bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences from the European Region: case studies and scenarios to inform ways forward in digital health
Authors: Davtyan K 
Published: October 2024

Abstract
Member States in the WHO European Region face similar challenges when it comes to strengthening their HIS and implementing digital health solutions. From WHO/Europe’s work with its Member States, several important preconditions have become apparent for successful and sustainable digital transformation. Firstly, the importance of recognising that implementing digital tools is not a one-off investment, but that this takes a long-term vision including long-term budgeting. Having business continuity plans also is a key element of sustainable implementation of digital tools, that is often not adequately addressed in practice. Secondly, the importance of comprehensive strategic planning. Implementing digital tools is not only about software and hardware, but also about people and processes. Here it is also crucial for policymakers to understand that, to be able to harvest the benefits of data that are gathered by means of digital tools, resources for data processing and analysis also need to be made available. Last but not least, an important precondition for successful digital transformation is stakeholder involvement. Often, new software is developed without adequately involving the end-user, resulting in for example apps that do not meet patients’ needs. Or in electronic health record systems that are not user-friendly for the healthcare staff that need to enter the data, with incomplete and low quality information as a consequence. Stakeholder involvement is essential in strategic planning for digital health as well. Think for example about standardization and accreditation agencies, and institutes that will be secondary users of data for statistics and research. In this presentation, several case studies from across the European Region will be presented, illustrating how digital transformation in health can be successfully and sustainably implemented.
Integrating social inequalities in the burden of environmental stressors
Authors: Gorasso V , Mogin G , Idavain J , Priem F , Assunção R , Delaunay-Havard S , Castro A , Charalampous P , Baravelli C 
Published: October 2024

Abstract
In the process of designing equitable policies to reduce the burden of environmental stressors, it needs to be taken into consideration that socially disadvantaged communities are disproportionately exposed to environmental pollutants. These environmental health inequalities are currently however not routinely taken into account when designing mitigation measures, amongst others because of the absence of a coherent methodological framework. Within the BEST-COST project, an innovative framework for assessing social inequalities in the socioeconomic impact of environmental stressors will be developed and implemented. In particular, a novel index of multiple deprivation was developed. This includes indicators that are considered to be temporally and culturally valid for assessing social and material deprivation in Europe. In particular the new index was developed to make comparison across different European countries and to be used at a small geographical level. Within the workshop we will discuss the stepwise framework developed, starting from the results of a scoping review conducted to gather information methodological approaches used in the currently existing MDIs developed in Europe. The results of the scoping review were used to make informative decisions about the selection of indicators and other relevant methods (e.g. weighting). The construction of the composite score for the use within BEST-COST was evaluated also considering the data availability of the selected indicators at a small geographical level (i.e. LAU2) for the case-study countries: Belgium, Estonia, France, Norway and Portugal. Initial results of the quantification of social inequalities in the burden of environmental will be presented. Participants to the workshop will be able to understand the advantages and challenges of this kind of exercises with specific examples.
Mapping Long COVID across the EU: definitions, guidelines and surveillance systems in EU Member States
Authors: Van Der Heide I , Hansen J 
Published: October 2024

Abstract
A mapping study had been conducted to provide insight into 1) Long COVID definitions, 2) guidelines and intelligence on diagnosis and treatment, and 3) surveillance systems, as used/implemented in EU Member States plus Iceland, Norway, the United States, Canada, New Zealand, and Australia. Findings show that most Long COVID definitions align with WHO or NICE criteria, although there are also notable differences between definitions. The study also found Long COVID guidelines for diagnosis and treatment in 21 out of 34 selected countries. Common elements include advocating a multidisciplinary approach, a central role for primary care, and the focus on rehabilitation. Some guidelines include recommendations for referral to specialised care and follow-up procedures. Guidelines also differ in their target audience and in terms of their focus specific symptoms or organ systems that are affected by Long COVID. When it comes to Long COVID surveillance systems only a limited number of (nine) registries were found. Five of the Long COVID registries are based on self-registration. As limited information is available for most registries, a detailed understanding of their structures and goals in comparison to others is hindered. In conclusion, the study underlines the interconnectedness of Long COVID definitions, the development of guidelines, and surveillance systems. Given the variability in definitions and the voluntary entry of patients into the existing registries, there are no good estimates yet of the total numbers of patients and the severity of their disease in EU Member States. Linking information from cohort studies and clinical trials may be necessary to provide the full picture of the burden of disease of Long COVID. Still, preliminary estimates indicate that a significant proportion of those infected with COVID-19 experience long lasting symptoms, leading to impaired quality of life, also placing a significant burden on national health systems in the future.
Developing a set of core items for assessing preparedness in Italy: a Delphi approach
Authors: Amicosante AMV , Baccolini V , Vacchio M R , Baglio G , Eugeni E , De Vito C , Migliara G 
Published: October 2024

