bluuebunny/crossref_metadata_2025 huggingface dataset:
Loneliness and Social Isolation: qualitative study among youth in vulnerable situations
Authors: Marques M J , Alves R , Pires J , Bertotti M , Torri E , Dantas C , Dias S
Published: October 2024

Background

Loneliness and social isolation are increasing among young people, particularly those in vulnerable NEET (Not in Education, Employment or Training) situations, potentially leading to poor health and well-being outcomes. We aim to explore these challenges from the perspective of NEET youngsters and link workers who support them in co-creating individual action plans for their social and economic integration.

Methods

Data were collected through in-depth and semi-structured interviews with 15 young people in NEET situations, aged 18-34, and 7 link workers from several social organisations in rural and urban areas in Portugal. The young participants were selected based on their age, educational level, mental health needs, and urban/rural regions. Thematic analysis was used to analyse the interviews.

Results

The results showed a convergence between the perspectives of young people and link workers on the factors that influence social isolation and loneliness, including social and emotional skill deficits, excessive use of social media platforms, and mental health problems. Young people reported to being heavily involved in social media platforms, which often did not translate into meaningful relationships in real life. Youngsters also highlighted the lack of local support and community resources in rural areas. Link workers identified specific challenges young migrants face in community integration, including language barriers (for the youth with a migrant origin) and lack of familiarity with local resources.

Conclusions

This study highlights social media platforms, mental health and social and emotional skill deficits as main factors contributing to the social isolation and loneliness of young people in a NEET situation. This emphasizes the importance of integrated proximity-based interventions that incorporate community resource mapping and local support networks, including mental health support services, and promote multi-sector collaboration.

Key messages

• Social media platforms, mental health needs, and social and emotional skill deficits drive social isolation in NEET youth, stressing integrated, community-focused interventions.

• Proximity-based strategies with community mapping and mental health support enhance NEET youths’ social integration, urging cross-sector collaboration.
Predicting PTSD among labour ward staff: The role of burnout, intent to leave, and emotional support
Authors: Halperin O , Yakov G , Idilbi N
Published: October 2024

Background

Healthcare professionals in delivery rooms frequently encounter stressful situations. Following an examination of how midwives coped and functioned during the unfamiliar and chaotic period of the Covid-19 pandemic, it is crucial to understand their challenges and the support they receive to enhance well-being and patient care. This study aimed to examine the relationship between burnout, intentions to leave, and PTSD (Post-Traumatic Stress Disorder) symptoms among healthcare professionals, and to identify predictors of PTSD.

Methods

We employed a mixed-methods design, consisting of a survey of 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences, and PTSD. Additionally, we conducted 15 semi-structured interviews and 13 interviews with labour ward head nurses.

Results

Most participants experienced difficult events in the delivery room or multiple such events, reporting insufficient emotional support. The main themes identified were stress, fear, anxiety, and frustration. Burnout and a lack of emotional support were significant predictors of PTSD symptoms, with participants highlighting the need for more support to manage complex situations.

Discussion

Addressing burnout through prevention and intervention programs is essential. Emotional support plays a crucial role in mitigating PTSD symptoms, enhancing resilience and well-being among midwives and gynecologists. Implications for Nursing Management: Understanding the psychological impact of stressful situations on healthcare professionals is crucial for guiding policies and interventions aimed at maintaining staff psychological well-being. Midwives’ managers can leverage this research to identify actions that improve staff resilience and cohesion during crises. Strengthening the resilience of health teams is pivotal in providing optimal health services.

Key messages

• Burnout and insufficient emotional support are key predictors of PTSD among healthcare workers in labour wards.

• Enhancing support and resilience for midwives and gynecologists is crucial for their well-being and patient care.
Experts in promotion and prevention - The 100th Anniversary of Finnish public health nurse education
Authors: Saastamoinen J , Putkuri T
Published: October 2024

Issue/Problem

Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed.

Description of the problem

Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree.

Results

In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses.

Lessons

In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics.

Key messages

• Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future.

