bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unguided online Cognitive Behavioral Therapy for insomnia in General Practice: a mixed method study
Authors: Van Der Heijde C , El Fassi S , Hilverda F , Vonk P 
Published: October 2020

Abstract

Background
Sleep contributes to physical, cognitive and emotional restoration. Sleep problems may eventually cause physical and mental dysfunctions. Insomnia symptoms are the most common, leading to insufficient sleep. Unguided online interventions for insomnia merit further study, because of their potential for care avoiders and their potential cost-efficiency in General Practice settings. The research question is which factors contribute to its' effectiveness and intention to use.

Methods
A mixed method approach was implemented with patients with insomnia symptoms of a General Practice in Amsterdam. Semi- structured in-depth interviews were administered after completion of an online CBTI of five sessions (N = 7 females; age from 30 to 54) A questionnaire was administered (N = 118; female: 68%; [Mean age = 24.5, sd = 7.8]) Severity of insomnia was measured with the ISI. Regression analysis was deployed in a prediction model to predict intention to use unguided online CBTI based on the Technology Acceptance Model.

Results
The interviews revealed that the level of knowledge, duration of the intervention and severity of symptoms contributed to the effectiveness of online CBTI. Additionally, therapeutic support is needed to convert knowledge into action. Unguided CBTI is more suitable for individuals with onset or milder insomnia symptoms. Results of the questionnaire indicated that the severity of symptoms predicted the intention to use. F(8, 110) = 14.36, p = .000; β = 0.20, t(113) = 3.01, p = 0.003.

Conclusions
These findings indicate a healthcare challenge: online unguided CBTI is perhaps more suitable for individuals with onset or milder symptoms, however they are less inclined to use such an intervention. Therefore, their awareness of potential CBTI treatments should be increased. Furthermore, the level of knowledge and capability to transfer that knowledge into action should be considered in order to determine the amount of support an individual needs.

Key messages
Unguided online CBTI has potential for insomnia patients in a General Practice setting; awareness of this should especially increase amongst those with less severe symptoms. Online CBTI for insomnia should also take into account, the level of knowledge and capability to transfer that knowledge into action to determine its content and communication.
Health and urban planning policy: mistaking symbolism for outcomes in New South Wales (Australia)
Authors: Lilley D , de Leeuw E 
Published: October 2020

Abstract

Background
During a Government review of the New South Wales urban planning system in the early 2010s, health and planning advocates were successful in having the term 'health' included in two objects of the NSW Planning Bill 2013. While the Bill was not ultimately passed into law, numerous studies have since been published celebrating these inclusions, and the processes through which they were achieved. This research set out to critically examine this optimistic interpretation of events and outcomes.

Methods
Two methods were employed in this research. First, comparative analysis of the existing law and the Planning Bill was conducted. This included a review of how health and like terms are used. Second, critical analysis of published interview data with stakeholders involved in the preparation of the draft legislation was conducted, to explore the motivation for including health, and the expected outcomes of doing so.

Results
In contrast to the dominant narrative, this research found that the use of health rhetoric acted as a smokescreen to disguise the financial and economic interests of powerful stakeholders. Health was not defined, and there were no additional requirements to consider health in planning and assessment processes. Had the Bill been passed it may have had a negative impact on health, as it gave the appearance of acceding to health advocates, and in so doing may have silenced them, though without any substantive means of achieving health outcomes.

Conclusions
The authors of the dominant narrative have homed in on and celebrated symbolic change, while downplaying both the cynical and transactional nature of the policy process, and ignoring the lack of substantive or outcomes-oriented change. This results in a misleading assessment of the way forward for the inclusion of health in urban planning, and should act as a cautionary tale to those of us committed to improving the social determinants of health via policy reform in sectors other than health.