Abstract

Background
Effective pandemic management relies on preparedness and several tools are available for evaluation. However, due to differences in regional healthcare organization and structures, these may not accurately evaluate Italy’s capacities. This study, part of a project funded by the Italian Ministry of Health, report on the development of an assessment tool capable of evaluating the preparedness to confront pandemics at the regional level based on the actions outlined by the Italian influenza pandemic plan.

Methods
A desk research was carried out for preparedness evaluation tools, consulting Public Health Agencies, and Google Scholar and Search. Tools evaluation items were extracted, associated with the Italian plan, and screened for relevance and data availability. Selected items were then subjected to a two-round Delphi procedure involving 18 stakeholders from academia, local health services, and national agencies. The agreement was assessed using a 10-point Likert scale, and defined as a mean score ≥8, and consensus as a score standard deviation (SD) ≤1.5. Items with mean score ≥ 8 and SD &gt; 1.5 after the first round were sent to the second round.

Results
A total of 6 tools were included in the study, from which 303 evaluation items matched the actions of the plan. After the screening phase, 122 indicators were deemed relevant and potentially available and sent to the Delphi procedure. Eighteen (14.8%) items reached both agreement and consensus in the first round, while another fifteen (12.3%) after the second. The 33 items covered all the domains of the national plan, especially Research and Development (21.1%) and Clinical Governance (15.2%).

Conclusions
The development of a set of core items that are agile, relevant, and readily available was facilitated by the involvement of stakeholders from different sectors. Moreover, adherence to the Italian pandemic plan should ensure that these items are deeply integrated into the unique context of the Italian regions.

Key messages
• The Delphi process identified a narrow number of evaluation items with great consensus.
• Consensus was searched involving stakeholders from central authorities, local units, and academia.
Excess mortality in individuals with and without COVID-19 vaccination in the Netherlands in 2021
Authors: Rijpkema C , Heins M , Bos I , Ramerman L , Verheij R A , Hek K 
Published: October 2024

Abstract

Background
The COVID-19 pandemic greatly affected public health, evident in higher mortality rates in 2020-2022. COVID-19 vaccinations reduced global mortality, though this may vary across subpopulations. We aimed to study the role of COVID-19 vaccination in excess mortality by examining individuals with and without COVID-19 vaccine while accounting for characteristics such as income and frailty.

Methods
In this observational study, electronic health record data from general practitioners participating in the Nivel Primary Care Database were linked to demographic data and COVID-19 vaccination data. Patients were categorized in age groups, based on vaccination invitation dates, with the index date set as vaccination date for vaccinated individuals and the expected vaccination date for nonvaccinated ones. Expected mortality rates were calculated using 2015-2018 data, accounting for season, sex, income, migration background, palliative care, and frailty. We compared expected mortality to observed mortality in 2021 to determine excess mortality.

Results
Preliminary results show that nonvaccinated individuals (n = 160.253) were younger, and less frail, but more often received palliative care than vaccinated individuals (n = 819.363). In nonvaccinated individuals, excess mortality in the three months after expected vaccination ranged from 22-61% for 36-60 year olds to 209-233% for the 81+ year olds. In vaccinated individuals, excess mortality ranged from -64- -61% in 36-60 year olds to 2-4% in 81+ year olds. When not correcting for palliative care, excess mortality estimations increased significantly in nonvaccinated individuals (e.g. for 81+ year olds: 504%-514%).

