bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depressive symptoms, neuroticism and participation in breast and cervical cancer screening in the UK
Authors: Niedzwiedz C L , Robb K A , Katikireddi S V , Pell J P , Smith D J 
Published: November 2019

Abstract

Background
Globally, more than 2 million women are diagnosed with breast or cervical cancer every year. Depressive symptoms and personality traits have been implicated in cancer-related mortality, but the potential mechanisms through which these associations may operate are not well understood. We aimed to assess how depressive symptoms and neuroticism are associated with participation in breast and cervical cancer screening.

Methods
273 402 women in the UK Biobank cohort who were eligible for breast cancer screening (aged 50-70 years) and/or cervical cancer screening (&lt;65 years) at baseline recruitment (2006-10) and those with follow-up data (2014-March 19) were identified. Depressive symptoms (4 items from Patient Heath Questionnaire) and neuroticism (12 items from Eysenck Personality Inventory Neuroticism Scale) were self-reported at baseline. The primary outcomes were reporting being up to date with breast and cervical cancer screening. For prospective analyses, patterns of screening participation from baseline to follow-up were derived. Logistic regression was used to analyse associations, adjusted for potential confounders.

Results
More severe depressive symptoms (range 0-12) were associated with reduced screening for breast (OR = 0.960, 95% CI: 0.950,0.970) and cervical cancer (OR = 0.958, 95% CI: 0.950,0.966). Prospective analyses revealed higher baseline depressive symptoms were related to decreased cervical cancer screening at follow-up (OR = 0.955, 95% CI: 0.913,0.999; equivalent to a difference of 4.08% between the highest and lowest depressive symptom score), but not with breast cancer screening. Results for overall neuroticism were inconclusive, but individual neuroticism items including anxiety and nervousness were related to increased screening participation.

Conclusions
More severe depressive symptoms may act as a barrier for cancer screening participation and could be an indication for more proactive strategies to improve uptake.

Key messages
Women with more severe depressive symptoms are less likely to be up to date with their breast and cervical cancer screening, which may exacerbate existing health inequalities. Interventions to increase screening participation among women with poor mental health may be merited.
Socioeconomic trajectories and risk of hospitalization in the Moli-sani Study cohort
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Persichillo M , De Curtis A , Cerletti C , Donati M B , de Gaetano G , Iacoviello L 
Published: November 2019

Abstract

Background
A life course approach was used to explore the impact of socioeconomic status (SES) on risk of hospitalizations for all-cause and for cardiovascular disease (CVD).

Methods
Longitudinal analyses on 19,999 subjects apparently free from CVD and cancer, recruited in the Moli-sani Study, Italy (2005-2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomized as low/high) defined the trajectories over life course. First hospital admissions were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression.

Results
Over a median follow up of 7.3 y, we ascertained a total of 7,594 all-cause and 2,539 CVD hospitalizations. Poor childhood SES was associated with 11% and 17% increased risk of all-cause and CVD hospitalizations, respectively. Among subjects with poor childhood SES, an upward trajectory in education was associated with lower risk of hospital admission for all-cause (HR = 0.85; 95%CI 0.76-0.94) and CVD (HR = 0.78; 0.64-0.95), as opposed to subjects remained stably low (low education and adulthood SES). Individuals with high childhood SES, but not educational achievement, were at 26% increased risk of hospitalization for any cause, as compared to the stably high SES group, while failure to achieve both educational and material advancements was associated with 37% higher risk of CVD hospitalization.

Conclusions
In a large sample of healthy adults, social mobility (educational and/or material upward trajectories) was associated with lower incidence of hospital admissions for all-cause and CVD.

Key messages
Social mobility may counterbalance the negative health burden associated with low early-life SES. High SES in childhood poorly affects hospitalization risk if no additional achievements across life course occur.
Outsourced management service to guarantee safety and cost-effectiveness in pediatric cardiac surgery
Authors: Ceradini J , Corsetti T , Brusco C , Mazzaccara A , Raponi M 
Published: November 2019

Abstract

Background
Children’s hospitals deal with young patients, who have greater variability than adults, therefore size of the medical devices ranges from the newborn to the adult-like patient. This complexity is associated with higher costs to ensure safety and logistics. In June 2014 Bambino Gesù Children’s Hospital (OPBG) adopted an outsourced service for medical device acquisition and stock records for the execution of cath-lab and heart surgery interventions.

