bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of pertussis in Tunisia; results of five years 2013-2017
Authors: Bouguerra H , Hechaichi A , Atawa T , Maazaoui L , Abdeddaiem N , Zorraga M , Sakly M , Alaya N Ben 
Published: November 2019

Abstract

Background
Pertussis or whooping cough, is a highly contagious respiratory disease caused by a bacteria gram negative mainly Bordetella pertussis. It is globally endemic despite a high vaccination coverage. In 2014, the World Health Organization estimated the total number of affected persons to 16 million and the number of child deaths reached 190 000. Since 2012, many countries have experienced a resurgence of pertussis including Tunisia. Our objective was to describe the epidemiological situation of pertussis in Tunisia from 2013 to 2017.

Methods
Our study was a retrospective descriptive study based on data of the surveillance system of Mandatory Reporting Diseases in Tunisia from 2013 to 2017. Data were collected using the declaration standardized forms which included in addition to the socio-demographic data, information regarding vaccination status, date of onset of symptoms and laboratory results (culture and PCR). Data entry was using EpiData and data analysis using SPSS-20.

Results
During the study period, a total of 252 cases were notified. Males were more affected (55.1%). Age was in average 89 days (3 months). Almost the third were hospitalized in Intensive Care Unit (32.2%). Most cases were reported during 2013 and 2014 (35.7% et 55.5% respectively) and the lethality rate reached 7.2% in 2014. Half cases were notified in the Grand Tunis region. PCR was positive in 74.1% of the cases and bacterial culture was positive in 14.3%, isolating Bortedella pertussis. Vaccination status was mentioned in 70.5% of the cases: it was up-to-date in only 35.7% of the cases and incomplete in 9.8% of the cases.

Conclusions
Our results showed that pertussis has known a considerable increase the last years, especially in 2013 and 2014. This prompts us to be more vigilant regarding this disease, which has been neglected the last decades. Education of population as well as health professionals is extremely important, particularly the importance of vaccination and preventive measures.

Key messages
From 2013 to 2017, number of pertussis cases in Tunisia varied with a considerable increase in 2013 and 2014. With the increase of pertussis cases and severity, preventive measures should be taken especially the importance of vaccination.
Changes in disease burden in Poland, 1990-2017: a systematic analysis for the GBD Study 2017
Authors: Ganczak M , Miazgowski T , Kozybska M , Kotwas A , Korzeń M , Rudnicki B , Nogal T , Kopec J 
Published: November 2019

Abstract

Background
In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The study objective was to use the GBD database to assess disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries.

Methods
The results of GBD 2017 for 1990 and 2017 for Poland were used to assess rates and trends in years YLLs, YLDs, DALYs.

Results
Between 1990 and 2017, age-standardized YLL rates for all causes declined in Poland by 46.0%, YLD rates declined by 4.0%, and DALY rates by 31.7%. Greater relative declines were observed for females regarding YLLs/YLDs. There was a decrease in communicable, maternal, neonatal and nutritional disease DALYs (48.2%); DALYs due to non-communicable diseases (NCDs) decreased 2.0%. In 2017, Poland performed better than CE as a whole (ranked 4th for YLLs, 6th for YLDs and 5th for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In both 2017 and 1990, the leading cause of YLLs and DALYs in Poland was ischemic heart disease (IHD), of YLDs - low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although the order was different. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990 and 2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios (OER) were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65 and 2.03 respectively).

Conclusions
Improvement in Health in Poland has been observed since 1990. In 2017 the country outperformed CE as a whole for YLLs, YLDs and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining.

Key messages
In the light of dramatic shortage/aging of the workforce and low public health expenditure, the observed rise in NCDs and between-gender inequalities pose a challenge for the Polish health-care system. To minimize the gap between Poland and Western Europe, an integrated response, which addresses the causes of death and ill-health, particularly those for which rates have increased, is urgently needed.
Daylight saving time and acute myocardial infarction: a meta-analysis
Authors: Manzoli L , Flacco M E , Bravi F , Carradori T , Cappadona R , Fabbian F , De Giorgi A , Manfredini R 
Published: November 2019

Abstract

Background
The current evidence on the effects of daylight saving time (DST) transitions on major cardiovascular diseases is limited, and available results are conflicting. We carried out the first meta-analysis aimed at evaluating the risk of acute myocardial infarction (AMI) following DST transitions.

