bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the direct and indirect impact of the COVID-19 pandemic in Tuscan nursing homes
Authors: Scardina G , Collini F , Mazzilli S , Forni S , Privitera GP , Tavoschi L 
Published: October 2021

Abstract

Background
Residents in long-term care facilities (LTCFs) are at higher risk of contracting and developing serious outcomes from COVID-19. Despite the media attention and the specific survey launched by the Istituto Superiore di Sanità, official data on Italian LTCFs are scarce. The objective of our study was to provide an estimate of the direct and indirect impact of COVID-19 in Tuscan LTCFs by assessing the rate of hospital admissions and the overall mortality rate among LTCF residents in 2020, comparing them with those observed in the period 2018-2019.

Methods
For the analysis two regional administrative data flows were linked. The first one providing data on the number of LTCFs residents - and deaths - affiliated with the regional health system, while the second on hospital discharges. The monthly hospitalization and mortality rates for 2020 were compared with those of the two previous years.

Results
The number of residents in LTCFs decreased significantly (-10.4%) and consistently in 2020 compared to the average of the previous two years. The rate of total admissions decreased slightly in 2020 (32.5%, -8.2% compared to 2018/19). However, excluding admissions due to COVID-19, the reduction was more pronounced (-21.9%), with large monthly variations (-33% and -43% in March and November 2020) statistically significant (RR2020/2018-19=0.66 and 0.57; 95%CI: 0.57-0.77; 0.48-0.68). A total of 581 admissions for COVID-19 occurred in 2020, with a monthly average of 0.6% and two peaks observed in April and November (1.86%; 1.82%). The overall mortality rate increased by 31% (2018/19= 18.6%; 2020= 24.4%), with a maximum (+201%) in November 2020 (RR2020/2018-19=3.01; 95%CI: 2.5-3.56).

Conclusions
The impact of the pandemic on Tuscan LTCFs in terms of deaths and patient care by hospitals has been considerable, with the greatest reduction in hospital admissions occurring mostly in the months characterised by the highest mortality rate and admissions for COVID-19.

Key messages
The direct and indirect impact of the pandemic on Tuscan LTCFs has been considerable, probably due to the reorganisation of LTCF services and limited coordination with hospital health care. The greatest reduction in hospital admissions, especially those not COVID-related, occurred mostly during the months characterised by the highest mortality rate and admissions for COVID-19.
Excess mortality in England during the COVID-19 pandemic
Authors: Fryers PT , Barnard S , Burton PR , Fox S , Waller Z , Fitzpatrick J 
Published: October 2021

Abstract

Introduction
Excess mortality monitoring is not dependent on completeness or consistency of coding of causes of death and captures deaths caused directly and indirectly by COVID-19. It takes account of existing inequalities in the baseline rates and shows the additional impact of COVID-19. We report weekly on excess mortality by age, gender, geographical area, deprivation, and ethnicity.

Methods
A quasi-Poisson model was fitted to deaths data for 2015-2019 to estimate expected mortality in population sub-groups each week during the COVID-19 pandemic. This was compared with observed mortality reported each week. Information on deaths registered was obtained from death certificates. Ethnicity was obtained from hospital records linked to deaths data.

Results
Early in the pandemic, excess deaths exceeded official reported COVID-19 deaths every week. Throughout the pandemic there were stark inequalities in excess death rates. Based on data from 21 March 2020 to 9 April 2021, people living in the most deprived areas in England experienced more excess (1.21 times; 95% CI 1.21-1.22) compared with people living in the least deprived areas (1.17; 1.16-1.18). Black (1.56; 1.53-1.58) and Asian groups (1.55; 1.53-1.56) experienced more excess than the White group (1.16; 1.16-1.17). There was wide variation between English regions.

Conclusions
Reporting overall excess mortality early in the pandemic is important to inform policy makers and public about the true scale of the death toll when coding is inconsistent and developing. This approach has highlighted the large increases in already established inequalities in mortality. It provides rapid surveillance of developing disparities for national and local decision makers. It has been used to inform policy around reducing disparities and to revise messaging to encourage hospital attendance for non- COVID-19 health problems.

Key messages
Excess deaths from all causes is a robust measure of overall impact, unaffected by coding consistency. COVID-19 has dramatically worsened established inequalities between ethnic groups and deprivation groups.
COVID-19: Identifying and addressing determinants of adherence to physical distancing guidance
Authors: Durand H , Bacon SL , Byrne M , Farrell K , Kenny E , Lavoie KL , McGuire BE , McSharry J , Meade O , Molloy GJ 
Published: October 2021

Abstract

Background
Optimising physical distancing measures has been a critical part of the global response to the spread of COVID-19. Adherence to these recommendations has been poorer than adherence to other key transmission reduction behaviours. The current project aimed to identify psychosocial determinants of adherence to physical distancing, and to determine whether Government of Ireland COVID-19 communications adequately address the determinants.