Goal
To evaluate the services effectiveness multi-dimensionally in terms of cost saving, safety, outcomes and operator satisfaction. We measured costs and indicators in pre and post intervention. Materials and methods. We compared the years from 2013 to 2017 in terms of cost-related device and prosthesis consumption, including mean costs per intervention using ANOVA with Tukey’s Post-hoc test. To evaluate the clinical proxy outcome we calculated the pediatric index of mortality for each year.

Results
In 2013-2017 we performed a mean of 1985 (ds 140) procedures per year with devices, the sample is homogeneous in size and clinical complexity. The trend shows a solid decrease of expenses after the service introduction: we observed a reduction of 20% of the mean consumption per intervention between year 2013 and year 2017 (1707€ vs 1391€) P &lt; 0.001. For what concerns outcomes we noticed a reduction of Standardized Mortality Ratio index from 0.51 to 0.27 (CI 0.18-0.42) in 2014-2017.

Discussion
Outcome indicators excludes any increase of risk following the adoption of the service. The hospital pharmacy did not receive any reports regarding incidents attributable to the service. The nurses evaluated the service positively regarding the availability, traceability of the devices and decrease of the warehouse work.

Conclusions
Outsourced service has been cost saving, safe and well accepted by operators and in our opinion is replicable also in other highly complex pediatric hospital settings.

Key messages
Children hospitals are associated with higher costs to ensure safety and logistics in surgery and cath-lab with medical devices. Outsourced management service can promote cost saving and safety.
Area deprivation and notifiable infectious diseases in Germany: A longitudinal small-area analysis
Authors: Rohleder S , Stock C , Maier W , Bozorgmehr K 
Published: November 2019

Abstract

Background
Socioeconomic inequalities may affect the infectious disease incidence. We studied the association between area deprivation and incidence of notifiable infectious diseases in Germany to understand spatio-temporal patterns and the effects of societal factors on disease epidemiology.

Methods
Using national surveillance data of 401 districts from 2001 to 2017, we examined the incidence of infectious diseases using spatiotemporal Bayesian regression models. We analyzed eight disease classes: blood-borne viral hepatitis, gastrointestinal, vaccine preventable, vector-borne, zoonotic, other bacterial, other infectious, and overall burden of infectious diseases. As explanatory factors we considered area deprivation (measured by the German Index of Multiple Deprivation), fraction of non-nationals, sex, age, and spatiotemporal effects.

Results
A risk gradient across deprivation quintiles was observed for the overall burden of infectious diseases. The relative risk (RR) for gastrointestinal diseases in areas with medium and high deprivation relative to low deprivation was 1.65 (95%-credible interval [CrI] 1.01-2.54) and 2.64 (1.22-4.98), respectively. The RR for vector-borne diseases was 1.89 (1.27-2.73) in districts with high deprivation compared to areas with low deprivation. Lower risks in highly deprived areas relative to low deprived areas were identified in vaccine-preventable diseases (RR = 0.39; 0.14-0.88) and zoonoses (RR = 0.69; 0.48-0.96). For blood-borne viral hepatitis, other bacterial, and other infectious diseases no association with area deprivation was observed. Spatial risks of infections were predominantly concentrated in eastern parts of Germany and changed marginally over time.

Conclusions
The risks of infections tend to be higher in more deprived areas and in eastern parts of Germany, but they varied by class of disease. Our results can guide measures of infectious disease control and prevention by considering spatial risks and deprivation.

