bluuebunny/crossref_metadata_2025_split huggingface dataset:
Communication between health professionals and their influence on the coordination of care
Authors: Mendes M F M , Samico I C , Hartz Z M A 
Published: October 2020

Abstract

Background
Problems linked to the coordination of care may represent a lack of communication between levels of care and reflect diagnostic errors, duplication of tests and unnecessary hospitalizations. This study aims to understand the role of communicational relationships between professionals and their influence on coordination between levels of care.

Methods
An evaluative and qualitative nature research. 24 interviews were carried out, with primary care physicians and specialists, institutional supporters and managers of a public health network in Pernambuco, Brazil. The content thematic analysis worked out sought to identify synergies and contradictions in the relationships between the actors.

Results
Knowledge about the role of primary care was incomplete, not being understood its primary role as a care provider. The primary care physician was not recognized as the responsible physician by most professionals. The specialists considered the references poorly filled out and showed a lack of confidence in the primary care physician, who in turn revealed that he did not receive any counter-reference and difficulty in contacting a specialist. Few articulation mechanisms have been reported between levels and the use of informal communication mechanisms. The managers acknowledged the existence of problems, but highlighted the commitment of management in the actions for organizing the network. The “goodwill” of the professionals was considered an articulation facilitator, but not a sufficient practice.

Conclusions
The results allowed to deepen the look at the complexity of the relationships between the actors and how they can influence coordination. Since is perceived the communicational tensions and weaknesses, it is urgent to think of strategies that establish institutionalized spaces for meetings and dialogues that allow articulation among professionals.

Key messages
The study analyzes communicational relationships between primary and specialized care professionals and their influence on the coordination of care. Strategies for mutual collaboration are mandatory.
Importance of work and diagnosis for economic well-being of disability pensioners
Authors: Polvinen A 
Published: October 2020

Abstract

Background
Disability pensioners' economic well-being is weaker than that of the same-age population on average. Approximately 80 per cent of the partial disability pensioners continue working alongside a pension. The same figure for full disability pensioners is 10 per cent. The aim of this study was to examine how working alongside a pension and how the cause of disability are associated with partial and full disability pensioners' economic well-being.

Methods
The data consisted of longitudinal register-based (100% sample of Finns) data from Statistics Finland and the Finnish Centre for Pensions. The data included 18,291 partial disability pensioners and 116,376 full disability pensioners aged 30-62 who were on a disability pension in 2017 and had received a disability pension for at least two years. Economic well-being was measured via disposable income. Linear regression analysis was used to analyze the economic well-being of disability pensioners.

Results
In 2017, the disposable income of disability pensioners who were working alongside a pension was, on average, 50 per cent higher than that of non-working disability pensioners. The median income from work was approximately 16,700 euros/year for working partial disability pensioners and 11,100 euros/year for working full disability pensioners. Adjusted regression models showed that working alongside a pension was associated with a higher economic well-being. Disability pensioners with a mental diagnosis, on the other hand, were working less often and had a lower economic well-being than others.

Conclusions
Working alongside a disability pension has a positive effect on the economic well-being of disability pensioners. Mental diagnosis, on the other hand, often leads to a lower income.

Key messages
Disability pensioners who work alongside a pension have a higher economic well-being than their non-working counterparts. Mental diagnosis was associated with working less often alongside a disability pension and a weaker economic well-being of disability pensioners.
Area deprivation is inversely associated with measles incidence: A spatiotemporal analysis in Germany
Authors: Rohleder S , Stock C , Bozorgmehr K 
Published: October 2020

Abstract

Background
Although measles is endemic in all WHO European regions, very few studies have directly analysed socioeconomic inequalities in disease incidence of measles. We examined the spatiotemporal association between socioeconomic deprivation and measles incidence considering relevant demographic and geographical factors at district level.

Methods
We conducted a longitudinal small-area analysis using nationally representative data of 401 districts from 2001 to 2017. We used Bayesian spatiotemporal regression models to assess the potential effects of area deprivation on measles incidence, adjusted for relevant demographic (district population size, sex, age, and proportion of non-nationals) and geographical factors (north-south-west-east effect) as well as spatial and temporal effects. We computed risk ratios (RR) for deprivation quintiles (Q1 - Q5), and district-specific adjusted relative risks (ARR) to assess the area-level risk profile of measles in Germany.

