bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential susceptibility to allostatic load and educational inequalities in coronary heart disease
Authors: Hicks B , Veronesi G , Ferrario M , Cesana G , Iacoviello L , Palmieri L , Kuulasmaa K , Soderberg S , Sans S , Kee F 
Published: October 2020

Abstract

Background
Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe.

Methods
51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models.

Results
AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility.

Conclusions
While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education.

Key messages
Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.
Psychological distress among elderly in Bangladesh
Authors: Sara H 
Published: October 2020

Abstract
Multimorbidity is a major public health problem in most developing countries including Bangladesh, where the population is moving towards aging. Elderly with chronic conditions may suffer from psychological distress which often goes unrecognized. Since psychological distress is curable, it is important to identify it at the earliest to enhance recovery. Thus the objective of the study is to examine the association between psychological distress and multimorbidity among hospitalized elderly.
This hospital-based cross-sectional study is followed by a two-stage stratified sampling method and all hospitalized elderly aged 60 and above are the target population. Data were collected from April 2017-June 2017 by a structured questionnaire through face to face interview. The level of psychological distress was measured with the Kessler 10 items scale K (10). SPSS version 23.0 was used for data analysis.
The internal consistency of the Kessler Psychological Distress Scale (K10) was good (Cronbach's a = 0.96). The average mean of psychological distress measured with K (10) was 29.18. The level of psychological distress increased by no chronic diseases. Findings show that 88 percent of respondents have severe mental disorders who were suffering from 3 chronic diseases while 45 percent reported for no psychological distress with single diseases. And among multimorbid respondents, elderly women reported a higher level of Psychological distress than male. Similarly, middle-old and old-old respondents have higher psychological distress than Young-old. Urban and currently married people reported for lower psychological distress. Respondents engaged in work have higher psychological distress than unemployed respondents.
Building sufficient systems of long-term care ensuring an appropriate setting that includes both formal and informal care to improve the psychological well-being of elderly people with chronic medical conditions is regarded as crucial.

Key messages
Psychological distress is significantly affected by chronic medical conditions. As many older people remain in hospital inappropriately with psychological distress, a number of measures can be applied to allow for more treatments out of the hospital.
Psychological resilience and cardiovascular disease? A systematic review of the literature
Authors: Ghulam A , Bonaccio M , Gialluisi A , Gianfagna F , Iacoviello L 
Published: October 2020

Abstract

Background
Psychosocial resilience is the capacity of responding positively to stressful events in life. We performed a systematic review of the literature to find whether resilience has any protective effect on cardiovascular disease (CVD) or mortality.

Methods
We searched Pubmed and Prospero systematic Review Registry using terms resilience, psychological or resiliency or resilience or resilient or hardiness, cardiovascular or stroke or or myocardial infarction or CVD or mortality or hospitalization. The references of each included paper were also searched for relevant studies. Longitudinal studies conducted on all populations, in English, with no time restriction were searched. They were included in the review if they examined resilience as primary exposition, and mortality for all causes, mortality for CVD, CVD events and hospitalization as outcomes and if they were longitudinal.

Results
The search identified 1,471 studies, of which only 8 were retained and fully examined based on the study design reported in the abstract, and 3 met all the inclusion criteria. Two studies on 237,879 young Swedish men showed that lower resilience compared with the highest (scores from an interview) resulted associated with both coronary heart disease (HR = 2.61, 95%CI:2.52-2.70) and stroke risk (HR = 1.54, 1.40-1.70) in adulthood (follow up 23 yrs). A third study on 2,765 postmenopausal Afro-American women showed that a modified Brief Resilience Scale was not associated with CVDs (lowest vs highest quartile, HR = 0.95, 95%CI:0.63-1.42; follow up 12.5 yrs).

Conclusions
There is not sufficient evidence of a protective attitude of resilience towards CVD: only 3 studies were eligible, with heterogeneity in sample size, exposures to stressors and scales used to measure resilience, and with resilience data available only at baseline. Further studies are necessary, since resilience is a powerful concept, and, if proved protective, might be improved in populations to ameliorate CV health.

