bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intersectional inequality through economic difficulties and lifestyle on body mass index in Sweden
Authors: Moreno-Llamas A , San Sebastián M , Gustafsson P 
Published: October 2024

Abstract

Background
A high body mass index (BMI) is listed among the top five risk factors for the Swedish population. Socially disadvantaged groups, including women, low-educated, and immigrants, are even at higher risk of a high BMI who may also face economic constraints, physical inactivity, and poor-quality diets. However, complex intersectional transmission of inequalities to BMI remains unexplored. Therefore, we aimed to examine intersectional inequalities in BMI mediated by economic strain and lifestyle in the Swedish population.

Methods
By using the Health on Equal Terms cross-sectional surveys in 2016, 2018, 2020, and 2021 in the Swedish population (n = 44,177 inhabitants aged 24 and over), we performed an intersectional mediation analysis to estimate how inequalities across intersectional strata, by gender (women or men), education (primary, secondary or university), and migration status (Swedish native or migrant), may be sequentially transmitted through economic strain (yes or not in the last 12 months) and unhealthy lifestyle (physical inactivity or inadequate fruit/vegetables consumption) to BMI (continuous).

Results
Compared with high-educated native men, socially disadvantaged strata experienced more economic strain, which in turn led to poorer health-related lifestyles and ultimately to a higher BMI. Some strata such as high-educated women, despite having a lower BMI, still experienced more pronounced transmissions of inequality on BMI through economic difficulties.

Conclusions
Not only inequalities in BMI, but also the material and behavioral pathways underpinning the inequalities, act by intersectional patterns. Public health interventions should ensure adequate economic resources to access healthy food and physical activity across all social strata groups.

Key messages
• Intersectional inequalities in BMI were driven by economic strain and lifestyle.
• Economic strain and poorer lifestyles were not only more prevalent in lower stratus but also more detrimental.
Using HIS administrative data for initial assessment of comorbid patients’ status (Covid-19 case)
Authors: Mircheva I , Usheva N , Mirchev M , Kiselkova S 
Published: October 2024

Abstract

Background
Despite numerous published articles, most of the studies on COVID-19 focused on influence of clinical characteristics and treatments on severity. Yet, the epidemiological viewpoint was rarely discussed. Based on our experience with comorbid hospitalized COVID-19 patients, we aim to show that HIS administrative data can be used to identify individuals that are more prone to worse outcome thus improving patient management not only during pandemics.

Methods
A retrospective single-center study was conducted using archived anonymized HIS administrative data for all 8319 COVID-19 patients in the university hospital ‘Saint Marina’-Varna, Bulgaria, in the period 14/06/2020-31/12/2021. Up to 7 comorbidities per patient were registered in HIS with ICD-10 codes, used for our analyses. Non-parametric tests and logistic regression were used at α=.05, 95%CI.

Results
Comorbid patients were 5741(69%), 50.3% ≥69y, 52% male; 1602(27.9%) died, 64% ≥69y, 54.4% male. Deceased were older (p&lt; .01) and had more comorbidities (p&lt; .01). Multimorbid patients (OR = 4.43; 3.80-5.17), male (OR = 4.72; 3.83-5.82) and older ones (OR = 1.91; 1.57-2.34) had higher odds of dying. The odds of dying increased with the number of comorbidities from OR=.635; .559-.721 for 1 to OR = 4.23; 3.28-5.46 for 7. From 4967 comorbid diseases (451 ICD-10 codes), only those from code groups A, J, N, E, I, Z were suitable for analysis. Patients with A41.9 (OR = 213.69; 52.88-863.43), J80 (OR = 52.88; 32.58-85.56), N17 (OR = 18.63; 10.24-33.87), E11.7 (OR = 4.72; 3.09-7.19), I13.2 (OR = 4.67; 3.151-6.93), Z95 (OR = 3.81; 2.74-5.31), I63 (OR = 3.56; 2.25-5.61), E66 (OR = 3.12; 2.10-4.64) died more often.

Conclusions
Our findings match the results based on EMR data: death with COVID-19 was associated with comorbidities (sepsis, acute RDS and kidney, heart and renal failure, diabetes, cerebral infarction, obesity, implants and grafts), age, gender, i.e. HIS administrative data can be used for quick assessment of comorbid patients’ status.