• By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.
Postgraduate medical education in Public Health: the Italian scenario and a call to action
Authors: Pennisi F , Ricciaridi G E , Minerva M , Signorelli C
Published: October 2024

Introduction

Public health training in Italy takes place within postgraduate medical training in Hygiene and Preventive Medicine. With 39 university schools of public health, spread across 17 of Italy’s 20 regions, the landscape is diverse. The government determines the number of available contracts annually. This study aims to provide an up-to-date analysis of the saturation of places in Public Health programmes, as well as an assessment of mobility trends between northern and southern Italy from 2017 to 2023.

Methods

Data on admissions, withdrawals and resignations were obtained from the Ministries of Universities and Health and from the archives of the ‘Associazione Liberi Specializzandi’ (ALS). Mobility was assessed as moving from the central-northern regions to the southern-islands of Italy, and vice versa, between registration with the Medical Council and specialisation programme enrollment.

Results

Between 2017 and 2023, a total of 2301 residents enrolled across Italy, out of 2953 available positions nationwide. During this period the number of available national places, increased from 180 to 576, impacting overall seat saturation. In 2017, 98.3% of positions were covered, compared to only 46.5% in 2023. Regarding the mobility trend, southern students attending northern schools increased from 8.3% in 2017 to 22.4% in 2023, while northern students attending southern schools decreased from 17.9% to 1%. However, the number of dropouts and withdrawals was higher in the North. Mobility students scored lower than non-mobility students nationally.

Key messages

• From 2017 to 2023, the number of residents enrolled increased, while the allocation rate decreased. There was a shift in mobility patterns, with more southern students moving north.

• Addressing the identified inequalities and understanding the underlying factors driving mobility patterns is crucial for effective planning and allocation of resources.
Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs
Authors: Marziali E , Lontano A , Pascucci D , Raponi M , Di Donato M , Corbo M I , Murri R , Fiori B , Cambieri A , Laurenti P
Published: October 2024

Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p < 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings.

Key messages

• Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation.

• Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.
Advancing data-driven decision-making for human papillomavirus (HPV)
Authors: Louette L L
Published: October 2024

Background

HPV is among the most important infections associated with cancers in men and women, including cervical cancer which is the second most common cancer affecting women aged 15-44 years in the EU. Yet, data on vaccine uptake, HPV infection rates and incidence of related cancers is lacking across Europe, obstructing policymakers’ ability to build adequate prevention strategies towards the EU’s goal of eliminating HPV-related cancers.

Methods

Vaccines Europe analysed the landscape of data collection practices for HPV, highlighting discrepancies across Europe as well as successful initiatives.

Results

Our analysis reveals stark gaps in data collection across Europe. Some countries do not report disease levels and vaccination coverage for HPV. When reporting does occur, methods and timelines often differ between countries. Limited data availability exists for vaccination uptake in boys and young adults. This lack of standardisation hinders the comparability and reliability of collected data. It also impedes the integration and analysis of data within and across countries, hindering the development of effective elimination strategies. Concrete actions are needed at EU and national level to further develop and strengthen data collection, sharing and use in decision-making. Our research calls on strengthening ECDC’s role, promoting best practice sharing between countries, ensuring sustained resource allocation for data systems/surveillance, establishing electronic vaccination registries, an EU implementation roadmap to support countries in achieving the objectives of Europe’s Beating Cancer Plan, and translating data into policy recommendations. The Council Recommendation on vaccine-preventable cancers provides a framework for EU Member States to establish electronic vaccination registries and the ECDC to develop an HPV dashboard by the end of 2024.

Key messages

• Current data collection practices leave Europeans more vulnerable in the fight against cancer.

• Robust data can guide policy and support elimination strategies for vaccine-preventable cancers.
Empowering Educators: Italian Nurses’ Knowledge, Attitudes, Practices, and Vaccine Hesitancy
Authors: Renzi E , Panattoni N , Baccolini V , Migliara G , Di Simone E , Marzuillo C , De Vito C , Villari P , Massimi A
Published: October 2024

Background

Vaccine hesitancy (VH) among healthcare workers is a prevalent global phenomenon and a public health concern. The study aims were i) identifying knowledge, attitudes, and practices (KAP); ii) estimating the prevalence of VH regarding recommended vaccines for healthcare workers (HWs).

Methods

Multicenter cross-sectional study of an Italian sample of nurses and nursing students. Following a systematic review (PROSPERO ID:CRD42020212252), a validated questionnaire was used (Cronbach’s alpha=0.82). Two multivariable logistic regression model were built to identify predictors of (1) VH to the recommended vaccine for HWs; (2) acceptance of the fourth COVID-19 vaccine dose.