Methods
We searched MedLine and Scopus up to December 31, 2018, with no language restriction, to retrieve cohort or case-control studies evaluating AMI incidence among adults (≥18y) in the week following spring and/or autumn DST shifts versus control periods. A summary relative risk of AMI was computed after: (1) spring, (2) autumn, (3) both transitions considered together versus control weeks. Stratified analyses were performed by gender and age. Data were combined using a generic inverse-variance approach.

Results
Seven studies (&gt;115,000 subjects) were included in the analyses. A significantly higher risk of AMI (Odds Ratio: 1.03; 95% CI: 1.01-1.06) was observed in the two weeks following spring or winter DST transitions. The risk increase was however significant only after the spring shift (OR: 1.05; 1.02-1.07), while AMI incidence in the week after winter DST transition was comparable to control periods (OR 1.01; 0.98-1.04). No substantial differences by age or gender emerged.

Conclusions
The risk of AMI increases modestly but significantly following DST transitions, supporting the proposal of DST shifts discontinuation. Additional studies fully adjusting for potential confounders are required to confirm the present findings.

Key messages
The risk of acute myocardial infarction increases modestly but significantly following DST transitions. Although preliminary, our findings support the proposal of DST shifts discontinuation.
Association of nationality and education with oral health: a screening programme in Northern Italy
Authors: Del Pin M , Varadi G , Pascut S , Tito R , Dovier A , Covre C , Honsell F , Valent F , Parpinel M , Brusaferro S 
Published: November 2019

Abstract

Background
Socioeconomic status (SES) has been proposed as an important determinant of oral health outcomes. The aim of this project is to assess the association between nationality, parents’ educational level and oral health in a sample of children in Udine, Italy.

Methods
Between February and May 2018, in the context of a screening programme carried out to evaluate the oral health status in 6-year-old children, parents filled out a questionnaire investigating behavioural, socioeconomic and demographical factors. For each child the number of decayed, missing and filled deciduous teeth (dmft) and caries prevalence (CP) were assessed.

Results
The screening was conducted on 976 children, 705 (72%) Italian (I) and 271 (28%) foreign residents (F). Not-Italian nationality significantly increased the CP (F: 59.32%; I: 32.74%; RR: 1.81 [95% CI: 1.57-2.10]; Risk Difference: 26.59 [95% CI: 19.98-33.19]) and dmft median value (F: 2±5; I:0±1; p &lt; 0.0001). Stratified by level of education, the differences between I and F were significant when both parents had low educational level (CP: RR = 1.62 [95%; CI: 1.00-2.62]; dmft: F = 5±5; I = 0±3; p &lt; 0.05) and when both parents had high school education (CP: RR = 1.45 [95%; CI: 1.14-1.84]; dmft: F = 2±6; I = 0±2; p &lt; 0.001). Otherwise, when both parents had university degree, nationality did not increase significantly the outcome (CP: RR = 1.17 [95%; CI: 0.91-1.50; p &gt; 0.1]; dmft: F = 0±2; I = 0±0; p &gt; 0.1).

Conclusions
The analyses suggest that being a foreign resident is a risk factor for lower child oral health. Moreover, parents’ educational level seems to be an effect modifier: when parents had a university degree there was no significant difference between Italians and foreign residents, otherwise the lower the level of education, the greater the difference between the categories. These data may help to identify particularly vulnerable groups and to develop preventive strategies.

Key messages
These findings confirmed the presence of a vulnerable population (foreign residents) in which socioeconomic factors had stronger associations to oral health than Italian citizens. Further research may be useful to identify both protective and risk factors associated with different nationality, in order to evaluate specific interventions in low-SES groups.
Population health indicators availability at regional level across the European Union
Authors: Costa C , Freitas A , Santana P 
Published: November 2019

Abstract

Background
The availability of reliable and comparable data at the regional level is extremely important to measure regional health inequalities. The aim of this research is to assess the data availability of the indicators included in EURO-HEALTHY’s Population Health Index (PHI), a multidimensional tool developed to measure population health across European regions.

Methods
Three consecutive steps where implemented: i) assessment of data availability and reliability of the indicators for the regional level and for the last year with data available; ii) application of a protocol to solve cases of missing data and assure the database completeness and iii) development of an availability scoring system, ranging from 0 (no data available) to 1 (all data available), by indicator and EU region.

Results
A set of 39 population health indicators were assessed. The mean availability is 0.8, ranging from 0.46 (worst) to 1 (best). Indicators such as ’Unemployment’, ’Higher education’, ’Ageing index’, ’Teenage motherhood’, ’Victims in road accidents’, ’Fatality rate’, ’Life expectancy’ and ’Infant mortality’ present the highest scores (&gt;0.95). ’Daily smokers’, ’Pure alcohol consumption’, ’Number of rooms per person’ and access to ’Public water supply’ and ’Wastewater treatment’ present the lowest availability scores (&lt;0.60), mostly due to the availability at the national level only.