Key messages
Health advocates need to be alert to the ‘dark arts’ of public policy development and avoid mistaking symbolism for the attainment healthy policies and outcomes. The inclusion of health rhetoric in urban planning policy is insufficient to attain health outcomes. Attention must also be paid to planning and assessment processes, impact assessment in particular.
Participatory development of the food literacy intervention “GUSTO” for older adults in Germany
Authors: Zastrow F , Neher K , Hassel H 
Published: October 2020

Abstract

Background
Healthy aging is one of the major challenges currently faced by an aging population. Food literacy (FL) refers to the ability to apply knowledge and practical skills regarding healthy and sustainable nutrition into everyday life. The project “GUSTO” is sponsored by the Bavarian State Ministry of Health and Care and aims to contribute to enjoyable aging by developing the nutritional skills of people aged 65 and over. This community-based program comprises independent working groups of older adults guided by peer moderators. The FL intervention is developed in cooperation with the target group.

Methods
The nutritional situation of older adults was first established through a literature research. The results of this research were compared to the “self-perceived food literacy scale” by Poelman et al. (2018) and the “nutritional framework for literacy courses” by Johannsen et al. (2019). The resulting data provided a basis for focus group discussions carried out in six municipalities, supported by local practice partners. In six guided focus group discussions, a number of recurring themes were identified and summarized.

Results
The focus groups consisted of a total of 44 people between 62 and 88 years of age (average age: 73.1 ± 6.1 years). 22.7 % were men. The group discussions revealed resources used and barriers encountered in terms of FL and interests of older adults. It was evident that, due to the high density of information available, the participants found it difficult to identify reliable information and to implement it in their everyday life. At the request of the focus groups, topics such as the best before date and the use of food waste were added to the intervention.

Conclusions
Older adults find it challenging to identify reliable nutritional information and implement it in their everyday life. With the help of the participatory approach outlined in this study, target group-related issues can be identified and taken into account in the intervention.

Key messages
Older adults can be involved in the development of an FL intervention. A participatory approach allows target group-related issues and specific needs to be taken into account in the intervention.
Associations of mental illness with smoking and vaping in university students in New Zealand
Authors: Wamamili B , Wallace-Bell M , Richardson A , Grace R C , Coope P 
Published: October 2020

Abstract

Background
People with mental illness have higher smoking prevalence, and vaping is generally higher among smokers than non-smokers. However, data on associations of mental illness with smoking and vaping in New Zealand (NZ) is lacking. This study examines associations of history of mental illness (HMI) with smoking and vaping in NZ university students.

Methods
Data came from a March 2018 national cross-sectional study. χ2 tests compared patterns of smoking and vaping in students with and without HMI. An HMI was defined as a diagnosis, or treatment for depression, anxiety or nervous disorder, or other mental health condition in the previous 12 months. Logistic regression model assessed the association of an HMI with smoking and vaping.

Results
1622 students were included: 82.7% aged &lt;25 years, 17.3% ≥25 years; 38.6% male, 61.4% female; 7.8% Māori, 92.2% non-Māori; 18.1% reported an HMI. Of respondents, 50.5% (95% CI 48.0-53.0) reported ever, 10.0% (8.6-11.6) current and 5.0% (4.0-6.2) daily smoking. Students with HMI were significantly more likely to report ever (p&lt;.001), current (p=.008) and daily smoking (p=.014) than those without HMI. 36.7% (34.3-39.1) of students reported ever, 6.7% (5.5-8.0) current and 2.5% (1.8-3.4) daily vaping. Students with HMI were significantly more likely to report ever (p&lt;.001), current (p=.002) and daily vaping (p=.022) than those without HMI. The full model containing all predictors was statistically significant, χ2 (5, N = 1621) = 34.843, p &lt; .001. Female gender: OR 0.55 (0.41-0.73); current smoking: OR 1.76 (1.19-2.60), and current vaping: OR 2.07 (1.32-3.25) were significantly associated with an HMI.