Results

226 participants were enrolled (169 nurses; 57 students). Regarding KAP: only four nurses (1.8%) had adequate knowledge among vaccine recommended for HWs, whereas 30% (N = 66) reported never having recommended vaccinations during clinical practice. 106 (46%) nurses/students reported VH for at least one of the vaccines recommended for HWs - high levels of VH were recorded for influenza vaccination (N = 88,38.9%) and fourth COVID-19 vaccine dose (N = 100,44.3%). At the multivariable analysis, (1) significant associations with highest levels of VH were found for nurses who reported having at least one child (OR:5.42, 95%CI: 1.64-17.89) and who had not received any dose of influenza vaccination in the last 5 years (OR:13.25, 95%CI: 5.29-33.16). Lowest odds of VH was found for nurses employed in Primary Health Care (OR:0.17, 95%CI: 0.03-0.98); (2) routinely recommending vaccinations during practice (OR:0.38, 95% CI: 0.15-0.95) was associated with acceptance of fourth COVID-19 vaccine dose. Conversely, reliance on social media as the primary information source seemed to be a predictor of COVID-19 vaccine refusal (OR:2.05 95% CI: 1.31-3.20).

Conclusions

Preliminary results identified predictors of VH among nurses, offering insights for organizations to effectively tailor public health interventions.

Key messages

• High levels of vaccine hesitancy among nurses towards recommended vaccines for healthcare workers pose a threat to patient safety.

• Empowering ‘educators’ through focused public health interventions is essential to address factors contributing to vaccine hesitancy among healthcare workers.
A systematic review of practices against healthcare associated infections and antibiotic resistance
Authors: Agodi A , Barchitta M , Campisi E , Di Liberto E , Maugeri A , Magnano San Lio R , Favara G , Vecchi E , D’Ancona F
Published: October 2024

Introduction

Antimicrobial Resistance (AMR) and Healthcare-Associated Infections (HAIs) can be preventable by promoting Infection Prevention and Control (IPC) practices. Despite the available evidence, there are still significant gaps regarding the combined and cumulative effects of AMR drivers, IPC practices and HAIs. To address this issue, we conducted a Systematic Review to evaluate the impact of AMR drivers and the effect of IPC practices on epidemiological variation of HAIs.

Materials and methods

After designing the protocol, the systematic literature search has been performed on PubMed, Scopus, and Web of Science. After obtaining the relevant articles, citations were imported into the Rayyan Systematic Review Software. Subsequently, basing on the predetermined inclusion criteria, articles screening process was conducted firstly evaluating the title and abstract of each article and then by full text reading. The predesigned data extraction template included first author’s last name, year of publication, location, study title, study design, aims of research, involved wards, population groups, type of Multidrug Resistant (MDR) pathogens, interventions, and outcomes.

Results

Literature search strategies identified 3,637 records in the databases consulted. After de-duplication, 2,881 titles and abstracts remained for screening, and 435 full-text articles were assessed for eligibility. Preliminary results show that among the eligible studies 4% had a pre-post study design, 25% focused on Intensive Care Units, 33% investigated antibiotic usage and antimicrobial stewardship, 17% investigated hand hygiene adherence and 10% analysed the compliance to IPC practices.

Conclusions

The knowledge gained from this comprehensive approach will be used to harmonize the AMR drivers explored to improve the general IPC measures. Moreover, this evidence will improve national awareness and will be important in identifying potential interventions on Governance and IPC measures to contrast AMR.

Key messages

• In the battle against AMR, it is crucial to recognize the impacts of its drivers and the effect of IPC practices.

• AMR and HAIs can be prevented through comprehensive IPC programs.
Tackling Pertussis in Schools: A Public Health Unit’s Approach
Authors: Roque Carvalho D , Gomes L R , Veríssimo V , Vital Brito D
Published: October 2024

Issue

Pertussis is a highly infectious bacterial respiratory disease, easily transmitted in closed settings, such as schools. In Portugal, 2019 was the last year with a significant number of cases (83). As pertussis usually follows epidemic cycles from 3 to 5 years, another wave is expected in 2024. Children aged 1-5 years are particularly vulnerable as they no longer benefit from maternal vaccination and have not yet received the 5-year boost recommended in the national schedule.

