bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in the risk of coronary heart disease associated with socioeconomic status in Turkey
Authors: Turunc O , Zwas DR , Calderon-Margalit R , Unal B 
Published: October 2021

Abstract

Background
Studies in high-income countries have demonstrated that low SES status is associated with increased risk of CHD, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries.

Methods
The database of the Chronic Diseases and Risk Factors Survey In Turkey from 2013 and 2019 was used. Education level and employment status were chosen as proxy indicators for SES. Cox regression analyses were conducted to assess the effect of SES on incident CHD controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess multiplicative interaction between sex and SES on the occurrence of stroke.

Results
The study included 13 975 participants (7 450 females (53.3%) and 6525 males (46.7%)). During 74.2±9.87 months of follow-up, 474 CHD cases occurred among females (10.28 cases per 1000 person-year) and 445 CHD cases occurred among males (11.05 cases per 1000 person-year). Incident CHD was not associated with education level among either sex. Retirement was associated with increased risk of CVD (HR = 1.31, 95%Cl: 1.18-1.66) among males. Both retirement (HR = 2.12, 95%Cl: 1.16-3.88) and unemployment (HR = 1.93, 95%Cl: 1.14-3.25) were associated with increased risk of CHD in females after adjustment for behavioral and biological risk factors. There was no multiplicative interaction between sex and employment status on the risk of CHD (p = 0.091).

Conclusions
This study of health outcomes in Turkey did not find sex differences in CVD in association with educational status but did show sex differences in association with employment status. This finding suggests that social determinants in middle-income countries may affect men and women differently than in high-income countries.

Key messages
Social determinants in middle-income countries may affect men and women differently with regards to the risk of CHD than in high-income countries. Employment status can predict the risk of CHD in middle-income countries.
Contextual factors in premature CHD mortality in selected African countries within the SDG framework
Authors: Dotun-Olujinmi O , Johnson J , Greenhill R , Wuenstel W 
Published: October 2021

Abstract

Background
The sustainable development goal number 3, target 4 (SDG 3.4) seeks by 2030, a 30% reduction in four premature chronic disease mortality (4CHD) from 2015 values. Since the implementation of SDG 3.4 in 2016, the highest risk of dying from CHD was observed in low and lower-income countries mainly in Africa. This study examined the relationship between contextual factors and diabetes-related deaths as an example of the 4CHD; to enable an improved contextualized evidence-based approach, to attain in part the SDG 3.4 among United Nations Member States in Africa region (UNMSAFR).

Methods
Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected UNMSAFR located in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to ascertain the association between diabetes-related deaths in individuals 20-79 years in UNMSAFR and contextual factors identified in the SDGs framework. Two regression models were tested by conducting unweighted and weighted data analysis.

Results
The unweighted analysis showed that diabetes-related deaths in individuals 20-79 years/1,000 varied across the selected UNMSAFR in IDF East and West Regions (n = 31), with a range of 0.06 - 0.48/1,000 and an average of 0.24/1,000. Contextual factors, i.e., unemployment rate and geographical region explained 23% variability in diabetes-related deaths across the selected UNMSAFR. However, in the weighted data analysis, voice and accountability explained 47% variability in diabetes-related deaths across selected UNMSAFR in IDF East and West Region (n = 32).

Conclusions
Contextual factors such as unemployment rate, geographical region, and voice and accountability (governance) were associated with diabetes mortality; identifying that salient modifiable features can inform targeted interventions and policies to reduce premature CHD mortality.

Key messages
Contextual factors should be considered in policies and interventions for a comprehensive approach to premature CHD mortality reduction. Spatial clustering of CHD is critical for region interventions.
2.G. Workshop: The European Health Data Space (EHDS): future opportunities and current challenges
Authors:   Organised by: EUPHA-DH, EUPHA-PHMR,   Chair persons: Anna Odone (EUPHA-DH), Petronille Bogaert (EUPHA-PHMR)
Published: October 2021