Results
The risk of measles infection in areas with lowest deprivation quintile (Q1) was 1.58 times higher (95%-credible interval [CrI] 1.32-2.00) than in those with highest deprivation (Q5). Areas with medium-low (Q2), medium (Q3), and medium-high deprivation (Q4) had higher adjusted risks of measles relative to areas with highest deprivation (Q5) (RR: 1.23 (0.99-1.51), 1.05 (0.87-1.26), and 1.23 (1.05-1.43), respectively). We identified 22 areas at high risk and 56 at medium-high risk for measles infections, with highest area-level risks in south-western Germany.

Conclusions
Socioeconomic deprivation in Germany is inversely associated with measles incidence, with elevated risk for measles infections in areas with higher socioeconomic status. Our findings contribute to current global and national debates on measles elimination strategies, and demonstrate the importance of spatial modelling techniques in identifying socioeconomic inequalities and spatial risk patterns of measles for public health actions.

Key messages
Socioeconomic deprivation is inversely associated with measles incidence in Germany, with higher risk of infection in areas with highest socioeconomic status. The social, spatial, and temporal patterns of elevated risk of measles infection require targeted public health action and policy to address the complexity underlying measles epidemiology.
Developing thresholds for intervention recommendation and treatment success after orthopedic surgery
Authors: Kuklinski D , Geissler A 
Published: October 2020

Abstract

Background
Patient reported outcome measures (PROMs) are increasingly used to monitor recovery paths and the outcome of orthopedic procedures. One of the focus areas is endoprosthetic joint care. Unfavorable post-surgery PROM scores might indicate adverse recovery paths. As of now, an adequate definition of thresholds for recommending an adaptation of therapy does not exist. The same is true for thresholds defining treatment success.

Methods
To address this research gap, minimal clinical improvement differences and patient acceptable symptom states are estimated using anchor-based methods. Moreover, to better capture the variance in patients' recovery paths, we calculate thresholds for subgroups of patients exhibiting similar pre-operative PROM scores. For this purpose, we use patient data from two German hospitals, covering roughly 6,000 total hip and knee replacement patients treated between 2016 and 2018. Patients answered standard PROM (WOMAC, EQ-5D) and tailored patient satisfaction questionnaires prior to surgery as well as three and twelve months after surgery.

Results
Whereas we found similar threshold values for total hip and knee replacement patients at the 12 months mark, threshold values after 3 months are systematically better for hip patients than for knee patients. Moreover, we find that thresholds depend on pre-surgery PROM scores. Patients with low pre-surgery scores recover slower, patients in mid-quartiles show large score improvements, and patients in the highest quartile show only mild improvements.

Conclusions
The study shows that when defining thresholds, it should not only be discriminated by indication but also by patient's pre-surgery condition. This pre-surgery condition can best be described by pre-surgery PROM scores. Further, to implement thresholds into standard care, policy makers need to collaborate with public sickness funds and hospitals to refine thresholds based on nation-wide data.

Key messages
An adequate definition of PROM score thresholds is necessary to be able to evaluate intervention recommendations and treatment success after surgery. So far, existing research is limited. Recovery paths and therefore PROM score thresholds differ between indications and are dependent on patients’ pre-surgery condition, best described by pre-surgery PROM scores.
Life course trajectories of weight status and risk of type 2 diabetes
Authors: Yacaman-Mendez D , Tyrnelius P , Gudjonsdottir H , Ponce de leon A , Trolle-Lagerros Y , Lager A 
Published: October 2020

Abstract

Background
Overweight and obesity are risk factors for type 2 diabetes (T2D) with a cumulative effect. However, individuals experience important variation throughout life. We aimed to identify life-course trajectories of changes in weight categories among men and women and their association with T2D.