Key messages
• HIS administrative data can be used for quick assessment of multimorbidity and following personalized treatment is highly recommended to decrease hospital mortality not only in times of pandemic.
• Older Bulgarians have many comorbidities from ICD code groups A, J, N, E, I, Z, and are more prone to death, especially in times of pandemic. Public health measures are needed to prevent comorbidity.
A Groundbreaking Prevalence Survey Conducted in Mauritania for Enhanced Sickle Cell Control
Authors: Cohen S , Baguet P , Bernit E , Soudier B , Petiteau L , Mahmoud E 
Published: October 2024

Abstract

Issue/Problem
Sickle cell disease is a major concern in sub-Saharan Africa, with a prevalence of 0.5 to 2% among children and a mortality rate exceeding 50% in untreated cases. However, the lack of reliable data hampers effective public health policies and resource allocation. To address this, Mauritania’s Ministry of Health, with technical support from NGO Santé Sud, conducted its first prevalence survey in 2023-24. The findings will support advocacy for a national strategy on the disease and offer valuable insights for neighboring countries with similar challenges.

Description of the problem
The prevalence survey comprised 3 field missions over 7 weeks, conducted across 24 primary healthcare facilities during immunization days, in Nouakchott, Dakhlet-Nouadibou, Trarza, Ghorgol, Brakna, Guidimakha and Assaba regions: 1,642 infants (0-9 months) underwent screening for sickle cell disease, with parents’ consent, and 30 paramedics and laboratory technicians were trained to administer point-of-care tests.

Results
The survey found that 9.7% of tested children were carriers of hemoglobinopathies, with 0.6% diagnosed with sickle cell disease. Lab technicians and nurses have improved knowledge about the disease and are better equipped for point-of-care testing. This initiative is expected to enhance sickle cell disease control by providing crucial data for advocacy and may lead to a nationwide newborn screening program, in line with WHO recommendations.

Lessons
This initiative highlighted the efficiency of screening infants for sickle cell disease, emphasizing the need for effective organization involving stakeholders from central to local levels. Screening during immunization days proved highly efficient in testing numerous children. Success depends on adequate human resources, technical skills, and dedicated health personnel. Additionally, having a team member to inform and counsel families, especially when test results are positive, proved crucial.

Key messages
• A prevalence survey on sickle cell disease to generate robust data for advocacy efforts in Mauritania.
• Conducting a prevalence survey on sickle cell disease in Mauritania for a better control of the disease.
Reactive surveillance of deaths involving a fall among the elderly in France, 2015 to March 2023
Authors: Torres M J , Fouillet A , Ung A , Hebbache Z , Martin D , Coudin E , Guldner L , Beltzer N 
Published: October 2024

Abstract

In 2022, France launched an elderly anti-fall plan with a goal to reduce fatal falls by 20% within 5 years. In a reactive monitoring approach ensuring comparability over the period, our study aims to develop an algorithm to identify deaths involving a fall using free-text medical causes in death certificates. This will enable proactive surveillance and evaluate plan effectiveness upon completion. We devised an algorithm based on textual search of fall-related expressions in death certificates. Performance metrics were assessed by contrasting algorithm-identified deaths with those flagged by ICD-10 fall-related codes. We compared also temporal dynamics between the algorithms from 2015 to 2021. Analysis was performed by age group, gender and place of death. Additionally, our algorithm enabled estimation of fall-related death trends from 2015 to 2023. The free-text algorithm exhibited robust performance, with a sensitivity and PPV of 95% when compared to deaths coded with an ICD-10 fall-related underlying or associated cause. Temporal trends between both were highly correlated (correlation coefficient=0.99). Instead of the usual 10000 deaths for fall, we revealed about 13000 deaths linked to falls considering both primary and associated causes. Among these, approximately three-quarters were coded as the underlying cause of death in ICD-10 coding. Regarding trends, the results are preliminary and suggested an increase in mortality rates related to falls detected by the algorithm between 2015 and 2022. Our approach distinguishes falls from other competing causes that often relegate them to secondary status in the chain of morbid events leading to death. With free-text medical causes accessible within 3 to 4 months, monitoring deaths involving falls can be done at a detailed geographic level and in a more reactive way. Looking ahead, we must also consider incorporating the impact of epidemics and/or heat waves to accurately evaluate the effectiveness of the anti-fall plan.