Key messages
Area deprivation has both positive and inverse associations with the incidences of infectious diseases in Germany. Regions with increased risks may benefit from targeted public health measures. Spatial risks of infections tended to be higher in eastern regions of Germany. Disparities in the incidence of infectious diseases may be still present between western and eastern Germany.
Discrimination of people living with hiv/aids: a survey with dentists in Abidjan, Côte d’Ivoire
Authors: Guinan J C , Meless G D , Sangaré A D , Danho-Da V , Kouassi B S , Datté A S , Samba M , Bakayoko-Ly R 
Published: November 2019

Abstract

Background
Despite several decades of fighting HIV infection, discrimination against people living with this infection persists, even among health professionals. Understanding the determinants of discriminatory attitudes of dentists is a first step towards access to oral health care and improved care for people living with HIV (PLHIV).

Objectives
To analyse the determinants of discriminatory attitudes towards people living with HIV among dentists in Côte d’Ivoire.

Methods
A cross-sectional survey was conducted among dentists in Abidjan in 2016. In addition to socio-professional characteristics, a questionnaire collected information on their knowledge about HIV (transmission, hiv-related oral diseases) and their individual perception (fear of being contaminated, cross-contamination...). The chi2 test for independent sampling was used to identify factors associated with discriminatory attitudes (threshold α = 5%).

Results
A total of 120 dentists were interviewed: 61.3% from the public sector; 56.7% men; 54.2% in couple; 53.3% had participated in continuing education on HIV; 29.2% did not know HIV-related diseases and transmission modes and 69.2% reported fear of being infected during care; 44.2% reported informing staff of the patient’s HIV status. The proportion of dentists with discriminatory attitudes was estimated at 69.2%. The main associated factors were: female gender (p = 0.001), living in couple (p = 0.000), lack of knowledge of the risk of HIV transmission after a blood exposure accident (p = 0.000), the law protecting people living with HIV in Côte d’Ivoire (p = 0.009) and fear of being infected (p = 0.000).

Conclusions
The results of this study show that the determinants of discriminatory attitudes among dentists result from their lack of knowledge of the disease, justifying the need to strengthen their continuing education on HIV/AIDS infection.

Key messages
Dentists discrimination towards people living with HIV infection result from their lack of knowledge about the infection. It’s essential to strengthen their knowledge about HIV in order to improve access to care for people living with HIV.
The Economic and Mental Health Impact of IAPT: Pragmatic Trial in Three English Regions
Authors: Toffolutti V , McKee M , Clark D M , Stuckler D 
Published: November 2019

Abstract

Background
Improving Access to Psychological Therapies (IAPT) programme is the English’s major initiative for treating anxiety and depression, currently provided to over 1 million people. We tested whether IAPT could reduce healthcare costs and improve employment in persons with long-term chronic conditions.

Methods
Stepped-wedge design of two cohorts covering 560 patients each with depression and/or anxiety and comorbid long-term physical health conditions, namely diabetes, chronic obstructive pulmonary disease (COPD) and cardio-vascular disease (CVD) from three areas in Thames Valley (Berkshire, Oxfordshire and Buckinghamshire) for the period March 2017 - August 2017. Panels were balanced. Difference-in-difference models were used and intention-to-treat analysis.

Results
Based on the step-wedge modelling, IAPT treatment decreased costs by £497 (95% CI: -£770 to -£224) total per person (pp) (from £1266 pp before starting the treatment to £768 pp since the treatment started)in the first 3 months. Results also showed a decrease by about 5.55 [95% CI: -6.35, -4.75] (-4.18 [95%CI: -4.91, -3.45]) points per person in the PHQ9 (GAD7). Our results show that IAPT increased the probability to an employment for those who were unemployment by about 7.92% (95% CI: 0.94% to 14.9%).

Conclusions
IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. It also significantly increased the probability of employment.

Key messages
IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. IAPT was significantly associated with increased probability to find employment for those unemployed.
Mental illness prevention in post-ACS men: A partcipatory action research
Authors: Jbilou J , Talbot F 
Published: November 2019

Abstract

Background
The prevalence of social determinants of health (i.e. rurality, low education and poverty) among men put them at an elevated risk for comorbid cardiac disease and mental illness. While, men are particularly vulnerable to mental illnesses (i.e. depression, anxiety) after an acute coronary syndrome (ACS), they are typically averse to seeking medical care, especially for mental health issues. Targeting interventions to at-risk population groups is a well documented approach. However, little in the literature presents how to prevent mental illness in cardiac men. This study aims to develop, implement and pilot a psychoeducational program tailored for post-ACS men.

