bluuebunny/crossref_metadata_2025_split huggingface dataset:
When childbirth turns red: the post-partum hemorrhagic emergency
Authors: Lorenzini C , Napolitani M , Rosano G , Alaimo L , Nante N 
Published: October 2021

Abstract

Background
WHO affirms that post-partum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide. The first step to recognize, prevent and diagnose this complication is to define it. The aim of this work is to identify risk factors for PPH.

Methods
A case-control study was conducted at the Hospital of Siena (Italy), including all females who have given birth from 2016 to 2018. In relation to presence of PPH (blood loss of ≥ 500 ml), the sample was divided into two groups. Analyzed variables were: age, parity, use of epidural, stimulation of labour with oxytocin or prostaglandins, episiotomy, manual removal of the retained placenta, medically assisted procreation (MAP), fetal weight, pre-pregnancy BMI (body mass index), placental localization and gestational age (GA). Statistical analysis was carried out using Stata 14.

Results
The sample was composed of 1490 women: 56% nulliparas, 18% had epidural, 34% had broken membranes, 22.6% had stimulation of labour, 1.5% had MAP. 8% older than 40 years, 32% of babies were ≥3500g; 5.1% had BMI ≥30; 11.2% had episiotomy; 2% had manual removal of the retained placenta, 3% had lateral placenta, 47.5% had GA ≥ 40th weeks. PPH occured in 15%; mostly in nulliparas (17.7% vs.12.4% p &lt; 0.01), those that used epidural (20% vs. 14.5%¸ p &lt; 0.05), MAP (32% vs.15.2%; p &lt; 0.05), those had manual removal placenta (71.9% vs.14.4%, p &lt; 0.05)in mothers of babies ≥3500g (21% vs. 13%; p &lt; 0.05), in those with BMI ≥30 (27% vs. 15%; p &lt; 0.05), those with lateral placenta (26% vs. 12.3%; p &lt; 0.05), and GA ≥ 40th weeks (17.3% vs. 13.6%; p &lt; 0.05).

Conclusions
PPH is one of the most studied obstetric emergencies being the leading cause of maternal mortality in the world. It is important to closely monitor during labour and childbirth to modify risk factors where possible.

Key messages
Postpartum bleeding is an obstetric emergency that causes mortality and morbidity in pregnant women. There are no effective treatments yet, so it is important to recognise the associated risk factors and prevent them.
9.P. Workshop: Impact of COVID-19 pandemic and containment measures on the mental health in youth
Authors:   Organised by: EUPHA-PMH, EUPHA-CAPH,   Chair persons: Jutta Lindert (EUPHA-PMH), Lourdes Cantarero Arevalo (Denmark)
Published: October 2021

Abstract

The Coronavirus pandemic is an unprecedented public health crisis impacting all age groups and all areas of society, irrespective of the risk of exposure or disease severity. In fact, containment measures put into place, such as social distancing, limiting mobility or closing of schools, carry risks for health, especially for mental health. This is particularly true for youth, defined as the age-group that spans from adolescence into young adulthood (15 - 24 yrs.). In this life phase youth are expected to acquire important social and intellectual skills, make decisions on their professional path, as well as master the transition from adolescence into young adulthood. It is further characterized by increasing independence from family and a high relevance of peer-groups. While this age group is so far not considered to be at high risk for serious SARS-CoV 2 disease, the epidemiological data indicating high incidence, but mostly mild symptoms and a low mortality risk, they are impacted by containment measures and concern for their parents and grandparents. First evidence indicates a rise in mental health problems with potential long-term impact. We present four studies with data collected during the lock-down or pandemic, of which three are set in the setting “tertiary education”. The workshop presents data from four European countries. While the first three studies present cross-sectional and longitudinal data on mental health outcomes in students during the pandemic and the uptake of treatment, the fourth presents qualitative data on coping mechanisms applied by youth.

Key messages
Young people are at risk to develop short and long-term mental health conditions due to the abrupt changes and challenges in their lives due to the Corona pandemic. Academic institutions offer a setting to reach young people, to provide low-threshold support and strengthen resilience to reduce the pandemic impact on young peoples’ health.
Spanish adolescents’ and young adults’ coping strategies under severe lock-down due to COVID-19: a dialogical research study
Authors: Arevalo L Cantarero 
Published: October 2021

Abstract

Background
During spring of 2020, millions of young adults throughout the world were sent home as a measure to contain the spread of COVID-19. In March 2020, Madrid became the city of the world with the highest incidence and mortality rates. By applying a phenomenological approach, this study aimed at gaining in-depth understanding of the subjective mental health experiences lived by Spanish young adults.