Key messages
• Algorithm using free-text of death certificates identify deaths involving falls.
• Our innovative approach isolates falls from other competing causes, elevating their significance in death processes.
Infertility in the Capital Region of Denmark: Prevalence and population characteristics
Authors: Eliasen M H , Grønkjær M , Schmidt L , Elsborg P , Toxværd C G , Vassard D 
Published: October 2024

Abstract

Background
Infertility is a disease defined by failure to achieve a pregnancy within 12 months of trying. Infertility has-until now-not been monitored in Denmark for three decades. The aim of this study was to assess the prevalence of infertility in persons aged 25-44 years in the Capital Region of Denmark, and to describe characteristics of persons with infertility.

Methods
Life-long experience of infertility was assessed in the Danish Capital Region Health Survey 2021, including 56,245 participants from the general population aged ≥16 years (response rate 54.9%). In this study, only persons aged 25-44 years who had tried to have children (thus knowing their fertility) were included, resulting in 8,203 participants. Characteristics of persons with infertility were assessed using national registries (socio-demographics) and questionnaire data (health status). Descriptive analyses and multivariate logistic regression models weighted for survey design and non-response were performed.

Results
Among persons aged 25-44 years, who had tried to have children, 20% had experienced infertility. Among those, 44% did not achieve the children they wanted. Infertility was most common among women (22%) and persons aged 35-44 years (21%). No associations were observed between infertility and ethnicity, education, and employment status. Persons with infertility were more likely to have poor physical health, have higher level of stress symptoms and have obesity compared with persons in same age group, who had tried to have children but not experienced infertility.

Conclusions
Infertility is very common in the general population and is associated with unmet fertility desires as well as poor physical health and high stress level. These findings highlight the importance of focusing on and prioritizing treatment and prevention of infertility and emphasize the need for further research in and continued monitoring of infertility.

Key messages
• Infertility is very common in the general population and associated with unmet fertility desires and poor health highlighting the importance of prioritizing treatment and prevention of infertility.
• Continuous monitoring of infertility in the general population is essential as well as further research into risk factors and consequences of infertility.
Surveillance of surgical site infections using artificial intelligence
Authors: Ladios Martin M , Delgado de los Reyes J A , Fernandez de Maya J , Belso Garzas A , Soler Oliva V M , Roig Perez V , Vilela Vilar F , Aznar Zamora F M , Torres Sanchez A M 
Published: October 2024

Abstract

Background
Surgical site infection (SSI) is a major health problem associated with high morbidity and mortality, the consequences of which can be very serious for the patient and costly for the organisation. Surveillance systems provide insight into the incidence of SSI, the analysis of which enables improvement plans to be established to reduce it. Traditionally, surveillance systems have been based on manual medical record review for evidence of the presence of surgical infection.

Objectives
To create and validate a global SSI diagnostic algorithm and to optimise the SSI workload of Preventive Medicine services.

Methods
The study population included patients undergoing surgical procedures of rectal surgery, colon surgery, knee replacement surgery, hip replacement surgery, coronary bypass and valve surgery, at the Hospital Universitario Vinalopó in Elche (n = 1240). Data mining was used to collect clinical, microbiological and postoperative follow-up values from the electronic medical record. Machine Learning techniques were used to train (n = 1054) and validate the model (n = 186). Time spent on SSI surveillance of the preventive medicine service was measured.

Results
Model performance after validation was: sensitivity of 0.83 specificity of 0.87, accuracy of 0.87, an F1 score of 0.45, and an area under the curve of 0.87. The time spent by preventive medicine staff in identifying patients with surgical site infection decreased from 168 person-hours per procedure per quarter to 34 person-hours, a 77% reduction in the workload allocated to this task.

Conclusions
This project not only improves surveillance efficiency, but also optimises the workload in Preventive Medicine services very significantly.