Description of the problem

In April 2024, the Cascais Public Health Unit (PHU) addressed two possible pertussis cases in preschools. A streamlined response protocol was drafted, including an online contact tracing form and task distribution among response team members, along with templates and a scripted guide for standardized communication.

Results

We were provided a list of close contacts for the children and staff and shared an online form. In the first case, 34 in 35 identified contacts responded to the form, while in the second case, 38 in 55. When comparing both scenarios, the average scripted call duration decreased from 10 to 6 minutes. The PHU response to the first index case took 6 hours, involving 4 physicians and 5 nurses, whereas to the second took 4 hours, involving 3 physicians and 3 nurses. However, implementation requires at least one team member with basic information technology skills to set up the system.

Lessons

Clear communication channels between schools and public health authorities are vital for effective outbreak management. Streamlining communication processes with online forms and scripted conversation guides improved efficiency. Centralised data collection reduced response time and resource requirements in each outbreak.

Key messages

• Established communication channel, standardized data collection, and streamlined protocol allow more effective outbreak management.

• Centralized data collection via digital tools is particularly useful in limited human resources settings.
Monitoring violence in healthcare. A lesson from the pandemic
Authors: Magnavita N , Meraglia I , Viti G
Published: October 2024

Introduction

Violence against healthcare workers is a serious, underreported, and underestimated problem. Only a few healthcare companies have efficient violence monitoring systems and risk assessment is often entrusted to non-validated algorithms. The monitoring system implemented in 2005 in a public health company allowed for an accurate analysis of the phenomenon.

Methods

For the entire observation period (2005-2023), the one-year prevalence of violent incidents (physical assaults, threats, and harassment) has been reported by all during the periodic medical examination in the workplace. Furthermore, after each periodical inspection of workplaces, the occupational doctor requested a detailed description of violent events that occurred in the department, using the Violent Incident Form distributed online anonymously.

Results

In 2005/6 the one-year prevalence of physical assaults was 8.2%. Prevention efforts led to a moderate reduction in the rate (7.8% in 2011/12). A collapse in rates was observed in 2021 (3.2%). In 2022, physical violence rose again to 5.6%. Harassment affected 19.6% of workers in 2005/6, falling to 7.2% in 2021 and rising again to 21.6% in 2022. Physical violence perpetrated by patients was more frequent in psychiatric services (OR 25.7, CI95% 11.1; 59.6) and violence perpetrated by visitors in emergency and urgence services (OR 8.8, CI95% 3.8; 20.5) than in general services. Workers attributed the drop in attacks primarily to the filtering of access to work areas, which limited the presence of visitors and relatives. The lower demand for services had also resulted in an optimal ratio between staff and patients, improving the quality of care. Furthermore, in the very first pandemic phase, health workers enjoyed a very favorable consideration from the population, which had further reduced the causes of conflict.

Conclusions

The pandemic has shown that better relationships between patients/visitors and staff are effective in reducing violence.

Key messages

• Monitoring of violence against healthcare workers shows that it has decreased during the pandemic.

• HCWs believe that (i) limiting visitor access (ii) better balancing demand for services and (iii) better opinion towards HCWs were the causes of the reduced rate of violence.
Evaluating Genetic Testing: A Systematic Review of Assessment Frameworks
Authors: Baccolini V , Migliara G , Sciurti A , Kaminska A E , Anniballo A , Pistollato A , Pitini E , Marzuillo C , La Torre G , Villari P
Published: October 2024

Introduction

The assessment of the risks and benefits of genetic/genomic tests has long been addressed using various frameworks. They are mostly ACCE-based, focus on technical aspects, but often overlook economic and organizational considerations. The few HTA-based approaches, though more comprehensive, lack validation and implementation. This review’s purpose is to identify all evaluation frameworks for genetic/genomic tests and synthesize their key aspects.