Conclusions
There were strong associations between an HMI and smoking and vaping (controlling for age, gender, ethnicity). These findings extend earlier work on the relationship between smoking and mental illness by demonstrating similar associations in university students, and generate new information on HMI and vaping.

Key messages
Significant numbers of students may have an HMI. Students with an HMI have higher prevalence of smoking and vaping than students without an HMI.
Incidence, and mortality associated with primary postpartum haemorrhage in northwest Ethiopia
Authors: Tiruneh B , McLelland G , Plummer V 
Published: October 2020

Abstract

Background
Primary postpartum haemorrhage remains the primary cause of maternal mortality, in low-resource countries such as Ethiopia. National datasets about the incidence of primary postpartum haemorrhage are often limited, incomplete or unavailable.

Objective
This study was designed to determine the incidence and mortality associated with primary postpartum haemorrhage following in-hospital births in Ethiopia.

Methods
A cross-sectional study design, this study was an audit of 1060 maternity care logbooks (medical records) of discharged women. The data were abstracted from December to May 2018/2019 using systematic random sampling technique. The tool used was the Facility Based Maternal Death Abstraction Form, adapted from the Maternal and Perinatal Death Response Team of Ethiopia. Data were entered and cleaned then analysed using SPSS version 25. Bivariate logistic regression was fitted. Adjusted odds ratio with 95% confidence interval was used to determine the statistical significance.

Results
The incidence of primary postpartum haemorrhage was nearly 9.0% (95% CI: 6.91, 10.73). Of these, there was 7% maternal mortality. Unique to women in Ethiopia health facility referrals of women in labour (AOR: 2.13; 95% CI: 1.19, 3.80), birth attended by final year medical students (AOR: 3.59; 95% CI: 1.89, 6.84), women who were discharged at six hours following birth (AOR: 3.50; 95% CI: 1.24, 9.91) were associated with primary postpartum haemorrhage (p &lt; 0.05).

Conclusions
This study found that the reported incidence of primary postpartum haemorrhage was relatively low, however, the associated deaths of women found was comparatively high.

Key messages
The increased maternal mortality appears to be associated with the three delays model ‘delay in seeking care’; ‘delay in reaching health care’ and ‘delay in receiving quality care’. Maternal mortality and morbidity in Ethiopia are influenced by delays in deciding to seek care, delay in reaching the health facility, and delay in receiving quality care.
Guidelines for Trustworthy AI application in clinical trials
Authors: Leventi N , Vodenitcharova A , Popova K 
Published: October 2020

Abstract

Issue
Innovative information technologies (IIT) like artificial intelligence (AI), big data, etc. promise to support individual patient care, and promote public health. Their use raises ethical, social and legal issues. Here we demonstrate how the guidelines for trustworthy AI, can assist to answer those ethical issues in the case of clinical trials (CT).

Description
In 2018 the European Commission established the High-Level Expert Group on Artificial Intelligence (AI HLEG). The group proposed Guidelines to promote Trustworthy AI, with three components, which should be met throughout the system's entire life cycle, as it should be lawful, ethical and robust.
Trustworthiness is a prerequisite for people and societies to develop, and use AI systems. We used a focus group methodology to explore how the guidelines for trustworthy AI can assist to answer the ethical issues that rise by the application of AI in CTs.

Results
The discussion was directed to the seven requirements for trustworthy AI in CTs, by questions like:
Are they relevant in CTs as a whole? Would they be applicable to the use of IIT as AI in CTs? Are you currently applying part, or all, of the proposed list? In the future, would you attach some, or all, of the proposed list? Is the administrative burden of applying the requirements justified by the effect?

Lessons
It was recommended that:
the guidelines are relevant in the conduct of the CT; planning and implementation of CTs using IIT, should take them into account; ethical aspects and challenges are of the utmost importance; the proposed list is a very comprehensive framework; particular attention should be paid where more vulnerable groups are affected; the administrative burden is acceptable, as the effect exceeds the resources invested.

