bluuebunny/crossref_metadata_2025_split huggingface dataset:
Green and blue spaces residential exposure over childhood and multimorbidity in adolescence
Authors: Santos S , Bruns C V , Pereira R , Araújo B , Ribeiro A I , Barros H 
Published: October 2024

Abstract

Background
Previous studies have explored associations of exposure to natural spaces with specific adverse health outcomes over childhood. However, knowledge is lacking on its effects on multimorbidity, defined as the co-occurrence of two or more diseases in the same individual. We aimed to assess the associations between exposure to green and blue spaces, at multiple time points and through trajectories over childhood, with multimorbidity in early adolescence.

Methods
In 2388 children from the Generation XXI birth cohort, we assessed, at birth, 4, 7 and 10 years, the residential greenness through the Normalized Difference Vegetation Index (NDVI), the distance from the child’s residence to the closest green and blue space, and the presence of green and blue space (&gt;5,000m²) within 300m distance from the child’s residence. We identified, from birth to 10 years, longitudinal trajectories of exposure to green and blue spaces, using latent class mixed models. At 13 years, participants were classified as having 0, 1 or ≥ 2 cardiometabolic, respiratory and/or neurodevelopmental adverse health outcomes. Adjusted multinomial logistic regression models were used.

Results
The prevalence of multimorbidity at 13 years was 43%, with overweight/obesity (35%), allergies and asthma (30%), and dyslipidemia (26%) as the most common adverse health outcomes. We observed that the presence of green spaces &gt; 5,000m² within a distance of 300m at birth, 4, 7, and 10 years was associated with lower odds of developing multimorbidity (Odds Ratio (OR) [95% CI] 0.55 [0.32-0.95]; 0.52 [0.32-0.84]; 0.51 [0.32-0.82]; 0.51 [0.32-0.80], respectively). No other significant associations were observed.

Conclusions
Green spaces around the child’s residence seem to have a protective effect on the development of multimorbidity at 13 years. These findings reinforce the importance of urban design, and the creation of green spaces close to residential areas to optimize health across childhood and adolescence.

Key messages
• The prevalence of multimorbidity at 13 years is high and worrying.
• Increasing accessibility to green spaces might decrease the risk of multimorbidity in adolescence.
“We must make sacrifices” - coping among left-behind adolescents in Georgia after parental migration
Authors: Antia K , Winkler V , Berner Rodoreda A 
Published: October 2024

Abstract

Background
Adolescence is challenging, particularly for those left-behind in their countries of origin while parents out-migrate for work. The Eastern European country Georgia has one of the highest percentages of left-behind children and adolescents worldwide, yet how they cope with migratory separation remains unknown. This study is the first to explore strategies of Georgian left-behind adolescents to cope with parental absence.

Methods
From December 2021 to January 2022, we conducted 29 narrative interviews with left-behind adolescents aged 12-18 in Georgia. We purposively sampled participants from a relatively large public school in the Samegrelo region, the second-largest region of Georgia. Interviews were audio-recorded, transcribed, and coded using NVivo 12. Resilience theory underpins this study, and reflexive thematic analysis is applied to identify main themes and sub-themes.

Results
Under the overarching theme of coping and resilience, we identified the following four main themes: (1) the time dimension (2) family connectedness (3) positive attitudes and self-care (4) social interactions beyond the family. Our findings revealed that adolescents whose parent(s) migrated when they were toddlers coped well, while children aged 6-10 felt heavily affected and vulnerable. Closeness with the migrant parent, siblings, caregivers, and other family members was crucial for children’s coping. Self-care, self-encouragement, and positive attitudes helped them overcome negative emotions related to parental absence. Awareness of parents’ motivation to migrate and appreciation of material benefits positively contributed to adolescents’ coping and resilience. In addition, those with many friends coped better and were more resilient than socially less active peers.

Conclusions
Self-motivation, positive attitude, supportive family, and social interactions help left-behind adolescents to cope with negative emotions related to parental absence.

Key messages
• left-behind children especially at the age of 6-10 need support to cope with migratory separation.
• Interventions are needed to strengthen family ties and support children in intensifying social interactions beyond family.
Long-Term exposure to NO2 and Stroke Mortality in Portugal: an ecological study from 2001 to 2021
Authors: Morgado J , Martins C , Martins R , Jardim B 
Published: October 2024

Abstract

Background
Air pollution is an important contributing factor for many pathologies, including stroke. Nitrogen dioxide (NO2), an air pollutant, has been associated in multiple studies with strokes’ mortality.