Methods
A mixed method including a scoping review, a qualitative study and a quasi-experimental pilot study.

Results
In total, 42 articles were retrieved to extract key components of cardiac men-sensitive psychoeducation programs. We led 22 focus groups and 14 semi-structured interviews (119 men in total). The mean age was 51.2 years [45-77]. We integrated the gathered data gathered from the scoping review and the qualitative study to develop a psychoeducational program (3 group sessions). The pilot study involved 48 men who completed the baseline, the 3-month and the 6-month data collections. We observed 80% of compliance. Findings show a significant improvement in PHQ-9, GAD-7, IES-R, CSI and EQ-5D scales. We also observed changes in the CMNI-22, a measure of attitudes, beliefs, and behaviors associated with both traditional and non-traditional masculine gender roles. Men appreciated the time flexibility (sessions were scheduled based on participants’ availability) and the responsiveness of the sessions (content was discussed based on their needs and interests). Life partners were invited and 65% attended to all sessions.

Conclusions
The program was a success and we expect to transform it into a peer-led intervention to improve its delivery in the community and its accessibility for rural and remote areas.

Key messages
At-risk population-sensitive approaches are key for compliance and effectiveness. Group sessions are effective approaches to improve men’s mental heatlh literacy.
Economic burden of cancer from 2012 to 2017 based on the French national claim database (SNDS)
Authors: Verboux D , Pestel L , Nicolas M , Lesuffleur T , Rachas A , Gastaldi-Menager C 
Published: November 2019

Abstract

Background
The aim of this study is to assess the economic burden of active cancer in France and to analyze structure and trends of expenditure between 2012 and 2017.

Methods
Using information about 57 millions of individuals from the general scheme insurance database (86% of the French population) and applying 5 specifically developed medical algorithms (for lung, colon, breast, prostate and other cancers), we identified all people with active cancer. All reimbursed expenditure (hospitalization, ambulatory care, disability/sickness benefits) were extracted for each individual. To analyze trends, we applied the same methodology from 2012 through 2017.

Results
In 2016 (results for 2017 will be available for the conference), among the 137 billion euros reimbursed by the general assurance scheme, 13 billion (10%) were related to active cancer and 1.2 million people were concerned (2% of the population). About 2.3 billion euros (2%) were related to breast cancer (189,000 people), 1.4 billion euros (1%) for colon cancer (123,000 people), 1.4 billion euros (1%) for lung cancer (77,000 people) and 1 billion (0.8%) for prostate cancer (167,000 people). Hospitalizations represented the main expenditure for colon (71%), lung (61%) and breast cancer (56%). Concerning prostate cancer, hospitalizations stood for 36% while ambulatory care represented 62%. From 2012 to 2016, the expenditure related to active cancer increase by 4.4%/year due to both an increase in patients and in the average annual cost per patient (both +2.2% per year). Focusing on breast cancer, average expenditure increased by 3.2% per year from 10,700€ per year per patient to 12,200€ per year per patient.

Conclusions
Our study demonstrates the high economic burden of active cancer in France with a detailed analysis of expenditures. The developed tool will help to monitor the burden of these diseases and to implement public health policies.

Key messages
Active cancers account for a significant proportion of healthcare expenditure in France. Knowing this weight allows designing and implementing public policies adapted to the situation.
Quantifying the impact of adherence to screening on colorectal cancer incidence and mortality
Authors: D’Andrea E , Ahnen D J , Sussman D A , Najafzadeh M 
Published: November 2019

Abstract

Background
Current recommendations of The US Preventive Services Task Force (USPSTF) on colorectal cancer (CRC) screening strategies are based on models that assume 100% adherence to screening. Since adherence can largely affect the outcomes of a screening modality, we aimed to assess the comparative effectiveness of CRC screening strategies under published rates of actual adherence.