Key messages
IIT are becoming increasingly important in medicine, and requirements for trustworthy IIT, and AI are necessary. Appropriate instrument in the case of the CTs are the provided by AI HLEG guidelines.
Lesson learned from an outbreak of invasive meningococcal disease: how HTA could have provided an evidence-based approach for public health response
Authors: Miglietta A 
Published: October 2020

Abstract
During 2015-2016 an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) occurred in Tuscany, a Region in Central Italy. Sixty-two cases with 13 deaths (13%) were recorded. Regional Authorities responded through a mass immunization campaign targeting all the age groups by offering free of charge a single dose of the tetravalent (ACWY) meningococcal conjugate vaccine or monovalent meningococcal C conjugate (MCC) vaccine. Nevertheless, the response was fragmented and the campaign did not reach the risk-population groups (i.e. men who have sex with men), that were identified only when a Regional outbreak investigation was implemented. Also linkage between cases (i.e. attending the same gay-venue) were identified at a second stage, not allowing prompt max-prophylaxis interventions. In such a situation, an evidence-based approach as Health Technology Assessment, could have informed public health emergency preparedness and response planning processes, i.e. by identifying through early warning alert systems similar ongoing clusters in Europe among specific population-groups and consequently better targeting the immunization campaign. The objective of this presentation is to explore through a practical example how HTA could provide an evidence-based approach for public health response during a real outbreak underlining lesson learned.
What is the value of digital health?
Authors: Jani A 
Published: October 2020

Abstract
The panellist Anant Jani will discuss about: What is the value of digital health? There is much hope and hype surrounding the potentially transformative effect that digital health tools can have in health and care systems but it is very difficult to ascertain the true value that digital health tools currently deliver or could deliver in the future. Compounding this uncertainty is the diverse, large and ever-changing digital health landscape - there are currently over 300,000 health and care apps on the market place in comparison to the less than 2000 drugs health and care systems normally have to deal with. In this session, we highlight how the quadruple value framework, recently endorsed by the EU Commission, can be used to help rationalize the digital health ecosystem by promoting the interventions that have the greatest potential to promote primary, secondary or tertiary prevention while optimising resource utilisation.
Determinants of child resilience in poverty: findings from the Taiwan Birth Cohort Study
Authors: Chiang L , Wang C J , Chiang T L 
Published: October 2020

Abstract

Background
Poverty has adverse effects on child health. While children in poverty face greater health challenges, some still achieve positive health outcomes. This is in part due to their resilience when facing adversity. Identifying the factors that foster child resilience can aid in developing strategies to promote child resilience and reduce the harmful effects of child poverty. This study aims to identify the biological and social factors of resilience among children in poverty from birth to age 12.

Methods
Data for the analysis came from the Taiwan Birth Cohort Study, a nationally representative sample of 17,354 children who completed six waves of interview surveys between 2005 and 2017. Our sample included 4,570 children who experienced poverty from birth to age 12. The primary outcome variable was child resilience, defined as impoverished children who maintained good health outcomes over the 12-year survey period. Multiple logistic regression was used to examine the factors of child resilience.

Results
Of the 4,570 children, 36.1% always had good health despite experiencing poverty before the age of 12. An easy temperament (OR = 2.5, 95% CI: 1.9-3.0), female (OR = 1.1, 95% CI: 1.0-1.3), a birth weight greater than 2,500 grams (OR = 1.6, 95% CI: 1.2-2.1), having a foreign-born mother (OR = 1.5, 95% CI: 1.2-1.7), receiving breast milk after birth (OR = 1.3, 95% CI: 1.1-1.5), and good parent-child interaction at 3 years of age (OR = 1.4, 95% CI: 1.2-1.7) were associated with child resilience. Early parent-child interactions can moderate the effect of children's birth weight on later resilience.