Conclusions
Excess mortality was hardly present in vaccinated subgroups, while it was high in all nonvaccinated subgroups. Our study shed light on characteristics of nonvaccinated individuals, who require special attention during future vaccination programs to prevent excess mortality.

Key messages
• Excess mortality in the three months after (expected) COVID-19 vaccination was high among nonvaccinated individuals and hardly observed amongst vaccinated individuals.
• Routine care data could help identify terminally ill individuals, who are overrepresented amongst nonvaccinated individuals, and mitigate the so called healthy vaccinee bias in vaccination research.
Systematic review of the literature about immunogenity and antibodies persistance of Tdap vaccination
Authors: Bartucciotto L , Genovese C , La Spada G , Saia I , Rizzo C , Squeri R 
Published: October 2024

Abstract

Introduction
In industrialized countries, routine use of pertussis vaccines has shifted the burden of pertussis disease from children to infants, adolescents and adults, leading to the necessity of booster doses.

Materials and methods
We prepared the review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) with the aim of a) to describe the immunogenity of the main available vaccines for adolescents and adults b) to describe antibodies persistance after immunization with the main vaccines available in childhood and adults and, also, possible co-administration and c) to identify the gold standard for adolescent and adult immunizations.

Results
Of 6906 records identified, after removing duplicate records, 12 RCT were included (people aged 11-73): of these 7 studies had only 1 control group, 4 studies had 2 control group and 1 had 5 control group; moreover, of the 12 studies included only 2 regarding co-administration and all were about immunogenity. 9 out 12 studies had a Jadad score above 3 points and 10 out 12 meet the criteria of Cocrane Back Review Group Criteria List for Methodological Quality Assessment.

Discussion and conclusions
We found a limited number of good-quality RCTs investigating our object. The five component vaccines, although containing a lower dosage of antigen, are found to be more effective than one components vaccines for prevention. Evidences support the use of 5- components vaccines for booster sessions in adolescence and adulthood.

Key messages
• Although 3-component and 5-component vaccines contain a lower dose of antigen, they are more effective than 1-component vaccines in the prevention of diphtheria-tetanus and Bordetella pertussis.
• The robustness of the data and the analytical tests support the use of vaccines with reduced antigen concentration for decennial booster sessions in adolescence and adulthood.
Impact of artificial intelligence on healthcare-associated infection control: a systematic review
Authors: Barbati C , Viviani L , Vecchio R , Arzilli G , De Angelis L , Baglivo F , Rizzo C , Odone A 
Published: October 2024

Abstract

Background
Healthcare-associated infections (HAIs) represent a significant public health concern, correlating with increased morbidity, mortality rates and healthcare expenditures. While artificial intelligence (AI) systems offer transformative potential in enhancing HAIs detection and control practices, the actual performance effectiveness of these systems remains uncertain. This systematic review updates a previously published study from 2020 and evaluates the performance of AI-based tools for surveillance, detection, and control of HAIs.

Methods
PRISMA 2020 guidelines were applied. The study protocol has been registered in PROSPERO (ID: CRD42024513145). PubMed, Embase, Scopus and Web of Science were searched for experimental and observational studies assessing the performance of AI-based tools to detect and control HAIs, published in English.

Results
From 8,701 articles initially identified, 4,212 records were removed due to duplication. Out of 4,489 papers screened, 147 were included. Studies reported performance measures including sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve, accuracy, precision, F1 score. Significant heterogeneity was found in the types of technology, infections targeted, health care settings and data sources between studies.

Conclusions
The increase in published evidence since the previous review reflects the growing interest and use of new technologies such as Large Language Models, showing promising performance in surveillance, early diagnosis and prediction of HAIs. However, the observed heterogeneity in study designs, targeted infections, healthcare settings, and data sources underscores the need for standardised methodologies and robust validation processes to ensure the reliability and comparability of results across different studies.