Methods
4,820 women and 3,128 men participants of the Stockholm Diabetes Preventive Program (1992-2017) provided self-reported weight status at age 7 and 18, BMI 10 and 5 years before the study and measured BMI at baseline. Exposure was categorized as low weight, normal weight and high weight. Diagnosis of T2D was assessed with an oral glucose tolerance tests (OGTT) or taken from inpatient and outpatient registries. The life course trajectories were estimated using latent group mixture models, risk of T2D and population attributable fractions with Poisson regression.

Results
We found five trajectories in women and men: stable normal (44.8%, 34.2%), low increasing (17.4%, 18.7%), high in early adulthood (18.6%, 27.8%), high in late adulthood (14.7%, 14.5%), and stable high (4.5%, 4.5%). Compared to stable normal, the risk of T2D was higher in the low increasing (RR: 1.4 (95%CI: 1.0-2.0), RR:1.54(95%CI: 1.0-2.2)), high in early adulthood ((RR: 2.79 (95%CI: 2.1-3.7), RR: 2.8 (95%CI: 2.0-3.6)), high in late adulthood ((RR: 1.6 (95%CI: 1.1-2.2), RR: 1.6 (95%CI: 1.1-2.3)) and stable high groups ((RR: 2.9 (95%CI: 1.9-4.3), RR: 2.7 (95%CI 1.8-4.0)), and 48.2% (95% CI: 36.3% - 57.8%) of the cases of T2D in women and 41.2% (95%CI: 27.4% - 52.3%) in men could have been avoided if participants had been in the stable normal group. PAF was higher for the high in early adulthood group -25.5% (19%-31%) and (27.2% (19%-35%)-.

Conclusions
We identified five life course trajectories of changes in weight status. Risk of T2D was greater in the stable high and high in early adulthood groups but the proportion of T2D cases that can be attributed to the high in early adulthood group was greater.

Key messages
Different life-course trajectories of high body weight are associated to the risk of diabetes in late adulthood. The largest proportion of cases of T2D can be attributed to weight gain in early adulthood.
Pediatric metabolic syndrome definitions impact prevalence and socioeconomic gradients
Authors: Lepe A , de Kroon M L A , de Winter A F , Reijneveld S A 
Published: October 2020

Abstract

Background
The choice of pediatric metabolic syndrome (MetS) definition influences prevalence estimates, but further implications, especially on the association with socioeconomic status (SES), are not well-known. This hampers a synthesis of the evidence to help guide the relevant stakeholders. For this reason, we aim to assess the impact of alternative definitions on the prevalence of MetS, the children that are identified, and the association between SES and MetS.

Methods
Data were used from the Lifelines Cohort Study, a prospective multigenerational cohort in the Netherlands. At baseline 9,754 children participated, of which 5,085 (52.1%) were included in the longitudinal analyses. We computed the prevalence of MetS according to five published definitions and measured the observed positive agreement between pairs of definitions, indicating the proportion of agreement across the average number of MetS cases. Logistic regression was used to assess the association between SES and MetS. All models were adjusted for age and sex; the longitudinal models were also adjusted for baseline MetS status.

Results
The prevalence rates of MetS varied between definitions (0.7-3.0% at baseline), but positive agreement between MetS definitions was generally fair to good ranging from 0.34 (95% confidence interval (CI) 0.28; 0.41) to 0.66 (95%CI 0.58; 0.75) at baseline. At both assessments, we found an inverse association between baseline SES and MetS, which ranged from 0.81 (95%CI 0.70; 0.93) to 0.92 (95%CI 0.86; 0.98) per definition in the longitudinal analyses with a mean follow-up (SD) of 3.0 (0.75) years.

Conclusions
Alternative definitions of MetS lead to differing prevalence estimates, and they agreed on 50% of the average number of cases of MetS. The alternative definitions also lead to similar socioeconomic gradients; regardless of which definition was used we concluded low SES was a risk factor for developing MetS.