Methods
A nationally representative cross-sectional survey as part of the International COVID-19 Awareness and Responses Evaluation (iCARE) study, a qualitative interview study, and a content analysis of COVID-19 poster communications were conducted to identify psychosocial determinants of adherence and determine the extent to which these were addressed in government communications.

Results
The iCARE survey showed adherence to physical distancing measures varies by sociodemographic group (e.g., age, sex, COVID-19 risk category) and beliefs. Poorest adherence was reported by younger people, males, those at lower risk of serious illness from COVID-19, and those who were less concerned about the impact of COVID-19 on public health and the economy. The qualitative interview study revealed maintaining and negotiating close relationships, public physical environments, habituation to threat, risk-taking to maintain wellbeing, and confusion and uncertainty around government guidelines as barriers to physical distancing behaviour. Having a sense of personal responsibility and control over one's own behaviour was identified as a potential facilitator of adherence to distancing. Content analysis revealed some important gaps, particularly in terms of rationale for specific public health guidelines.

Conclusions
Though adherence was high overall, there was variability among sociodemographic groups. Government communications to promote physical distancing could be refined to better address key barriers and facilitators of the behaviour.
Falsified medicines and shortage as urgent challenges in health care
Authors: Vardanyan L , Kazaryan I , Sevikyan A , Amirkhanyan A 
Published: October 2021

Abstract

Background
Worldwide healthcare systems are faced with certain challenges related to medicines which can compromise population health. These include shortage of medicines, falsified products and so forth. Identifying these problems and informing policy-makers are the first steps in a process of developing appropriate policy strategies. The objective of this work was to identify pressing problems related to medicines which are able influence population health in Armenia.

Methods
209 pharmacy practitioners from different regions of Armenia participated in survey by completing specially designed questionnaire. Data were analysed with SPSS statistical software.

Results
The great majority of participants (89.5%) consider that substandard and falsified medicines are a threat to public health. 77.0% of respondents thinks that substandard and falsified medicines are present on the local pharmaceutical market. The percentage of professionals reporting this problem is higher among those who completed continuing education courses (p = 0.007). 81.8% of professionals suppose that unauthorized/unlicensed medicines are also available. 96.2% of participants are sure that strengthening Health care system in Armenia by introducing additional tools for assuring quality of medicines is necessary. 84.7% of responders consider that shortage of medicines for priority diseases is also a threat to public health. A half of participants (50.2%) suppose that there is a shortage of medicines needed for treatment of priority diseases in Armenia. 90.0% of participants believe that strengthening Health care system by introducing strategies to manage medicines shortage is essential.

Conclusions
Many pharmacy practitioners consider that there are problems with substandard and falsified medicines, as well as shortage of medicines needed for treatment of priority diseases in Armenia. There is an urgent need in developing strategies aimed to solve problems identified. Recommendations are developed.

Key messages
Substandard and falsified medicines are a public health concern and introducing additional tools for assuring quality of medicines considered to be necessary. Shortage of medicines needed for treatment of priority diseases is a public health concern and introducing strategies to manage medicines shortage is essential.
Health assets in transgender adolescents: The role of socio-political engagement and competence
Authors: Moreno-Maldonado C , Ciria-Barreiro E , Rivera F , Luna S , Moreno C 
Published: October 2021

Abstract

Background
Research has shown lower mental health in transgender youth compared to cisgender peers. However, little is known about assets in their development. Self-determination theory posits that certain behaviours increase wellbeing, such as engaging in activities that meet the psychological need for competence and relatedness. This study analyses the mediator roles of political interest, sense of unity, and social self-efficacy in the association between gender identity and health.

Methods
Two samples of Spanish adolescents (15-18 years-old) were analysed. The first sample included 170 transgender and 575 cisgender (selected through a matching process) students who participated in the 2018 Health Behaviour in School-Aged Children study. The second sample included 67 transgender and 2,100 cisgender participants who collaborated in the UNICEF OPINA Barometer. Political interest, social self-efficacy, and sense of unity scales were used to measure community engagement and were considered as sources of resilience. Health-related quality of life (HRQL) was measured using the Kidscreen-10 scale. Data analysis was conducted using linear regressions and parallel mediation effects.

Results
Gender identity predicted well-being, showing lower HRQL in transgender adolescents than cisgender peers. Furthermore, sense of unity and social self-efficacy - but not political interest - significantly predicted wellbeing (higher levels have a positive impact on HRQL) in both groups, and indirectly mediated between gender identity and HRQL.

