bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bridging the information gap on cancer survivors in Europe: results from the iPAAC Joint Action
Authors: De Angelis R , Demuru E , Rossi S , Ventura L , Baili P , Bettio M 
Published: October 2020

Abstract

Background
Due to demographic transition cancer survivors are dramatically growing and challenging the sustainability of public health systems. Despite accurate indicators are increasingly needed for Health Technology Assessment and health care planning, population-based cancer prevalence is not systematically available in many countries. The European Joint Action “Innovative Partnership for Action Against Cancer” (iPAAC) aims at bridging this gap by supporting the inclusion of indicators on prevalence to complement the cancer burden statistics already available in the European Cancer Information System (ECIS).

Methods
Analysis of a European-wide standardized dataset gathering information on 26 million patients from 100 cancer registries in 29 countries (EUROCARE-6). Methods to estimate and project complete and limited duration population-based prevalence indicators by demographic variables, cancer type and phase of care.

Results
Cancer survivors are mostly women (about 55%) and people over-60 years. Highest crude prevalence proportions in women are observed for breast, colon-rectum, corpus uteri, skin melanoma and cervical cancer (from 1,600 to 200 x 100,000). Prostate, colon-rectum, bladder, non-Hodgkin lymphoma and skin melanoma were the most frequent cancers among male survivors (from 1,000 to 200 x 100,000). Between-country differences are wide, consistently with varying demographic structure, incidence and survival patterns. Impact of long-term survivorship strongly depends on disease lethality.

Conclusions
Cancer survivors are a quite heterogenous population in respect of age, sex, cancer type and disease duration. Reliable and comparable prevalence indicators are essential to improve cancer care planning in European countries. Joint analysis of European wide population-based datasets strengthens the impact of cancer registries information and foster the release of complete statistics on cancer survivors.

Key messages
Cancer survivors are a growing and heterogeneous population to be monitored in public health. Detailed and comparable indicators on cancer prevalence are proposed to complement the cancer burden statistics of the European Cancer Information System (ECIS) through improved collaborative efforts.
Child abuse and all-cause mortality in the Canadian population
Authors: Bhattarai A , Dimitropoulos G , Williams J , Bulloch A , Patten S 
Published: October 2020

Abstract

Background
A history of child abuse is common and is associated with the later occurrence of risky health behaviors, mental disorders, and chronic conditions, strongly suggesting that child abuse may be associated with elevated mortality. However, most of the literature on child abuse has studied psychosocial/behavioral or medical outcomes and have not addressed mortality directly.

Methods
Data from the 2012 Canadian Community Health Survey, linked to the Canadian Vital Statistics Database, were used in the analysis. The CCHS-2012 interview (n = 19,830) retrospectively assessed childhood physical abuse, sexual abuse, and witnessing intimate partner violence before the age of 16. Each type of abuse was analyzed separately using Cox proportional hazards models for all-cause mortality. Hazard ratios (HR) and associated 95% confidence intervals (CI) were estimated with and without adjustment for covariates.

Results
An effect on mortality was observed among men for witnessing interpersonal violence (age-adjusted HR 2.47, 95% CI 1.48-4.12), and severe physical abuse (age-adjusted HR 2.3, 95% CI 1.21-4.36). In each case, the association was not significant for women; the age-adjusted HRs being 0.93 (95% CI: 0.51-1.70) and 0.59 (95%CI: 0.64-2.60) respectively. The association was seen only among those reporting frequent abuse ( &gt; =10 times) and weakened (became not significant) with adjustment for covariates that may mediate the association such as smoking and chronic conditions.

Conclusions
As predicted by a broader literature on childhood adversity, child abuse increases the risk of mortality. The effect was significant for severe physical abuse in men, but imprecision due to a limited number of deaths may have rendered other associations non-significant. The study provides some degree of confirmation that child abuse contributes to later life mortality. Hence public health strategies that prevent child abuse and mitigate the harms of the mediators might prevent mortality.

Key messages
Witnessing intimate partner violence is just as harmful as actually experiencing physical abuse. Preventing children's exposure to violence in family is valuable in preventing mortality in adulthood. Enhancing child abuse prevention programs and mitigating the harmful effects of the mediators such as smoking, substance use, and chronic conditions is important in reducing mortality in adult life.
Supportive maternity care services: A Danish study exploring parents’ experiences with perinatal mental health issues
Authors: Frederiksen M S , Schmied V , Overgaard C 
Published: October 2020

Abstract

Background
Mental illness can have negative impact on pregnant women, their infants and their families, including adverse birth outcomes, as well as place children at risk of developing mental illness later in life. It is recommended to offer additional support in the ante - and postnatal period, but to be able to offer appropriate, timely and effective care, more knowledge is needed on women's own experiences. The aim of this paper is to explore women's experiences with mental illness in the context of pregnancy and early motherhood, and how they experience and engage with supportive services.