Methods
dialogical research was used to interact with AYA and young adults. AYA were recruited using the network of networks and snowball strategies. 36 were initially contacted and 35 decided to participate. All participants were informed of their right to stop the dialogue at any time without providing any further explanation to the researcher, and were informed of the data protection rules of the University of Copenhagen. All signed an informed consent. The 35 dialogues were held online using Zoom, recorded and saved in a secured folder.. The dialogues lasted on average 55 minutes, were transcribed with Nvivo Transcription software. The sociological theory on Resonance was used to shape specific segments of the dialogues and to analysis the data.

Results
35 online dialogues with 20 adolescent girls and 15 adolescent boys aged from 17 to 23 were held from the second to the 28 of April 2020. The majority of youth did not leave their residences for 2 months. Three of them lost relatives due to COVID-19, one was admitted at the hospital and seven had relatives who contracted the disease. Different themes were brought up: 1) AYA' relations with their physical spaces and with time. 2) Relating with others. 3) Strategies to overcome sense of alienation, loss and fear and to re-find resonance. AYA living with chronic or mental diseases realized the importance of developing supportive habits and of adhering to treatments.

Conclusions
Dialogical research allowed youth to reflect upon their experiences and abilities to cope with the shock a provoked by COVID-19.
Pharmaceutical expenditure: what has changed in ten years in Italian Health Care System?
Authors: Scattaglia M , Lenzi J , Gianino MM 
Published: October 2021

Abstract

Introduction
In the last 20 years, Italian pharmaceutical policies have moved to contain public expenditure. This study analyses the trajectory of retail pharmaceutical expenditures to investigate whether there has been a switch from public to private expenditure, how the composition of private and public expenditure has changed, and whether there are correlations with supply/demand variables. These research questions have received little attention in the literature.

Methods
This study used secondary data from Italy covering the period 2010 to 2019. A time-trend analysis was performed using the average annual percent change (AAPC) as the summary measure for the rate of change over the period 2010/19. The AAPC was estimated by fitting a linear regression model for the logarithm of each aggregate indicator. Kendall's τ coefficient investigates the correlation between the 2010-19 pharmaceutical expenditure items and other relevant health statistics (ages, categories of practising physicians, Gini coefficient, etc.).

Results
Italy's public pharmaceutical expenditure did not change significantly between 2010 and 2019 (AAPC = +0.03%, 95% CI = -1.4% to + 1.4%), nor did private spending (AAPC = +0.6%, 95% CI = -0.2% to + 1.3%). Public expenditure without the direct distribution of drugs in class A experienced a slowdown (-3.9%), and public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). The regression analysis evaluates the relationship between supply/demand variables and pharmaceutical expenditures. A significant result relates to the positive correlation between income inequality and out-of-pocket expenses for over-the-counter drugs (τ = 0.62, p-value = 0.046).

Conclusions
Pharmaceutical spending has increased over time, especially for drugs reimbursable by the NHS but paid for by citizens. This could be an alarm for a public healthcare system that should be able to guarantee healthcare services to all citizens.

Key messages
Public expenditure with the direct distribution of drugs in class A exhibited a significant increase (+8.4%). There has been increasing expenditure on drugs reimbursable by the NHS but paid for by citizens.
Comparing provider payment adjustments across 20 countries during COVID-19
Authors: Waitzberg RW , Quentin W , van Ginneken E ,   HSPM Network
Published: October 2021

Abstract
COVID-19 has affected health providers economically in two main ways. First, some providers lost income due to postponed services or patients refraining from seeking care. Second, other providers took on new tasks by treating (high volumes of) COVID-19 patients. All providers faced higher costs due to new hygiene and distance requirements. We reviewed if and how countries have adjusted payments to health providers during 2020 using an analytical framework and data from 20 countries. The analysis is based on information collected in the COVID-19 Health System Response Monitor (HSRM) and complemented by grey literature by country representatives who are experts on health policy and have reported the developments and responses to the pandemic since is very onset.
We found that payments were not adjusted for many providers whose income did not depend on activity such as salaries, capitations and budgets. Most of the compensatory payments were in the form of new salaries and budgets that substituted activity-based payments, and some higher fees to compensate for activity shortfalls. New FFS payments were created to incentivize virtual services. Payments for COVID-19 related costs included mainly new fees for services. Hospitals also received new budgets to cover the costs of adjusting wards, creating new (ICU) beds, and hiring more workforce. Some countries also created new per diem and DRG tariffs to pay for COVID-19 patients. Consumables such as personal protective equipment and hygiene material were provided in-kind or reimbursed in-cash. Overall, governments bore many COVID-19 financial risks. Payment adjustments should be carefully designed in order to protect providers from income shortfalls without undermining productivity, access or quality of care. Payments for COVID-19 services should promote provision without leading to overtreatment or overspending.
Social Health Insurance country responses to the COVID-19 pandemic
Authors: Schmidt A , Winkelmann J , Merkur S 
Published: October 2021