Conclusions
This study provides a comprehensive assessment of data availability of population health indicators from multiple areas of concern, at the EU regional level. The results highlight the urgent need for sub-national data in several domains that are important to close the health gap between and within countries. Still, as data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.

Key messages
There is an urgent need for sub-national data in several domains that are important to close the health gap between and within countries. As data collection in EU is driven by a policy derived framework, it is essential to give awareness to the regional scale, prior to the policy development.
How effective is AAL? Results from an RCT among older persons in Austria
Authors: Schmidt L , Majcen K , Löffler K , Schuster E , Augustin T , Murg S , König C , Steiner J 
Published: November 2019

Abstract

Background
Many older people wish to remain in their own environment for as long as possible; an aim shared by the wider community. Here the results of the RegionAAL study (Steiermark, Austria) are reported.

Methods
An RCT was implemented to evaluate a programme of interventions (e.g. medication, drink and physical activity reminders, automatic light systems, watches to detect falls, video telephone with carers). Data was collected via quantitative questionnaires at baseline, 6 months and 1 year regarding quality of life and carers’ burden.

Results
111 persons and 104 carers took part in the intervention group; 110 participants and 100 carers in the control group. Participant characteristics were similar at baseline. Average age was 76 years. Around 1/3 were formal carers. A tendency for more persons in the control group to require assistance after one year could be observed. The subscales autonomy and participation of the WHOQOL-OLD showed some significant declines in the control group (no deterioration in the intervention group). No differences between study arms regarding general health, chronic conditions or hospital admissions were observed. Expected reduction in worry among carers could not be observed, although there was a tendency for some aspects of burden to be reduced. The interventions did not lead to a reduction in carers’ workload; neither did the carers see any direct improvement of their situation.

Conclusions
Some technologies such as cognitive games on the tablet, portable door bell and automatic light sensor were positively assessed. The participants in the intervention group scored better on autonomy and participation subscales than the control group; the intervention group also fared somewhat better regarding independence. The technologies had little influence on general health states or quality of life of participants or carers. Further good quality studies are needed before AAL technologies are considered as a public health initiative.

Key messages
AAL may reduce aspects of worry among carers and prevent age-related decline in autonomy, participation and independence among older persons but not have an effect on general health status or burden. AAL has only a very limited impact upon general health status or quality of life of older persons and the general burden experienced by carers.
Visualising Q - from the bootstrap to interactive graphics
Authors: Staines A , Gauttier S , Connolly R , Davis P , Connolly J , Weston D , Boilson A 
Published: November 2019

Abstract

Introduction
The MIDAS (Meaningful Integration of Data Analytics and Services) project is developing a big data platform to maximize the use of health & social care data. The goal is to link data sources to support senior managers & policy makers in delivering services. The project includes 4 case studies, in 4 countries. As part of the evaluation, we need to understand the perspectives of the users, developers, and senior managers involved, and to see how these change over time. We employ Q-methodology, an objective mixed method for the study of human perspectives, to do this. In this paper we describe the use of bootstrap methods, and visualizations to assist in the execution and interpretation of the first round of our Q study.

Methods
A concourse of 36 items was developed from the literature, a logic model for the project, and a series of semi-structured interviews with project participants. Sixteen people (3 female, and 13 male) took part in the Q study, six developers, five managers, two health professionals, and 3 others. The 36 statements on the concourse were ranked online, by each participant, using the HTMLQ software, in order of their agreement with each statement. These are then subjected to a form of factor analysis, but by person, not by statement, using the qmethod package in R.
For each Q-sort 1,000 bootstrap replications were done, using sampling with replacement. A range of visualisations were prepared, using ggplot2.

Results
Visualizations of bias and variability showed modest levels of both, suggesting that the Q-method model fitted well. Interactive visualizations of the factors, and respondents, were done. These showed distinct clusters of respondents, with divergent perspectives on the project. These assisted in making final decisions, both on the number of factors to report on, and the interpretation of those factors.
Further use of advance visualisations is recommended for future Q-studies.
Funded by the European commission under contract 727721

Key messages
Q methodology is useful across many areas of public health, and is a valuable way of studying individual perspectives. Modern statistical visualisation tools can enhance the interpretation of Q methodology studies.
Sickness absence and disability pension sequences before and after a bicycle crash; a Swedish study
Authors: Kjeldgård L , Stigson H , Alexanderson K , Friberg E 
Published: November 2019

Abstract

Background
In recent years, bicycle injuries have increased, yet little is known about impact of such injures on sickness absence (SA) and disability pension (DP). The aim was to explore the long-term patterns of SA and DP among injured bicyclists.

