bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ductal Carcinoma in Situ in Ireland, 2008-2020: Screening Data related to Low-Risk Management Trials
Authors: Kelly C , Fitzpatrick P , Quinn C , Flanagan F , Connors A , Larke A , Mooney T , O'Doherty A 
Published: October 2021

Abstract

Background
Four clinical trials are on-going to determine if active surveillance is a feasible management option for patients with low-risk ductal carcinoma in situ (DCIS), in response to concerns that breast cancer screening programmes have increased the incidence of DCIS, some of which may never progress to invasive cancer. This study aimed to describe the epidemiology of screen-detected DCIS in Ireland through the BreastCheck, the national breast screening programme in Ireland (commenced 2000 but fully national since 2008).

Methods
This was a cross-sectional analysis of anonymised BreastCheck data provided by the National Screening Service, including all cases of screen-detected DCIS between 2008 and 2020. Statistical tests included Mann-Whitney U, Chi square, and multivariable logistic regression.

Results
2,240 women were diagnosed with DCIS through BreastCheck between 2008 and 2020 (1353 (60.4%) high-grade and 876 (39.1%) low/intermediate grade). The overall rate of screen-detected DCIS incidence has remained relatively stable during this time. Women with high- grade DCIS were older than women with low/intermediate DCIS (57 (IQR 53-61) years v 56 (IQR 56-61) years; p &lt; 0.001). They were also more likely to have been diagnosed at a subsequent screening episode than at an initial episode (71.0% v 57.5%; p &lt; 0.001). After adjustment (deprivation score, screening unit and year) the odds ratio for high-grade was 1.62 (95% CI 1.30-2.03; p &lt; 0.001) for subsequent compared with initial screening episode.

Conclusions
When trial results are available, these data will assist with service planning should active surveillance be approved as a management option. Based on trial inclusion criteria, up to 40% of women diagnosed with DCIS through BreastCheck may be eligible for consideration for active surveillance. These women are younger and often diagnosed on initial screening episode, so may require longer active follow-up.

Key messages
Majority of DCIS in national screening programme is high grade. Randomised controlled trial evidence will provide guidance on management of low-risk DCIS.
Prevalence of cognitive impairment before treatments for prostate cancer
Authors: Araujo N , Costa A , Lopes-Conceição L , Ferreira A , Carneiro F , Oliveira J , Morais S , Ruano L , Pereira S , Lunet N 
Published: October 2021

Abstract

Background/Objective
Up to 30% of patients with cancer may present cognitive impairment (CI) before treatment but data are scarce regarding prostate cancer (PCa). We aim to estimate the prevalence of CI in patients with PCa, before cancer treatment.

Methods
Between February 2018 and April 2021, the NEON-PC cohort included 609 patients with a recent PCa diagnosis to be treated at Instituto Português de Oncologia do Porto. Previous history of chemotherapy, radiotherapy, androgen deprivation therapy, and neurologic or psychyatric conditions impairing cognitive performance were exclusion criteria. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance before any treatment for PCa. Participants with a MoCA at least 1.5 SD below age- and education-specific norms were considered to have probable cognitive impairment (PCI) and were proposed for a comprehensive neuropsychological (NP) assessment. Participants scoring &lt;2.0 SD age-corrected norms in at least one cognitive test, or &lt; 1.5 SD age-corrected norms in ≥ 2 cognitive tests were classified as having CI. Data from the population-based cohort EPIPorto (n = 351 men, evaluated in 2013-2015) were used for comparison.

Results/Discussion
Prevalence of PCI was 17.4% in the EPIPorto and 15.1% in the NEON-PC cohort (age- and education-adjusted OR = 1.02,95% confidence interval: 0.70,1.50). NP assessment was performed in 65 patients with PCa: 38.5% had normal cognitive function; 7.7% had a light deficit (&lt;1.0 SD of age-corrected norms in ≥ 1 cognitive tasks); and 53.9% had CI.

Conclusions
PCI was as frequent in patients recently diagnosed with PCa as in the general population. Prevalence of CI was lower than in previous reports, which may be explained by differences in the assessment and definition of CI and of the type of cancer.

