bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public health impact of COVID-19 pandemic on the emergency healthcare system: a region-wide analysis
Authors: Stirparo G , Oradini-Alacreu A , Migliori M , Villa GF , Botteri M , Fagoni N , Signorelli C , Sechi GM , Zoli A 
Published: October 2021

Abstract

Background
The Lombardy region has been one of the Italian regions most affected by the COVID-19 pandemic in 2020, with 22.7% of total Italian cases and 33.9% of total deaths. The emergency healthcare system was under deep stress throughout the period under consideration due to the admission of COVID-19 patients to the Emergency Department (ED) and had to be thoroughly reorganized.

Methods
We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL. We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020.

Results
The number of admissions to the ED decreased by 32.5% in 2020 compared to 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalised after ED significantly increased in 2020 compared to 2019 (OR 1.47, p &lt; 0.0001), reflecting the management of patients with a more severe clinical condition. Indeed, the number of patients classified as red or yellow codes at hospital admission was significantly higher in 2020 than in 2019 (p &lt; 0.0001). Moreover, more patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019. OR 1.56, p &lt; 0.0001), with more than 35% of patients transported by ambulance in March and April 2020.

Conclusions
Our results showed, on the one hand, inappropriate visits to the EDs by non-emergency and low complex cases in 2019 before the pandemic and, on the other hand, they also highlighted that patients in critical condition were reluctant to visit the ED due to the fear of getting infected. This analysis showed that EMS played a crucial role in the overall public health impact of the COVID-19 pandemic, increasing the percentage of patients transported to the hospital with a severe clinical condition, reorganizing and allocating resources to the areas that were most affected during the pandemic.

Key messages
This is a descriptive analysis of the public health impact of the COVID-19 pandemic on the admission to Emergency Departments in 2020. Our results underline the need to monitor the pandemic’s evolution in order to reorganize the hospitals that admitted the COVID-19 patients.
2.K. Round table: Everything you always wanted to know about (COVID-19 and) EU-health policy
Authors:   Organised by: European Observatory,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2021

Abstract

Objective
There is no European Union (EU) health system but there is an EU health policy and this health policy is rapidly changing due to the COVID-19 responses of the EU and Member States. The aim of this panel discussion is to analyze and put into context the rapid evolvement of EU health policy during the pandemic. This panel discussion will therefore focus on 1) EU public health policy 2) EU action for health 3) the EU Market shaping health 4) the fiscal governance 5) the institutions, processes and powers.

Background
EU health policy has often been overlooked and was never on the political agenda. COVID-19 and the pandemic response, however, changed this dramatically. EU-health policy has become centre stage followed by bold investments and new regulatory initiatives. Obvious examples are the EU4Heatlth programme, the Recovery and Resilience fund, the new agency HERA, the new remit for the European Medicines Agency and the European Center for Disease Control. There are also new European Commission mechanisms with regards to the purchase of personal protective equipment, supplies, medicines including vaccines and medical technologies. But will the new EU health policy strengthen health systems of Member States or just focus on stronger emergency responses? Will the constitutional asymmetry between health and internal market be addressed? Will EU-health policy remain after the crisis a centre-piece of European Integration? This panel is based on the COVID-19 update of the EU-health policy handbook ‘Everything you always wanted to know about European Union health policies but were afraid to ask'

Interactivity
There will be a high level of interactivity. After an introductory presentation, attendees can use the chat-box to choose specific topics from the aforementioned five themes. These topics will be presented in a table. The chair will then pass the questions and topics to the panelists.

Speakers/Panelists
Sarah Rozenblum University of Michigan, Ann Arbor, USA Holly Jarman University of Michigan, Ann Arbor, USA Nick Fahy University of Oxford, Oxford, UK Anniek de Ruijter University of Amsterdam, Amsterdam, Netherlands Eleanore Brooks University of Edinburgh, Edinburgh, UK

Key messages
The European Health Union will be one of the most important constitutional and policy outcomes of the pandemic. It is essential that the European Health Union is not only strengthening emergency planning and response but also accessibility, equity and resilience of health systems.
Introduction to the Expert Panel on Effective ways of investing in health (EXPH) and its mandate
Authors: Barros Pedro Pita 
Published: October 2021

