bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urban rural paradox -when easy access to mammography services does not mean active participation
Authors: Padilla C , Prajapati N , Soler Michel P , Vieira V M 
Published: October 2020

Abstract

Introduction
The detection of breast cancer in its latent stages through mammography screening can improve patient's chances of recovery. However, geographic variation in mammography participation remains. Our objectives were first to assess whether the geographic accessibility of mammography-screening services influences mammography-screening participation and second to estimate the extent to which geographic variation in the use of cancer screening can be explained by spillover effects between adjacent areas, while controlling for covariates.

Methods
Mammography-screening services participation rates were calculated, for women aged 50-74 years who live in Lyon metropolitan area and did a mammography between 2015-2016 after being invited with a letter by the mammography screening program. We used spatial autoregressive models to estimate the extent of spatial spillover effects by applying spatial lag models. The geographic accessibility (availability, distance and affordability) on participation was evaluated adjusting on socioeconomic characteristics of census blocks.

Results
We found evidence of urban rural paradox. The mammography screening participation was 53.2% in residential and rural areas and 46.6% in urban and active areas, p &lt; 0.001. Conversely to rural areas, women living in urban census blocks had high availability, lower distance to the closest mammography services, and lower mammography screening participation. Moreover, the coefficients for the spatial lag are significant and positive. The positive spatial lags indicate that screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas.

Conclusions
This study makes an important methodological contribution to measure access to services and better understand the variety of community contextual factors that drive mammography use decisions; which is a critical component of health care planning and equity almost everywhere.

Key messages
Evidence of urban rural paradox in mammography screening participation. Screening utilization rates are determined by knowledge spillovers and geographic proximity between adjacent areas.
Validation of mobile Decision Support System for scheduling age-appropriate immunizations
Authors: Ali R F , Hossain Z , Siddiqi D , Abdullah S , Shah M T , Chandir S 
Published: October 2020

Abstract

Background
The prevalence of missed opportunities for immunization among children is estimated to be 32.2%. The introduction of new vaccines in EPI schedule and lack of training of frontline health workers (FHWs) on the guidelines for number and spacing of doses and manual construction of vaccine schedules based on a child's age deteriorates efficiencies of FHWs, especially in forecasting catch-up schedules. We have designed and tested the validity of an innovative Decision Support System Application Programming Interface (DSS-API) which will automatically generate an age-appropriate immunization schedule for a child.

Methods
Using a multi-country setting approach, DSS was deployed in six immunization facilities of Pakistan and Bangladesh between July 2019 to April 2020. Details of all visiting children were recorded in database. Information on date of birth and past immunization history was used by the DSS-API to determine an individualized age-appropriate immunization schedule. These schedules were compared to the gold standard's outputs calculated by an immunization expert.

Results
A total of 6,241 vaccination events were recorded from all the sites. Using area under the curve, the calculated sensitivity of DSS to determine age-appropriate immunization schedule was found between 99-100% for the individual EPI vaccines, while the specificity of the DSS algorithm was found between 98-100%.

Conclusions
DSS is a feasible feature that can be incorporated in Digital Immunization Registries to accurately schedule routine and catch-up immunizations and can effectively reduce Missed Opportunities for Immunizations by assisting FHWs through automatic construction of immunization schedules.

Key messages
DSS-API is a unique application that can improve process efficiencies of frontline health workers by automatic generation of accurate age-appropriate catch-up vaccine schedules. DSS has the potential to reduce missed opportunities for immunization (MOI) and improve immunization coverage and timeliness among children aged under 2 years.
“Sometimes I don’t have a pulse, and I’m still alive!” Healthcare providers on digital health techs
Authors: Tomasella F , Morgan H M 
Published: October 2020

Abstract

Background
Digital health technologies (DHTs) are increasingly becoming an integral part of our lives, healthcare field included. The WHO recently has even released the first digital health guidelines for worldwide intervention. Commercially available DHTs (e.g. smartphones, smartwatches, apps) may hold significant potential in healthcare, upon successful and constructive integration. Literature on the topic is split between enthusiasm for the potential benefits, and concerns about reliability and effectiveness. Little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they believe the main issues for implementation may be. This study aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public.

Methods
Nine HCPs volunteered to take part in semi-structured interviews. Data were thematically analysed adopting a pre-constructed framework (deductive approach) based on current (April 2019) literature and the findings from the first two interviews.

Results
The following main themes were identified and explored in detail: HCPs' experience, perceived knowledge and views on DHTs; advantages and disadvantages; barriers towards healthcare implementation and solutions; future perspectives. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this included factors such as time/resources availability; colleagues' mindset; lack of evidence of effectiveness for practice; privacy/data security concerns.