Key messages
No clear association between resilience and CVD risk has been shown in literature. This is the first systematic review on the topic and further research is needed to broaden our understanding of the relation between resilience and CVD.
Prevalence of type 2 diabetes and associated risk factors among Saharawi refugees in Algeria
Authors: Henjum S , Kjollesdal M K R , Flaaten M O , Andersen E , Hjellset V T , Morseth M S 
Published: October 2020

Abstract

Background
The Saharawi refugees have been living in refugee camps in the Algerian desert since 1975 and are dependent on food aid. A double burden of malnutrition by the coexistence of undernutrition among children and overweight and obesity among adults has been observed in the Saharawi refugee camps. Limited knowledge about the prevalence of type 2 diabetes (T2D) and associated risk factors exists in this population. The aim of this study was, therefore, to address this gap in the literature.

Methods
A cross-sectional survey was carried out in five Saharawi refugee camps in Algeria in 2014. A total of 180 women and 175 men were included. HbA1c was used to assess the prevalence of T2D and prediabetes. The Finnish Diabetes Risk Score (FINDRISC) was used to estimate the risk of developing T2D. Multiple logistic regressions were performed to assess risk factors associated with T2D and prediabetes.

Results
Median (min, max) HbA1c among the Saharawi refugees was 35 (4, 135) mmol/mol. The prevalence of T2D and prediabetes was 7% and 10%, respectively. The prevalence of overweight and obesity combined was 45%, and higher in women than in men. According to FINDRISC, 9% of participants had high risk of developing diabetes and 10% had moderate risk. In adjusted models, significant predictors for T2D were age, waist circumference and having a first-degree relative with T2D. Significant predictors for prediabetes were age, body mass index (BMI), waist circumference and a history of high blood glucose.

Conclusions
We found moderate prevalence of diabetes and prediabetes and a relatively high prevalence of overweight and obesity among the Saharawi refugees, especially the women. Given the fragility of the Saharawi health care system, screening for diabetes should be conducted in a cost-effective manner and high-risk individuals should receive advice about lifestyle changes (e.g. diet and physical activity).

Key messages
We found moderate prevalence of diabetes and pre-diabetes among the Saharawi refugees, and a high proportion were classified as overweight or obese. In light of this, the rates of T2D are likely to increase in the near future. The Saharawi health authorities should pay attention to the increased risk of diabetes in this vulnerable population.
Screening in health impact assessment: issues and practice in France
Authors: Jabot F , Dardier G 
Published: October 2020

Abstract

Background
Health impact assessment (HIA) is a method aimed at anticipating the potential effects of proposals on health prior to their implementation in order to include health issues in decisions made outside the health sector. It is structured in several steps. The first one (screening), aimed to decide if a full assessment is required or not, is poorly documented. In France, the interest shown for HIA has led to a growing number of experiments, which questions the quality of practices linked to this step and its capacity to fulfil its purpose. This study describes how screening is implemented, explores the main issues at this stage, the decision-making process and to what extent it conditions the HIA's success.

Methods
All HIAs undertaken between 2011 and 2019 were listed in order to provide a picture of the process. Then, we focused on the 3 most involved regions to describe the screening process (reports, interviews, observation). Drawing on quality standards and literature review, we built an analytical framework to analyze practices, the interface with other approaches, the influence of the local context and the HIA's success factors.

Results
59 HIAs were identified. Among them, 54 have gone beyond screening. HIAs are applied to land use planning (72%,) policies (19%), equipments (9%) and are carried out by public organisations (37%), private firms (35%), universities (15%), municipalities (13%). 11 regions (out of 18) conducted at least one HIA and practice varies significantly across regions. Case studies in 3 regions (36 HIAs) show that screening length and depth vary greatly. Its features depend on political commitment to HIA, advocacy for HIA, guidance, relationship with local authorities, technical skills. Overall, screening is more dedicated to promote HIA and select a pilot project than to study the HIA's relevance and feasibility.

Conclusions
Since screening is methodologically poorly underpinned, it weakens HIA's quality and efficiency whatever its duration.