Methods
This paper presents selected findings from an ethnographic field study carried out in a Danish municipality. The findings are based on data from 22 women, who were recruited when they were pregnant or had a newborn baby. The women were currently facing or had previously suffered from one or multiple mental health conditions.

Results
Analysis found that women with current or prior mental illness experienced a high level of fear, worries and uncertainty during pregnancy and early motherhood, which shaped how they engaged with supportive maternity services. Some were deeply worried about their mental health and reached out for support to cope with this. Concerns about being a bad mother and about the potential influence of their mental illness on their infants were common. Furthermore, some women were scared of being judged as unfit mothers and losing custody of their children. Many experienced stigma surrounding mental illness, making some more hesitant about reaching out for support.

Conclusions
By providing new insight into women's own perspectives, this study contributes with in-depth knowledge on women's experiences with mental illness during pregnancy and early motherhood, and illustrates how engaging with supportive services may be an ambivalent experience.
Social inequalities in overweight and obesity in 26 European countries
Authors: Charafeddine R , Demarest S , Drieskens S , Renard F 
Published: October 2020

Abstract

Background
Previous studies have shown inequalities in overweight and obesity in disfavor of the socially disadvantaged groups. This study examines the extent of these inequalities in 26 European countries.

Methods
Data from the 2017 EU Statistics on Income and living Conditions (EU-SILC) were used (18 years and older, n = 482,595). A body mass index of 25.0 to 29.9 kg/m2 was classified as overweight and 30.0 and more as obese. Educational level (EL) was used as socioeconomic indicator. Generalized linear models were fitted to compute low-versus high absolute (RD) and relative (RR) inequality. Absolute inequality amplitude (RDA) was calculated as RD/Prevalence.

Results
Among men, average EU inequalities for overweight were slightly in disfavor of the low educated (RR = 1.05, RDA=5%). A mixed inequality pattern was observed across countries, as the risk of overweight was higher among high educated men in most Eastern countries, in contrast to other parts of Europe (RR from 0.74 to 1.19, RDA from -27% to 20%). Male obesity showed more pronounced inequalities (RR = 1.22, RDA=18%), and a consistent pattern of higher risk among the low educated and wide variation across countries (RR from 1.20 to 2.18, RDA from 16% to 49%). Among women, significant inequalities in overweight were observed (RR = 1.23, RDA=21%), with a consistent pattern of higher risk among the lowest EL, and substantial variation across countries (RR from 1.06 to 1.53, RDA from 7% to 36%). Inequalities were even larger for female obesity, with average RR and RDA reaching 1.49 and 35%, and wider variation (RR from 1.35 to 2.77, RDA from 12% to 88%).

Conclusions
Social inequalities in weight status are widespread in Europe, but vary substantially between countries. Inequalities are larger among women. For male overweight, a reverse inequality is observed in most Eastern countries. This study allows countries to benchmark the inequalities observed nationally to the situation in other EU countries.

Key messages
Social inequalities in weight status are widespread in Europe. The pattern of social inequalities in overweight and obesity varies substantially by country and gender.
The risk of preterm birth in combinations of mental disorder and socioeconomic position among Danish women
Authors: Knudsen C K , Christensen A M S , Heuckendorff S , Fonager K , Overgaard C 
Published: October 2020

Abstract

Background
Inequality in preterm birth is a public health challenge requiring identification of pregnant women at particularly high risk of preterm birth. Therefore, the aim was to estimate the risk of preterm birth in women with different combinations of mental health conditions and socioeconomic position.

Methods
Based on Danish registries, we conducted a nationwide cohort study including all first-time mothers giving birth to a singleton liveborn infant in Denmark between 2000 through 2016. We examined the risk of preterm birth (&lt;37 weeks of gestation) in different combinations of mental health conditions (no, minor, and moderate/severe) and educational level (high, intermediate, and low) in three age strata (&lt;25, 25-30, and &gt;30 years). The relative risk of preterm birth was estimated using Poisson regression with a robust error variance. We measured the attributable proportion to assess additive interaction between the effects of exposures.

Results
Of the 415,523 included first time mothers, 29,069 (7,0%) gave birth preterm. The risk of preterm birth increased in combinations of higher degree of mental health conditions, lower degree of educational level, and increasing age. Women aged&gt;30 years with moderate/severe mental health conditions and low educational level had the highest risk of preterm birth (13.7%). The analysis of additive interaction revealed only a limited additional effect of being exposed to mental health conditions and lower educational levels in each age strata. However, positive additive interaction was found between age&gt;30 year and combinations of mental health conditions and educational level.

