bluuebunny/crossref_metadata_2025_split huggingface dataset:
Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil
Authors: Ishitani L , Teixeira R , Abreu D , Paixão L , França E 
Published: October 2020

Abstract

Background
Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil.

Methods
Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence.

Results
In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9).

Conclusions
Analysis of GCs is essential to evaluate the quality of mortality information.

Key messages
Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.
Challenges and opportunities in promoting health equity for migrants
Authors: Nordström C , Ingleby D , Dias S , Magnus J , Eikemo T A , Kumar B 
Published: October 2020

Abstract

Issue
What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors.

Description of the problem
As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply?

Results
The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP.

Lessons
A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other.

Key messages
The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.
Ensuring access to medicines at a fair price? Innovative contracting experiences in France
Authors: Alaoui I , Izambert C , Toullier A 
Published: October 2020

Abstract

Issue
Innovative contracting models are developed to ease price-setting negotiations in case an extremely expensive drug has not proven sufficient efficiency in clinical trials. As disruptive HIV treatments are expected in the near future, French patient organizations evaluated the ability of these innovative contracts to ensure accessible medicines at a fair price.

Description
Performance-based schemes condition prices paid by the State to the efficiency of the medicine observed through real-world data. In France, thirteen performance-based contracts have been concluded between 2008 and 2015. They are presented as a triple solution: innovative treatments are available to patients, manufacturers access markets, and states ensure healthcare within limited budgets. Establishing the added value of these models implies determining if they allow rapid access to treatments with substantial savings for payers, while ensuring rigorous price and cost transparency.

Results
Performance-based contracts indeed ensure patient access to treatments, but other mechanisms (such as temporary use authorizations) already serve this purpose. Regarding expenditure reduction however, these schemes have not proven their worth. The Court of Auditors' evaluation showed they do not generate substantial savings, as final prices correspond to those that would have applied with the European price guarantee. Lastly, as contracts are protected by business secrecy, the public cannot access neither to actual prices negotiated by payers, nor the amount of public investment that have been used for the research and development of the drug.

Lessons
The derogatory nature of performance contracts invites us to consider them on a case-by-case basis if ensuring access to a specific innovation is necessary. These contracts are certainly innovative, but they cannot be presented as technologies providing access at a fair price. Finally, their contractual and derogatory nature raises serious transparency issues.

Key messages
Performance-based contracts should be considered as alternatives to existing administrative channels provided that they lead to substantial savings and are drawn up in full transparency. Patient organizations need to assess innovative schemes such as performance-based contracting to ensure access to treatments without undermining historical struggles for fair and transparent pricing.
The economic impact of air pollution: a European assessment
Authors: Conti S , Ferrara P , D'Angiolella L S , Lorelli S C , Agazzi G , Fornari C , Cesana G , Mantovani L G 
Published: October 2020

Abstract

Background
In 2017, the Global Burden of Disease Study estimated that in Europe 0.42 million deaths and 8.9 million disability-adjusted life years were attributable to air pollution. Monetizing this burden is a key step for estimating benefits of exposure reduction strategies. However, robust and synthetic estimates of direct (e.g. due to hospitalizations or medications) and indirect (e.g. due to premature mortality or loss of productivity) health-related costs of air pollution seem to be still lacking. We carried out a systematic review, aimed at identifying evidence from research in Europe.

Methods
We searched 5 electronic databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web Of Science) in which we applied algorithms tracing keywords such as “cost of illness”, “health care costs”, “economics” and synonyms, together with “air pollution” and synonyms. We limited our search to articles written in English and Italian, without date restriction.

Results
The initial search retrieved 2420 records. 200 were classified as relevant, and 38 fulfilled inclusion criteria. Most of them (68%) were published after 2010. 26% were multi-country studies, while the remaining focused on a single country or city. Investigated pollutants were usually particulate matter (79% of the studies) and nitrogen oxides (37%). The approaches to the economic analysis were heterogeneous: estimates could include direct and/or indirect costs. Among the studies, the most comprehensive one (12 countries) estimated that complying with WHO guidelines would avert €31 billion yearly, of which €19 million due to hospitalizations.

Conclusions
Over the last decade, progress has been made in evaluating the economic burden of air pollution. However, estimates based on indirect costs are affected by high levels of uncertainty, while those based on direct costs are more robust and should be further investigated, since they are crucial information for healthcare policy makers.

Key messages
Air pollution poses a high economic burden on European countries, mainly due to social costs. More attention should be devoted to estimating direct healthcare costs of air pollution, in order to properly inform policy makers about the impact on healthcare systems.
Mapping variability in allocation of Long-Term Care funds across payer agencies in OECD countries
Authors: Waitzberg R , Schmidt A E , Blümel M , Barbabella F 
Published: October 2020

Abstract

Background
Long-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions). The objectives of this cross-country study is to highlight to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.

Methods
Qualitative data were collected through a questionnaire filled by experts from 17 OECD countries.

Results
11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.

Conclusions
A minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.

