bluuebunny/crossref_metadata_2025_split huggingface dataset:
Place of death in Europe: trends and associations in a 30-country panel (2005-2017)
Authors: Jiang J , May P 
Published: October 2021

Abstract

Background
End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time.

Methods
We aimed to collate population-level data on place of death in Europe for the years 2005-2017, and to evaluate association with national characteristics and policy choices. We sought outcome data from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analysed these cross-national panel data using linear regression with panel-corrected standard errors.

Results
Our analytic dataset included 30 countries accounting for over 95% of Europe's population and economic activity. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing hospital deaths in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths.

Conclusions
We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to curb worrisome trends in-hospital mortality. Data on places of death outside hospital can improve future research, policy and practice.

Key messages
Cross-national longitudinal analysis. Trends of hospital deaths in Europe, association between hospital mortality rate, palliative care and other healthcare factors.
Vitamin D status and its influencing factors among pregnant women in Szeged, Hungary
Authors: Paulik Edit , Horváth E , Szabó A , Polanek E , Gyurkovits Z , Németh G , Orvos H 
Published: October 2021

Abstract

Background
During pregnancy vitamin D plays an important role in maternal and fetal immune regulation as well. The aim of our study was to evaluate vitamin D serum level and its influencing factors among pregnant women and their newborns.

Methods
A cross-sectional study was performed among women delivering at the Department of Obstetrics and Gynecology in 2019. Altogether 301 women were included into the study, who filled the questionnaire one or two days after delivery. Data collection was based on a self-administered questionnaire, health documentation, and maternal serum and infant cord-blood vitamin D laboratory tests. Vitamin D intake was evaluated by dietary and vitamin D containing dietary supplement intake. Statistical analyses (descriptive statistics, chi square, Pearson's correlation, Kruskal-Wallis test) were performed with the IBM SPSS 26.0 program. The study protocol was approved by the Research Ethics Committee of the University of Szeged (number: 4419). Written informed consent was obtained from each participant of the study.

Results
The average maternal age of the included women was 33.28 years. More than half of women did not eat sea fish during the pregnancy, 66.3% drank daily milk, 51.5% ate daily yoghurt, and 30.2% used daily margarine as a spread. During pregnancy 77.6% of included women took some kind of vitamin D containing dietary supplement with which their average daily vitamin-D supplementation was 17.19 microgram (SD = 22.45 microgram). The average serum vitamin D level was 52.81 nmol/L in mothers and 72.96 nmol/L in newborns' cord-blood. Only 12.1% of mothers, and 43.1% of their newborns reached the optimal (75 nmol/L) level.

Conclusions
Our results showed that dietary and supplementary vitamin-D intake are insufficient among pregnant women, and consequently vitamin D serum levels are also lower than the optimal among mothers and their newborns, consequently.
Grant support: University of Szeged, Faculty of Medicine, Hetényi Géza Grant

Key messages
Low vitamin D level is a global public health issue. Vitamin D supplementation during pregnancy is important to maintain the optimal vitamin D serum level.
SARS-CoV-2: serological evidence of circulation in Southern Italy in late 2019?
Authors: Marchi S 
Published: October 2021

Abstract

Background
Italy has been one of the first countries hit by the COVID-19 pandemic. On 22 February, 2020, clusters of infection in Northern Italy were reported and transmission was assumed to be local. The presence of SARS-CoV-2 in wastewaters in Italy in late December 2019 suggested that the virus has been silently circulating before the first autochthonous case was identified. This study aimed to retrospectively assess the presence of antibodies against SARS-CoV-2 in a sample population from Southern Italy in the last months of 2019.

Methods
Human serum samples were collected from late September to the end of December 2019 in a local laboratory in the province of Bari, Apulia region, Southern Italy. A total of 455 samples were tested for SARS-CoV-2 IgA, IgM, and IgG by commercial ELISA. Samples with borderline or positive result for at least one antibody class were further tested by in house-ELISA for IgA, IgM, and IgG targeting the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2 and by micro-neutralization test (MNT).

