bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)
Authors: Leitao S , Robinson L , O’Donoghue K 
Published: October 2024

Abstract

Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p &lt; 0.001) and 46% were employed (vs 75% of white women, p &lt; 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p &lt; 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p &lt; 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p &lt; 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities.

Key messages
• Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues.
• Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.
Strategies to improve recruitment to multimodal group programmes for obesity: a systematic review
Authors: Reinsperger I , Wolf S , Zechmeister-Koss I 
Published: October 2024

Abstract

Background
The World Health Organization describes obesity as one of the greatest public health challenges in the 21st century. Possible therapies include multimodal (group) programmes with nutrition, exercise, and behavioural therapy elements. However, programme providers often have difficulties recruiting the target groups and motivating them to participate. This systematic review aimed to identify barriers and facilitators as well as strategies to improve recruitment.

Methods
We systematically searched five databases (Medline, CINAHL, Cochrane, PsycInfo, Web of Science). Based on predefined inclusion criteria, we selected primary studies of different study designs (e.g. [randomised] controlled trials, qualitative studies). We extracted barriers and facilitators as well as recruitment strategies into predefined tables, assessed the quality of the studies and summarised the results narratively.

Results
Of the 1,082 articles identified, 16 met the inclusion criteria. The main active recruitment strategies were writing directly to potential participants and referrals from health professionals. The most frequently reported passive strategies included media adverts, websites, flyers, social media, and word of mouth. The information on how many people approached actually participated was heterogeneous, which illustrates that recruitment depends on the setting/context and the people involved. Some studies came to contradictory results, e.g., regarding whether passive or active methods are more successful. In most cases, a combination of strategies was recommended. The studies reported numerous recruitment barriers, e.g., lack of staff time, lack of motivation, or fear of discrimination.

Conclusions
The review provides a broad overview of recruitment methods that can be applied depending on the framework conditions and target groups. The summary of possible barriers can serve as an overview of which aspects could be considered when designing or adapting a programme.

Key messages
• To improve recruitment to obesity programmes, a combination of several recruitment strategies, including active and passive methods, should be applied.
• Results on the “effectiveness” of the strategies were inconclusive, which indicates that the success of methods depends on the context, setting and the people involved.
Housing items and amenities a non-traditional risk factors for all-cause and cardiovascular mortality
Authors: Luksiene D , Tamosiunas A , Aukstakalniene G , Radisauskas R , Bobak M 
Published: October 2024

Abstract

Background
Higher satisfaction levels are associated with improved psychological well-being (PWB), such as housing amenities being a determinant of health. However, their potentially influencing effect on mortality risk at this moment is not enough. For this reason, searching for non-traditional risk factors that could reduce all-cause and cardiovascular disease (CVD) mortality risk is our primary objective of this study.

Methods
The cohort study was based on the framework of the international study Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE). Data from the Official Lithuanian Mortality Register were used to evaluate mortality from the baseline survey (2006- 2008) to 31 December 2022. The 20 housing items and amenities were used. The items were categorized into three groups: basic needs, socially oriented needs, and luxury.

Results
A total of 6472 participants aged 45-72 years were examined in the baseline survey. Cox proportional hazards regression analysis results show that increasing the number of housing items per 1 unit decreased the risk of all-cause mortality by 8% (Hazard ratio (HR)=0.92;95%CI 0.90-0.94) in males and by 7% (HR = 0.93;95%CI 0.91-0.96) in females. Increasing the number of housing items per 1 unit decreased the risk of mortality from CVD by 10% (HR = 0.90;95%CI 0.87-0.93) in males and by 9% (HR = 0.91;95% CI 0.87-0.95) in females (data adjusted by age, education, smoking, metabolic syndrome, PWB, CVD at baseline survey). Once more, the increased number of items from the luxury group (4-7 vs. 0-1) significantly decreased all-cause and CVD mortality risk (respectively in males HR = 0.74(95%CI 0.60-0.91) and HR = 0.71(95%CI 0.52-0.96); in females HR = 0.66(95%CI 0.48-0.91) and HR = 0.57(95%CI 0.33-0.96).

