bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological distress from the COVID-19 confinement is associated with unhealthy dietary changes
Authors: Bonaccio M , Costanzo S , Bracone F , Gialluisi A , Di Castelnuovo A , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L 
Published: October 2021

Abstract

Background
The confinement due to COVID-19 pandemic had adverse effects on mental health, but the relation between psychological distress resulting from lockdown measures and dietary habits needs to be elucidated.

Methods
We analysed 2,741 subjects (mean age 58.1±15.3 y) pooled from 2 retrospective Italian cohorts recruited from May to September 2020: 1) The Moli-LOCK cohort consists of 1,401 adults, a portion of the larger Moli-sani Study (n = 24,325) who were administered a telephone-based questionnaire to assess lifestyles and psychological factors during confinement; 2) the ALT RISCOVID-19 is a web-based survey of 1,340 individuals distributed throughout Italy who self-responded to the same questionnaire by using Google® forms. Psychological distress was measured by assessments of depression (PHQ-9), anxiety (GAD-7), stress (PSS-4), and post-traumatic stress disorder (PTSD). Diet quality was assessed either as changes in consumption of ultra-processed foods (UPF) or adherence to Mediterranean diet (MD).

Results
In a multivariable regression analysis controlled for major sociodemographic factors, depression (β=-0.06, 95%CI -0.10, -0.01), anxiety (β=-0.05, -0.09, -0.004) and PTSD (β=-0.04, -0.08, -0.002) were inversely associated with MD and directly with UPF (β = 0.13, 0.09, 0.18; β = 0.12, 0.08, 0.16 and β = 0.10, 0.06, 0.13, respectively); stress was associated with UPF (β = 0.06, 0.02, 0.10) but not with MD (β=-0.03, -0.08, 0.01).

Conclusions
Psychological distress resulting from confinement due to the COVID-19 pandemic is directly associated with unhealthy dietary modifications in a sample of the Italian population. In view of possible future restrictive measures, particular attention should be paid to public health actions promoting psychological support to more vulnerable groups.

Key messages
Psychological distress resulting from confinement due to the COVID-19 pandemic is directly associated with unhealthy dietary modifications. Particular attention should be paid to public health actions promoting psychological support to more vulnerable groups also in view of future restrictive measures to contain the pandemic spread.
Ultra-processed food consumption modifies the association of Nutri-Score with all-cause mortality
Authors: Bonaccio M , Di Castelnuovo A , Ruggiero E , Costanzo S , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L 
Published: October 2021

Abstract

Background
The Nutri-Score front-of-pack label rates foods according to their nutritional quality while the NOVA classification is focused on degree of processing; both systems separately predicted mortality in epidemiological contexts. We evaluated whether ultra-processed food (UPF) modifies the association of the Nutri-Score with mortality.

Methods
Longitudinal analysis on 22,549 Italian men and women (mean age 54±12 y) from the Moli-sani Study (2005-2010) followed for 11.2 y. Food intake was assessed by a food frequency questionnaire. The Food Standards Agency nutrient profiling system (FSAm-NPS) score, used to derive the Nutri-Score, was calculated for each food based on its amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes and nuts per 100 g of product. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed, and increased values indicate lower nutritional quality. UPF intake was the proportion (%) of UPF in the total weight of food consumed (g/d) and categorized as low/high (below/above the population median, respectively).

Results
In a multivariable analysis, 1-SD increase in the FSAm-NPS index led to increased risk of all-cause (HR = 1.07; 95%CI 1.02-1.13) and CVD mortality (HR = 1.08; 1.00-1.18). UPF intake was an effect modifier since the association of FSAm-NPS index with mortality was confined to individuals with high UPF intake (HR = 1.14; 1.05-1.25) but not in those with low UPF (HR = 1.00; 0.93-1.07; p for interaction=0.034). Similar findings were reported for CVD mortality (HR = 1.14;0.99-1.31 and HR = 1.01;0.90-1.13 for high and low UPF consumers, respectively; p for interaction=0.18).

Conclusions
Higher mortality risk associated with a NutriScore revealing nutrient-poor food intake is limited to individuals also reporting high UPF intake. Food labelling systems should account for food processing in addition to nutritional content.