Abstract
EXPH members and Opinion collaborators
The Expert Panel on Effective ways of investing in health (EXPH) is an interdisciplinary and independent group established by the European Commission to provide non-binding independent advice on matters related to effective, accessible and resilient health systems. The mandate from the European Commission asked EXPH to address the following questions: 1. What are the specific factors influencing mental health (MH) of the health workforce and essential workers? 2. What interventions could be effective in addressing MH support needs of health workers and essential workers, including those with preexisting MH conditions? Using existing data, assess the cost of MH problems in the health workforce and the cost-effectiveness of MH interventions. What are the conditions for the delivery of these interventions in a cost-effective, affordable and inclusive manner? 3) How can the EU address these concerns?
Recommendations to support the mental health of the health workforce
Authors: Zaletel Jelka 
Published: October 2021

Abstract
EXPH members and Opinion collaborators
The Opinion concludes with eight evidence-based recommendations, complemented by action points with EU-wide and Member-State relevance. The recommendations are addressed to policy makers and managers, as well as with mental health and occupational health practitioners. The focus of these recommendations to support the mental health of the health workforce is on fostering their mental wellbeing and the need to treat mental wellbeing as an organisational responsibility within the workplace. The recommendations address the roles of stakeholders at several levels (organisations, national authorities and EU). The action points detail the general principle described in each recommendation. Specifically, there is the need for appropriate guidance frameworks to be established, in some cases deserving legal status, to clearly establish mental wellbeing as an important workplace responsibility within organisations. This requires awareness and competencies by the leadership of organisations, which can be facilitated via education and training. To support promotion of mental wellbeing in SMEs, the use of common digital tools (to be developed) can be advantageous. In addition, workplaces must develop adequate mechanisms for early identification of factors influencing mental wellbeing and for referral to professional help when preventive efforts are not effective. The organisation, as opposed to the individual worker, is to be held accountable for worker wellbeing. Building and sharing knowledge on interventions that work via the creation of learning communities is recommended. The identification of best practices that are cost-effective require further evidence, which should be developed by overcoming methodological challenges. Lastly, a common EU-wide view of mental health care and its re-organisation is needed with emphasis on prevention and support of mental wellbeing in not only the health workforce, but the general population as a whole.
How genetics and epigenetics can improve cardiovascular risk prediction: examples from the Moli-sani and Moli-family studies
Authors: Gianfagna F , Iacoviello L 
Published: October 2021

Abstract
One of the goals of personalized medicine (PM) is to use the ever-growing understanding of biology to provide a higher level of precision in disease prevention and patient care. The simultaneous study of the risk markers and epigenetic factors may have the desired discriminatory accuracy to distinguish between high-risk and low-risk subjects. The presentation will illustrate how genetics and epigenetics can improve cardiovascular risk (CVD) prediction in Italian adults from the general population. A subcohort of 1160 subjects (55.3±11.7 years; men 47.7%) was randomly selected from the Moli-sani cohort study (N = 24,325, yrs:2005-2010) and compared in a nested case-cohort design with incident CVD events (N = 592 validated myocardial infarctions or strokes), identified in a median follow-up of 9.2 years. DNA samples were used to genotype 14 tag SNPs in the genes NMU (encoding for Neuromedin U, a hypothalamic peptide), NMUR1 and NMUR2 (receptors) and NMS (Neuromedin S) and to quantify methylation levels at 17 CpG sites of two NMU regions through pyrosequencing. ELISA tests on circulating NMU levels are on-going. The associations between variants and incident CVD events using classical CVD risk factors as covariates and prediction metrics using standard risk alogrithms as reference were calculated. Four SNPs in NMU and NMUR1 genes and 6 NMU CpG sites showed a statistically significant association with events (p from 0.037 to &lt; 0.0001), independently from classical CVD risk factors. Combined epigenetic and genetic variants in genes from the NMU pathway are associated with increased CVD risk and could have a potential clinical utility when added to current CVD risk algorithms for CVD prediction.
Research methodologies to assess the impact of COVID-19
Authors: Nogueira PJ , Forjaz MJ , Rodriguez-Blazquez C , Diaz-Franco A , Unim B , Palmieri L , Carcaillon-Bentata L , Makovski T , Feteira-Santos R 
Published: October 2021

Abstract

Background
PHIRI WP5 aims at identifying the research approaches, data uses, pathways, indicators, and new methodologies to assess the impact of COVID-19 on Population Health.

Methods
Based on a collaborative work of researchers from 20 European institutions, several literature reviews were planned using automatized strategies to map the research methods analysing the impact of COVID-19 and data pathways: i) a scoping literature search to identify indicators of direct and indirect impact; ii) systematic literature reviews on determinants of severity for short and longterm health outcomes; and iii) a systematic literature review and meta-analysis to determine the effectiveness and impact of tracking COVID-19 patients using digitals tools.