Abstract

The creation of a European Data Space is one of the priorities of the Commission 2019-2025, including the health sector. A common European Health Data Space will promote better exchange and access to different types of health data (electronic health records, genomics data, data from patient registries, etc.), not only to support healthcare delivery (so-called primary use of data) but also for health research and health policy-making purposes (so-called secondary use of data). The COVID-19 pandemic has further underlined the importance of having timely access to health data within the Members States and across Europe. The EHDS would give a valuable contribution to research activities on new preventive strategies and effective treatments and medical devices, thus contributing to improving citizens' health and their quality of life. The European Health Data Space will require a common framework that should be based on three pillars:
a strong system of data governance and rules for data exchange; data quality; strong infrastructure and interoperability
A concerted effort is needed to overcome some of the difficulties that are arising and that relate to: different levels of health digitalization and infrastructure quality at national levels; fragmentation of data standards and limited interoperability between healthcare systems; limited access and operability due to legal (GDPR) issues.
We believe there is an urgent need to discuss with relevant stakeholders about strategies to:
Establish an appropriate legal and governance framework to cover the access to and exchange of health data for healthcare provision, research, policy-making and regulatory activities. Lower technical barriers hindering data use and re-use, in particular those related to infrastructure, interoperability, data quality and standards in the health field. Ensure access and control of patients and citizens over their own health data.
The workshop's structure and content aim at accomplishing with the above by: 1) introducing the principles and potential of the European Health Data Space (EHDS) project, ii) providing contributions from stakeholders on the three pillars of the EHDS, stimulating the debate around current gaps in knowledge, as well as system and policy barriers to the design and implementation of the EHDS.

Key messages
The European Health Data Space (EHDS) will have a strategic importance for public health, supporting policy makers and researchers all across Europe. To fully develop the potential of the EHDS, some main challenges need to be addressed within the legal and technical frameworks.
How can population health research benefit from a European Health Data Infrastructure?
Authors: Schutte N , Bogaert P , Saso M , Abboud L , Van Oyen H 
Published: October 2021

Abstract
Health is a cross-border issue, recently demonstrated by the COVID-19 public health crisis. Now more than ever, the healthiness of European populations requires the use of the full capacity of the European research community to generate evidence in these uncertain times for better health system preparedness and pragmatic approaches to interventions in the health care system. However, data on population health is fragmented across institutions, projects and research networks. To bring evidence and scientific consensus to the attention of policy makers and inform their actions, researchers should have facilitated access to high quality comparative data to answer urgent research questions and the generation of new research hypotheses; improved streamlining of research efforts and international comparison; learning through exchange and priority-setting. Population Health Information Research Infrastructure (PHIRI) for COVID-19 facilitates research and supports policy making across Europe through the implementation of a research infrastructure to generate the best available evidence for research on health and well-being of populations as impacted by COVID-19. PHIRI will form a cornerstone of the emerging European Health Data Space, as there is a need to pilot the premises of sustainable federated research infrastructure that will ultimately contribute to improved population health.
Impact of the Covid-19 pandemic on health services utilization: a cross-sectional study
Authors: Isonne C , Migliara G , Turatto F , Mazzalai E , De Vito C , Marzuillo C , Villari P , Baccolini V 
Published: October 2021

Abstract

Background
Health services disruption during the COVID-19 pandemic has forced to postpone or cancel most scheduled health visits. Within this context, disadvantaged people may have been suffered the most from the indirect consequences of the emergency. The aim of the study was to quantify the pandemic impact on health services utilization in the Roman population based on the economic, sociodemographic and cultural characteristics.

Methods
In January 2021, an online survey was administrated to 640 patients attending a Roman general practitioner. The questionnaire investigated sociodemographic characteristics, working and living conditions, COVID-19 experience, consequences of lockdown or policy responses, and health literacy. A multiple logistic regression model was built to investigate factor associated with a reduction in the healthcare use.

Results
Overall, 451 respondents were surveyed. More than 60% were women and mean age was 55 years. In total, 211 patients referred to have cancelled one or more scheduled health visits (14 vaccinations, 60 screening exams, 168 medical examinations and 23 surgeries). At multivariable logistic regression analysis, the loss of at least one visit seemed to be associated with lower perceived wealth (aOR=1.60, 95%CI: 1.07-2.39), pre-existing comorbidities (aOR=1.60, 95%CI: 1.04-2.45), and older age (aOR=1.03, 95%CI: 1.01-1.04). No association was found for sex, education, or health literacy.

Conclusions
A few socio-demographic characteristics seemed to identify people that may have suffered the most from the health services disruption during the COVID-19 pandemic, contributing to worsen the existing health inequalities. Future research is needed to devise strategies aimed at containing the negative effects of the pandemic on vulnerable populations.

Key messages
The COVID-19 pandemic seemed to have a greater impact on health service utilization among disadvantaged people. The COVID-19 pandemic may have exacerbated health inequalities.
Health Literate Schools (HeLit-Schools): Organizational Health Literacy in the School Setting
Authors: Okan O , Kirchhoff S , Bauer U 
Published: October 2021

Abstract

Background
Health literacy of schoolchildren has been recognized as an important target for school health promotion. Yet, the environmental and organizational health literacy (OHL) capacities of the school setting has not been addressed so far. The aim of this project is to adapt the “health literate organization-approach” to school settings, including a self-assessment tool to measure the OHL capacity of schools. In terms of sustainability, intersections and links with the health promoting school will be explored.