Key messages
• The use of AI-based tools has the potential to enhance surveillance, detection, and control of healthcare-associated infections, offering a transformative impact on healthcare systems.
• Standardised methodologies and validation processes are needed to ensure comparable results across studies and to maximise the real-world impact of AI tools in HAI surveillance and control efforts.
How effective are eHealth literacy interventions? A meta-analysis of experimental studies
Authors: Maranesi E , Barbati C , Vigezzi G P , Bonciani M , Bailoni T , Giammarchi C , Lenge M , Dragoni M , Barbi E , Odone A 
Published: October 2024

Abstract
The rapid evolution of digital health emphasises the need for effective eHealth literacy (eHL) to ensure equitable access to health information and improve patient outcomes. This systematic review and meta-analysis aim to assess the effectiveness of eHL interventions, addressing the significant gap in knowledge about which strategies are most beneficial. Adhering to PRISMA guidelines, we systematically retrieved, quantitatively pooled and critically appraised available experimental evidence on the effectiveness of eHL interventions across different populations. PubMed, Scopus, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies reporting original quantitative outcomes of eHL, assessed by the eHealth Literacy Scale or other validated scales. Data were pooled using a random-effects model, with critical appraisal of the included studies. From the 504 records screened, 15 studies met the inclusion criteria. They encompass interventions targeting adults with chronic diseases (6 studies), older adults (5), and young people (4) and examine either individualistic or collaborative approaches (respectively, 9 and 5 studies, and 1 assessing both). The meta-analysis revealed significant improvements in eHL, both pre- vs post-intervention (UMD 5.81, 95%CI 3.38-8.26, N = 1,025) and experimental vs control groups (OR 3.65, 95%CI 2.06-6.46, N = 1,258). Meta-regression showed a significant correlation between pre/post-intervention outcomes and baseline eHL levels (slope=-0.91, p-value=0.009). Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights (role of baseline eHL levels and intervention approach) for intervention design and implementation that are adaptable to various demographic contexts. This research was supported by the National Plan for Complementary Investments to the NRRP Hub Life Science-Digital Health (PNC-E3-2022-23683267, DHEAL-COM).
Precarious employment expectancy by history of mental-health-related sickness absence in Finland
Authors: Leinonen T , Salonen L , Hartikainen E , Bodin T , Solovieva S 
Published: October 2024

Abstract

Background
Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence.

Methods
We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history).

Results
Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%.

Conclusions
Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability.

Key messages
• People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market.
• Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.
Predictors of disability retirement - a prediction model for disability pension application risk
Authors: Sohlman P 
Published: October 2024

Abstract

Background
Regarding the objective of preventing early exits from labor market, the late life-course years present an important timeframe. It is essential to identify the employees in the greatest risk of permanently losing their work ability. In practical applications, multifactorial models are needed to evaluate the combined effect of risk factors. In this study, the disability pension risk is modeled based on large unique register data, at the same time assessing the effect of sickness absences (SA) of different lengths.

Methods
We utilize a logistic model for the risk of filing a first-time disability pension application (DPA) based on register data on 222,321 Finnish municipal sector employees. The data include employment and sickness spells, occupations, and wages in 2016-2018 as covariates. During the 3-year follow-up, 2,969 employees filed a DPA. The data include also short SA spells, a novelty in these kinds of studies. DPA is used as a follow-up to include employees who receive a rejecting decision but still carry a physician’s evaluation of diminished work ability.

Results
The resulting model can accurately predict the risk of DPA in employee groups. Age, occupation, cumulative SAs preceding the application, and the number of SA spells of all lengths, also short ones, have a significant increasing effect on the DPA risk. Proximity of the retirement age and high earnings decrease the risk of DPA. Surprisingly gender had no effect on the risk.

Conclusions
The results indicate that register-based sociodemographic data is very useful in modeling the employee DPA risk in public sector employee groups. The resulting model provides a basis for tools for predicting the risk status of employee groups for the use of employers responsible for risk management and early intervention, also allowing for the assessment of economic effects of SAs and disability risk. The presented modeling results are already utilized among public sector employers in Finland.

Key messages
• Disability pension risk can accurately be predicted in public sector employee groups based on readily available sociodemographic register data.
• All sickness absences have a significant increasing effect on the risk of disability pension application, but the effect varies greatly depending on age and occupation.