Methods

PubMed, Scopus, Web of Science, and Google Scholar were searched. Inclusion criteria were documents describing evaluation frameworks for genetic/genomic tests, that were original, specifically created, and covering at least three assessment domains. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results

Overall, 12546 unique records were screened, of which 67 documents were assessed for eligibility. A total of 29 studies were included, reporting 24 different frameworks. These frameworks were published between 2000 and 2019, mostly from USA (50%), Canada (13%) and UK (13%). There was substantial interest in the economic facets of the technology (92%), albeit without extensive detail, and high attention was given to its technical accuracy (70-90%). The clinical value was also consistently mentioned (70-90%), similarly to legal, ethical, and social considerations (70-80%). However, there was minimal emphasis on non-health outcomes (20-50%), and insufficient attention to organizational, educational, and implementation barriers (20-50%).

Discussion

A pressing need exists for a universally accepted evaluation framework for genetic/genomic tests. Applying a general HTA methodology, potentially based on the EUnetHTA core model, that can integrate solid theoretical and methodological principles, and result in a validated, comprehensive, and widely shared tool for genetic test evaluation, is a viable option to foster the implementation of these technologies.

Key messages

• Genetic/genomic test evaluations focus on technical accuracy and clinical value, often missing economic and organizational aspects.

• A universal, validated, HTA-based evaluation framework for genetic/genomic tests is needed to enhance their implementation in clinical practice.
BE-SAFE: Intervention to reduce benzodiazepine and sedative hypnotics in elderly with sleep problems
Authors: Tsoutsi V , Aubert C E , Maldonado L F , Wichniak A , Agoritsas T H , Callegari E , Macq J , Dikeos D , Rodondi N , Spinewine A
Published: October 2024

Introduction

Benzodiazepine and sedative hypnotics (BSH) may have significant adverse effects and associated costs, especially in older adults: increased risk of falls, fractures, hospitalisations, impaired functioning, delirium, cognitive impairment and mortality. Addressing BSH overuse is therefore an urgent priority to improve patient safety in Europe.

Objectives

To present the 5-year research project BE-SAFE, funded by the European Commission (HORIZON Europe) and by the Swiss State Secretariat for Education, Research, and Innovation. BE-SAFE aims to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSH used by older adults for sleep problems.

Methods

BE-SAFE involves seven inter-related work packages and six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland) as well as experts from Canada; it proposes an interdisciplinary and inter-sectorial approach with experts in guidelines, implementation, dissemination, case studies, geriatrics and sleep. BE-SAFE will develop an intervention comprising trustworthy clinical guidelines, implementation recommendations and patient-centred material. This intervention will be tested in a cluster randomized controlled trial; 470 patients (65 years old and above) and 62 prescribing physicians in hospital and outpatient settings.

Results

BE-SAFE is expected to result in reduction of BSH use. Its toolkit, encompassing setting-specific implementation recommendations, will enable healthcare professionals (HCPs) to identify, evaluate and prevent risks of BSH use. The BE-SAFE approach could also be expanded to cover reduction of use of other medications.

Conclusions

Through BE-SAFE, patient safety is expected to improve; BE-SAFE project will reach a wide-ranging audience, including general population, informal carers, older adults, HCPs, healthcare system leaders and decision makers. Authors acknowledge the significant input of J. Grimshaw and W. Levinson, Canada.

Key messages

• Deprescription of benzodiazepine and sedative hypnotics, especially in older adults, is a priority due to their side effects, particularly in this age group.

• The European project BE-SAFE aspires to create easy-to-use guidelines to this aim, improving thus patient safety and healthcare.
Genetic and other omics-based information in the most-cited recent clinical trials
Authors: Russo L , Farina S , Siena L M , Pastorino R , Boccia S , Ioannidis JPA
Published: October 2024

Introduction

Since the genomic revolution, the utilization of genetic and omics technologies has undergone considerable expansion within clinical studies, employed in design, analysis, and interpretation.

Methods

A recent study of Siena et al. developed a database containing the 600 most cited clinical trials published from 2019 to 2022. Building on this database, the aim of our study is to assess how frequently genetic and other omics-based information has been used in the design, analysis, results or conclusion of these recent influential trials.