Key messages
Evidence regarding different definitions of metabolic syndrome in children can be combined because the agreement among definitions is generally fair to good. As low socioeconomic status is a consistent risk factor for developing metabolic syndrome, preventive interventions should preferentially target children from low socioeconomic backgrounds.
Time trends of risk and protective factors for non-communicable diseases in São Paulo City 2006-2017
Authors: Siqueira Borges R S , Seoane Leal C H , Sipukow Sciama D , Gaspareto N , D'Elia Nunes R P 
Published: October 2020

Abstract

Background
Non-Communicable Diseases (NCD) were responsible for approximately 73% of mortality in São Paulo, Brazil in 2017, in addition to a high burden of disease, costs for the Health System and a lower quality of life. Monitoring the main risk and protection factors for NCD is essential to transform information into action and support public health promotion policies.

Methods
This is a time trend analysis (2006 - 2017) with data from VIGITEL - Brazilian Surveillance System of Risk and Protective Factors for NCD through Telephone Interviews with adults (≥ 18 years), carried out annually since 2006. Data from the adult population of the city of São Paulo were selected for the following risk and protection factors: obesity, regular consumption of fruits and vegetables, leisure-time physical activity, alcohol abuse and tobacco smoking. The annual percentual change (APC) were estimated by Prais Winstein regression, using Stata 14.

Results
In the period of 2006 to 2017, the prevalence of obesity increased from 11.3% to 18.5% (APC 4.84; CI 3.56-6.16). In relation to regular consumption of fruits and vegetables and leisure-time physical activity, the prevalence increased from 26.8% to 35.5 % (APC 2.03; IC 0,87-3,21) and 27.5% to 29.9% (APC 3,08; IC 1.12-5.08), respectively. Regarding smoking, the prevalence decreased from 18.8% to 14.2% (APC-3.83; IC-5,64- -1.98). However, alcohol abuse increased from 12.0% to 17.4% (APC 2.5; IC 1.42-3.58).

Conclusions
The analysis showed some advances, such as reducing smoking, increasing regular consumption of fruits and vegetables and leisure-time physical activity. On the other hand, there was a significant increase in obesity and alcohol abuse. It is worth remembering that these risk and protection factors can be modified and are related to the Social Determinants of Health that influence lifestyle, so intersectoral population strategies are necessary to face them, as well as public policies that promote healthier environments.

Key messages
Monitoring the main risk and protective factors for Non-Communicable Diseases is essential to implement and to support public health promotion policies and programs. This analysis showed some advances, such as reducing smoking, increasing regular consumption of fruits and vegetables. On the other hand, there was a significant increase in obesity and alcohol abuse.
Implementing mhGAP training to strengthen mental health in primary health care centers in Brazil
Authors: Mendonca J M T , Freire A A , Rewa T , Zorzi D , Monteiro C N , Palacio D C , Borges L M , Marcolino F F , Bonfim D 
Published: October 2020

Abstract

Introduction
Although it is already known that 14% of the global disease burden is attributed to Mental, neurological and substance use disorders, three quarters of people affected by mental disorders in low-income countries do not access treatment. Launched by WHO in 2008, the mhGAP Intervention Guide is a simple technical tool based on scientific evidence which facilitates the management of priority mental health conditions, using protocols for clinical decision in the PHC centers.

Objective
This work aims to describe the methodology of training the primary care staff and specialized mental health workers from São Paulo, Brazil, in the mhGAP Intervention Guide.

Methods
The training was designed in three steps. In the first step, mhGAP Training of Trainers and Supervisors (ToTS) capacitated 76 trainers. In the second a working group (WG) responsible for planning the replication for 100% of the technical staff of 13 PHC centers and 3 mental health community services was formed. The WG defined that the trainers should attend in two alignment moments to guarantee uniformity. And the third stage is the replication, divided in nine groups with forty participants, throughout the year 2020.

Results
The training promotes the exchange of experiences between the participants, who share their personal experiences, enriching the discussions. They also approximate the relationship between PHC and Mental Health services, as well as favors the interdisciplinary and collaborative practice. The PHC workers are more aware of their responsibility in mental health care and feel more empowered. As a challenge, the PHC professionals showed insecurity and reluctance to give the training.

Conclusions
The training provides evidence-based tools for the assessment and integrated management of priority mental disorders by PHC professionals.