Key messages
• This project improves the efficiency of surgical site infection surveillance and significantly optimises the workload in preventive medicine departments.
• It makes it possible to extend surveillance to new surgical procedures and to work more intensively on preventive measures.
Cognitive performance in breast cancer survivors: a ten-year follow-up
Authors: Lopes C , Costa A , Araújo N , Rocha J , Lopes C , Oliveira V , Ferreira A , Pereira S , Lunet N 
Published: October 2024

Abstract

Background
Cognitive impairment (CI) has been widely reported as a frequent non-fatal cancer outcome. 15% to 25% of breast cancer (BCa) patients may have CI; however long-term variations of cognitive performance during and after the cessation of the treatments remains unclear. The present study aims to describe the evolution of cognitive performance in BCa survivors that are still in follow-up at breast cancer clinic, 10 years after diagnosis.

Methods
506 women with BCa admitted to the Portuguese Institute of Oncology, Porto, in 2012, were evaluated with the Montreal Cognitive Assessment (MoCA) before any treatment, after one, three, five, and ten years. Patients with a MoCA score ≤1.5 standard deviation below the mean of age- and education-specific norms were considered to have probable cognitive impairment (PCI). The 10-year follow up started in October 2022, and is still in progress (as of March, 118 were evaluated). All women that are still being followed at IPO-Porto for consultations and treatments were evaluated with MoCA assessment.

Results
PCI prevalence at the 10 years was 43.0% (95%Confidence Interval: 34.1%-52.7%). Several pathways for cognitive performance were identified throughout the 10-year follow-up: 58 women (49.2%) never had PCI at baseline assessment or during follow-up; 19 women (16.1%) had PCI at baseline, from whom 5 (4.2%) had PCI in all evaluations, 2 (1.7%) did not have PCI in any follow up evaluation, 2 (1.7%) had PCI during follow up, but not at 10 years and 3 (2.5%) had PCI again only at the 10-year follow-up; 5 women (4.2%) did not have PCI at baseline but had PCI at least once during follow-up but not at 10 years, and 24.6% had PCI for the first time at 10 years.

Conclusions
The results show a high prevalence of PCI 10 years after diagnosis with a significant part being new cases. These results highlight the need for including regular assessments of cognitive performance as a part of the clinical follow-up of BCa survivors.

Key messages
• There is a high prevalence of cognitive deficits in breast cancer suvivors 10 years after diagnosis.
• Including cognitive evaluations of breast cancer survivors during clinical follow up are recommended.
Systematic review of clinical effectiveness and safety of abdominal aortic aneurysm screening in men
Authors: Foley E , Jordan K , Lopez A , Carrigan M , Maher A , O’Neill M , Ryan M , Spillane S 
Published: October 2024

Abstract

Background
Abdominal aortic aneurysm (AAA) is characterised by a bulging in the aortic wall. AAA is typically asymptomatic until aneurysm rupture, which is associated with a very high mortality rate (approximately 80%). In the context of an ageing population and increasing life expectancy, innovative approaches to early detection and intervention are needed. The aim of this review was to assess the clinical effectiveness and safety of one-time ultrasound screening for AAA in men.

Methods
Systematic searches were conducted in electronic databases and grey literature sources. The primary outcomes of interest were AAA-related mortality, AAA rupture, all-cause mortality, rate of surgical repair and safety. The following study designs were included: systematic reviews, randomised controlled trials (RCTs), comparative observational studies and population-based non-comparative observational studies.

Results
Results from a systematic review by the US Preventive Services Task Force analysed 4 population-based RCTs, showing that one-time population-based screening for AAA in men (≥ 65 years) led to significant reductions in AAA-related mortality (OR = 0.65, 95% CI: 0.57 to 0.74), AAA rupture (OR = 0.61, 95% CI: 0.54 to 0.69) and emergency surgeries (OR = 0.53, 95% CI: 95% CI: 0.44 to 0.64) at 13-15 years follow-up, relative to no screening. Separate to this systematic review an additional 24 studies reported on clinical effectiveness, safety and psychosocial harms of AAA screening. Limited evidence from these studies suggest screening was associated with a reduction in AAA-related mortality and rupture but also transient psychological distress in some cases.

