilling, benefiting the system. Examples were also given of system-wide clinical, reputational, and economic benefits. However, this activity impacts short term staffing and can cause personal emotional issues that systems need to support.

We also explored facilitators of engaging in global health work which included operational support, supporting healthcare staff to engage, and system acceptance. Barriers included lack of senior buy-in, opportunity access inequities, operational challenges, and the current UK health system challenges.

Conclusions

This study demonstrated the potentially significant system-level benefits of engaging in global health activity. These focused on improved workforce, which is a major public health issue worldwide. We have also identified system characteristics, such as buy-in and operational support, which influence success. We hope this work provides a building block demonstrating there are benefits to be had for donor health systems, but barriers must be overcome.

Key messages

• The potential benefits and drawbacks that may arise from high-income health systems engaging in global health, as well as facilitators and barriers, are explored.

• This study creates a foundation to understand donor-system benefits and encourages further research, particularly in systems who do not engage with global health activity to understand why this is.
Role of epidemiology in the EU policy formulation of chemicals
Authors: Chinchio E , Di Novi C , Martín-Olmedo P , Bopp S
Published: October 2024

Over the past 50 years, the European Union has built a robust legal framework for managing chemicals. This framework balances the benefits of using chemicals for societal well-being and economic prosperity with the need to protect human health and the environment from potential risks. As part of the EU’s Zero Pollution ambition in the context of the Green Deal, the European Commission adopted in 2020 the Chemicals Strategy for Sustainability, with the aim to better protect human health and the environment from harmful chemicals, while boosting innovation by promoting the use of safer and more sustainable chemicals. Assessing quantitative health impacts within the EC Better Regulation guidance typically involves indicators measuring the environmental burden of disease (EBD), providing a useful mean for legislators to evaluate the benefits of policy actions both in terms of health gains and cost. While such analyses are common in air pollution studies, challenges arise in the chemical legislation area, particularly in non-occupational settings, where the population is exposed to low concentrations of many chemicals through multiple exposure routes. In such contexts, the intrinsic complexities linked to exposure characterization and to the assessment of causality between the exposure and the health outcome may hinder the estimation of benefits of legislative actions. Debates may arise regarding the reliability of the underlying epidemiological studies, making challenging for policymakers to ascertain the robustness and generalizability of the findings of such analyses. Our work provides a summary and analysis of recent case studies in the context of chemicals. We focus on how epidemiological evidence was used in conducting EBD analyses in supporting better formulation of EU polices of chemicals.

Speakers/Panelists

Marleen Bekker

Wageningen University & Research, Wageningen, Netherlands
Equity of continuous glucose monitoring in young people with type 1 diabetes: a systematic review
Authors: Howard Dicks J , McCann L , Tolley A L , Barrell A , Johnson L , Kuhn I , Ford J
Published: October 2024

Background

Socioeconomic (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are widespread. There is concern that unequal access to technologies, such as continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in access to CGM for children and young people (CYP) and outcomes for CGM users.

Methods

MEDLINE, Embase, and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-plus criteria for T1D patients under 26. Reports based in low- or middle-income countries or ≤ 500 participants were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from extracted data, though heterogeneity precluded meta-analysis. The protocol was pre-registered with PROSPERO (CRD42023438139).

Results

Of the 3,369 unique studies identified, 27 met inclusion criteria. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured, and minority ethnic, especially black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were generally associated with poorer outcomes, there was no significant association between domains of disadvantage and higher HbA1c for CGM users, excepting parental education.

Conclusions

There are significant SES, ethnic, and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This is contributing to outcome inequalities. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities.

Key messages

• There are significant SES, ethnic, and education inequalities in continuous glucose monitoring use for young people with T1D. Inequalities are more marked when technology is not reimbursed.

• Increasing access to CGM may reduce outcome inequalities, as evidence suggests that young people benefit equally from CGM use, regardless of ethnicity or SES.