Key messages
Screening step is key to raise decision-makers’ awareness of the consequences of their engagement in HIA. Screening allows to ensure that HIA is the relevant method for the project and the conditions are met to gain its utility.
Success story in technical cooperation among countries of the south
Authors: Alsheikh G , Al Darazi F 
Published: October 2020

Abstract
The policy paper aims at sharing experience in medical education between Tunisia and Djibouti through technical support from WHO EMRO. Djibouti, a francophone country located in the English-speaking horn of Africa, could not rely on neighboring countries to help in establishing a badly needed medical school. Djibouti a low middle-income country, with around one million population has a low density in medical professionals. Most of them were trained in France or other francophone countries and the rate of return to practice. WHO EMRO was requested to support in establishing a medical school.
A feasibility study to develop a problem based and community oriented medical school was carried out by experts from WHO EMRO and from senior medical professors from Lebanon and Tunisia. A plan was designed to establish the medical school with support from WHO EMRO and technical cooperation from Tunisia using the same approach in establishing the medical school of Nouakchott in Mauritania. Initial funding was provided from WHO EMRO to support acquisition of education materials and laboratories and by a 600,000 $ grant from the African Bank to secure travel and accommodation of visiting professors from Tunisia and from other francophone countries from the region. More than 300 physicians were trained locally and efforts are being made to train Djiboutian residents in various specialties and to train future teachers.
The objectives of the paper are to: To share a success story in south to south cooperation with technical support from WHOTo harness solidarity mechanisms among countries of the southTo highlight the positive role played by WHO in facilitating technical cooperation and in mobilizing financial resources from development bank to support medical education

Key messages
need to harness solidarity among countries of the south in human resource development. highlight the facilitating role of WHO In technical cooperation and in fund raising.
eConsultation between health care professionals in primary health care and specialized medical care
Authors: Seppänen M , Hämäläinen T , Joffe G , Mäkitie L 
Published: October 2020

Abstract
The synchronous eConsultation is provided by a specialist in a hospital to a GP appointment either by pre-set request or without scheduling. The patient participates in the session. The eConsultation employs video or chat and the program integrated into Health Village service platform enables also sharing x-rays, still photos and other EHR material. Health Village delivers public health services for general public, digital care pathways for patients with specific diagnoses and digital tools for professionals.
The eConsultation project started in 2018, after interviewing the member municipalities (n = 24, 1 600 000 inhabitants) of the Hospital District of Helsinki and Uusimaa (HUS) in Finland. The municipalities gave a high priority to eConsultation as a way of further integration of service chains and dissemination of common practices between and within the specialized and primary health care services.
Funded by the HUS and supported by the HUS IT Department eHealth Services, eConsultation pilots started in 2018 in close collaboration between the public specialized and primary health care organizations in neurology, orthopedics and wound treatment. The pilots indicated that eConsultation are more efficient than traditional consultation methods (e.g., the time used by a neurologist in eConsultation dropped by 87% vs. a face-to-face consultation visit). Almost all of patients and 84% of primary care professionals reported high level of satisfaction. The consultants found that the presence of a patient fostered, if needed, additional clinical interview and diagnostic procedures by proxy, as well as assessment of individual needs of a GP. The primary care professionals appreciated queue-free response (45 seconds in eConsultation with no pre-set appointment time) and augmented educational validity.
Scaling of eConsultation across the whole hospital district and more specialties is going on. eConsultation will be explored in depth in two starting scientific studies.

Key messages
Synchronous eConsultation. more efficient than traditional consultation methods.
XarxaSalut, network of municipalities for health, Valencia Region (Spain): policy process evaluation
Authors: Peiró Pérez R , Pérez Sanz E , Legaz Sanchez E , Quiles Izquierdo J , XarxaSalut Grupo 
Published: October 2020

Abstract
“XarxaSalut” started in 2017, with the municipalities that have taken the commitment to boost the Promotion of Health (HP) at the local level through community participation, intersectorality and equity perspective. The objective is to present a policy process evaluation (2'5 years) of the implementation of XarxaSalut.
Different approaches have been used; a questionnaire addressed to the municipalities at the time of adhesion including data on intersectorality, participation, HP actions and open questions; description of instruments that Regional Public Health Authorities (RPHA) has mobilized and an analysis of barriers and strengths made by the coordination office.
In 2017, 17 municipalities were joined, being 197 in February 2020 (70% of the population). 65% are in a process of an organizational change through the intersectoral, decision making and participative working group. 35% are doing analysis of determinants and /or health situation, assets maps and a prioritization of HP actions. The main barriers identified by municipalities are lack of economic and personal resources, and difficulties in achieve citizen participation. The main benefits were the optimization of resources, the exchange of experiences, training, or economic support from the RPHA. Some support instruments develop for RPHA are a collection of guides for community development, funds that the municipalities can apply to support actions related with training, HP action on vulnerable population, on asset maps, participation processes, vulnerable neighborhoods, etc.; Community actions have been included in the “Health Observatory” to give visibility and social support to XarxaSalut. Interdisciplinary training processes with health and municipal professionals have been made in order to develop a common language and strength the competences for HP.
Lesson learned: The need to improve coordination and a common language between different types of participants and professionals