Conclusions
One-time ultrasound screening in men ≥65 years appears to offer benefits in terms of reducing AAA ruptures and AAA-related mortality, though the balance of benefits and harms requires careful consideration. In an ageing population, AAA screening could be transformative, by reducing mortality and rupture risks.

Key messages
• One-time ultrasound screening for AAA in older men (≥ 65 years) can reduce AAA-related mortality and rupture.
• In the context of an ageing population in Europe, AAA screening could be transformative, but benefits must be weighed against potential risks.
‘Positive disruption’: catalysing system-wide work on health inequalities through embedded research
Authors: Passey A , Woodall J 
Published: October 2024

Abstract

Background
This presentation explores embedded research as an innovative model for bridging system-level knowledge to action gaps in public health. Embedded researchers (ERers) are university-employed researchers co-located in public health organisations, who work to boost capacity in these organisations to tackle inequalities by better use of evidence in decision-making, evaluation and service improvement

Methods
Drawing on the initial phase of the role and wider literature, we qualitatively reflect on strengths and limits of a system-level ERer model. Most ERer evidence draws on a one-to-one organisational model. This presentation explores a different model of an ERer embedded in and working across a public health system (health services, municipality, third sector) in a large city in north England

Results
Our focus is on catalytic features of the ERer role (1) positionality: being embedded at system-level gives fuller understanding of inter-organisational connections and of the implications of emergent system changes; (2) convening: bringing together partners improves mutual awareness and builds interest in collectively pursuing research aligned to identified population health needs and public health priorities in the city; (3) co-production to build capacity: working with a new cross-organisational partnership to collectively address issues constraining opportunities to pursue system-level research; working with the municipality to explore the production/use of research to inform decisions on approaches towards health inequalities. This includes work on links between public health and other functions focused on social determinants of health

Conclusions
This presentation outlines distinctive consequences of system-level embedded research in a city-wide public health system. It critically appraises the transferability of this model of knowledge production and mobilisation at the intersection of system and cross-organisational action on health inequalities.

Key messages
• System-level embedded research is an innovative model for helping to bridge system-level knowledge to action gaps in public health.
• The model has catalytic benefits and transferability potential, although this needs to be considered in relation to the specific context for proposed system-level embedded research.
Methods to Handle Missing depression (PHQ-8 Score) Values among Adults in the United Arab Emirates
Authors: Al Balushi M , Ahmad A , Javaid S , Grivna M , Al Maskari F , Sherman S , Abdulle A , Piano F , Ali R 
Published: October 2024

Abstract

Background
The UAE Healthy Future Study (UAEHFS) is one of the first large prospective cohort studies in the Gulf region which examines causes and risk factors for chronic diseases among adult UAE nationals. Missing values are often unavoidable in empirical research and can in many cases, lead to bias. The aim of this study is to estimate the percentage of depression in the UAEHFS pilot data using the eight-item Patient Health Questionnaire (PHQ-8) variables, using different statistical methods.

Methods
Five common statistical machine learning methods of handling missing values were included in this analysis. These are mode imputation, k-nearest neighbor (KNN) imputation, classification, and regression trees (CART), random forest (RF) imputations, and random sample from observed values (Sample). 100 multiple imputations were used.

Results
487 (94.2 %) eligible participants were included in the analysis. 231 (44.7%) were included in the complete case analysis. The median age was 30 years (Interquartile-Range: 23 - 38). More males (67.8%) than females included in the analysis. The estimated percentage of depression was 8.4%, 8.9%, 9.9%, 12.5%, 15.4% and 17.9% by the mode, complete case, sample, RF, CART, and KNN respectively. In additional analyses, the estimated proportions of depression were 11.5% by the Complete Case, 11.9% by KNN, 13.2% by K-means clustering, and 13.2% by Random Forest.

Conclusions
The estimated percentage of depression in the UAEHFS pilot data varies between the applied methods of handling missing values. This shows that the problem of missing values in the variables is not negligible. Further research is needed using multiple imputations in the main UAEHFS dataset after completing recruitment.

Key messages
• For the depression missing values, we recommend using multiple imputations not to generate data but to prevent the exclusion of observed data.
• To have a better estimate of the percentage of depression, is recommended to use different machine learning methods.