Conclusions
The potential advantages of DHTs' adoption in healthcare are substantial - e.g. patient autonomy, time/resources saving, health and behaviour change promotion. However, future research is warranted focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

Key messages
We explored healthcare providers’ views on the role of commercial digital health techs in clinical practice. Despite some privacy and reliability concerns, commercial digital health techs show promise.
Is the technical quality of root fillings associated with socioeconomic status?
Authors: Raittio E , Huumonen S , Suominen A L 
Published: October 2020

Abstract

Background
Socioeconomically better-off tend to receive better care, and to benefit more from care they receive, than the less well-off. The technical quality of root fillings can be assessed radiographically. Our aim was to investigate differences in the technical quality of root fillings according to socioeconomic status not studied before.

Methods
In the Finnish Health 2000 Survey, a sample of 8 028 over 29-year-old adults was selected by a stratified two-staged cluster sampling. Of these, 6 115 (76%) underwent panoramic radiography. A total of 7 986 endodontically treated teeth were detected among 3 905 participants. The criterion for a technically inadequate root filling was a distance from the root filling to the root apex of over 3 mm or material over the apex. Education, employment status and household income were used as measures of socioeconomic status. Differences in the quality of root fillings according to socioeconomic status were investigated using the Multiple Additive Regression Tree mediation analysis, taking into account age, gender and tooth type of the root filled tooth.

Results
Almost half (47%) of the root fillings were inadequate. Root filling quality was associated particularly with age of the participant and type of tooth. Mediation analysis showed that among the over 64-year-olds, higher education or income were associated with a slightly higher probability of inadequate root filling quality (ORs 1.15-1.20, p &lt; 0.05). Among the under 65-year-olds, age of the participant and type of tooth explained the observed variations in root filling quality according to socieconomic status, and socioeconomic status had no influence (ORs 0.99-1.02, p &gt; 0.05).

Conclusions
Those in a lower socioeconomic status had not received poorer endodontic treatment quality. It seems that those in a lower socioeconomic status are not prone to receive poorer quality care in endodontic setting, that they tend to receive in longer and more socially complex treatments.

Key messages
Variations in the technical quality of root fillings by socioeconomic status has not been studied. Lower socioeconomic status was not associated with poorer technical quality of root fillings.
Social variations in pregnancy outcomes in Murmansk county-one of the Northernmost European provinces
Authors: Grjibovski A M , Usynina A A , Postoev V A , Kharkova O A , Odland JØ 
Published: October 2020

Abstract

Background
Pregnancy outcomes are widely used indicators of population wellbeing varying both between and within countries. The aim of this study was to assess social variations in preterm births and term small-for-gestation-age (SGA) infants in the Northernmost provinces of Europe - the Murmansk region - using the data from the first Russian population-based birth registry.

Methods
A registry-based study of 52 806 births in the Murmansk region for a 5-year period was performed. We studied the prevalence and social determinants of moderate-to-late preterm births (MLPTB, 224-258 days of gestation), very preterm births (VPTB, 196-223 days) and extremely preterm births (EPTB, 154-195 days) and term SGA for both weight and length births (SGAWL). Associations between social factors and pregnancy outcomes were studied by multivariable logistic regression.

Results
The prevalence of PTB was 6.9 with EPTB, VPTB and MLPTB constituting 0.3%, 0.6% and 6.0%, respectively. A total of 4.1% of infants were SGAWL. Women with primary, secondary and vocational education were 1.59 (95%CI:1.22-1.85), 1.33 (95%CI:1.20-1.48), 1.19 (95%CI:1.22-1.85) times more likely to have MLPTB than women with higher education. Corresponding values for VPTB were 1.65 (95%CI:0.88-3.08), 1.41 (95%CI:1.02-1.95) and 1.27 (95%CI:0.92-1.75), respectively. Single and cohabiting women had significantly elevated risk for MLPTB (ORs=1.47 (95%CI:1.30-1.66) and 1.39 (95%CI:1.26-1.44)) and VLPTB (ORs=2.00, 95% CI: 1.42-2.81 and 1.32, 95% CI: 0.97-1.79) compared to married women. Unmarried mothers were more likely to have SGAWL boys (OR = 1.60, 95% CI: 1.38-1.86) and SGAWL girls (OR = 1.51, 95%CI:1.31-1.76) compared to married women.

Conclusions
We observed significant social variations in pregnancy outcomes by maternal education and marital status in the Murmansk region. Registry data can be used as an effective tool for monitoring inequalities in pregnancy outcomes as indicators of social inequalities.