Key messages
A minority of LTC systems in OECD countries fully meet distributional equity in allocation of resources across payer agencies. Countries that value distributional equity should harmonize the eligibility criteria to LTC at the national level and allocate funds according to needs across regions.
What is the health-related burden of EU-Candidate Countries? A snapshot of public health indicators
Authors: Šantrić Milićević M , Boskovic N , Vasic M , Bjegovic-Mikanovic V , Stamenkovic Z , Todorovic J , Terzic-Supic Z 
Published: October 2020

Abstract

Background
Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system.

Methods
The most complete and available EUROSTAT data describing health-related burden (13 indicators) for current EU- candidate countries (Serbia, Turkey, the Republic of North Macedonia and Montenegro) were evaluated and compared.

Results
Total health expenditures (Purchasing Parity Power) per capita in EU candidate countries is almost one-third of that in the EU. General government health expenditure for all four countries was below the EU average with Montenegro spending the highest and North Macedonia spending the least. Turkey, with a significantly higher gross domestic product (GDP), allocated the smallest percentage of its GDP on health (4.31%), while Serbia the highest percentage (8.55%), both being below the EU average (10%). The private health expenditure for all of the countries was higher than the EU average, with Serbia's proportion being double that of the EU average. Assessing the burden of disease for these countries, Serbia has the highest disability-adjusted life years (DALY) rate per 100,000 (25,468.38), while the average DALY rate of the other three countries was 23,656.33 and the EU average was 16,390. Turkey and North Macedonia tying for the highest infant mortality rate, three times the EU average. Of the candidate countries, Serbia contains the highest density of physicians and nurses and Turkey, the lowest.

Conclusions
The process of entry to the EU is a varied experience for each country since attaining benchmark standards affects the time needed to achieve them. This study on a selected number of public health indicators contributes to the evidence on the current health-related burden of EU-candidate countries.

Key messages
All EU candidate countries have a much higher burden of disease and a much lower health workforce and health expenditure than the EU average. The challenge for countries in the accession process is to reach a level of quality and achievement in health care in the EU.
Do you Vape With Aloha?: How culture and place are used to spread misinformation on Instagram
Authors: Sentell T , Kearney M , Hazen A , Dela Cruz M R , Yamauchi J , McHenry L , Rodericks B , Massey P 
Published: October 2020

Abstract

Background
Forty-two percent of high school teens in Hawai'i have tried e-cigarettes, double the United States' national average. Native Hawaiians have higher use than other racial/ethnic groups. While Hawai'i state law prohibits tobacco sales to anyone under 21, many Hawai'i adolescents purchase e-cigarettes on the internet, often through social media.

Methods
We collected 717 public Instagram posts from April and December 2018 geotagged in Hawai'i that mentioned one or more hashtag search terms (e.g., #vape, #ecig). All relevant, working posts (n = 476) were manually coded for text and image characteristics.

Results
Over 80% of posts were from vape shops (n = 389 of 476;81.7%). Caption text commonly mentioned brand names (n = 409;85.9%), vape shop names (n = 379;79.6%), and flavors (n = 103;21.6%). The most frequent image elements were logos (n = 395;82.7%), e-cigarettes (n = 324;68.1%), and flavors (n = 110;23.1%). Less than one in 50 (n = 9;1.8%) included caption text warnings.
One in five posts (n = 94,19.7%%) featured content specific to Hawai'i including references to Native Hawaiian culture, flavors and foods, scenery, plants, animals, and language. For example, “Hawai'i Nei...Stay Blessed n Vape With Aloha” or “Ma'o Hau Hele” is the state flower of Hawaii, combined with a refreshing sweet raspberry it makes the perfect balance of flavor.” User engagement (i.e., likes) varied, with a median of 17 likes per post (range: 0-308). Posts with Hawaiian cultural elements received significantly more likes than other posts (median: 22 versus 16;p=0.0047).

Conclusions
Culture is a critical strength that can support positive health outcomes in many communities. Vape shops and product promoters explicitly misappropriated Native Hawaiian culture to sell e-cigarettes on Instagram, while downplaying known harms. Adolescents and young adults may be particularly vulnerable given social media's role as a powerful health behavior influence and an e-cigarette purchasing source.

Key messages
Health misinformation is contextualized within culture and place in a way that is compelling to users, may put youth at particular risk, and can perpetuate health disparities. Our study supports tailored health campaigns and interventions for local communities and cultures to combat such online misinformation.
Developing a core set of indicators for quality assessment of cancer genetic services
Authors: Unim B , Sindoni A , Pitini E , Vacchio M R , Marzuillo C , De Vito C , Villari P 
Published: October 2020

Abstract

Background
One of the major challenges of personalized medicine is how to assess the quality of genetic services offered both in public and private sectors. Although the quality of genetic services can be assessed and compared with structure, process or outcome measures, a consensus on the appropriate quality assessment measures is lacking worldwide. The aim of the study is to develop a core set of indicators for the quality assessment of genetic services providing testing for breast and ovarian cancer (BRCA1/2 testing).