Key messages
Ultra-processed food modifies the association between the 5-color Nutri-Score front-of-pack label with all-cause mortality in an Italian general population. Food labelling systems, that are conceived to help consumers make healthier food choices, should also account for food processing in addition to nutritional content.
Moral distress: Ethically appropriate actions
Authors: Maeckelberghe E 
Published: October 2021

Abstract
Andrew Jameton in 1984 coined the concept of moral distress as: “knowing what to do in an ethical situation, but not being allowed to do it” This original description presupposes that the right moral act can be identified and precludes situations of doubt and uncertainty. The 1984 definition emphasizes barriers that make it impossible for someone to do what they ought to do. Whereas Jameton in a revision in 2013 of his original concept emphasized reduction of the psychological dimensions, Peter& Liaschenko stress the element of moral agency. Moral distress then is a threat to the moral integrity of the professional. This requires three-step ananlysis: first, what is the moral question?; two, what are morally adeguate answers to this question?; three, what ethically appropriate actions are under pressure in the given situation? This will be illustrated with examples from the COVID-19 pandemic.
New evidence on the prevalence and risk of peripartum mental illness amongst migrant women: A global review of the literature
Authors: Fuhr D , Stevenson K 
Published: October 2021

Abstract
Migration is known to affect an individual's health and social status, and migrant women who are pregnant or postpartum are known to be at high risk of adverse health and social outcomes. They are at particularly high risk of mental disorders, especially perinatal depression (PND). Previous studies have demonstrated the prevalence of PND may be higher amongst migrant women when compared to the general population. The determinants of perinatal mental disorders amongst migrant women are complex and may include social isolation, discrimination, poor healthcare access, and low levels of emotional and practical support. The consequences of perinatal mental disorders include a high risk of suicidality and depression in the woman, as well as adverse outcomes for the child including a high risk of low birth weight, diarrhoeal disease, and poorer cognitive outcomes. We will present updated data on the prevalence and risk factors for perinatal mental illness (depression, anxiety, post-traumatic stress disorder, psychosis) amongst migrant women (refugee women, and internally displaced women) at a global level. We will synthesize the available evidence which is available to date, and create consensus on the prevalence and risk of perinatal mental illness amongst migrant women. We expect that migrant woman will be at significantly higher risk of perinatal mental illness when compared to the general population. We will discuss appropriate health system responses which may address the health care needs for migrant women in fragile or conflict-affected settings.
Experiences of Trans and Non-Binary Patients during Medical Transitioning and Associations with the Patient-Physician Relationship in Austria
Authors: Markovic L , Seiler-Ramadas R , Grabovac I 
Published: October 2021

Abstract

Background
Trans and non-binary (TNB) patients confront various issues in the healthcare system and with healthcare workers (HCWs) tasked with navigating complex systems to achieve optimal outcomes. The most time intensive and intimate contact TNB patients have is typically with physicians making the physician-patient relationship instrumental. This study aimed to explore the experiences of patient-physician relationship in TNB patients in Austria in order to identify caveats for future interventions.

Methods
We conducted an exploratory cross-sectional study using an online questionnaire consisting of 86 items including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9) distributed between June and October 2020 through various organizations working with TNB people. Austrian residents older than 18 who self-identified as TNB and were undergoing or finished medical transitioning were included. Descriptive statistics and linear regression models were applied.

Results
From a total of 91 participants, 58.3% identified as trans, 70.3% were assigned female at birth, and 87.7% were on hormone replacement therapy. Most (58.1%) perceived physicians as the most problematic HCWs, and 60.5% reported having never or rarely been taken seriously in healthcare settings. Linear regression model showed that PDRQ-9 score was associated with a diagnosis of a mental illness (beta=3.88, 95%CI 0.24 - 7.51), quality of life (beta=0.66, 95%CI 0.43 - 0.90), never being taken seriously (beta=11.69, 95%CI 2.91 - 20.47) and being misgendered (beta=-7.64, 95%CI -14.88 - -0.41) by HCWs.

Conclusions
TNB patients in Austria reported negative experiences in the healthcare system, mostly with physicians that often did not take their gender identity seriously or used inappropriate language. Future interventions should focus on increasing transgender care competencies across various components of medical education.
Health services use in people with chronic diseases during the pandemic: Results from the iCARE study
Authors: Stojanovic J , Deslauriers F , Lavoie KL , Bacon SL ,   iCARE study team
Published: October 2021

Abstract

Background
COVID-19 containment measures, such as stay-at-home orders and transportation shutdowns, might have created barriers to healthcare access and impacted service utilization worldwide. This cross-sectional study aims to explore how COVID-19 impacted health service utilization in individuals with chronic health conditions across the globe.

Methods
We included a convenience sample of the global iCARE study (www.icarestudy.com) from March, 2020 to January, 2021. Logistic regressions were used to test association between difficulties getting non-COVID-19 related care and presence of physical health conditions, individuals' sex and age as well as countries' economy, with appropriate time adjustments. Stratified analysis was conducted for three continents (Europe, Asia and America).