Results
After commercial ELISA testing, 11 samples were positive for IgG, 3 for IgM, and 3 and 2 were positive and borderline for IgA, respectively. 8 samples (1.8%, 95% CI 0.8-3.4) were positive when tested by in house-ELISA: 5 (1.1%, 95% CI 0.4-2.5) for IgG and 3 (0.7%, 95% CI 0.1-1.9) for IgM. No samples were positive for in house-ELISA IgA or by MNT.

Conclusions
The results of this study showed that some samples collected before the first autochthonous case was detected in Italy had antibodies reactive to the RBD of SARS-CoV-2. The Apulia region has been less severely affected by the first epidemic wave than the northern regions; however, these results suggest the spread of SARS-CoV-2 in the population in the late months of 2019. Since the majority of SARS-CoV-2 infections does not require hospitalization, it is possible that many of these have gone unnoticed.

Key messages
The spread of SARS-CoV-2 in the Italian population could have already occurred in late 2019. The extent of SARS-CoV-2 infections in the population could be far greater than reported.
Pfizer-BioNTech vaccine side effects among healthcare workers in Malta
Authors: Cuschieri S , Borg M , Agius S , Souness J , Brincat A , Grech V 
Published: October 2021

Abstract

Background
COVID-19 vaccination is critical to protect healthcare workers (HCWs) from serious infection. The first vaccine approved for emergency use was the Pfizer-BioNtech vaccine. European countries received their first supplies at the end of December 2020. The European country of Malta started its vaccination roll-out immediately targeting HCWs. The aim of this study was to evaluate side effects.

Methods
An anonymous online Google Forms survey was disseminated to all HCWs via work e-mail addresses (29th March to 9th April 2021). This gathered demographic data and side-effects regarding pain, redness, and swelling at the injection site, fever, chills, fatigue, muscle/joint pains, headache, vomiting, and diarrhea severity following each dose (Likert scale). Descriptive, comparative, and multiple binary regression analyses were performed.

Results
There were 1480 responses (response rate 30.30%). The commonest side-effect (SE) was pain at the injection site (88.92% CI95%:87.21-90.42), with the majority reporting it as mild (51%) and moderate (43%). Fatigue reported by 72.97% (CI95%:70.65-75.17), with 42% reporting it as mild and 41% as moderate. Headaches reported by 44.28% (CI95%:41.74-46.80), with 51% claiming to be mild and 34% as moderate. Females had significantly (p = &lt;0.01 respectively) more pain (OR:1.90), redness (OR:2.49), swelling at the injection site (OR:1.33), fever (OR:1.74), chills (OR:2.32), fatigue (OR:2.43), muscle (OR:1.54) and joint pains (OR:2.01), headache (OR:2.07) and vomiting (OR:3.43) when adjusted for age and HCW role. Younger individuals (18-34 years) reported higher SE rates than older adults. Localised SE was reported following both vaccine doses, unlike systemic SE that was mostly reported following second doses.

Conclusions
Females and young adults appeared to be more susceptible to SE among this study's cohort, however the nature of these SE was mostly mild or moderate. This is encouraging and should allay vaccine apprehension/hesitancy.

Key messages
Vaccination benefits outweigh the minor side effects experienced. Caring physicians should be notified of the female higher susceptibility to side effects. Vaccination should be encouraged among all eligible population.
Educational Level Inequalities in Cardiovascular Outcomes and All-Cause Mortality in Turkey: A Cohort
Authors: Erkoyun E , Ünal B , Sakarya S , Sözmen K , Dinç Horasan G , Ekinci B , Ergör G 
Published: October 2021

Abstract

Background
Recent decades witnessed an increase in the burden of non-communicable diseases including adverse cardiovascular outcomes in low- and middle income countries and the burden was not equal across socioeconomic strata. This study aimed to define educational level inequalities in cardiovascular outcomes and all-cause mortality in a six-years cohort in Turkey.