Conclusions
These data suggest that the increasing number of household items and amenities, as an essential aspect of people’s lives, may be used as non-traditional risk factors in assessing the risk of all-cause mortality and CVD.

Key messages
• Household items and amenities may be used as non-traditional risk factors in assessing the risk of all-cause mortality and CVD.
• Increasing the number of housing items decreased the risk of all-cause and CVD mortality.
Educational inequalities in cervical cancer mortality: A systematic review and meta-analysis
Authors: Machado M , Eikemo T A , Mohammad T , Balaj M 
Published: October 2024

Abstract

Background
Educational inequalities in mortality continue to persist. We aimed to systematically analyse the association between level of education and cervical cancer mortality.

Methods
We conducted a systematic review and meta-analysis. We systematically searched Pub-Med, Web of Science, Scopus, EMBASE and Global Health (CAB), EconLit and Sociology Source Ultimate databases. A protocol has been registered with PROSPERO (CRD42023411757). We included studies that measured the association between level of education and cervical cancer mortality using individual level data. Included articles were assessed for study quality and risk of bias using the Joanna Briggs Institute critical appraisal checklists. A random-effects meta-analysis was conducted to evaluate the overall and stratified effects of education on mortality.

Findings
Our literature search resulted in over 47,000 articles. 30 studies mentioned cervical cancer as a cause of death, and of these, 11 were eligible for the meta-analysis. Results showed an overall risk ratio of 2.41 (95% CI 1.81-3.20) for low education (ISCED 0-2) and 1.62 (95% CI 1.18-2.24) for medium education (ISCED 3-4). Those aged 25-64 with low education had more than twice the risk of cervical cancer (RR = 5.73; 95% CI 5.04-6.51) compared to those aged 25 and above (RR = 2.11; 95% CI 1.82-2.45). Besides, the impact of an additional level of education on reducing risk of cervical cancer mortality was higher in Northern Europe, compared to the South.

Interpretation
Lower educational attainment is associated with an increase in the risk of cervical cancer mortality, with an additional level of education greatly reducing this risk in Northern Europe. Younger cohorts with low education have a higher risk of cervical cancer mortality. This study provides important information for evidence-based policy seeking to reduce health inequities and inequalities in both the health and education sector.

Key messages
• Lower educational attainment is linked to a higher risk of cervical cancer mortality.
• Younger cohorts (aged 25-64) with low education are at a particularly heightened risk compared to those aged 25 and above.
Cardiovascular diseases risk assessment: the Italian Health Examination Survey 2023 - CUORE Project
Authors: Donfrancesco C , Lo Noce C , Di Lonardo A , Marcozzi B , Vannucchi S , Morello M , Bernardini S , Galeone D , Bellisario P , Palmieri L 
Published: October 2024

Abstract

Background
The reduction of NCDs premature mortality is pursued by the WHO; risk conditions targets are recommended as well as population-level monitoring of cardiovascular disease (CVD) risk. The Italian Ministry of Health (MoH) has strengthened prevention/health promotion and supported periodic CVD risk assessment through national health examination surveys (HESs), funded by the MoH-CCM and conducted within the CUORE Project.

Methods
In 2023 a new HES started including the 10-year fatal and non-fatal CVD risk assessment based on knowledge of sex, age, smoking habit, measured systolic blood pressure and fasting total and HDL serum cholesterol, and presence of diabetes (on measured fasting serum glycemia and/or treatment) and anti-hypertensive therapy. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy, aged 35-69 years, without previous CVD, are available (585 men, 617 women). Determinations were assayed by a central lab. CUORE Project functions developed on and for the Italian adults were used.

Results
Mean values of the CVD risk assessment resulted 6.9% (95% CI: 6.3-7.4) in men and 2.3% (2.1-2.5) in women. For men aged 35-44 years risk was 1.6% (1.5-1.8), for 45-54 years 3.8% (3.5-4.2), for 55-64 years 10.0% (9.0-10.9), for 65-69 years 17.6% (16.4-18.9); for women was 0.5% (0.4-0.6), 1.0% (0.9-1.1), 3.3% (2.9-3.7) and 6.0% (5.5-6.6) respectively. Prevalence of CVD risk less than 5% was 57% (49-64) in men and 88% (84-93) in women, of 10-15% risk were 22% (15-28) of men and 9% (5-14) of women, of 15-20% risk were 5% (1.6-8.0) of men and 0% of women, of over 20% risk were 2% (0-3.6) of men and 0% of women.