Results
In November 2020, more than 73,000 papers about COVID-19 were published. About 16,000 (22%) reported data aspects, and approximately half reported both data aspects and methodologies. The most used indicators of direct impact are incidence and prevalence, mortality, severity and sequelae. To explore the etiological and prognostic effects of frailty, multimorbidity and socioeconomic status, the main identified outcomes were: infection, hospitalization, ICU admission, mortality by COVID-19 (etiological); as well as ICU admission, hospitalization, survival, functional decline, quality of life, disability, mental health difficulties and work absence (prognostic). The search generated 10,139 records. The initial literature search about mobile applications and electronic devices for tracking of COVID-19 patients yielded 2500 records.

Conclusions
The use of machine learning tools to synthesize the research about methods and data pathways on COVID-19 impact is feasible, as the amount of published evidence is very large. The vast amount of available literature on COVID-19 requires specific methods of literature search and synthesis, and an integrated effort of an extensive network of researchers.
Dietary factors and non-communicable disease risk in Europe: evidence for European nutritional guidelines?
Authors: Grosso G , Di Cesare M 
Published: October 2021

Abstract
Findings from large global studies support the hypothesis that Europe is suffering from a double burden of malnutrition, affecting food security, undernutrition and nutrition deficiencies on one side, and overnutrition and higher risk of obesity and chronic diseases on the other. Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study as well as meta-review from the scientific literature provides insight on the burden of nutritional risk factors on non-communicable diseases in Europe. Over the last 40 years, obesity prevalence has increased threefold in several European countries, reaching over 50% of individuals having weight problems. However, obesity prevalence levels and trends vary substantially by gender and between European countries, with Malta and Eastern European countries having higher overweight and obesity rates. At European level, it has been estimated that over 950,000 deaths and over 16 million DALYs are attributable to dietary risks due to unhealthy diets. The main causes of death attributable to dietary risks include cardiovascular diseases (817,302), neoplasms (101,477) and diabetes and kidney diseases (32,009). The most important dietary factors contributing to cardiovascular diseases were diet high in sodium, sugar sweetened beverages, and processed meat, while metabolic disorders are also affected by low whole grain, fruit, nuts and seeds intake. Neoplasms affected by dietary risk factors involve the upper aerodigestive and low digestive tracts, and may be due to low intake of fiber, calcium and milk. Although similar, some differences across countries can be observed due to different dietary habits and food preferences. The presented findings emphasize the need of common guidelines that could be applied to all people living in Europe. While advocating for healthier dietary habits, policy orientation is needed to improve nutrition and prevent non-communicable diseases.
Sex differences in functional limitation level and the role of socioeconomic factors
Authors: Bloomberg M , Dugravot A , Landré B , Britton A , Steptoe A , Singh-Manoux A , Sabia S 
Published: October 2021

Abstract

Background
Women are more likely to have functional limitations than men, partly due to socioeconomic disadvantage. As much of this research is based on dichotomised measures of limitation, how sex differences vary by level of limitations remains unclear. The aim of our study was to examine sex differences in functional limitations in people born between 1895 and 1960, with attention to the role of socioeconomic factors and level of limitations.

Methods
Longitudinal data on limitations in basic/instrumental activities of daily living (ADL/IADL) and mobility activities were drawn from studies in 14 countries. For ADL, IADL, and mobility activities, participants were grouped into limitation levels based on number of limited activities (0, 1, 2, or ≥ 3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-1938, 1939-1945, 1946-1960) were analysed before and after adjustment for socioeconomic factors using mixed effects ordinal logistic models.

Findings
Among 62,375 participants, sex differences in IADL and ADL limitations (≥1) were minor after adjustment for socioeconomic factors (sex difference in probability of limitations (female - male) age 75, 1895-1929 cohort for IADL=3.7% (95% CI 2.6, 4.7) before and 1.7% (1.1, 2.2) after adjustment; ADL=3.2% (2.3, 4.1) before, 1.4% (0.9, 1.8) after). Sex differences remained for mobility (16.1% (14.4, 17.7) before, 14.3% (12.7, 15.9) after). At older ages, women were more likely to have ≥3 IADL or mobility limitations, while men were more likely to have 1 to 2.

Conclusions
Socioeconomic factors explain the majority of sex differences in IADL and ADL limitations but not mobility, with women reporting greater mobility limitations than men starting in middle age. Our findings suggest sex differences in mobility limitations from middle age might be important targets for future study and interventions.