Abstract

Background
Pandemic response is largely also driven by organization and governance of health systems. In countries with social health insurance (SHI) systems, pluralism of actors and decentralisation may represent a particular challenge in crisis times.

Objectives
We aim to present a comprehensive analysis of the health system responses during the COVID-19 pandemic of eight SHI countries: Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland. The question at the centre of the analysis is how SHI funds and defining characteristics of SHI systems have shaped pandemic response and which lessons to draw from the experiences of the first wave (spring to autumn 2020).

Results
Our analysis highlights key characteristics driving pandemic response common across SHI countries, particular the level of (de)centralization of responsibilities and providers and the role of SHI funds (compared to other actors). Five key themes emerged: governance, SHI fund sustainability, the role of GPs, surveillance strategies and (essential) health service provision. We found that SHI funds were not represented in crisis management teams during the pandemic in the majority of countries analysed. Responsibility partly shifted towards central government and away from the SHI funds.

Conclusions
Decentralization may pose significant challenges among local authorities with regard to the coordination of policies and information system flows. At the same time, decentralized pandemic management may be favourable as it supports bottom-up self-organization of ambulatory care providers. In fact, coordinated ambulatory care often helped avoid overburdening hospitals in the countries analysed.
Economic evaluation of the LTVEEG-m for refractory epileptic patients
Authors: Garcia-Lorenzo B , Becerra-Cuñat JL , Rocamora R , Dávalos A 
Published: October 2021

Abstract

Long-term video-EEG monitoring (LTVEEG-m) is the diagnostic test of certainty of epilepsy. The European Commission recommends one epilepsy unit with LTVEEG-m for every 3,000 patients with refractory epilepsy. In Spain, there was one center accredited every 10,600 patients with RE in 2019. There are different publications on LTVEEG-m about clinical effectiveness; however, very scarce scientific evidence has been shown on the efficiency of using of LTVEEG-m. This study aims to conduct an economic evaluation of the LTVEEG-m versus no LTVEEG-m (continuing with anti-sei¬zure drugs) in RE patients, which should support funding decision-making of the LTVEEG-m in Spain. Based on a prospective cohort of patients referred for refractory epilepsy for LTVEEG-m in the epilepsy unit of the Germans Trias i Pujol Hospital, a cost-effectiveness analysis was conducted using a decision tree followed by a Markov model which simulated the costs and health outcomes of individuals treated under both alternatives (LTVEEG-m vs. no LTVEEG-m) for a lifetime horizon from a hospital perspective. The effectiveness measure was quality-adjusted life years (QALYs). An extensive sensitivity analyses was run, including a probabilistic sensitivity analysis. In the base case analysis, the LTVEEG-m led to higher QALYs and health care costs with an estimated mean incremental cost of 17,472 EUR and an incremental effectiveness of 8 QALY s, generating an incremental cost effectiveness ratio of 2,175 EUR per QALY, a lower figure than the cost effectiveness threshold of 20,000 EUR per QALY in Spain. The sensitivity analysis showed the robustness of the results. The probability that LTVEEG-m is a cost-effective technology against the no LTVEEG-m was 100%. LTVEEG-m is an efficient diagnostic test compared to not use the LTVEEG-m and continuing with anti-sei¬zure drugs. This is a pioneering study in Europe and scalable to other similar economic contexts to Spain.

Key messages
There is a huge lack of epilepsy units using the LTVEEG-m as a diagnostic test of certainty of epilepsy for refractory epileptic patients in Spain, disregarding the European recommendations. LTVEEG-m is an efficient diagnostic test compared to not use the LTVEEG-m and continuing with anti-sei¬zure drugs. This is a pioneering study in Europe and scalable to similar Spanish economic context.
Trajectories of sickness absence and disability pension by type of occupation in multiple sclerosis
Authors: Bosma A , Murley C , Aspling J , Hillert J , Schaafsma F , Anema J , Boot CRL , Alexanderson K , Machado A , Friberg E 
Published: October 2021

Abstract

Background
Multiple sclerosis (MS) can impact working life, sickness absence (SA), and disability pension (DP). Different types of occupations involve different demands, which may be associated with trajectories of SA and DP among people with MS (PwMS). We aim to explore if annual levels of SA and DP differ according to type of occupation among PwMS and references. Further, we aim to gain knowledge of how trajectories of SA and DP are associated with type of occupation among PwMS.