Methods
Non-communicable Diseases and Risk Factors Cohort randomly sampled two adults (&gt;14) from each of the registered family physicians in Turkey in July 2011 (n = 18,477). The family physicians collected demographic data. Incident coronary heart disease (CHD), cardiovascular and all-cause deaths were obtained from electronic health records in the end of 2017. Ridit score transformation was applied to the educational level by gender (illiterate, primary school, secondary school, high school or higher) and then Relative Index of Inequalities by educational level were estimated using Poisson Regression for morbidity and Cox Regression for mortality.

Results
There were 17,847 participants in CHD and 18,461 in the mortality cohort. During six-years 1,026 cases were diagnosed with CHD, 185 cardiovascular and 769 all-cause deaths occurred respectively. The inequalities were not significant for all outcomes however Relative Index of Inequalities were close to be significant for CHD incidence among men and all-cause mortality among women (0.721 (0.507 to 1.025) and 1.721 (0.969 to 3.057), respectively).

Conclusions
This is the first-ever cohort in Turkey with the aim to define educational level inequalities in cardiovascular outcomes and all-cause mortality. The inequalities may not have been observed due to the low number of outcomes.

Key messages
In Turkey, there were no educational level inequalities in our cohort. The possible inverse inequalities among men and inequalities among women may arise with a longer follow up.
Socio-economic position and burden of ischemic heart disease in Finland in 2017
Authors: Paalanen L , Reinikainen J , Härkänen T , Tolonen H 
Published: October 2021

Abstract

Background
Ischemic heart disease (IHD) caused every fourth death in the European region in 2017. Furthermore, it accounted for about 12% of total disease burden estimated with disability adjusted life years (DALYs). DALYs summarize premature mortality (years of life lost, YLL) and morbidity (years lived with disease, YLD) in a specific cause. These disease burden estimates are customarily used to examine time trends or differences between countries or regions. However, they have seldom been calculated by socio-economic position (SEP), especially using individual-level SEP indicators.

Methods
We calculated DALYs for the Finnish 30+ year-old population in 2017. For YLL, we used Statistics Finland database for total population. For YLD, we used individual level data from the cross-sectional health examination FinHealth 2017 survey (n = 6538), which was linked with administrative register data. Population attributable fractions (PAFs) for selected IHD risk factors (smoking, blood pressure, total cholesterol and body mass index, BMI) were also calculated. Methodology published by the Global Burden of Disease study, such as disability weights for YLD and relative risks for PAFs, was applied where applicable.

Results
DALYs for IHD per 1000 population were 61.1 for men and 31.0 for women. Premature mortality (YLL) caused over 80% of DALYs. Burden of IHD morbidity (YLD) was higher in low education groups. In the total population, PAFs for IHD risk factors for men and women, respectively, were as follows: 17% and 8% for smoking, 56% and 58% for elevated systolic blood pressure, 25% and 28% for high cholesterol, and 27% and 24% for high BMI.

Conclusions
IHD morbidity was higher among low education groups. A large part of IHD burden was attributable to major cardiovascular risk factors, most markedly to elevated systolic blood pressure. In the future, the burden of disease could be increasingly assessed also by SEP.

Key messages
The burden of IHD in Finland was especially high among men, and majority of the burden was due to premature mortality. Over 50% of the IHD burden was attributed to elevated systolic blood pressure. Assessing the burden of diseases by socio-economic position provides a new perspective for examining socio-economic differences in health.
Improving Health through Green Deal and Climate Pact (motivation for WB Region)
Authors: Jevtic M , Belis C , Bouland C 
Published: October 2021