Aim
This study aims, for the first time, to estimate the number of deaths by stroke due to long-term, ambient exposure to nitrogen dioxide in Portugal for the years 2001-2021.

Methods
An ecological study was considered, including data for NO2 outdoor concentration from Portugal. Mortality data by stroke was obtained divided in 5-year groups. It was also obtained life expectancy for each year to calculate the years of life lost (YLL). The hazard ratio (HR) was obtained from literature (1.009, CI 1.003-1.016). The population attributable fraction (PAF) of YLL by stroke due to ambient NO2 long-term exposure was calculated.

Results
The annual average NO2 concentration in Portugal decreased from its peak in 2001 of 29.4 to 12.2 µg/m3 in 2021. The YLL by stroke decreased from an estimated 57452 to 31204 from 2001 to 2021. The PAF of YLL by stroke due to ambient NO2 long-term exposure reached its peak in 2001, when an estimated 5.2% of all the YLL by stroke, corresponding to 3029 YLL, were due to NO2 exposure and a bottom in 2021, when 2.2%, corresponding to 682 YLL, where due NO2 exposure.

Conclusions
The policies and legislation implemented to curb down NO2 seem to have had an effect in Portugal. A reduction in NO2 emissions was achieved, having a significant impact on YLL by stroke in Portugal, suggesting that curbing the NO2 emissions down had a positive effect on mortality by stroke in Portugal. To further enhance our knowledge on the real impacts of NO2, further studies must be conducted to estimate the morbidity associated with NO2 on stroke as well as in other diseases.

Key messages
• Pollution by nitrogen dioxide decreased significantly from 2001 to 2021.
• Around 20000 years of life were lost just in Portugal due to nitrogen dioxide between 2001 and 2021.
Factors Affecting Household Health Expenditures: Evidence from Iran
Authors: Jalili F , Akbari A , Karami Matin B , Soofi M 
Published: October 2024

Abstract

Background
Productivity plays a crucial role in driving economic growth, and its primary determinant is human capital. Human capital, in turn, is influenced by health and education investments, leading both households and governments to allocate substantial resources toward these sectors. Understanding the factors influencing health expenses is vital for designing effective policies.

Methods
This study investigates the factors affecting health costs by analyzing data from various provinces in the Islamic Republic of Iran, spanning from 2006 to 2019. The data, sourced from the Statistics Center of Iran, was analyzed using the panel data approach to uncover the relationships between health expenditure and several key variables.

Results
The analysis revealed significant disparities in health expenditure among provinces. Sistan & Baluchestan had the lowest health expenditure per household, while Tehran reported the highest. Inflation emerged as a significant factor, having a negative impact on health expenses due to its influence on purchasing power. Conversely, the education and salary of household heads had a positive impact on health expenditure. Notably, economic growth did not exhibit a significant relationship with health expenses.

Conclusions
The study highlights the importance of education and income levels in shaping health expenditures, while inflation can curtail spending on health due to reduced purchasing power. Policymakers should consider these factors to ensure equitable and effective allocation of health resources.

Key messages
• Improving health and well-being, essential for comprehensive progress and human development, relies significantly on household health expenditure.
• The efforts to enhance human capital should focus on reducing inflation.
Burden of disease due to road traffic noise in Flanders, Belgium
Authors: Pauwels A , De Clercq E M , Demoury C , Devleesschauwer B 
Published: October 2024