Conclusions
Sense of unity and social self-efficacy act as sources of resilience, increasing adolescent wellbeing. Thus, social inclusion and active citizenship can help adolescents to better cope with pressure and promote health. Moreover, the positive contributions of sense of unity and social self-efficacy was similar for cisgender and gender minority adolescents, suggesting similar underlying mechanisms.
Role models and well-being among trans and non-binary youth
Authors: Taylor AB , Chan A , Saewyc EM 
Published: October 2021

Abstract

Background
It is important for young people to see themselves represented in stories, on television and in different job opportunities, so they can have an awareness of what is possible. While we often hear the words “representation matters,” research on how representation affects health outcomes of trans and non-binary (TNB) youth is lacking. In this presentation, we will use the Social Cognitive Theory to identify how the presence of role models relates to social and health outcomes of TNB youth across Canada.

Methods
The 2019 online Canadian Trans Youth Health Survey included 1,519 TNB youth ranging from 14-25 years old. Youth identified as 43.7% trans masculine, 12.3% trans feminine, and 44% non-binary. Analyses explore differences in the relationship between the presence of TNB role models and social and health outcomes using crosstabulations and chi square tests, logistic regressions, and ANOVAs, by age and across gender identity groups.

Results
Youth with role models had a higher odds of participating in school sports [OR = 1.3, 95% CI: 1.03 - 1.59] and youth who had a role model they want to be like were significantly more likely to report living in their felt gender (p = .036). The relationship between TNB youth's identification of role models and being able to think of something they are good at, living in their felt gender, avoiding public spaces, future school plans, sports involvement, self-rated physical and mental health, emotional wellbeing and general health outcomes across developmental groupings will be discussed. Demographic and contextual factors that moderate the relationship between role models and social/health outcomes will also be presented.

Conclusions
Youth with role models have better social and emotional well-being. The importance of role models for TNB youth should not be diminished. We will share the implications of our findings for health promotion and public health policy, as well as recommendations for further research.
Identifying trans and non-binary youth in population-based school health surveys in western Canada
Authors: Saewyc EM 
Published: October 2021

Abstract

Background
Most research about gender-diverse adolescents is with clinical samples, skewing population estimates of health and risk. With trans youth estimated at around 0.5% of the population and no reliable measures, school health surveys have not asked gender diversity items. In 2018, the British Columbia Adolescent Health Survey (BCAHS) in Canada trialled measures to differentiate cisgender, trans, and non-binary youth, to capture a representative picture of health for gender-diverse young people.

Methods
The 2018 BCAHS is a stratified random survey of 2,175 classrooms of grades 7-12 (ages 12-19) in 58/60 school districts province-wide (N = 38,015). Two measures asked about sex assigned at birth and current gender identity, combined to identify cisgender boys and girls, trans boys, trans girls, non-binary and questioning youth. We examined patterns of missingness by demographics.

Results
Overall, nearly 99% of youth responded to both items, with very low missing (0.5% for sex, 0.8% gender identity) with no differences by school or district, or by age. Missing responses were higher among international students and English language learners but still low (1.1%). Youth living in foster care or with a disability or chronic condition also had higher odds of skipping both items, but the highest missing was only 3.7% among youth with FASD. Overall, 48.9% identified as cis girls, 48.6% as cis boys, 0.13% as trans girls, 0.33% trans boys, 0.75% non-binary, and 1.28% as not sure (479 trans/non-binary, and 484 unsure). Preliminary analyses show positive assets also support gender diverse youth well-being.

Conclusions
A two-step measure of gender identity is feasible for adolescents as young as 12 years old in large scale school surveys, with very low missing responses in western Canada. Although &lt;1% identified as trans, in large samples stable estimates for population comparisons are possible. Future studies should pilot gender identity measures in other nations/languages.
Perceived need of health care and barriers in access to health services among migrants in Portugal
Authors: Gama A , Marques MJ , Pedro AR , Mendonça J , Fernandes AC , Dias S 
Published: October 2021