Abstract
The WB Green Agenda (WB GA) aims to implement the GD principles in this region and has defined five priority areas: climate, energy, mobility; circular economy, pollution reduction, sustainable agricultural and food production, and biodiversity. Some of the WB GA goals are strongly related to health: e.g. the continent's carbon neutrality by 2050, the ambitious climate policy, the reform of energy and transport sectors. The launch of the EU CP is an important opportunity for the WB to promote action in this area. For instance, promoting energy efficiency and supporting building renovation are directly related to the quality of life and hygiene of housing. Reduction or cancellation of coal subsidies as well as the region's withdrawal from the use of coal is of great importance for reducing externalities. In the WB, citizens are concerned about their health due to air, water and soil pollution and their reduction is in the common interest. To that end, it is necessary, inter alia, to: ratify the Convention on Long-range Transboundary Air Pollution and its protocols in each of the WB economies; to implement air quality strategies; and to strengthen air quality monitoring systems (and network accreditation). Appropriate processes are needed to reduce water and soil pollution, as well as to ensure the transformation of the agricultural sector. It is also necessary to harmonize the agricultural and food sector with EU standards for food safety, plant and animal health and environmental protection. To achieve the WB GA goals it is important to develop policy strategies based on the most up-to-date scientific studies for this region (JRC, 2020). On the basis of the analysis presented in this study we conclude that the processes associated with the GD and the CP will be of benefit for both individual and public health in the EU and in the WB.
Are public health experts providing useful information for the control of COVID-19 pandemic?
Authors: Bekker Marleen 
Published: October 2021

Abstract
The decision-making is always a complex process that should be based on best available scientific evidence and experts judgments. COVID-19 pandemic has added more complexity to this process, demanding a fluid, accurate and rapid respond from public health experts and science. This panellist together with the rest of speakers will help us to revise this process to identify possible gaps and space of future improvement.
2.P. Workshop: Disasters and mental health
Authors:   Organised by: EUPHA-CHR, EUPHA-PMH,   Chair persons: Martin McKee (UK)
Published: October 2021

Abstract

Objectives
To better understand the mental health impact of disasters in general and specifically the mental health health impact of the COVID pandemic.
Humanity has witnessed disasters of all forms and from all causes across the globe in recent decades; we have seen the consequences on people, their health and on their mental wellbeing. The presentations of the workshop will present knowledge to answer the following questions: Could we have known and planned for what to expect when a pandemic like this was to hit? How were people's lives really affected by this pandemic and the subsequent measures taken? We do know that COVID 19 as a disaster had a wider scale of social impacts than it did physical ones. How does the isolation, inability to work as usual and general downturn of ordinary life impact on people? What if those persons already have a history of serious life events or of mental illness? We search for answers to these and other questions in this workshop of 3 differing perspectives: First, Prof. Sandro Galea will present knowledge on disaster and mental health, second we will identify specific impacts on mental health on older persons (Jutta Lindert) and third a view point from practice will help to better understand perspectives of those involved in giving care in the community during times of disaster such as the Covid-pandemic (Julian Mamo).

Key messages
Disaster have not only short but as well long term impacts on mental health. Disaster specific factors can be identifed which contribute to mental health in the aftermath of the disaster.
Mental health impact of the COVID disaster on older people – how does it feel to be a burden?
Authors: Lindert Jutta 
Published: October 2021

Abstract
The coronavirus disease 19 (COVID-19) pandemic is a disaster that has impacted lives globally. The purpose of this paper is to understand the linkage between the COVID 19 disaster and its impact on mental health of older people 70+. To reach this aim we reviewed the literature on disasters, COVID and mental conditions of older people (70+). The mental responses of the COVID disaster are multidimensional and potentially long-lasting. Rates of mental conditions of older persons vary widely due to exposure to COVID, country, population groups and methods used when conducting the study. We identified a multitude of factors contributing to mental conditions in older people, in general. We identified COVID-19 specific factors which have an impact such as threat to own life and threat to life of loved ones, interruption of behaviors and services, and physical as well as social isolation. Additionally, in older age, life events and feelings of being a burden contribute to mental conditions. To better understand the long impact of the COVID disaster on older people`s mental health we need to understand also the impact of past life events which may exacerbate the impact of the COVID disaster on mental conditions as well the impact of the current exposure to the pandemic.
2.Q. Workshop: Intersex human rights and wellbeing - Part I: From frameworks to ethics and lived experiences
Authors:   Organised by: EUPHA-SGMH, EUPHA-ETH,   Chair persons: Arjan van der Star (EUPHA-SGMH), Els Maeckelberghe (EUPHA-ETH)
Published: October 2021