Abstract

This study estimates the disease burden of ischemic heart disease (IHD), stroke and diabetes mellitus attributable to road traffic noise in the Flemish Region (Belgium) for the year 2020, expressed in disability-adjusted life years (DALYs). The research proposes an approach to stratify population exposure to noise according to age and sex, which allows to examine internal differences in noise burden related to both varying risk and baseline burden. Stratification of population exposure to noise is achieved by (1) linking modelled noise exposure to age- and sex-stratified population data at small area-level, (2) dividing the prevalence in each exposure class proportionally over the strata, and (3) aggregating the small areas to a Flemish total per stratum. Annual day-evening-night level exposure is translated into the fraction of attributable burden relying on relative risks (RR) from the WHO’s Environmental Noise Guidelines and more recent studies. Baseline burden for the three outcomes is sourced from the Belgian National Burden of Disease Study. The lower and upper bound of the RR’s 95% confidence interval (CI) are used to calculate the uncertainty range on the burden estimates. The total noise DALYs estimated are 1092 (95% CI: 135, 2061) for IHD, 761 (379, 1017) for stroke, and 671 (486, 918) for diabetes. Noise burden rates rise steeply with age for all outcomes, although the wide CIs on the IHD estimates prevent to ascertain a significant trend. The IHD burden is twice as high in men as in women, while both sexes are almost equal for the other outcomes. The variations between age and sex groups are largely explained by differences in baseline burden, as exposure is fairly constant across strata. This study estimates age- and sex-stratified disease burden attributable to noise traffic in Flanders, Belgium. As differential exposure between the population subgroups is limited, any variation in noise DALYs is mainly related to stratum-specific baseline burden.

Key messages
• Road traffic noise is responsible for hundreds of healthy life years lost in Flanders, Belgium.
• The noise burden for stroke and diabetes rises sharply with age, and the burden for ischemic heart disease is twice as high in men as in women.
Prevalence of potentially inappropriate medication use in the older population living in Germany
Authors: Sarganas G , Grams D , Ordoñez-Cruickshank A , Fuchs J , Neuhauser H , Gaertner B , Thuermann P 
Published: October 2024

Abstract

Background
Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany.

Methods
Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented.

Results
96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline).

Conclusions
PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level.

Key messages
• PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level.
• Strategies to promote and monitor appropriate medication use are needed.
Exploring the dynamics of alcohol use, poverty and the role of social context in Athens, Greece
Authors: Kyriakidou S , Temenos C , Henry C , Paparrigopoulos T , Triantafyllou K 
Published: October 2024

Abstract

Background
A body of research conducted across diverse national context, including the United Kingdom, Russia, Denmark and Norway, shows a robust link between poverty and increased alcohol related harm, even after accounting for different drinking patterns. This paper examines the unexplored relationship between poverty and alcohol use in Athens, Greece, focusing on alcohol’s impact related to the familial and social life of individuals and whether this system is affected by poverty.

Methods
This is a 2021 cross-sectional study, with 300 adult participants of mean age 45.8. We administered four questionnaires. The participants were equally distributed above and below the poverty threshold, sampled randomly. The latter were beneficiaries of social services. The data analysis established two scoring variables: the level of dysfunction from alcohol use and the level of strength of family ties. We computed their correlation and multiple linear regressions to assess their relationships.

Results
Individuals not residing in poverty exhibit a higher frequency of alcohol use (81.9%) than their counterparts (57.1%), however, those living in poverty tend to consume greater quantities of alcohol per occasion (p &lt; 0.001) and reported elevated levels of dysfunction within familial and social interactions.

Conclusions
This study indicates that different consumption patterns are tied to diverse socioeconomic strata, with binge drinking behaviours specifically linked to financial hardship. Also, alcohol related dysfunction and family and social dynamics are affected by poverty. Our findings show that as dysfunction attributed to alcohol use increases, participants socialize less and report lower levels of well-being. In contrast those with balanced family ties and social encounters exhibit the opposite trend. This study warrants further exploration in cities in Southern Europe.

Key messages
• To mitigate alcohol use, policies empowering social and familial connections are of high importance.
• Uncovering poverty as a factor for binge drinking can inform prevention strategies.
Optimizing Colorectal Screening in Portugal with Process Mining
Authors: Monteiro H , Oliveira M , Reis J , Tavares F 
Published: October 2024

Abstract

Background
Efficient healthcare screening programs management influences patient outcomes. Process mining has emerged as a powerful tool to enhance these programs by refining complex workflows and pinpointing operational deviations.

Objectives
This study utilizes process mining techniques to analyze the colorectal cancer screening program in Northern Portugal, focusing on detecting deviations and performance bottlenecks in process models.

Methods
This screening program started in March 2018, but process mining was only used on data posterior to 2020. Over 1 million case observations from administrative data were included in the process model analysis, involving more than six key process activities and numerous resources. We used new software and statistical tools for process mining to rapidly compute observations and filter for different operational needs and monitor interventions.