Results
The study included 28,340 individuals from 33 countries (female (71%), mean age=43.4, low and middle-income country (LMIC) (31%)). Overall, 30% of people with chronic diseases had difficulties getting non-COVID related care, compared to 24% of individuals with no conditions. Individuals with chronic conditions were around 1.6 times more likely to have trouble in healthcare access in Europe, America, and Asia. Older age was associated with fewer difficulties in healthcare access (in Asia and America). Females, compared to males, had around 30% and 50% higher odds of difficulties in access (in America and Europe, respectively). Finally, individuals from LMICs reported higher difficulties in getting care (OR = 1.64; 95% CI = 1.50-1.79).

Conclusions
We observed decreased service utilization in people with chronic diseases during the pandemic, with certain disparities across continents and country income. Future research should assess indirect health effects of the pandemic (i.e., morbidity and mortality of specific diseases). Public health efforts should be directed towards improving the resilience of health systems, healthcare access and delivery in emergency situations.

Key messages
Globally, around 1 in 3 individuals with chronic health conditions reported decreased healthcare utilization during the pandemic. COVID-19 impacts on healthcare utilization were more pronounced in low and middle-income countries, compared to high-income countries.
National cancer planning instruments in Europe and their developments
Authors: Albreht Tit 
Published: October 2021

Abstract
National cancer plans (NCPs) saw a strong push with the recommendation of the European Commission from 2009, which called upon Member States to adopt NCPs or national cancer strategies. This process resulted in rapid adoption of NCPs. Joint Action EPAAC developed the European Guide for Quality National Cancer Control Programmes in support of their preparation. Europe's Beating Cancer Plan poses a new task and challenge in the need to transpose its recommendations into the national cancer documents.
Telemedicine: first steps in a north-eastern Italian region during first year of pandemic
Authors: Antinolfi F , Deroma L , Moccia A , Lesa L , Grillone L , Virgili G , Lattuada L 
Published: October 2021

Abstract

Background
Covid-19 pandemic imposed searching for innovative solutions to ensure safety access to outpatient services. In March 2020 first cases were reported in Friuli Venezia Giulia (FVG) region, in Italy; in April 2020 FVG included teleconsultation in the healthcare offer. This study evaluated in-presence medical consultations (IPCs) delivered in FVG before and after first cases reported in region and correlation between IPCs, teleconsultations and new admissions to Covid-19 wards during pandemic.

Methods
IPCs were analysed dividing in pre (February 1st, 2019-February 29th, 2020) and post (March 1st, 2020-March 31st, 2021) Covid-19 emergency period and comparing mean months values with t-test. IPCs and teleconsultations delivered during emergency (March 1st, 2020-March 31st, 2021) were divided in months and correlated with new admissions to Covid-19 wards in the same period with Pearson test.

Results
IPCs delivered in pre-Covid-19 period compared with post were 1,105,823 vs 973,350 (-12%), peaking in October (98,980 vs 86,821; -12.3%) and minimum in April (82,061 vs 61,523; -25.1%). Pre-Covid-19 mean IPCs were significantly different compared to post (85,063 vs 74,873; p=.003). Focusing on emergency period, IPCs were negatively related to teleconsultations (973,350 vs 2140; r=-.43; p=.13). The negative correlation found between new admissions to Covid-19 wards (9154) and IPCs was weak and not significant (r=-.12; p=.69), while a positive and significant correlation was found between teleconsultations and new admissions to Covid-19 wards (r=.59; p=.03).

Conclusions
Results showed a significant reduction of post-Covid-19 IPCs compared to pre and a significant correlation between teleconsultations and new admissions to Covid-19 wards in FVG during first year of Covid-19 emergency. Contagion containment measures and fear probably influenced access to outpatient services while teleconsultation should be considered as an alternative to face-to-face during pandemic period.

Key messages
A reduction of in-presence medical consultations was found in a north-eastern Italian region during first year of pandemic. Teleconsultation could be a valid solution in case of increasing Covid-19 hospitalizations.
The concept of Knowledge Translation in relation to Burden of Disease
Authors: Pallari E , Hilderink HBM 
Published: October 2021