Key messages
The decision makers and professionals in the municipalities understand the impact in health of the policies developed at local level but needs guide and support to deal with it. The coordination between different administrations and primary health at local level and the misunderstandings about health and their determinants are the main aspect to reinforce.
Elements of the built environment that can promote physical activity in elderly: an umbrella review
Authors: Manzi F , Del Riccio M , Naldi E , Setola N , Dellisanti C , Lorini C , Bonaccorsi G 
Published: October 2020

Abstract

Background
All healthy adults aged 65 years and above, unless specific medical conditions, benefit from physical activity. The built environment can support and encourage physical activity. The aim of this study is to establish which specific elements of the built environment can contribute to improve the physical activity of self-sufficient, non-institutionalized and living in the city adults &gt; 65 years.

Methods
An extensive literature search was conducted in several database. Umbrella review methodology was used to include the systematic reviews that presented a sufficient methodological quality. Data from reviews were undergone to critical appraisal, data extraction and synthesis.

Results
Eleven reviews were included. The elements positively associated with physical activity in the elderly resulted: walkability; residential density/urbanisation; street connectivity; access/availability of services and destinations (land-use mix destination diversity and access, public transit, recreational facilities, parks and open spaces); pedestrian/cycling infrastructures and streetscapes (footpaths presence and quality, infrastructures for walking or cycling, easy access to building entrance, benches and sitting facilities, street lights); greenery and aesthetically pleasing scenery; safety and traffic (crime, personal and general safety, traffic and pedestrian safety, human or motorised traffic volume). The elements that resulted as negatively associated with physical activity were: the presence of slopes or hilliness; presence of barriers to walking/cycling; littering/vandalism/decay/vacant buildings; pollution (air, noise, sewer).

Conclusions
Evidences show that specific elements of the built environment can contribute to promoting elderly people's physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.

Key messages
Evidences show that specific elements of the built environment can contribute to promoting elderly people’s physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.
The spatial epidemiology of alcohol-related mortality among the Czech adult population
Authors: Kazmer L , Kulhanova I , Lustigova M 
Published: October 2020

Abstract

Background
In Czechia, alcohol-induced deaths account for a significant portion of preventable mortality. As inequalities in health are both socially and spatially determined, the paper aims at the detailed examination of socio-geographic inequalities of this phenomenon.

Methods
The 2011-2015 annual data on both ICD-10 cause-specific deaths (K70; F10; X45/64; Y15) and mid-year population were obtained from the official Czech registries - the data were cross-classified by gender, 5-year age-groups, and permanent residence (N = 6,302 small area spatial units). The selected socio-demographic indicators (education, unemployment, religious population) from the Czech 2011 Census were spatially merged to the mortality dataset. From the data on education and unemployment, composite deprivation index (DI) was derived. In the adult population aged 25+, the age-standardised mortality ratios (SMR) were computed for each of the spatial units, separately by genders. The SMRs were spatially modelled by the Besag-York-Mollié (BYM) autoregressive approach, applying a fully bayesian framework integrated within the INLA R-package. The study applied cross-sectional design and employed ecological regression conducted on observational data.

Results
Compared to the Czech average, the highest SMRs were located in the historical regions of Moravia [SMR=1.15; 95%CI: 1.11-1.19] and Silesia [SMR=1.59; 95%CI: 1.52-1.66]. The SMRs were significantly correlated with DI among males [Rel.Risk=1.15; 95%CI: 1.11-1.19], and with religiousness rate among females [Rel.Risk=0.83; 95%CI: 0.77-0.90].

Conclusions
Significant socio-geographic inequalities were detected, particularly with respect to the Czech historical regions. Among males, higher mortality was associated with a structural deprivation. Among females, protective effect of religiousness rate was found to be significant. The results highlight an importance of both socially and spatially integrated efforts for public health promotion.

Key messages
The inequalities in health are both socially and spatially contextualised. The paper presents robust empirical evidence in favour of the proposition, as examined on alcohol-related mortality data. The health determinants may be gender sensitive. Males might be more responsive to a structural disadvantage. Among females, cultural factors related to a local community might be more relevant.