Results

132 out 600 (22%) trials used genetic or other omics. These trials were more likely to be oncology trials (76%vs34%), having industry funding (59%vs47%), and having industry authors (75%vs54%) than others. Overall, genetics and genomics were present in 75% of the trials (100/132), and oncology was the predominant medical field (76%, n = 101). The prevailing use was detection of specific mutations (n = 99), often (n = 60) used as eligibility criterion. These mutations were mostly somatic (n = 85), while 14 were germline. Other applications included transcriptomics (20.4%), proteomics (10.6%), metabolomics (8.3%) and metagenomics (8.3%). 36 studies (27%) employed multiple applications. Genetics or other omics were used in 10% of the studies (14/132) for randomization stratification and in 63% (83/132) to conduct subgroup analysis. Among the latter, in 48% (40/83) the presence of a somatic mutation was significantly associated with the investigated health outcomes, while germline mutation or other omics only in the 12% (10/83). In the trials conclusions, authors addressed the relevance of the genetic or omics information in 62.1% (82/132) of the trials.

Conclusions

A sizeable proportion of the most-cited clinical trials use genetics or omics-based information, but the large majority pertains to cancer mutations in oncology trials. Use of genetics and omics needs to become more common in other clinical trial fields.

Key messages

• Genetic profiling and omics applications should be incorporated into trial design.

• Genomic research is mostly oncology related and it needs to be expanded to other medical fields.
Is confidence in knowledge related to childbirth fear and mode of birth among Polish women?
Authors: Surma P , Micek A , Bednarek-Chałuda M , Stoll K , Nenko I
Published: October 2024

Background

In Poland, cesarean section (CS) rate is 48% what means that it is one of the highest rate among OECD countries and the highest in the European Union. WHO has considered that CS rates higher than 15% at the population level are not associated with reductions in maternal and newborn mortality rates. Fear and attitudes towards childbirth are shaped years before the first pregnancy. Yet, little is understood about how young people’s knowledge, attitudes and fears concerning the birth process shape their healthcare preferences around birth. Thus, the aim of the study was to examine whether confidence in knowledge was associated with childbirth fear prior to pregnancy and preference for CS.

Methods

We recruited 782 women aged 18 - 35 (mean 24.7, sd = 3.19) who had never been pregnant but wished to have at least one child in the future. The women answered questions about: (i) socio-economic situation, (ii) confidence in knowledge and educational needs related to pregnancy and childbirth; (iii) fear of childbirth prior to pregnancy; (iv) preferred mode of birth in the hypothetical pregnancy in which there are no medical indications for cesarean section.

Results

Almost one in four women (22.1%) preferred CS in a hypothetical low-risk pregnancy. In addition, most often young women gained knowledge on pregnancy and birth from experiences and stories of family members (62.3%). Women with moderate and high level of confidence in knowledge had respectively lower odds of high level of childbirth fear prior to pregnancy comparing to women with low level of confidence in knowledge (OR = 0.57, 95% CI: 0.39-0.83 and OR = 0.54, 95% CI: 0.33-0.88, respectively).

Conclusions

Increasing knowledge about pregnancy and childbirth among young women might lower childbirth fear and thus, indirectly, lower rates of CS in the future.

Key messages

• The results of this study may solve very important public health problem i.e. the growing rates of cesarean section.

• Confidence in knowledge may be an important factor associated with the level of childbirth fear.
Prenatal exposure to phthalates and children’s mental health trajectories: Rhea Cohort, Greece
Authors: Mouatsou C , Margetaki K , Kampouri M , Psoma S , Roumeliotaki T , Vafeiadi M , Chatzi L , Kogevinas M , Koutra K
Published: October 2024

Background

Accumulating evidence suggests that phthalate exposure affects neurodevelopment, including emotional and behavioral outcomes. Our aim was to investigate if prenatal phthalate exposure affects the developmental course of internalizing and externalizing symptoms from early childhood to adolescence.

Methods

Concentrations of seven phthalate metabolites were measured in first-trimester maternal spot urine samples, and DEHP, and high and low molecular weight phthalate concentrations were calculated (HMW and LMW, respectively). Mothers reported internalizing and externalizing symptoms via the Strengths and Difficulties Questionnaire at 4 years and the Child Behavior Checklist at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 546 participants of the Rhea Cohort (Crete, Greece) into 4 distinct groups (Stable low, Stable high, Low-Increasing, and High-Decreasing symptoms). We evaluated the association of prenatal phthalate exposure with the odds of an adverse (Stable high, Low-Increasing, and High-Decreasing) internalizing and externalizing symptom trajectory in 150 children using multivariable-adjusted logistic regression (reference group: stable low).