Funding
POCI-01-0145FEDER-032358;PTDC/SAU-EPI/32358/2017;UIDB/4750/2020; SFRH/BD/119390/2016

Key messages
Patients with prostate cancer and the general population had similar odds of having a score below normative values in the MoCA. Differences in the prevalence of CI between this study and others suggest that the type of cancer may affect patients’ cognitive performance differently, which deserves further confirmation.
Ethnic diversity and mortality in northwestern Burkina Faso: a cohort analysis from 2000 to 2012
Authors: Wasko Z , Dambach P , Kynsat-Wolf G , Steiglbauer G , Zabré P , Bagagnan C H , Schoeps A , Souares A , Winkler V 
Published: October 2021

Abstract

Background
Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established. This study aims to explore the association between ethnic diversity and all-cause mortality.

Methods
We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths for each village was compared to the expected deaths based on the whole HDSS accounting for sex, age, rainy season, calendar year, and village. SMR were calculated on a village level for ethnic diversity (using the Simpson Index), geographical region, wealth, distance to Healthcare Facility (HCF), and religious diversity (Simpson Index). Also, we modeled SMR with a multilevel random intercept Poisson model considering individual ethnic and religious groups in addition to the above-mentioned village-level information.

Results
Village wealth (poorest quintile: SMR 1.07; 95% CI: 1.02-1.13, richest quintile: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and village geographical region showed significant associations with overall mortality. Villages in the high ethnic diversity tertile had a lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the overall HDSS, while those with low diversity yielded an elevated SMR (1.13; 95% CI: 1.09-1.17). The multivariable model including all co-variables confirmed the association.

Conclusions
This study shows a link between ethnic diversity and health. Historically established ethnic diversity in rural areas of Burkina Faso is associated with lower all-cause mortality. A lack of standardization exists in defining and measuring ethnic diversity. More research is needed to understand this relation and to establish it in different settings.

Key messages
Ethnic diversity is potentially linked to health. Further studies in different settings are needed to fully understand the relation between ethnic diversity and health.
Foodborne outbreaks surveillance in hospitals and nursery homes: investigation on catering data
Authors: Iannetti L , Boone I , D'Errico ML , D'Orsi F , Ricchiuti L , Pomilio F , Cornacchia A , Centorotola G , Tucci P 
Published: October 2021

Abstract

Background
Healthcare associated foodborne outbreaks (HA-FBO) can result from exposure to contaminated food in premises where highly vulnerable patients are cared, including hospitals and nursery homes. The probability of developing severe foodborne diseases such as invasive listeriosis is much higher for susceptible populations. There is limited knowledge on the data on food exposures that could be used to investigate HA-FBOs. There is also lack of data relating to specific policies in the health facilities aimed to prevent the administration of potentially risky foods, possibly bringing them from home.

Methods
This study was in the framework of One Health EJP Project NOVA. A semistructured questionnaire was administered to 4 general hospitals, 1 specialist clinic and 3 nursing homes located in the Abruzzo and Molise regions, Italy. The questionnaire included 25 questions in 3 sections (I. General organization of the catering service; II. Food menu data; III. Food from home).

Results
In most facilities (75%) external catering companies used in-house kitchens. Trace-back of food to individual patients was possible in 5 premises out of 8 (62.5%), but only in 1 nursery home out of 3 (33.3%). Data were collected in electronic format (hospitals) or paper (nursery homes) and stored 1-12 months. Food at risk of Listeria monocytogenes were not excluded from the menus, such as pre-sliced cooked meat products (served in 4 out of 8 premises, 50%), smoked fish (20%), soft cheese (20%). The consumption of food brought from home was possible in “special occasions”, mostly in the nursery homes (66.6%).

Conclusions
In case of HA-FBO it could be difficult to trace back the food particularly in the nursery homes where food data are not individually collected and usually on paper. More studies are needed in order to understand the effective exposure to foodborne pathogens, given that some types of foods considered by EFSA as at high risk of microbial contamination are commonly served.

Key messages
Served food could not be traced back to the patient mostly in nursery homes. Foods at risk of Listeria monocytogenes contamination are commonly served to patients and residents.
Is the hospital Safety Walkround effective to control the risk of contagion during COVID-19 pandemic?
Authors: Gintoli I , Boietti E , Bert F , Barbaro S , Corsi D , Griffa D , Rabacchi G , Scarmozzino A , Siliquini R 
Published: October 2021

Abstract

Background
The Safety Walk Round (SWR) is a risk assessment technique designed to decrease adverse events and improve workers attitudes about safety culture through visits and interviews about safety of care. A new field of application could be the safety requirements that hospitals have to guarantee during the Covid-19 pandemic. Our study aimed to investigate the efficacy of SWR on identifying and solving the critical issues that can increase the risk of SARS-CoV-2 infection in three Italian hospitals.