Key messages
We found significant social variations in pregnancy outcomes in the Northernmost province of Europe - the Murmansk county (Russia). Birth registry data can be used for monitoring of health inequalities in Russia.
Social inequality in obesity in an Eastern Mediterranean population: a national health survey
Authors: Quattrocchi A , Kolokotroni O , Demetriou C A , Charalambous A , Heraclides A 
Published: October 2020

Abstract

Background
This study aimed to explore socioeconomic factors associated with obesity in the Republic of Cyprus.

Methods
We interviewed 3021 Greek-Cypriots aged 25-64 years through a multistage survey. We collected self-reported information on demographics, health behaviours (physical activity, smoking, alcohol consumption and dietary intake), socio-economic characteristics (educational attainment, household income and occupational social class) and anthropometric measurements. Obesity was defined as body mass index ≥30 kg/m2. For the association between obesity and each socio-economic indicator, we conducted sex-specific Poisson's regression with robust variance, adjusting for all demographics and health-related behaviours, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (CI).

Results
The prevalence of obesity was 22% and 17% among men and women, respectively. There was a significant trend of higher obesity prevalence with increasing age as well as with being widowed in both genders and being a refugee in men. Obesity prevalence decreased with increasing educational attainment (postgraduate vs. none/gymnasium: a PRmen=0.45; 95%CI=0.25-0.82; a PRwomen=0.41; 95%CI=0.18-0.95; p-trends&lt;0.005), and household income (&gt;€4000/month vs. ≤€1000/month: a PRmen=0.45; 95%CI=0.26-0.81; a PRwomen=0.45; 95%CI=0.22-0.92; p-trends&lt;0.005). Occupational social class did not show any clear association with obesity. After adjustment for health-behaviours as mediators the association between income and obesity in women was attenuated.

Conclusions
The current study highlights striking social inequalities in obesity among Cypriot men and women, characterised by a linear decrease in obesity prevalence each step up the socioeconomic hierarchy. We recommend that comprehensive and multifaceted public health interventions are considered to address income and education-related barriers resulting in higher obesity rates among specific population sub-groups.

Key messages
Among Greek Cypriot adults, obesity affects almost one in five whilst obesity prevalence shows gender-specific social inequalities. When investigating social inequalities in health, the choice of socioeconomic indicators should reflect the context of the population and gender-specific differences.
Testing a self-assessment tool for HP competencies with participants of training courses in Austria
Authors: Lang G 
Published: October 2020

Abstract

Background
High quality health promotion (HP) depends on a competent workforce for which professional development programmes for practitioners are essential. The “CompHP Core Competencies Framework in HP” defines crucial competency domains but a recent review concluded that the implementation and use of the framework is lacking. The aim was to develop and validate a self-assessment tool for HP competencies, which should help evaluate training courses.

Methods
A brief self-assessment tool was employed in 2018 in Austria. 584 participants of 77 training courses submitted their post-course assessment (paper-pencil, RR = 78.1%). In addition, longitudinal data are available for 148 participants who filled in a pre-course online questionnaire. Measurement reliability and validity was tested by single factor, bifactor, multigroup, and multilevel CFA. A SEM proved for predictive and concurrent validity, controlling gender and age.

Results
A bifactor model (X2/df=3.69, RMSEA=.07, CFI=.95, sRMR=.07) showed superior results with a strong general CompHP factor (FL&gt;.65, wH=.90, ECV=.85), configurally invariant for two training programmes. On course level, there was only minimal variance between trainings (ICC&lt;.08). Structurally, there was a significant increase in HP competencies when comparing pre- and post-course measurements (b=.33, p&lt;.01). Participants showed different levels of competencies due to prior knowledge (b=.38, p&lt;.001) and course format (b=.16, p&lt;.06). The total scale had good properties (m = 49.8, sd = 10.3, 95%-CI: 49.0-50.7) and discriminated between groups (eg by training length).

Conclusions
The results justify the creation of an overall scale to assess core HP competencies. It is recommended to use the scale for evaluating training courses. The work compensates for the lack of empirical studies on the CompHP concept and facilitates a broader empirical application of a uniform competency framework for HP in accordance with international standards in HP and public health.

Key messages
The self-assessment tool provides a good and compact foundation for assessing HP competencies. It provides a basis for holistic, high quality and sustainable capacity building or development in HP.
Health labour markets: an overview of some human factors that influence demand and supply
Authors: Dussault G , Zurn P 
Published: October 2020

Abstract

Background
The global demand for health workers is expected to double by 2030 and it is estimated that if need is taken into account, there will be a deficit as high as 18 million according to the World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030. Combined with inequities in the access to qualified health workers, this impedes progress towards the achievement of universal health coverage, global health security and the SDGs. This paper addresses health labour market deficiencies. It aims to provide guidance for a comprehensive analysis of health labour market dynamics, including the political and social factors that, in addition to economic ones influence the behaviour of health workers and of employers.