Results

Only for girls, exposure to DEHP and HMW phthalates was associated with higher odds of being grouped in an adverse internalizing symptoms trajectory (OR [95%CI]: 1.52 [1.03, 2.25] and 1.57 [1.03, 2.39], respectively). Regarding externalizing symptoms, interactions with gender emerged for DEHP (p = 0.024) and HMW (p = 0.028) phthalates, and increased odds of being grouped into an adverse trajectory were observed in girls, whereas boys showed the opposite trend, albeit none reached statistical significance.

Conclusions

The findings suggest programming effects of prenatal phthalate exposure on the developmental course of emotional symptoms in girls. Further research is needed to clarify the association between in utero phthalate exposure and behavioral symptoms.

Key messages

• Phthalate exposure is linked to adverse trajectories of emotional symptoms, emerging from preschool age and up to adolescence.

• Phthalate effect on internalizing and externalizing symptoms varies by gender.
Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022
Authors: Myhr A , Vesterbekkmo R K , Sund E R
Published: October 2024

Background

Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents.

Methods

This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

Results

The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p < 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period.

Conclusions

Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors.

Key messages

• The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls.

• While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.
The association between screen use, psychological distress and sleep among adolescents in Norway
Authors: Steigen A M , Bonsaksen T , Stea T H , Leonhardt M , Lien L , Kleppang A L
Published: October 2024

Background

Today’s adolescents dedicate a significant portion of their time to screens. Concerns have arisen regarding the lasting impact of screen use on adolescent health, making it a crucial public health topic. Previous studies have presented both positive and negative outcomes associated with screen use. Further insight is required into various forms of screen use and the influence on adolescent health. The objective of this study is to examine the relationship between gaming, social media use, psychological distress, and sleep among adolescents.

Methods

This study is based on cross-sectional data from the Ung-HUNT4-study, a health study conducted among adolescents 13-19 years old in Trøndelag municipality in Norway from 2017-2019 (n = 8066). Binomial logistic regression was used to analyse the association between gaming, social media, psychological distress and sleep. Analysis was controlled for gender, age, family economy and having friends.

Results

Preliminary results showed that the odds for having psychological distress were higher for those who spent more than 3 hours on social media after school (OR: 1.31, 95% CI: 1.10-1.57), and on weekends (OR: 1.45, 95% Cl: 1.22 - 1.73), and on gaming in weekends (OR:1.30 Cl: 1.08-1.55) compared to those who spent 3 hours and less. The odds for sleeping < 8 hours per day on weekdays were higher for those who spent more than 3 hours on gaming after school (OR: 1.27 Cl:1.07-1.52), and more than 3 hours on social media after school, (OR:1.41 Cl:1.20-1.67) or on weekends (OR:1.39 Cl: 1.19-1.62), compared to those who spent 3 hours or less.

Conclusions

More than 3 hours spent on social media after school and on weekends was associated with significantly higher odds for psychological distress and less sleep on weekdays. More knowledge about the impact of different types of screen use on adolescents’ health is needed, and new public health strategies to secure safe screen use should be developed.

Key messages

• Screen use is associated with psychological distress and less sleep.

• Awareness on various types of screen use and its influence on health in adolescence, is important in public health policy and practice.
Antibiotic use in the first 1000 days and maternal-infant outcomes: results from the MAMI-MED cohort
Authors: Barchitta M , Maugeri A , Magnano San Lio R , Favara G , Campisi E , Di Liberto E , Ojeda-Granados C , La Mastra C , La Rosa M C , Agodi A
Published: October 2024

Introduction

Antibiotic use within the initial thousand days of life could potentially lead to a range of negative health outcomes for both mothers and infants. This study seeks to identify the primary factors influencing antibiotic use and examine the associations with adverse neonatal outcomes, specifically focusing on neonatal intensive care unit (NICU) admissions.

Methods

Data were gathered from pregnant women and their offspring enrolled in the ‘MAMI-MED’ study at ARNAS Garibaldi Nesima in Catania (Italy), from December 2020 to January 2024. Information regarding antibiotic exposure and maternal-infant health outcomes was collected through follow-up questionnaires administered at birth, one year, and two years postpartum.