Methods
The adaption work is carried out by a cooperative and intersectoral approach including different experts from the school setting, the education sector (teachers, principals), and health experts in various circulating phases of commenting, revision and feedback. We jointly developed attributes and indicators of the health literate school, see fit to integrate the concept into the health promoting school framework and consider gender and diversity aspects critical to health literacy. To assess the degree of OHL, school principals will fill out a survey based on a self-assessment tool.

Results
The health literate school concept comprises of eight dimensions, addressing aspects of OHL development including the organisational level (policies and structures enabling health literacy development), the personal level (promoting student health literacy and in school staff), the classroom and education level (materials and principles for classroom learning) as well as networking and cooperating with relevant actors (parents). The assessment of OHL is currently being prepared.

Conclusions
This is the first-time adaption of the OHL concept to schools in Germany, including its assessment. The health literate school shares various intersections with the health promoting school framework, which is partly being implemented in Germany. This systems approach will facilitate both the uptake and promotion of health literacy in students, teachers, and principals.
Profile of unobservant women regarding contraception in Sousse (Tunisia)
Authors: Bannour I , Frigui R , Bannour R , Khairi H 
Published: October 2021

Abstract

Background
The contraceptive prevalence rate in Tunisia is estimated around 62.5%meanwhile the rate of voluntary termination of pregnancy is constantly increasing. The aim of this study was to define the profile of unobservant women regarding contraception and to assess their knowledge about oral contraception.

Methods
A cross-sectional study was conducted during the month of March 2018 at the Obstetrics and Gynecology Service in Sousse (Tunisia). This study included 100 women who had undergone voluntary termination of pregnancy. All the participants were using contraceptive means.

Results
Roughly 49% of participants were aged between 30 and 38 years, 64% came from an urban environment, 68% had low socio-economic status and 34% had a secondary level of education. Most of them (98%) were using progestin-only pills. Approximately 40 % did not know what ‘back-up' measures they should take after missing a dose of the contraceptive pill.

Conclusions
We cannot extrapolate these results to the whole Tunisian women but we are facing a lack of minimal knowledge about contraception among at least this category of women. Those patients should be more educated and monitored by the prescribers of contraception such as midwives.

Key messages
The rate of voluntary termination of pregnancy is constantly increasing. Patients should be more educated and monitored by the prescribers of contraception such as midwives.
Intersex human rights, sexual orientation, gender identity and the Yogyakarta Principles
Authors: Carpenter M 
Published: October 2021

Abstract

Background
Intersex people are at risk of human rights abuses because their bodies do not fit medical and social norms for female or male bodies. The 2006 Yogyakarta Principles aim to promote good practices in protecting the rights of LGBT and intersex people by applying human rights law in relation to ‘sexual orientation' and ‘gender identity'. They were ineffective in protecting the rights of intersex people, including due to an inappropriate framing around sexual orientation and gender identity. In the same year, a group of clinicians published a ‘consensus statement' reframing intersex traits as ‘disorders of sex development', reinscribing medical authority over intersex bodies. In 2015 a first country (Malta) enacted protections of rights to bodily integrity and physical autonomy and freedom from discrimination, associated with a new attribute of ‘sex characteristics'.

Methods
In January 2017, the International Service for Human Rights and ARC International issued a call for submissions to supplement the Yogyakarta Principles, and brought together a drafting team. The Asia Pacific Forum of National Human Rights Institutions and United Nations Development Program also held a gender- and geopolitically-balanced conference to mark a decade of the original Principles and produce recommendations. An expert meeting was held in Geneva in September 2017 to agree the update.

Results
The ‘Yogyakarta Principles plus 10' elaborated a new attribute of sex characteristics and recognised rights to bodily integrity, truth and legal recognition. These directly respond to the human rights situation of intersex people, with relevance to intersex populations, healthcare workers, advocates, and policymakers.

Conclusions
Adoption of the new attribute and attention to the new Principles can help address the human rights of people with intersex variations within health, education, and other social policy settings.
Partial care: the need to uncover cultural bias to reach intersex wellbeing
Authors: Prandelli M 
Published: October 2021

Abstract

Background
The umbrella term Variations of Sex characteristics (VSCs), also known as Intersex variations, indicates the lived experience of the socio-cultural consequences of being born with a body that does not fit the normative social constructions of male and female (Van der Have, 2016). Currently, there is not a universal consensus on the ‘management' of VSCs, and the existing guidelines and recommendation vary depending on the chosen disciplinary perspective. However, normalising interventions are still guided by sociocultural reasons.