Abstract

Intersex newborns, children and adolescents frequently are subjected to not clinically necessary surgeries and other non-consensual treatments. According to the UN Factsheet Intersex, “Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies”. The intersex movement, international and regional human rights bodies, clinical practitioners, bioethicists and researchers have contributed reflections and recommendations related to intersex human rights, wellbeing, health and healthcare. International intersex activism demands, among other claims, the cessation of not clinically necessary surgeries and other non-consensual treatments performed on intersex newborns, children and adolescents, as well as access to clinical records, continued healthcare and psychosocial support. International and regional human rights bodies have supported these demands, calling on member states to prohibit not clinically necessary intersex-related surgeries. The discussion in the field of intersex studies includes the review of human rights and bioethical principles, clinical and research practices, as well as lived experiences, social circumstances and healthcare needs of intersex people. The workshop series “Intersex human rights and wellbeing” is structured in two parts “Part I: From frameworks to ethics and lived experiences” and “Part II: From ethics to healthcare approaches and experiences”. The first workshop in the series aims at exploring theoretical frameworks, ethical aspects in intersex research and lived experiences of intersex people. The presentations provide a review of the human rights framework (Presenter: Morgan Carpenter, Australia), the presentation of a European research project on intersex wellbeing and rights (Presenter: Dr. Surya Monro, United Kingdom), reflections on relevant ethical aspects in intersex studies (Presenters: Dr. Amets Suess Schwend and Yessica Mestre Martínez, Spain), as well as the presentation of research projects on the lived experiences of intersex youth in Aotearoa /New Zealand (Presenter: Dr. Denise Steers, Aoteearoa/New Zealand) and cultural aspects in intersex healthcare in Italy (Presenter: Marta Prandelli, Italy).

Key messages
The protection of intersex people’s human rights, health and wellbeing requires a critical review of current clinical and research practices. Human rights frameworks, bioethics, public health approaches and social sciences can provide relevant contributions to this discussion.
Introducing intersex wellbeing and rights and the INIA programme
Authors: Monro S , Suess Schwend A , Aegerter A , Keating A , Mestre Y , Gramc M 
Published: October 2021

Abstract

Background
Intersex people are exposed to human rights violations all over the world. Ongoing practices of sex-normalising surgery and other medical interventions on minors too young to give informed consent encroach on their bodily autonomy. Little is known about the public health implications of bodies with variations of sex characteristics (VSC). What key issues do VSCs raise?

Methods
In 2020 the INIA international consortium began work on a large research programme to address intersex people's wellbeing and human rights from a variety of new and innovative perspectives. The programme will train a cohort of 10 early-stage researchers working collaboratively to develop knowledge that will inform policy making and practice across a range of key sectors. Drawing on critical intersex studies, the research projects are relevant to stakeholders who are concerned with supporting the wellbeing and rights of intersex people through knowledge sharing and development. The project received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 859869. Please see https://www.intersexnew.co.uk/.

Results
Indicative findings show that VSC could be an important area of public health work concerning diversity and equality. Early-stage results show a dearth of intersex visibility in key areas including social policy, education, and elder care. Intersex people and those with VSC face major health challenges and discrimination. There is a pressing need for appropriate healthcare.

Conclusions
The interdisciplinary INIA programme surfaces multiple discourses about intersex people and those with variations of sex characteristics. Projects of particular interest to public health practitioners and policy makers include those concerning multi-disciplinary healthcare, ethics, social policy, education, aging, and service user participation.