Methods
We developed an individual-level simulation model and validated it against landmark trials and USPSTF models. Then we assessed the effectiveness of colonoscopy (COL), flexible sigmoidoscopy (FS), high-sensitivity guaiac fecal occult blood test (HS-gFOBT), fecal immunochemical test (FIT), multitarget stool DNA test (FIT-DNA), computed tomography colonography (CTC), and methylated SEPT9 DNA test (SEPT9) in reducing CRC incidence and mortality. For each strategy, we also estimated the incremental life-years gained, number of colonoscopies, and adverse events.

Results
Assuming 100% adherence, FIT-DNA, FIT, HS-gFOBT, and SEPT9 averted 58 to 59 CRC cases and 28 CRC deaths; COL and CTC strategies 56 cases and 27 deaths, while FS averted 39 cases and 19 deaths per 1,000 individuals. Life-years gained were similar across FIT-DNA, FIT, HS-gFOBT, SEPT9, CTC, and COL strategies. The total number of colonoscopies was highest with COL (3,567), followed by SEPT9 (3,231), HS-gFOBT (2,584), FIT-DNA (2,079), FIT (2,067), CTC (1,691) and FS (1,538) strategies. Assuming actual adherence, SEPT9 averted 54 CRC cases and 26 CRC deaths, followed by COL with 49 cases and 24 deaths, and FIT-DNA, FIT, CTC and HS-gFOBT with approximately 36 to 41 cases and 18 to 21 deaths averted per 1000 individuals screened. Life-years gained reflected the effectiveness of each strategy in reducing CRC cases and deaths.

Conclusions
Adherence is a key factor in determining the effectiveness of CRC screening and strategies with higher expected adherence rates have the potential to reduce cancer incidence and mortality.

Key messages
Adherence has a substantial impact on screening outcomes, such as cancer incidence and mortality, and may influence selection of optimal screening strategies. Strategies with higher expected adherence rates can lead to clinically meaningful benefits compared to strategies that may have better one-time sensitivity and/or specificity.
Socio-economic position across the lifecourse and risk of breast cancer: findings from EPIC-Italy
Authors: Berger E , Krogh V , Palli D , Panico S , Sacerdote C , Tumino R , Vineis P , Severi G , Castagné R , Delpierre C 
Published: November 2019

Abstract

Backgrounds
Socio-economic position (SEP) is linked to many health outcomes but the link between SEP and breast cancer (BC) is complex. This study explores the relationship between SEP from early life and future risk of BC.

Methods
We used data from the Italian component of the European prospective investigation into cancer and nutrition: EPIC-Italy (up to 26,391 women). Cox proportional hazard models were used to estimate the association between measures of life course SEP (father’s occupation, educational level, highest household occupation) with risk of BC, adjusting for health behaviours (smoking, alcohol, physical activity, Mediterranean diet), height, weight and reproductive factors (postmenopausal status, age at first full term pregnancy). To mimic life course experiences, we analysed the relationship between father’s occupation and risk of BC, sequentially adjusting for SEP in young adulthood and adulthood, as well as the impact of social mobility.

Results
We observed a significant association between father’s occupation and risk of BC, where participant with low SEP had lower risk to develop BC (HR[95%CI] = 0.88[0.78; 0.99]). This association was borderline significant when we analysed educational level and highest household occupation. These associations were only slightly modified after adjustment for health behaviours, height and weight but more strongly affected by reproductive factors. However, the association between father’s occupation and BC remained borderline significant in the fully adjusted model (HR[95%CI] = 0.91[0.80; 1.03]). Stable low trajectory showed a lower risk of BC (HR[95%CI] = 0.82[0.71; 0.96]) slightly attenuated after adjusted for reproductive factors (HR[95%CI] = 0.88 [0.75; 1.03]).

Conclusions
Our findings suggest that low early-life SEP and stable low trajectory are associated with a lower risk of BC, which is partly explained by reproductive factors.

Key messages
Low early life socioeconomic position and stable low trajectory are associated with a lower risk of BC. Reproductive factors, especially age at the first full term pregnancy, explain part of these associations.