Materials and Methods
The project was developed during the first wave of SARS-Cov-2 pandemic, from May to July 2020, it involved 3 hospitals in Turin: Traumatology and Orthopaedic Centre, Paediatric Hospital Regina Margherita and Sant'Anna Hospital (obstetric and gynaecological hospital). Pre-triage services and outpatient waiting rooms were identified as areas at higher risk of crowding and potential non-compliance with anti-contagion rules. The first round consisted of observations focused on hands sanitation, safety social distance, PPE correct use. Than the workers of the observed areas were interviewed. Thanks their participation, the critical issues about patient safety and the potential resolutions were identified. A second round was realized to verify the implementation of the planned actions and their effectiveness in solving the issues.

Results
A total of 4907 moments were observed and the 9,1% of them was at risk of contagion. During the interviews 23 critical issues and their possible resolutions were identified. A total of 14 critical issues were solved, 4 partially solved and 5 were build environmental problems and cannot be solved. The 77% of total were completely solved, excluding built environment issues.

Conclusions
SWR project was effective in involving health workers in safety promotion activities, sharing informations and improving trust between hospital managers and operators and spreading new skills about safety culture in Covid-19 pandemic contest.

Key messages
SWR was effective in a pandemic context. During the emergency, the front line staff were enthusiastic about the method and felt listened and guided.This has contributed to achieving the aim of safety. The study showed that SWR is a useful tool for hospital infection control. It also showed that the SWR method can be used in a time of constant change that requires adaptability like a pandemic.
Predictive utility of the ages and stages questionnaire for below average cognitive ability at age 5
Authors: Bowe A , Staines A , Murray D 
Published: October 2021

Abstract

Background
The first 1000 days of life are a period of unique sensitivity and plasticity during which critical cognitive abilities are formed. For children at risk of later cognitive difficulties, this period is the ideal target for early intervention initiatives. Routine developmental screening tools aim to identify infants who would benefit from early intervention. While these tools have been validated for detecting children with more severe neurodevelopmental disorders, their ability to identify the larger proportion with below average cognitive ability has not been sufficiently explored. The aim of this study was to examine the predictive utility of the Ages and Stages Questionnaire (ASQ), for identifying children with later below average cognitive function.

Methods
The study population (n = 8260) is formed from two national cohort studies, the Growing Up in Ireland Infant cohort (n = 7,444) and the Cork BASELINE cohort (n = 816). The ASQ was completed at 8- and 24-months respectively. Cognitive assessments were performed at age 5. Those scoring &lt;1 standard deviation below the mean were categorised as below average cognitive ability. Applying the currently used onward referral criterion (one fail in any domain) the sensitivity, specificity, positive and negative predictive values of the 8- and 24-month ASQ for detecting children with later below average cognitive function were calculated.

Results
The sensitivities of the 8-month and 24-month ASQ for detecting children with below average cognitive ability were 16.4% (95% CI 14.0-19.0) and 20.8% (95% CI 13.6-30.2) respectively, with specificity of 92.0% (95% CI 91.3-92.6) and 91.1% (95% CI 88.6-93.2).

Conclusions
The ASQ has a low sensitivity for identifying children with below average cognitive ability at age 5. The findings of this study suggest that if we are to intervene early in the developmental trajectory for children with below average cognitive ability alternative methods of identifying high risk infants are needed.

Key messages
The ages and stages questionnaire, a widely used routine infant developmental screening tool, has a low sensitivity between 16%-21% for detecting later below average cognitive ability. To enable intervention in the first 1000 days of life for children at risk of later below average cognitive ability alternative methods of screening and risk identification require investigation.
Exploring young people's perspectives of inequalities in health: a qualitative study
Authors: Fairbrother H , Crowder M , Dodd-Reynolds C , Egan M , Er V , Goyder E , Griffin N , Holding E , Lock K , Scott S , Summerbell C , Woodrow N 
Published: October 2021

Abstract

Background
Reducing inequalities in health is an enduring global public health challenge. Worryingly in England, inequalities across some groups and places are worsening, highlighted and exacerbated by the Covid-19 pandemic. While there has been growing interest in exploring public understandings of health inequalities, few studies have explored the views of young people. Our study seeks to redress this by exploring young people's perspectives of inequalities in health.