Methods
In the first phase, a literature review was performed to identify genetic services providing BRCA1/2 genetic testing in Europe. In the second phase, structural, process and outcome measures retrieved from the literature records will be rated, with a 5-point Likert grading scale, by members of multinational genetic associations in a three-round Delphi survey. The survey will also accommodate quality assessment measures proposed by the participants. In the last phase, the feasibility of using a core set of indicators will be assessed across European countries.

Results
The literature search yielded 92 relevant records published 2000-2019, in English or Italian. The records reported outcome measures (92/92) and, to a lesser extent, process (80/92) and structure measures (71/92). An ad hoc data extraction form has been developed and the evaluation of the literature records is ongoing. Highly rated measures obtained through consensus among genetics professionals will form the core set of indicators for quality assessment of genetic services providing BRCA1/2 genetic testing.

Conclusions
The development of a standardized set of indicators for the assessment of genetics services is an essential step forward in defining common quality standards of the services in Europe. It will also facilitate direct comparisons across countries, highlighting examples of good practices and points of improvement for currently implemented genetic services.

Key messages
A minimum set of indicators for the assessment of genetics services is required to guarantee quality standards of the services across European countries. A core set of indicators will facilitate direct comparisons across European countries, underlining good practices and points of improvement for currently implemented genetic services.
The burden of cancer in Belgium, 2004-2017
Authors: Cornez A , Silversmit G , Gorasso V , Grant I , Wyper G M A , De Smedt D , Devleesschauwer B , Speybroeck N 
Published: October 2020

Abstract

Background
Monitoring the health status of a population requires consistent and comparable data on the morbidity and mortality impacts of a disease. The Disability-Adjusted Life Year (DALY) is an increasingly used disease burden indicator, combining healthy life years lost due to living with disease (Years Lived with Disability; YLDs) and due to dying prematurely (Years of Life Lost; YLLs). In Belgium, as in many other developed countries, cancer is a major contributor to the overall burden of disease. To date, however, local estimates of the burden of cancer are lacking.

Methods
We estimated the burden of 48 cancers in Belgium from 2004 to 2017 in terms of DALYs, using national population-based cancer registry data and international disease models. We developed a microsimulation model to translate incidence- into prevalence-based estimates, and used expert elicitation to integrate the long-term impact of surgical treatment.

Results
In 2017, in Belgium, breast cancer was the cancer with the highest disease burden among women, followed by lung cancer and colorectal cancer. Among men, lung cancer had the highest disease burden, followed by colorectal cancer and prostate cancer. Between 2004 and 2017, the burden of lung cancer increased by more than 50% in women, while in both sexes, significant increases were observed in melanoma and skin cancer burden. The majority of the cancer burden remained linked to premature mortality.

Conclusions
Cancer maintains a major impact on the health of the Belgian population. Current resources allocated for their prevention and treatment will need to be maintained to further reduce the cancer burden. Lung cancer remains a crucial challenge, among both men and women, calling for strengthened tobacco control policies. Integrating the current study in the Belgian national burden of disease study (BeBOD) will allow monitoring the burden of cancer over time, highlighting new trends and assessing the impact of public health policies.

Key messages
Burden of disease studies allow assessing and monitoring the impact of diseases and risk factors in a comparable way. Cancer maintains a major impact on the health of the Belgian population; lung cancer in particular remains a crucial challenge.
Raising the bar: Sex and Gender-Based Analysis and Reporting (SGBAR) in health research
Authors: James L , Menezes S , Lawrence S 
Published: October 2020

Abstract

Issue
For decades, research has been male dominated: research led by men with male participants. Two-thirds of heart disease and stroke clinical research is based on men. When research is led by women, sex and gender are more likely to be incorporated into the research itself, and the levels of sex reporting also increases. Unfortunately, the low involvement of women in research around the world - as both researchers and participants - has led to findings that are not always applicable to women, resulting in gaps in treatment, care and recovery. The results are worse health outcomes for women in most countries.

Background
Applying sex and gender methods and analysis in research leads to higher quality results. A review of the literature and research landscape showed that sex and gender analysis was more common in public health, but not in clinical, biomedical or health systems research.

Results
The Heart and Stroke Foundation (Heart & Stroke), as both a funder of research and advocate for systems change recognized the research system perpetuated the inequities in women's health. The solution was to restructure the organization's research funding enterprise and also push for change among the health community. H&S put SGBAR requirements into its research funding program. To build on the change, H&S is now working across all levels of government and research institutions to secure SGBAR as a standard of practice. To date, this advocacy pursuit has created substantial systems change.

Lessons
Due to the complex research landscape, making SGBAR a priority across all research institutions is a massive undertaking. There is a need for both top down and bottom up approaches to ensure wide scale change.

Key messages
Incorporating sex and gender-based analysis and reporting in health research will improve health equity. Health research Funding agencies have an opportunity to raise the bar and shift the research environment.