Conclusions
Compared to 2008, these data showed stable mean levels of CVD risk both in men and women at any age-classes and stable prevalence of CVD risk classes. CVD risk perception represents a challenge in primary prevention especially for young age groups and women.

Key messages
• In the Italian general population, CVD risk assessment remained stable compared to 15 years ago.
• CVD risk perception represents a challenge in primary prevention.
Disability-adjusted life years 19 former socialist economies in the European region, 1990-2019
Authors: Šantrić Milićević M , Stevanović A , Todorović J , Stamenković Ž , Rosic N , Anton A , Rommel A 
Published: October 2024

Abstract

Background
Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Enhanced Surveillance), we conducted a study to describe health progress in 19 former socialist economies (FSEs) in Europe from 1990 to 2019. Our metric of choice was age and sex-standardized rates per 100,000 population of total disability-adjusted life years (ASR-DALY).

Methods
We applied joinpoint regression with extracted ASR-DALY data from the Institute for Health Metrics and Evaluation result tool. The annual per cent change (APC) and average annual per cent change (AAPC) from 1990 to 2019 were analyzed in 19 former socialist economies (FSEs) in Europe, including Albania, Belarus, Bosnia and Herzegovina (BH), Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Montenegro, North Macedonia, Poland, Moldova, Romania, Russia, Serbia, Slovakia, Slovenia, and Ukraine.

Results
The ASR-DALY decreased in Estonia (APC1994-1997= -5.2%, p = 0.034; APC2013-2019= -0.7%, p = 0.07), Latvia (APC1994-1997= -6.3%, p = 0.03; APC1997-2007= -1%, p = 0.001; APC2007-2011= -3.9%, p = 0.01), BH (APC1995-1998= -13.3%, p = 0.041; APC1998-2019= -0.5%, p = 0.004), Bulgaria (APC1997-2000= -2.5%, p = 0.022), Lithuania (APC2007-2010= -4.9%, p = 0.018), North Macedonia (APC2007-2011= -1.9%, p = 0.023, APC2011-2019= -0.5%, p = 0.005), Czechia (APC2014-2019= -0.6%, p = 0.014), Moldavia (APC1998-2007= -0.6%, p = 0.06), and Ukraine (APC1995-2008= -0.5%, p = 0.035). Slovenia performed the best amongst the FSEs (ASR-DALY2019: 16677.51 for women, 21985.95 for men and 19134.73 for both sexes), Ukraine the worst (ASR-DALY2019: 26154.88 for women, 47983.60 for men and 35852.17 for both sexes).

Conclusions
Except for Ukraine, all FSEs in the European region achieved health improvement. The most common was a three-year decline in ASR-DALY. Health policy changes, investments in health care, and harmonization with EU regulations were among the factors contributing to improved population health in the FSEs.

Key messages
• Bosnia and Herzegovina is the only FSE in Europe with a continuous 24-year decline in total ASR-DALY.
• Reducing total ASR-DALY significantly in a three-year time frame is possible.
Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador
Authors: Puig-García M , Caicedo-Montaño C , Márquez-Figueroa M , Chilet-Rosell E , Lumbreras B , Parker L A 
Published: October 2024

Abstract

Background
The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context.

Methods
Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals.

Results
Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia.

Conclusions
The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations.

Key messages
• The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities.
• Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.
Overdiagnosis for screen-detected prostate cancer incorporating patient comorbidities
Authors: Beltran A , Parker L A , Moral-Pélaez I , Caballero-Romeu J P , Chilet-Rosell E , Hernandez-Aguado I , Alonso-Coello P , Ronda E , Gómez-Pérez L , Lumbreras B 
Published: October 2024

Abstract

Background
Evidence regarding the likelihood of overdiagnosis in prostate cancer (CaP) screening with PSA are mainly based on clinical trials, which include younger population with fewer comorbidities than those receiving the test in clinical practice. We aimed to assess the likelihood of overdiagnosis and associated variables using real-world data.