Methods
A nationwide Swedish register-based prospective cohort study with six-year follow-up was conducted, including 6,100 individuals with prevalent MS and 38,641 matched population references. Mean annual SA and DP net days during follow-up years were calculated and stratified by type of occupation. Trajectories of SA and DP were identified with group-based trajectory modelling. Multinomial logistic regressions were estimated for associations between identified trajectories and different types of occupations.

Results
An increase of SA and DP over time in all types of occupations was observed in both PwMS and references, with higher levels of SA and DP among PwMS. Managers had the lowest levels of SA and DP in both groups. Three SA and DP trajectory groups were identified: Persistently Low (55.2%), Moderate Increasing (31.9%), and High Increasing (12.8%). Managers (Odds Ratio [OR] 0.37, 95%CI 0.26-0.52) and those working in Science & Technology (OR 0.64, 95% CI 0.50-0.82) had less probability of belonging to the Moderate Increasing group. Similarly, Managers (OR 0.52, 95%CI 0.30-0.89) and Science & Technology (OR 0.58, 95%CI 0.39-0.88) had also less probability of belonging to the High Increasing group.

Conclusions
Our findings suggest that the type of occupation plays a role in the level and course of SA and DP among PwMS.

Key messages
Over time SA and DP levels increased among PwMS regardless of type of occupation. PwMS in Managers or Science and Technology had less probability of belonging to the increasing trajectories.
Portuguese validation of the Adult Carer Quality of Life Questionnaire (AC-QoL)
Authors: Teixeira F , Moura A , Alves E 
Published: October 2021

Abstract

Background
Assuring informal carers' quality of life (QoL) must be a priority for public health policies and practices. The Adult Carer Quality of Life Questionnaire (AC-QoL) is a recent and valid instrument, overpassing limitations of previous tools, and being already used among informal stroke carers. This study aimed to assess the feasibility, reliability and validity of the AC-QoL among Portuguese informal carers of stroke survivors.

Methods
The linguistic adaptation of the AC-QoL was performed. Informal carers (n = 212) of stroke survivors hospitalized between September 2018 and August 2019 in all Stroke Units of the North of Portugal (n = 12) were invited to participate, 18 to 24 months post-stroke. Data on sociodemographic characteristics, psychological profile, burden and QoL were collected using a structured questionnaire. The psychometric properties of the AC-QoL were investigated through exploratory and confirmatory factor analyses. Cronbach's alpha was used to measure internal consistency. Construct validity was assessed through the association of the overall score of AC-QoL with anxiety and depressive symptoms, burden and sociodemographic characteristics.

Results
Exploratory factor analysis supported the original eight-factor structure of the AC-QoL, revealing an adequate goodness of fit to the study sample (X2(674)=1145.926; CFI=0.916; TLI=0.908; RMSEA=0.058). The AC-QoL showed a high degree of reliability, with Cronbach's scores for the subscales ranging from 0.64 to 0.97 and a Cronbach's alpha of 0.91 for the overall score. Anxiety symptoms (p &lt; 0.001), depression symptoms (p &lt; 0.001) and burden (p &lt; 0.001) were inversely associated with the overall score of AC-QoL. Younger (p = 0.032) and employed (p = 0.021) informal carers presented more frequently higher scores of overall QoL, than those older and unemployed.

Conclusions
The Portuguese version of the AC-QoL is a comprehensive, simple, reliable and valid instrument to assess informal stroke carers' QoL.

Key messages
The Portuguese version of the AC-QoL is a comprehensive and valid instrument with a high degree of reliability, that can be briefly and easily applied to informal carers of stroke survivors. A comprehensive and brief assessment of informal carers’ QoL will contribute to devise strategies to promote well-being and social integration of stroke survivors and their informal carers.
COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease
Authors: Cardwell K , O'Murchu E , Byrne P , Broderick N , O'Neill S , Smith SM , Harrington P , O'Neill M , Ryan M 
Published: October 2021

Abstract

Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.

Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.

Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.

Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.