Conclusions
Substantial inequality in preterm birth remains with increasing risk in women with combinations of higher degree of mental health conditions and lower degree of educational level. In the prevention of inequality in preterm birth special attention on women aged&gt;30 years exposed to mental health conditions and lower educational levels is essential
Variations in use and access of mental health services in Europe
Authors: Borghini A , Seghieri C , Brodo L , Breschi M 
Published: October 2020

Abstract

Background
Mental illnesses comprise a wide range of mental health (MH) conditions -prevalence 3,90%- among European (EU) countries with significant effects on quality of life, life expectancy and disability. They are also related to substantial direct and indirect costs, consequences of inpatient care - not always beneficial for those patients. The main goals of our study are: to report on geographic variations in utilization rates and quality of care for adults MH diseases among 30 EU countries and regions; to explain the determinants of such variations.

Methods
Different data from EUROSTAT regarding healthcare resources, activities and self-perceived health and wellbeing for the years 2013-2015 are combined in a unique database at level of EU countries and NUTS 2 regions to allow for comparisons in utilization rates, perceived conditions and service local supply for MH diseases in Europe.

Results
Preliminary findings show a decline in the global trend of hospitalization rates for mental diseases; however, significant variations were observed among and within countries (High-Low ratio=25 in 2015, at country level). Males were more hospitalized than females (p = 0.40). Women were more likely than men to report depressive symptoms and to access to MH consultations (p &lt; 0.001). Significant and positive correlations were found between resources (hospital beds and psychiatrists per capita) and adjusted hospitalization rates for MH disorders and between self-reported MH consultations and psychiatrists per capita (p &lt; 0.001).

Conclusions
Preliminary findings confirm the presence of wide variations in the care of mental diseases across and within EU countries. Significant correlations between utilization rates and local supply of resources might indicate that part of the variation might be explained by differences in the local organization and availability of resources rather than patients' needs.

Key messages
There is a wide variation in the care of mental diseases across and within EU countries which might be explained by differences in the local organization and resources instead patients’ needs. These results can help policy makers and professionals to identify unwarranted variations that need to be removed and to shift to value-based healthcare.
Impact of maternal mental health problems on perinatal outcomes for the infant
Authors: Christensen L F , Heuckendorff S , Fonager K , Overgaard C 
Published: October 2020

Abstract

Background
Mounting evidence suggests that mental health problems in pregnant women may negatively affect the intra- and extrauterine health and development of the child. This is especially of concern as the prevalence of mental health problems in pregnant women is high and believed to be increasing. We set out to quantify the effect of maternal mental health status on the risk of adverse perinatal outcomes for the infant.

Methods
We undertook a nationwide register-based cohort study including children born alive in Denmark between 2000 and 2016. The exposed cohort was children born to mothers with mental health problems in the two years prior to childbirth that had been cared for in primary care settings only (Group 1, minor problems, n = 71 759) or had required psychiatric intervention (Group 2, moderate-severe problems, n = 41 099). All non-exposed children served as comparison group (n = 908 268). We calculated risk ratios (RRs) with 95% confidence intervals (CI) for each perinatal outcome of interest.

Results
Infants in Group 1 as well as Group 2 were at higher risk of neonatal death than infants born to unaffected mothers, although for Group 2 the trend was non-significant (Group 1: adjusted RR (aRR) 1.34, 95% CI 1.17-1.52; Group 2: aRR 1.11, 95% CI 0.94-1.32). Both exposure groups were furthermore at significantly increased risk of 5-minute Apgar scores &lt;7 (Group 1: aRR 1.27, 95% CI 1.17-1.37; Group 2: aRR 1.52, 95% CI 0.94-1.32) and &lt;4 (Group 1: aRR 1.26, 95% CI 1.10-1.44; Group 2: aRR 1.28, 95% CI 1.08-1.52) and of hospital admission in the neonatal period (Group 1: aRR 1.22, 95% CI 1.19-1.24; Group 2: 1.29, 95% CI 1.26-1.32), paralleled by a significantly higher risk of preterm birth and several neonatal morbidities.