Results
The discovery analysis identified deviations, such as unexpected performance issues and irregular activity sequences. Although over 100 traces were identified, fewer than five traces accounted for more than 90% of all case paths, indicating the most common traces that have a true impact in participation rates, referral rates, and treatment rates. Notable differences in resource performance during specific periods, such as COVID-19 or seasonal events, were also observed. These findings provided insights for adjusting resource allocation and improving coordination, with impact in minimizing seasonal phenomena or peak production periods.

Lessons
Process mining offers actionable insights for effective health program coordination, enabling the monitoring and timely response to process deviations. With key areas for action identified in a more timely and precise manner, we can enhance efficiency, and expand population coverage and treatment referral. Future initiatives will focus on further process optimization and national coverage expansion using these management tools.

Key messages
• Process mining revolutionizes healthcare by enabling the strategic management of complex oncological screening program workflows.
• Comprehensive data analysis across the patient pathway enhances program efficiency and expands treatment access.
Associations of adolescent academic performance, sports, disordered eating, and menstrual dysfunction
Authors: Moro S , Holopainen E , Kosola S 
Published: October 2024

Abstract

Background
Regular menstruation is a crucial indicator of comprehensive well-being in adolescents. We aimed to assess risk factors associated with menstrual cycle dysfunction in a population-based cohort of high school students, focusing on academic performance, sports participation, and disordered eating.

Methods
In 2022, we recruited 1161 female first-year students from 21 diverse high schools in the capital region of Finland. They completed an online survey comprising questions about menstrual cycle, academic achievement, sports involvement, disordered eating and school burnout.

Results
Of 935 (81%) participants (mean age 16) not using hormonal preparations, 336 (37%) reported irregular menstruation. Adolescents with irregular menstruation showed higher middle school grade point average (GPA) (OR 1.4, 95% CI 1.1-1.8), lower body mass index (OR 2.2, 95% CI 1.3-3.5), and more disordered eating symptoms (OR 2.1, 95% CI 1.4-3.0) than adolescents with regular menstruation. While overall physical activity showed no significant correlation with irregular menstruation, casual exercisers with irregular menstruation exhibited both higher GPAs (OR 1.4, 95% CI 1.4-1.9) and more disordered eating symptoms (OR 2.6, 95% CI 1.6-4.1) than competitive athletes, whereas competitive athletes with irregular menstruation showed higher school burnout scores than casual exercisers but no disordered eating.

Conclusions
We recommend the use of screening tools to recognize disordered eating and school burnout among female high school students facing menstrual irregularities.

Key messages
• A third of adolescent females had irregular menstruation. Casual exercisers with irregular menstrual cycle were at risk of eating disorders and competitive athletes at risk of school burnout.
• Screening of disordered eating and school burnout among adolescent females facing menstrual irregularities could be beneficial.
Review of national climate change risk assessment methods for impacts on health and health systems in WHO European Region
Authors: Turner G , Kovats S , Hajat S , Wan K 
Published: October 2024

Abstract

Background
Climate change poses significant risks to health and health systems. The European Union climate adaptation strategy sets out the pathway to become climate resilient by 2050 and supports the development of adaptation strategies across all levels of governance. Whilst many European countries have published climate change risk assessments (CCRA), it is unclear to what extent health outcomes have been quantified or prioritised. There is a need to improve methods for CCRA methods to support decision making on adaptation and better quantify future impacts on health. The aim of this study is to review the methods used in national CCRAs for impacts on health and health systems in the WHO European region.

Methods
National and European level CCRAs were identified from national government websites and European document databases e.g. Climate-ADAPT. The most recently published CCRA from each country was included. Data extracted from CCRAs included climate scenarios used, modelling data, outcomes, types of evidence evaluated, stakeholder involvement, health information, methods for prioritization of adaptation options and urgency scoring. Data extracted from each document was grouped by climate risk or outcome.

Results
Nearly all WHO EURO countries have conducted a formal assessment of climate risks and over half specifically include risks to health. All countries assessed the urgency to adapt to heat and flooding however, less than half consider the health related risks related to disrupted water supply and quality as well as impacts on food supply and security. The key reported health outcomes identified across countries were mortality, infectious disease, chronic diseases and mental health.

Conclusions
There is varying progress in the quantification and prioritization of health risks from climate change across Europe. To support better public health decision-making, CCRAs should integrate sub-national and local information for targeted adaptation action.