Abstract

Health care has been pointed out as a key determinant of migrants' health and social integration, but there is evidence of disparities in its access across subgroups. A deeper understanding of the barriers in access to health care, particularly among vulnerable groups, is needed. Our study aims to examine perceived need of health care, access to health services and barriers among migrants in Portugal. A cross-sectional survey was conducted with 1126 adult migrants (53.4% females), originated from African, Middle East, Asian countries and Brazil, living in Portugal for no longer than 10 years. The collected data included sociodemographic characteristics, perceived need of health care, access to health services and difficulties experienced. Differences between groups were analysed through chi-square tests. Results showed that most of the participants (64.7%) have needed health care in the previous 12 months in Portugal. Of these, 87.8% accessed a health care service. However, even needing health care, 3.3% decided not to seek care and 8.8% were not able to access a health care service. Reporting no access to health care was more frequent among migrants with shorter length of stay in the country (&lt;1 year: 19.4% vs. 1 to 5 years: 7.3% and 6 to 10 years: 4.6%; p = 0.001) and those with non-regular migration status (in regularisation process: 11.5% and undocumented: 9.5% vs. documented: 7.2%; p = 0.040). Most common barriers were lack of the National Health Service user card (38%), financial constraints (15%), undocumented status (11%) and language difficulties (7%). Although efforts have been made over the past decades in Portugal to adopt inclusive policies and promote migrants' access to health care, strategies are needed to improve information on migrants' health rights, especially of those undocumented and recently arrived. Economic and language difficulties should be further addressed in comprehensive interventions to promote equal access to health care.

Key messages
Migrants residing in the country for less than a year and those with non-regular migration status reported more frequently not being able to access health care. Despite the efforts to adopt inclusive policies and promote migrants’ access to health care, strategies are needed to improve information on migrants’ health rights and promote equal access to care.
The International Assessment of COVID-19-related Attitudes, Concerns, Responses and Impacts in Relation to Public Health Policies (iCARE) study
Authors: Stojanovic J , Lavoie KL , Bacon SL ,   for the iCARE study
Published: October 2021

Abstract

Issue/problem
COVID-19 global pandemic has had significant health, social and financial impacts on global communities. Many of the national mitigation strategies to curb the virus spread have been targeting human behaviours. Insights from behavioural sciences are crucial for effective community engagement and positive behaviour change on a population-level.

Description of the study
The iCARE Study (which is co-funded by CIHR and the Quebec government) is a multi-wave, international observational study of public awareness, attitudes, concerns and behavioural responses to public health policies implemented to reduce the spread of COVID-19 (www.icarestudy.com). Survey data is being continuously collected in 6 week rounds (since March 2020) using representative sampling (in Canada, Italy, Israel, France, Ireland, Australia, Colombia etc.) and convenience sampling methodology (globally). The survey was constructed around the: (1) The COM-B (Capability, Opportunity, Motivation-Behaviour) model; and the (2) The Health Beliefs Model, which provide a framework for understanding factors that predict behaviour change on a population level.

Results
The iCARE study leverages an existing online assessment platform, and has received over 90,000 survey responses to date. This research initiative provides real-time evidence to support COVID-19 policy strategy and communication around the world, through a global multi-stakeholder engagement that gathers expertise from almost 200 collaborators in 40 countries. Of note, the study has received a range of local, national and international media coverage and directly inputted into several government policies.

Lessons
iCARE study is an example of a successful intersectorial, collaborative research and policy initiative that leverages multiple stakeholders to bring behavioural perspective at the forefront of the development and delivery of public health policies globally.
Trends in incidence of uterine cancer in England, 1985-2017
Authors: Apata A , Bannister P , Memon A 
Published: October 2021

Abstract

Background
Cancer of the corpus uteri (hereafter, uterine cancer) is the fourth most common cancer in women in the UK, accounting for 5% of all cancers in women. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of uterine cancer in England during the past four decades.

Methods
Individual level data for women diagnosed with uterine cancer in England during 1985-2017 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the six five-year time periods (1985-89 to 2010-14) and the recent three-year period (2015-17). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-17). Index of Multiple Deprivation (IMD) quintiles (2015-17) were examined to determine the social gradient of the disease.

Results
During the 33-year study period, a total of 169,768 women with uterine cancer were registered in England. In women aged 0-49 years, the average annual incidence rates increased by about 51% (from 1.8/100,000 in 1985-89 to 2.8/100,000 in 2015-17), and in women aged 50+ years, the rates increased by about 74% (from 39.0/100,000 in 1985-89 to 67.7/100,000 in 2015-17.). At all ages combined, the rates increased by 88%. With regard to the social gradient, in the young age group the highest proportion (46%) of cases occurred in women from the most deprived areas, whereas in the older age-group the highest proportion (43%) occurred in women from the least deprived areas.

Conclusions
There has been a steady and substantial increase in the incidence of uterine cancer in England over the last four decades. The observed dichotomy in risk between the young and older women by social gradient needs further investigation.

Key messages
Considering that 34% of the cases of uterine cancer in the UK are associated with obesity, the study informs formulation of public health programmes to reduce the prevalence of obesity. The difference in risk between the young and older women by social gradient highlights the importance of reducing health and social inequalities.