Methods
Starting from a qualitative research involving 65 semi-structured interviews with health professionals and ethnographic observations in 2 hospitals and 2 patients' associations conducted in Italy between 2015 and 2017, this presentation explores how beliefs systems play a crucial role in maintaining the medical status quo through cultural and gender biases.

Results
Whether it be sexual health, psychological wellbeing, physical features, other syndromes, transgender identity or sexual orientation, participants' beliefs frequently drifted to cultural rather than clinical interpretations of VSC. Results show that health professionals' experience of VSC include (1) social, (2) medical and (2) gender biases as guiding principle in the assessment of intersex variations, denoting cultural concepts of ‘abnormal' behaviours, identities, sexual orientation and gender roles as VSCs' frames of meaning.

Conclusions
Despite the increasing international awareness around intersex human rights, results show the critical role of belief systems in maintaining VSC's surgical and social erasing processes, reinforcing the need to consider the mediating aspects - culture, religion and social factors - that affect different social contexts when assessing intersex human rights, social policies and professional training.
Depression among higher education students in Greece during the first C19 lockdown
Authors: Stathopoulou T 
Published: October 2021

Abstract

Background
The imposition of containment measures internationally during the first wave of the Covid-19 pandemic has indicated the need for data on the psychological impact of quarantine. We use the C19 ISWS Greek dataset to examine self-reported depression in relation to alcohol and tobacco use, social contacts, relationship status and perceived risk of infection.

Methods
Online survey data was collected between May-June 2020. Eligible participants were higher education students in Greece and 889 students participated. We performed frequency analysis on the participants who completed the questionnaire (N = 585). Weights were applied to eliminate response bias and adjust the sample survey means and proportions to the student population in the country.

Results
Findings suggest that depressive symptoms are more frequent among female students, first generation migrant students and those in their first year of study. Students who were anxious about getting infected with COVID-19 reported higher rates of depressive symptoms. However, students with slightly higher rates of depression were not very worried about getting severely ill from an infection. The share of students who drunk systematically did not change during the COVID-19 outbreak, their rate is low (0% - 2.2%) and they do not report high rates of depressive symptoms. Depression scores seem to be affected by relationship status, the degree of contacts with friends, and the availability of a trusted person. Results indicate that the fewer the contacts with friends are, the higher the mean depression score is.

Conclusions
The results confirm the gender-gap in depression and are in line with evidence indicating the high prevalence of depression among women in Greece in the aftermath of austerity and recession. As Greece was one of the South-European countries hardest hit by economic crisis, it is possible that negative effects of the crisis have had a cumulative effect on students' mental health in the pandemic.
European Green deal and Climate Pact: A roadmap for digital public health
Authors: Jevtic M 
Published: October 2021

Abstract
The Covid-19 pandemic crisis caused a serious ‘tectonic' disturbance in all sectors, especially pointed out weaknesses of the healthcare systems. The recently adopted European Green Deal (EGD). It should take into account the Covid-19 pandemic challenge and maintain its primary objectives. The pandemic crisis has shown not only individual health risks, but also global health threats (direct and indirect). The SARS-CoV-2 virus causes an insufficiently known infectious disease. The subsidiary health effects are still countless: mental health, health-economic costs, deadlock in the other diseases treatment, etc. One of the main messages regarding environment, is that society should find new economic models less damaging to the environment and to biodiversity, implying circular economy, a less consumerist and active society: e.g. a 4 days-working week. Covid-19 took us to the extreme of being confined at home, either working or taking care of our families. However, the Covid-19 global quarantine and confinement (and huge reduction of travelling, mainly flights) had a great impact on decrease of CO2 levels, on the quality of air and on biodiversity. Vulnerability and lack of efficient action in many countries, is a strong warning for Europe (and globally) to insist in strengthening public health and convert lessons learned into action. The Coronavirus, originating from destruction of wildlife and intensive animal farming, will bring more pandemics in the future. We need more public health consideration towards effects of climate change on public health. It is possible to keep economy functioning by promoting remote work supported by digital platforms and innovation for international networks. Strategically, the European recovery plan should be aligned with the EGD.
These challenges open the way to digital health, and as such, can be defined a roadmap to tackle climate change.