Methods
Working with existing youth organisations, we recruited young people (aged 13-21) from six youth groups in areas of high deprivation across three geographical locations in England. Each group took part in three interlinked focus groups (n = 18), the majority of which were run online using video conferencing platforms. Focus groups were co-delivered with partnering youth organisations during 2021. They involved participatory concept mapping activities, and the discussion of health related news articles.

Results
Key themes emerged around young people's perspectives of: i) factors influencing health within their local area; ii) understandings of inequalities in health; and iii) key messages to convey to those with a role in addressing health inequalities at a place level.

Conclusions
Our study highlights the importance of exploring and understanding young people's perspectives of inequalities in order to better shape policies which are supported by the communities and people they impact.

Key messages
Young people have a nuanced, experiential understanding of key factors influencing their health and inequalities in health within their local areas. Building upon young people’s understandings of inequalities in health provides opportunities to mobilise support for policies seeking to change the distribution of key social determinants.
A complexity science perspective on the impact of adverse socioeconomic conditions on chronic stress
Authors: Crielaard L , Sawyer ADM , Quax R , Nicolaou M , Stronks K 
Published: October 2021

Abstract

Chronic stress increases chronic disease risk and may underlie the association between adverse socioeconomic conditions and adverse health outcomes. The relationship between such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined this relationship from a complexity science perspective. We developed a causal loop diagram to interpret available evidence. Literature evidence was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by 8 independent researchers. Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified 5 feedback loops describing these mechanisms: progressive deterioration of access to coping resources because of repeated insolvability of stressors; perception of stressors as uncontrollable due to learned helplessness; tax on cognitive bandwidth caused by stress; stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; susceptibility to appraising stimuli as stressors against a background of stress. The complexity science perspective revealed that adverse socioeconomic conditions imply recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. Therefore, in order for individual-level psychological interventions to be effective, the context of adverse socioeconomic conditions also needs to be addressed.

Key messages
We examined the mechanisms underlying the relationship between adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops. The complexity science perspective illustrates that interventions are unlikely to be successful if they focus only on individual-level psychological factors.
Mental Health in times of COVID-19: Policy Brief
Authors: Almeida T , Heitor MJ , Santos O , Costa A , Rasga C , Martiniano H , Virgolino A , Fialho M , Vicente AM 
Published: October 2021

Abstract

Issue
The COVID-19 pandemic caused profound disruptive changes worldwide. Mental health (MH) and wellbeing (WB) have been particularly affected, namely with increased levels of anxiety, depression, post-traumatic stress disorder and burnout symptoms. Several factors can have contributed to individuals' vulnerability, including perceived uncertainty, the strict measures adopted, the socioeconomic hardship and the direct effects of the virus. Although the pandemic is primarily a public health and a socioeconomic crisis, it could turn into a serious MH crisis with all the associated implications.

Description
As a Health Observatory, National Institute of Health Doutor Ricardo Jorge, in collaboration with Institute of Environmental Health of Lisbon School of Medicine, and Portuguese Society of Psychiatry and Mental Health, coordinated an observational study to characterize the MH and WB of general population and health professionals residing in Portugal, during pandemic's first wave. Anxiety, depression, post-traumatic stress disorder, burnout and resilience were selected as main outcomes, measured using validated instruments with sound psychometric properties.

Results
High levels of psychological distress were observed among general population and health professionals. Women, younger, individuals with lower income or unemployed, lower educational level and frontline health professionals were most susceptible to psychological suffering. The research team produced a Policy Brief with a set of 14 recommendations for immediate action to ensure equal access to psychological and emotional support for all citizens, to reduce the impact of mental disorders and to promote MH.

Lessons
The mitigation of psychological suffering is of paramount importance, from an equitable perspective focus on identified vulnerable sub-groups. Particular attention should also be given to citizens infected with SARS-CoV-2 and patients with COVID-19, who faced direct consequences of the disease.

Key messages
In a pandemic context, monitorization of population’s mental health is of paramount importance. Health Observatories should have an active and reinforced role in this public health area to mitigate potential negative impacts of pandemics.