Methods
A longitudinal register-based study was conducted, including all individuals aged 18-59 years and living in Sweden, who in 2010 had incident in- or specialized out-patient healthcare for injuries sustained in a bicycle crash. Information about sociodemographics, the injury, SA, DP, and deaths were obtained from several nationwide registers. Weekly SA/DP data for four years: one year before and three years after the crash were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with each sequence cluster.

Results
Among all 6465 individuals injured in a bicycle crash 2010, five clusters were identified: No SA or DP (60.2%), Immediate SA (17.7%), Episodic SA (15.3%), Part-time DP (1.6%), and Full-time DP (5.2%). Compared to the cluster No SA or DP, all other clusters had high ORs for female sex, older age, living in small cities/villages, and inpatient care. Immediate SA also had high ORs for cyclists who sustained a fracture (OR 5.53; CI 4.47-6.83), dislocation (3.26; 2.29-4.65), sprains and strains (2.29; 1.68-3.10), and internal injuries (4.39; 1.95-9.90). Episodic SA had high ORs for other traumatic brain injury than concussion (6.27; 2.23-17.64) and injuries located in the spine and back (3.52; 2.12-5.86), torso (1.78; 1.29-2.45), upper extremities (1.95; 1.54-2.46), and lower extremities (1.85; 1.43-2.41).

Conclusions
Having SA in direct connection to the crash was associated with type of injury, in contrast to Episodic SA where the injured body region was of more importance, in particular other traumatic brain injuries and injuries to the spine and back.

Key messages
This nationwide study of new bicycle crashes found five clusters of sickness absence (SA) and disability pension (DP) sequences; No SA or DP, Immediate SA, Episodic SA, Part-time DP, and Full-time DP. The type of injury was more important for SA in direct connection to the crash, while the injured body region was of more importance for continued and repeated SA up to three years after the crash.
Prognostic and Predictive biomarkers in a Mediterranean cohort (Review from Atena Project)
Authors: Rubba F , Gentile M , Scamardo M S , Iannuzzo G , Panico C , Pacilio M , D’Onofrio G , Panico S , Rubba P , Triassi M 
Published: November 2019

Abstract

Background
Atena project involved 5,062 women aged 30 to 69 years living in the area of Naples. The purpose of this study is to investigate the causes of those chronic diseases that have a major impact on the female population. As a part of the design (scheduled in 2002-2004). After 10 years, in 228 women, some biochemical measurements were performed.

Methods
This systematic review and meta-analysis biomarkers were evaluated in studies nested into the Atena cohort. Studies were searched using MEDLINE/PubMed. The search was performed by entering individually or in combination: Atena, Mediterranean woman, biomarkers. The preferred reporting of systematic reviews and meta-analysis (PRISMA) guidelines were used for the review. Studies selected for this review are conducted in the Atena project Cohort and reported the study of biomarkers. Disagreements on data extractions between the two investigators were solved by consensus. The extracted data were entered and analyzed using REVMAN software. The original articles were described using forest plot and table. Heterogeneity was computed by Cochran’s Q test.

Results
The search strategy retrieved 13 potential articles, 11 were screened as full text articles and 6 were included in the pooled estimates. Among the articles included, biomarkers chosen as predictors were Lipids, Hcrp, as prognostic where predictive of IMT; and cycle length and LPa as predictive of an augmented LDL cholesterol mean. According to the comparability of data presented, for the first comparison we selected 3 of the 5 studies that assed IMT, for the second we selected 2 of the three studies that analyzed for LDL mean. Results were shown into forrest plots. The pooled estimates verified the potential of biomarkers as predictor of IMT, the significance seemed lower for prediction of LDL cholesterol.

Conclusions
Both results, consistent with the multifactor profile of the CV risk, identify the impact of secondary prevention according to biochemical profiles.

Key messages
Biomarkers studied in nested cohort stufies have predictive potential. pooled estimates may identify the impact of secondary prevention according to biochemical profiles.
Against lead poisoning: effectiveness of housing first and counselling in the home
Authors: Laporte R , de Barberini H Barberin , Jouve E , Hadji K , Gentile S 
Published: November 2019

Abstract

Background
Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration).

Methodology
A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions.

Results
151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p &lt; 0.005; p &lt; 0.05 and p &lt; 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p &lt; 0.005).

Conclusions
Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices.

Key messages
In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.