Key messages
The mhGAP Intervention Guide training strengths the relationship between Primary Care and Mental Health services and improves Mental Health treatment access. The training improves integrated management of priority mental disorders by PHC professionals.
Interaction between physical activity and polygenic risk score for type-2 diabetes in older Americans
Authors: Wu Y Y , Thompson M D , Youkhana F , Pirkle C M 
Published: October 2020

Abstract

Background
Genetics plays an important role in the development of type-2 diabetes (T2D). Polygenic risk scores (PRS) are increasingly used to quantify genetic risk of T2D in epidemiological studies. These scores, when integrated into analyses of modifiable lifestyle factors, may improve understanding of T2D etiology, as the strength of association with T2D and some lifestyle or demographic factors may vary according to genetic predisposition.

Methods
We examined PRS-lifestyle factor interactions on T2D with data from the United States Health and Retirement Study (HRS), a prospective longitudinal cohort of older adults (≥50 at baseline). HRS contains nationally representative samples of Black and White Americans with pre-calculated PRS for T2D (N = 14,001). Covariates included sex, education, BMI, smoking, alcohol, and physical activity. Predicted prevalence and incidence of T2D were calculated with logistic regression models. Nonparametric bootstrap method was performed to calculate differences in T2D prevalence and incidence by PRS percentiles and interaction variables.

Results
Significant interaction (p_interaction=0.0096) was detected between PRS and physical activity among Whites only. In those with the lowest decile of PRS, T2D prevalence was similar (∼10%) for those reporting no physical activity compared to low or moderate activity. In those with the top decile of PRS, lower T2D prevalence (17%, 95%CI:14.8,19.6) was observed among those with moderate compared to no activity (24%, 95%CI:20.4,27.5). Incident T2D in Whites followed a similar pattern (p_interaction=0.0194). Among Black participants, no significant interaction with any lifestyle variables was detected.

Conclusions
Interaction of different genetic risk profiles with lifestyle factors may inform understanding of why certain inventions are more or less effective in different groups of people, potentially improving clinical and prevention interventions.

Key messages
Protection conferred by physical activity on T2D varied by underlying genetic risk. Gene-environment interaction studies provide insights on why lifestyle factors vary in their associations with T2D.
Factors associated with short term transitions in frailty status in the population ≥ 50 years of age
Authors: Van der Heyden J , Braekman E , Demarest S , De Ridder K 
Published: October 2020

Abstract

Background
Frailty is a clinical state that increases an individual's vulnerability and leads to chronic and complex medical needs in the older population. Transition to frailty is a dynamic and reversible process. Therefore, identification of determinants of transitions between frailty states is important for preventive action. This study assesses correlates of short time transitions in frailty states in the non-institutionalized population aged ≥ 50 years in Belgium.

Methods
404 respondents of the Belgian health interview survey 2018 belonging to the target age group participated in a subsequent health examination survey (average time lapse 53 days). At both time points frailty was assessed with the SHARE frailty instrument classifying respondents as robust, prefrail or frail according to Fried's phenotype. Physical, biomedical, mental, social and demographic determinants of transitions in frailty status were explored through relative risk ratios (RRR) from a backward stepwise multinomial regression analysis.

Results
Both upward and downward transitions occurred in 21% of the respondents. Transitions were more frequent in women. Being obese (RRR 1.93; 95%CI 1.02-3.67) and being unsatisfied with social contacts (RRR 4.35; 95%CI 1.59-11.86) were significantly associated with a transition to a less favorable frailty status. Activity limitations (RRR 0.30; 95%CI 0.13-0.68) and a high serum total/HDL-cholesterol ratio (RRR 0.19; 95%CI 0.04-0.79) were inversely associated with an improvement of the frailty status. No significant associations were found with age, education level, multimorbidity, mental health, quality of life, smoking, physical activity, hyperglycemia, hypertension and increased C-reactive protein.

Conclusions
Preventive action to delay or reverse the transition towards frailty should start from 50 years onwards and include nutritional advise, actions that facilitate people to participate in activities and initiatives to improve social networks of people.

Key messages
Obesity and a high serum total/HDL-cholesterol ratio are risk factors for developing frailty. Investing in a good social network and an environment which facilitates participation in activities is important to delay or reverse the evolution towards frailty.