Results

Among 1492 women (average age: 31 years) included in the study, 20.4% reported using antibiotics during pregnancy. The mean age of antibiotic users during pregnancy was significantly higher compared to non-users (p = 0.008). Among the 304 women who used antibiotics during pregnancy, 45.5% did so during the third trimester, 41.4% during the second trimester, and 13.1% during the first trimester. Furthermore, 47.1% of women reported antibiotic use at delivery or postpartum. Of the 904 children studied, 63% were administered at least one antibiotic between birth and the first year of age. A greater proportion of newborns admitted to the NICU were born to mothers who used antibiotics during the second trimester of pregnancy compared to those who used antibiotics during other trimesters (p = 0.013).

Conclusions

Comprehensive research is needed to delve deeper into the intricate factors influencing maternal antibiotic use. This should thoroughly explore socio-demographic variables, such as income level, education, and access to healthcare. Understanding these multifaceted influences can provide valuable insights into designing tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy.

Key messages

• Different factors influence maternal antibiotic use.

• Tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy are needed.
Big bang in the middle of a storm: Lessons from implementing health system reform in Finland
Authors: Tynkkynen L
Published: October 2024

Introduction

Finland is often defined as a Nordic welfare state, characterised by universal access to healthcare and an emphasis on national and local politics in the governance of the system. In 2023, the Finnish health system was reformed by centralising organisation (purchasing and service delivery) to regional entities, as well as funding and overall governance to the state from 200 local organisations. The aims of the reform were to improve accessibility, decrease inequities, promote population health and curb growing costs. In the Finnish health system, as in other fields of society, we “find a huge number of very small changes, and a very small number of huge changes” (Cairney 2016). This makes the Finnish health system reform a rare opportunity to use a large-scale reform as a context for a study on reform implementation.

Methods

This research is based on document analysis and interview data collected from top regional managers. The data was analysed using a political determinants of health framework and thematic analysis.

Findings

The Finnish reforms were introduced by a left-centre government but implemented by a right-wing government with strong opposition to the reforms, which made full implementation challenging. The results highlight the importance of political commitment to implementation, demonstrate that reforms shape power relations at all levels of the health system and highlight how health system reforms are essentially about redistributions of power between different actors. The results also highlight the importance of contextual factors and suggest that large-scale reform should be treated as a system shock for which health systems need to prepare.

Conclusions

Understanding the political determinants of health and political commitment to reform is essential to implementation, as is the importance of resilience and preparedness to unexpected circumstances either due to reform-related factors or to external and contextual factors.
Discrimination against migrants: does social capital moderate harmful effects on mental health?
Authors: Biddle L , Stacherl B , Heidinger E
Published: October 2024

The harmful mental health effects of perceived discrimination are well established. Yet, the role of regional-level social capital in mitigating these effects remains underexplored. Using data from the German Socioeconomic Panel (SOEP; 2010-2021) we apply random effects models to assess the effect of perceived discrimination on mental health (mcs subscale of the SF-12) adjusting for individual socio-demographic factors and regional-level socioeconomic deprivation. We assess interaction with general social capital (civic organisations, electoral turnout, generalised trust) and migrant-specific resources (proportion of non-nationals and share of far-right votes). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to assess for bias introduced by selective mobility into regions. In the non-refugee sample, we confirm negative effects of frequent discrimination experiences on mcs (ß: -3.74; 95%CI: -4.39, -3.08). Moderation analyses show insignificant results for general social capital, but a negative interaction effect of proportion of non-nationals (ß: -0.71; 95%CI: -1.34, -0.08). Analyses among refugees confirm the negative effect of discrimination on mcs (ß: -6.29; 95%CI: -7.49, -5.08) and the moderating effect of the proportion of non-nationals (ß: -1.63; 95%CI: -2.78, -0.48), as well as showing a positive moderation effect for generalised trust (ß: 0.84; 95%CI: 0.11-1.57). Results demonstrate the negative implications of living in areas with a high proportion of non-nationals for migrants experiencing discrimination, which may be explained by the higher marginalisation of migrants in these areas and increased service access barriers. The absence of a moderation effect of general social capital appears to be the result of selection bias, with positive effects of generalised trust seen for refugee migrants.

Key messages

• Ethnic discrimination affects mental health of refugee and non-refugee migrants.

• The effect of discrimination on mental health are stronger in areas with higher proportion of non-nationals.