Methods
Retrospective cohort of men &gt;40 years with PCa, who had been diagnosed being asymptomatic and after a positive PSA test in the previous 12 months in two hospitals (2004-2022). The probability of overdiagnosis was estimated considering the life expectancy of the Spanish male in the year 2022 and the Charlson Comorbidity Index (lead time 10 years). PSA values and Gleason score were included as independent variables.

Results
Of the 2,331 patients in the cohort, 1,070 (46%) met the inclusion criteria for this analysis. The median follow-up time was 5.7 years (IQR 3.2-8.6). The median age was 71 years (IQR 65-78) and 37% had more than one comorbidity. At diagnosis, the median life expectancy was 12 years (IQR 4-18) and the probability of overdiagnosis was 30.8% (IQR 17.6-52.4). Patients with PSA levels &gt;10 mg/dl tended to be older and with more comorbidities than those with PSA levels 4-10 mg/dl, and thus, with shorter life expectancy. The median probability of overdiagnosis was higher in patients with PSA levels &gt;10 mg/dl (41.4%, IQR 21.5-73.9) than in those with PSA levels 4-10 mg/dl (20.1%, IQR 12.8-30.4), p &lt; 0.001. Correspondingly, patients with Gleason score ≥8 were more likely to be overdiagnosed (median 42.6%, IQR 23.6-68.6) than those with Gleason score ≤6 (median 20.1%, IQR 12.8-30.4) (p &lt; 0.001).

Conclusions
In clinical practice, older patients with comorbidities showed high PSA levels and Gleason score ≥8, presenting low life expectancy at diagnosis and, therefore, high probability of overdiagnosis. This highlights the importance of considering the patient’s comorbidities when ordering a new PSA test.

Key messages
• A detailed assessment of the prevalence of comorbidities among CaP patients in real-life settings has significant implications for patient management.
• The decision to make an early diagnosis should be based on individual life expectancy, where comorbidity is at least as important as age.
Impact of Noncommunicable Diseases on Years of Life Lost in FB&H During the COVID-19 Pandemic
Authors: Cilović Lagarija Š , Skočibušić S , Rommel A , Anton A 
Published: October 2024

Abstract

This study aims to comprehensively investigate the impact of noncommunicable diseases (NCDs) on years of life lost (YLL) within the Federation of Bosnia and Herzegovina (FB&H) across distinct phases: pre-pandemic, pandemic, and post-pandemic periods. Given that NCDs currently represent more than half of the global disease burden, our focus lies in assessing YLL specifically for cerebral infarction (I63-I64) and diabetes mellitus (E10-E14). Conducting a retrospective data analysis, we utilized mortality data sourced from the Institute for Statistics of FB&H to quantify YLL. This assessment involved multiplying age-specific mortality figures by the remaining life expectancy at the corresponding age, utilizing the GBD 2019 life expectancy table. Examining the period between 2019 and 2022, our analysis aimed to elucidate the pandemic’s potential influence on NCD burden, through the examination of age-standardized YLL rates based on the world standard population. In 2019, YLL attributable to I63-I64 for both sexes totaled 41,244 in 2019, escalating to 44,790 in 2020, and subsequently decreasing to 39,439 and 32,055 in the pandemic years of 2021 and 2022, respectively. For diabetes mellitus (E10-E14), YLL in 2019 amounted to 23,675, with figures for 2020, 2021, and 2022 standing retrospectively at 24,329, 24,114, 19,125. The increase in 2020 may be attributed, in part, to initial healthcare hesitancy during the pandemic’s onset, leading to delayed treatment and heightened mortality rates. Furthermore, patients who died in 2020 from C-19 without being tested may have skewed mortality registration by inflating rates attributed to pre-existing conditions. The declining rates thereafter could be due to a harvesting pandemic effect, in that people who were previously ill died prematurely from C-19. These insights show the pandemic’s profound impact on NCD-related mortality, underscoring the urgent need for targeted interventions and healthcare strategies.

Key messages
• A substantial reduction in years of life lost (YLL) related to certain noncommunicable diseases was observed during the pandemic.
• The pandemic significantly influenced mortality among individuals with noncommunicable diseases, driven partly by healthcare hesitancy and potential misregistration of causes of death.