Abstract
The importance to bridge the gap between research and policy making has been widely recognised. Also, in the field of Burden of Disease, this gap exists. There are various terms used to define the dynamic process of synthesising, exchanging and applying generated knowledge into policy making. These are among other interchangeably used terms: knowledge translation, research utilization, implementation science, knowledge transfer or knowledge exchange, here referred to as knowledge translation (KT). The driver behind the systematic effort of KT is to bridge the gap between the generation of that knowledge and its application such as to improve public health. Among communication strategies to achieve KT include the engagement with policy and decision-makers for effective use of the findings into potential benefits for the health and wellbeing of the population. Other strategies, include the development of patient-public-involvement partnerships to communicate the findings with the public and create an open dialogue for further use of research results into practice. The focus of KT by researchers to date has mainly been on the ‘translation' of biomedical research, including findings from clinical trials, evidence from clinical practice guidelines, mixed-methods data on the development of implementation tools and other. However, similar findings on the translation of such evidence from burden of disease studies (BoD) have been non-existent. Potential reasons for this may have been challenges such as creating effective engagement strategies with appropriate stakeholders for the use of BoD findings, establishing a common methodological framework, difficulties in interpreting the findings for health-policy purposes, or miscommunication practices on the value and impact of BoD. Further, BoD methodological tools require specialist knowledge and interpretation of results into practice, hence, making KT even more challenging. Therefore, the prospect of developing a KT framework specifically for BoD remains an opportunity but also a pressing challenge.
Scottish Burden of Disease (SBOD) study: a population health surveillance system for meaningful action
Authors: Wyper G , Grant I , Fletcher E , De Haro Moro MT , McCartney G , Stockton DL 
Published: October 2021

Abstract
In 2012, planning began to launch the Scottish Burden of Disease (SBOD) study. The aim was to create a population health surveillance system to assess the impact of over 100 causes of disease and injury, and risks, measured by disability-adjusted life years (DALYs). The study has become a mainstay over the last five years as a tool to aid strategic and proportionate decision-making. In 2017, its scope expanded to highlight the extent of inequalities in DALYs by socioeconomic status. Additionally, it now provides comprehensive estimates for 14 regional Health Boards, which are responsible for protecting and improving the health of their local populations. It also provides estimates for 32 local government regions, which provide services related to the broader determinants of health, such as: education, social care and housing. To help turn findings from the SBOD study into action, push, pull and integrated efforts are used. Push efforts involve working together with publishing and communications leads to share key findings. These are commonly in the form of plain English and academic reports, summary briefings, social media messages and infographics. Key messages are also shared through television, radio and newsprint. Pull efforts have recently been improved to house estimates within interactive R Shiny dashboards, which contain user-friendly charts and easy to download data. Integrated approaches involve working with relevant national and local stakeholders, to help shape national and local priority setting. Findings from the study are being used by national and local government and health institutions. Third sector organisations are also key users of SBOD findings, particularly for health conditions that generate high-levels of ill-health, rather than mortality. In 2021, the study will publish an update, and increase capacity on integrated efforts to further embed the SBOD in national and local strategic planning.
Documenting experiential knowledge to enhance breast and cervical cancers screening uptake in France
Authors: Gaspard S , Georgelin B , Soudier B , Halfen S ,   IPCSP Project Steering Committee, Bouhier F , Berdougo F , Rush E 
Published: October 2021

Abstract

Issue
Improving uptake of Cancer Screening programs (CS) remains a public health priority in France, as stated in the latest national cancer control strategy. The French Society for Public Health designed in 2020 a project to document Interventions Promoting CS Participation (IPCSP) for vulnerable groups, for both breast and cervical cancers. This project provides experiential and practical evidence built up from IPCSP and offers relevant insights for the new strategy.

Methods
The project aims at capitalizing, i.e. collecting, documenting and circulating, experiential knowledge from practitioners who implement IPCSP locally (health professionals, social workers, grassroots organizations, etc.). The project consists in 3 main steps: 1/identify promising IPCSP through a nationwide call for applications; 2/ document the key mechanisms impacting how IPCSP unfold (context, partnerships, barriers and levers, ethics), 3/ publish a summary for each IPCSP, available online. The goal is to build up original knowledge from field actions, documenting how IPCSP tackle several factors that can hinder uptake, in various contexts.

Results
20 IPCSP were selected. IPCSP targets included: women of low-income neighborhoods, allophone women, inhabitants of healthcare deserts, handicapped persons, etc. Most IPCSP (16 out of 20) featured reaching out strategies, such as: peer education, on-site screenings, etc. All promoted informed choice. A cross-case analysis of IPCSP highlighted key, recurring implementation levers. One is co-constructing IPCSP throughout within local, multi-professional, long-standing partnerships, in which partners bring complementary skills: medical expertise, proximity with target populations, project management skills, community engagement skills, etc.

Lessons
20 detailed summaries will offer concrete data on how to put insights to enhance CS uptake into action. Other stakeholders and policymakers alike can benefit from experiential knowledge built up from IPCSP.

Key messages
Documenting interventions promoting uptake of breast and cervical cancer screening programs and detailing how they work is crucial to building knowledge and to helping enhance participation for all. Partnerships can provide effective, population-specific and context-specific levers to promote uptake of cancer screening programs in France. Co-constructing the intervention throughout is key.