Key messages
Sex differences in disability vary considerably between disability measures. Comprehensive assessment of sex differences in disability should consider disability severity across different measures. Findings suggest there may be fewer sex differences in disability in the future with progressively decreasing socioeconomic disparities between men and women.
Trends in ionizing radiation exposure of healthcare workers in France (2009-2019): the EXPERTS study
Authors: Baudin C , Vacquier B , Partarrieu I , Ducou Le Pointe H , Mora S , Feuardent J , Leuraud K , Bensefa-Colas L , Bernier MO 
Published: October 2021

Abstract

Background
Health workers exposed to ionizing radiation (IR) account for +50% of workers exposed to artificial IR in France. Over the last 10 years, the use of IR in medicine has developed due to the introduction of new practices. The EXPERTS study aims to evaluate and characterize the trends in IR exposure of health workers in France between 2009 and 2019.

Methods
The study includes all health workers with at least one dosimetric record in the System for occupational dosimetry registration (SISERI) database for each of the years 2009, 2014, and 2019, in the 6 hospitals included in the study (in Paris & Bordeaux). Individual passive external doses, professional activity, age and gender were collected via SISERI and occupational medicine units. Doses were estimated from badges worn at chest level under the lead apron.

Results
1,999 workers were included. Mean Hp(10) doses significantly decreased between 2009 and 2019 (-0.004 mSv/year; p &lt; 0.05). Workers in Bordeaux hospitals were more exposed than those in Paris in 2009 and 2014, while trend was reversed in 2019 (p &gt; 0.05). Doses in men were significantly higher than women's doses in 2009 and 2014 (p &lt; 0.02), but were similar in 2019 (p = 0.99). Physicians had the highest mean IR doses between 2009 and 2019 (0.14mSv ±1.09), and more specifically surgeons and cardiologists, but their exposure tended to decrease in recent years. Radiological technologists have similar mean doses (0.14mSv ±0.38), relatively stable over the study period - the most exposed in the nuclear medicine unit (0.60mSv ±0.58).

Conclusions
IR exposure of health workers in France decreased significantly between 2009 and 2019, despite an increase in practices using IR - this decrease was partly recorded in orthopaedic surgeons. This may be related to radiation protection rules' application. However, badges may not always be worn properly. This study could be extended to other healthcare centres to study local specificities and to adapt radiation protection policies

Key messages
Despite the increase in medical practices using ionising radiations (IR), the average exposure of health workers to IR has decreased over the 10 last year, mainly in Bordeaux hospitals. Differences in average IR exposure were found by occupation, gender, health care units, and hospitals. Policies should use these results to promote radiation protection rules.
Barriers to the preceptor’s role in interprofessional education: scoping review
Authors: Silva CM , Mazzi NR , Duarte TCR , Leonello VM 
Published: October 2021

Abstract

Background
With the expansion of interprofessional health education, preceptors are increasingly working with learners from several professions to promote collaborative practice. It is unclear what are the challenges toward interprofessional education in preceptor's learning environment. A scoping review was conducted to map the barriers to preceptorship role in interprofessional health education. The following research question was formulated: What are the barriers to preceptor's role in interprofessional education?

Methods
The research question was defined with the framework PCC: Population - preceptors; Concept - barriers to preceptorship role; Context - interprofessional health education initiatives. A systematic search in 8 databases was conducted in April 2020 to identify primary research studies published in Portuguese, Spanish or English. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. This review followed the Institute Joanna Briggs Manual of Evidences (2020) and the PRISMA-ScR guideline.

Results
A total of 28 studies from the United States, Brazil, Canada, Australia, Sweden and the United Kingdom remained to extract barriers. Barriers were summarized in five main aspects: limited resources, preceptorship regulation, patients participation, teaching-service integration, local culture for interprofessional teamwork and preceptor development. Some of the barriers were: lack of coordination between educational institutions and health services, hierarchical relationship among professionals, unfavorable working environment for interprofessional collaboration, unclear professional roles and need of preceptor development.

Conclusions
Many barriers have been identified at the macro and microstructural levels of health systems. Discussing and analyzing such barriers is fundamental for advancing the debate on the skills and roles of preceptors, with a view to strengthen the Interprofessional Health Education.

Key messages
Preceptorship is important to development interprofessional collaboration. The results make it possible to plan strategies that contribute to professional recognition and professional development.