Conclusions
Infants born to mothers with moderate-severe as well as minor mental health problems were at increased risk of multiple adverse perinatal outcomes, thus calling for effective preventive strategies to improve outcomes in both groups.
28.K. Workshop: Advancing health inequality monitoring in Europe – challenges, opportunities and actions
Authors:   Organised by: JAHEE,   Chair persons: Malin Ahrne - Sweden, Gabriella Olsson - Sweden
Published: October 2020

Abstract
Much of the focus on health inequality monitoring is based on aggregate descriptions at national levels where averages or proportions are compared. However, inequalities evolve from systematic differences in living conditions, circumstances, and opportunities between population groups within geographical entities. To be able to follow such trends in health, to detect less favourable trends at an early stage, and to reveal the trends in the population and in subgroups of the population, it is essential to have a national health inequality monitoring system (HIMS) in place. In fact, in line with the “no data, no problem” notion, one might even claim that the most essential part of combatting social inequalities in health is a well-functioning health inequality monitoring system.
The Joint Action Health Equity Europe (JAHEE) is a Joint Action financed by the Third Health Programme 2014-2020 of the European Union. It represents an important opportunity for countries to work jointly to address health inequalities and achieve greater equity in health outcomes across all groups in society in all participating countries and in Europe at large. One of the aims with JAHEE and the specific focus of work package five (WP5) is to advance member states ability to monitor national health inequalities.
The overall objective of the work conducted in JAHEE WP5 is to attract attention to and improve countries' capacity to monitor health disparities in a “do something, do more, do better” manner. The advancement of HIMS varies greatly between countries in Europe. Yet, there is scope for improvement in virtually all countries. In addition, challenges that impede the way health inequality monitoring can be conducted are often common across countries. These challenges cannot be eliminated within the course of a three-year EU project. The JAHEE project, however, offers an unique opportunity to move forward by working together in a structured work process that allow partner countries to share, build and transform available knowledge into concrete actions aimed at strengthening national health inequality monitoring systems in Europe.
In this workshop, we will present the experiences from JAHEE WP5 and give examples on concrete actions and initiatives taken across Europe to challenge some of the barriers faced and to strengthen the national health inequality monitoring processes in Europe. There will be room for discussion between each presentation and in the end of the workshop.

Key messages
Raised awareness a politically committed system infrastructure to assure sustainability in health inequality monitoring. Raised awareness of need for agreed data but also agreed methods to compile data to measure inequalities within populations.
Joint Action Health Equity Europe - turning knowledge on health inequality monitoring into actions
Authors: Olsson G , Henriksson G 
Published: October 2020

Abstract
Growing social inequalities in health challenge a sustainable development. To reduce health inequalities, it will be necessary to provide relevant data to policymakers on how health inequalities and the social determinants of health are distributed within populations over time, i.e. it will be necessary to form appropriate health inequality monitoring systems (HIMS).
One of the aims with Joint Action Health Equity Europe (JAHEE) and the specific objective of work package five (WP5) is to advance partner countries ability to monitor national health inequalities. Country assessments has been conducted to assess the status of the HIMS in the participating countries, and a joint framework has been developed, describing the core components of an “ideal” HIMS. All partners have committed to the overall objective of the WP5 through the identification and implementation of concrete actions, which is now ongoing.
The countries in JAHEE WP5 are Cyprus, Finland, Germany, Italy, Lithuania, Netherlands, Poland, Romania, Serbia, Slovenia, Spain and Sweden, where The Public Health Agency Sweden is the lead.
The aim of this presentation is to present the experiences from JAHEE WP 5, and what they imply is needed to build coherent health inequality monitoring systems at a national level. More specifically, the JAHEE project in general, the WP5 project in particular will be presented, the structured work process described, and some general results and conclusions discussed
Towards a national health equity monitoring strategy
Authors: Costa G , Zengarini N , Marra M 
Published: October 2020

Abstract
The 2017 Italian Review on health inequalities identified two main needs with regards to Italian health equity monitoring. (1) The need to collect a social covariate at individual level in each health information system at local, regional and national level. Such a social covariate is fundamental for monitoring if any avoidable inequality in access, use, quality of care and health outcome is occurring at local, regional, national level. (2) The need to re-engineer and frame the different health equity monitoring surveys already established into an explicit health inequalities monitoring strategy (HIMS). Both challenges are accounted for by Italy in the Joint Action Health Equity Europe workplan.
As for the social covariate, a pilot project is conducted. Data from 2011 census (education and area deprivation) and the national identification code used to link individual data on health and services utilization in four representative regions is linked. This will allow monitoring the social variation in selected performance indicators by region, across regions and through time.
As for HIMS, previous research projects have designed and successfully piloted different models of low-cost data linkage for already established longitudinal studies. Now these pilot results will evolve into a national HIMS. As a first step, a special project of consensus building will be implemented among institutional partners responsible for the following national longitudinal studies based on record linkage: a) Work Histories Italian Panel followed up prospectively for health outcomes; b) Italian Longitudinal Study: 2000, 2015, 2013 Health Interview Surveys followed up prospectively for health outcomes; c) differential mortality 2011-2017 in the 2011 censused Italian population; d) the network of the metropolitan and regional census based longitudinal studies followed up prospectively for mortality disease registries and health care utilization. Experiences gained will be shared and discussed.