Methods
This paper uses the material of the WHO Health Labour Market Analysis Guidebook, which is based on the most recent literature on the demand and supply of health workers and on factors that affect them. It also draws from empirical analysis conducted recently by WHO in four regions of the world.

Results
On the supply side, the paper illustrates how social norms, such as those related to gender, influence the decision to become a health professional, the choice of a specialty, the choice of a practice location, and labour market participation. As to demand, examples are given of how professional interest groups' political actions (councils, trade unions) influence the division of tasks and which types of jobs will be offered.

Conclusions
The analysis of the dynamics of health labour markets must include human factors to achieve a better understanding of the forces that drive health worker shortages and surpluses, skills-mix and geographical imbalances, and suboptimal performance and to develop effective policies to address these issues.
The challenge of defining chronic illness for health monitoring in children: opening a can of worms
Authors: Neuhauser H , Thamm R , Mauz E , Poethko-Müller C 
Published: October 2020

Abstract

Background
A straightforward health monitoring definition of chronic illness in children would have great utility for estimation of health care and social service needs as well as resource allocation.

Methods
This study analyses various definitions of chronic illness in children and adolescents in cross-sectional national health surveys in Germany based on: the Children with Special Health Care Needs (CSHCN) 14-item-questionnaire, a list of 15 self-reported medical diagnoses in the past 12 months, and a generic single-question parent-reported chronic condition from the Minimum European Health Module (MEHM), also used in EU-SILC and EHIS surveys.

Results
13.7% (95% CI 13.0-14.4) of children and adolescents aged 0-17 years had special health care needs in the first National Interview and Examination Survey in Children and Adolescents in Germany KiGGS 2003-2006. However, surprisingly, the prevalence was less than half in children with a migration background and was not associated with social status or income. The list of diagnoses identified a very high proportion of 31.5 (30.7-32.4) of children aged 0-17 years as chronically ill but does not take into account disease severity or impact. The generic MEHM-question in the KiGGS 2009-2012 survey identified 16.2% (15.3-17.1) of 0- to 17-year-olds as chronically ill, however, only one in five was affected in their daily activities. Parents denied chronic illness in 11.2% of children with epilepsy, 18.8% of children with asthma and 62.8% of children with attention deficit hyperactivity disorder.

Conclusions
None of the three definitions of chronically ill children is entirely satisfactory so far: CSHCN may need an adaptation of the German version to better capture inequalities, the disease list needs further severity differentiation and MEHM has recently shown low test-retest reliability (kappa 0.56) when administered twice within 6 months in a large Belgian sample and may need revisiting as well.
On the art of doing surveys among adolescents
Authors: Due P , Arnarsson A M , Lyyra N , Löfstedt P , Madsen K R , Thorsteinsson E B , Välimaa R , Torsheim T , Damsgaard M T , Eriksson C 
Published: October 2020

Abstract
The aim is to discuss methodological challenges for research on adolescent positive mental health. A first consideration is which questions should the measurement instrument answer. In the clinical context it should have the properties of giving enough information for making a diagnosis of high quality. In the public health context, its objective may be to give information that enables the researcher to describe trends at the population level and provide guidance on areas of intervention.
The HBSC study is monitoring the health and health behaviour of school-aged children in a public health context. It is a population survey, defined by the form of data collection and the method of analysis. The data is collected by questionnaire from a representative sample of school-aged children. It tries to answer descriptive questions (What, who, when?), but also tries to explore causal associations (Why?), given the limitations of the cross-sectional design.
Surveys have advantages: Good for gathering descriptive data; Can cover a wide range of topics. Are relatively inexpensive to use; Can include large number of respondents; and Can be analysed using a variety of existing software. Among the disadvantages can be mentioned: Self-report may lead to biased reporting; Data may provide a general picture but lack depth; Difficult to obtain adequate information on context; and Differences in understanding: it is difficult to formulate questions in such a way that it will mean exactly same thing to each respondent.
The choice of measurement tools or indicators involves both theoretical and practical issues. Multidisciplinary research teams may include different theoretical traditions, which is an asset but also make it necessary to be explicit regarding overall aims of the study. Most often the theoretical issues focus one of three topics: the value of the types of data; the relative scientific rigor of the data; or basic, underlying philosophies of evaluation.