Conclusions
Our findings indicated the factors associated with child resilience in the context of poverty, suggesting that supporting breastfeeding and nurturing parent-child relationships are effective public health actions to foster child resilience. Future research is needed to unravel the underlying mechanisms of biological factors associated with child resilience.

Key messages
Breastfeeding after birth and high-quality parent-child interaction can lead to positive adaptations to child poverty. Children with difficult temperaments, boys and those born at low birthweight are more vulnerable to poverty and should be targeted for building resilience against poverty.
Social vulnerability and heat on emergency medical services in San Antonio, Texas, 2015-2018
Authors: Zottarelli L K , Xu X , Sunil T S 
Published: October 2020

Abstract

Background
A burgeoning body of research indicates that excessive heat is a leading weather-related cause of fatalities in the United States. The average annual heat-related deaths in the U.S. are about 1,500, which are more than deaths resulting from all natural disasters combined. Extreme heat conditions are also associated with non-fatal medical complications. More importantly, socially and economically disadvantaged or vulnerable populations can face greater exposure to health risks during extreme heat events. The purpose of this study is to investigate the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, from 2015 to 2018.

Methods
Heat Index data were collected from the San Antonio International Airport weather station, including the dates from May 1, 2015 to September 30, 2018. Social vulnerability was measured by the Centers for Disease Control and Prevention's Social Vulnerability Index at the zip-code level. Morbidity was gauged by the number of Emergency Medical Service incidents. Sixty-two zip codes in the San Antonio area were analyzed for the 612 constrained calendar days from May 1 to September 30, 2015-2018. Three time-stratified case-crossover negative binomial regression models were estimated to examine the independent effects of Heat Index and Social Vulnerability Index as well as the interaction effects of Heat Index and Social Vulnerability Index on the rate of Emergency Medical Services incidents.

Results
Both Heat Index and Social Vulnerability Index are significantly and positively associated with the rate of Emergency Medical Services incidents. Additionally, while Heat Index increases the rate of EMS incidents, the rate is even higher as social venerability becomes more pronounced.

Conclusions
As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including emergency medical services.

Key messages
Excessive heat and community-level social vulnerability are significantly and positively associated with emergency medical service incidents. There is a significant and positive interaction effect of heat and social vulnerability on emergency medical service incidents.
Social determinants of depression: association with age, gender and primary health care model
Authors: China J 
Published: October 2020

Abstract

Background
Depression is one of the most common mental disorders worldwide and is a major contributor to the overall global burden of disease. The social determinants of age, gender and access to a primary health care physician have been identified as significant determinants of variability in the prevalence of depression. This research evaluates the association between depression and these social determinants in the city of Almada, in Portugal.

Methods
This cross-sectional study reports the one-month prevalence (December, 2015) of depression and its association with age, gender and access to a primary health care doctor in Almada's primary health care population. Data was collected from the 'Information System of the Regional Health Administration' (SIARS) database. The diagnostic tools used for the identification of cases were the ICPC-2 codes 'P76: Depressive Disorder' and 'P03: Feeling Depressed'. An odds ratio was applied as an association measure.

Results
Regarding gender and age: women are more likely to develop depression than men (OR 3.21) and the age group of 40-64 years is more likely to develop depression compared with other age groups (OR 2.21). The odds of being affected by depression for patients with a permanent primary health care physician, compared with users without a permanent primary health care physician, are higher (OR 2.24).

Conclusions
The patterns of association of age and gender, uncovered in this dataset, are consistent with previously reported findings for other Western countries. The association between depression and the assignment of a permanent primary health care doctor is highly significant. This finding suggests the existence of a higher detection rate of depression in patients with a permanent doctor and adds weight to the need to implement health policies that guarantee a primary health care physician for each patient.

Key messages
The age and gender gap in depression calls for stronger public health and intersectoral strategies to promote and protect mental health, in community-based settings. Reducing barriers and enhancing access to high-quality primary medical care must be a cornerstone of mental health policies.