bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple behavioural risk factors and mental health complaints among adults in Estonia
Authors: Opikova G , Reile R , Konstabel K , Kask K 
Published: October 2024

Abstract

Background
Behavioural risk factors are inter-related and often coincide, resulting in potentially worse mental health outcomes. This study explores the association between multiple behavioural risk factors and mental health among adults in Estonia.

Methods
We used nationally representative survey data from 2020 (n = 6404) to study the co-occurrence of lifestyle risk factors (smoking, alcohol consumption, physical inactivity, unhealthy diet, drug use, and high screen time) in relation to mental health indicators. Latent class analysis (LCA) was used to identify lifestyle risk profiles, while regression analysis was used to examine associations.

Results
Mental health outcomes were more frequent among females and younger respondents, but 54.4% of respondents reported having at least one mental health problem. Using LCA, three lifestyle classes were identified: multiple risk factors (17.9% of respondents), healthy lifestyle (76.1%), and drug use lifestyle (5.9%). Compared to individuals in healthy lifestyle class, respondents in multiple risk factors had higher odds for experiencing depressiveness (OR 1.46; CI 1.24-1.72), stress (OR 1.26; CI 1.06-1.49), and suicidal thoughts (OR 1.50; CI 1.26-1.80), as well as self-reported diagnoses of depression and insomnia, and using medications, such as antidepressants, hypnotics and sedatives. Respondents in drug use lifestyle had 1.5-2.5 times higher odds for all mental health items compared to healthy lifestyle class with largest difference found for suicidal thoughts (OR 2.46; CI 1.92-3.16) and medication use (OR 2.58; CI 1.91-3.47).

Conclusions
The current data highlights the importance of preventive measures targeting multiple behavioural risk factors, given that these factors often coincide. Moreover, the study showed a high proportion of individuals with at least one mental health problem, highlighting the necessity to continue efforts in preventive and interventive methods.

Key messages
• The study highlights the significant association between multiple behavioural risk factors and mental health outcomes.
• The study also emphasizes the importance of focused interventions targeting multiple behavioural risk factors to address the increased risk of mental health problems.
HIV risks and transactional sex among Swedish-born MSM and foreign-born MSM in Sweden
Authors: Causevic S , Strömdahl S , Ekström A M , Berglund T , Ingemarsdotter Persson K , Salazar M 
Published: October 2024

Abstract

Background
Transactional sex, which includes exchanging sex for material goods, services, or money, is a key HIV risk factor. Risk patterns associated with transactional sex among men who have sex with men (MSM) in Sweden, where buying sexual services is illegal, have not been examined earlier. This study aims to assess whether transactional sex (both buying and selling), country of birth, and migration-related factors (described by country of origin) are associated with self-reported HIV status among MSM in Sweden.

Methods
We analyzed secondary data from the 2017 European MSM Internet Survey (EMIS-2017), including participants reporting to live in Sweden (n = 4443). Using multivariate logistic regression analysis, we aimed to understand factors related to involvement in transactional sex and risk of HIV acquisition.

Results
Among the respondents, 5.4% reported living with HIV, with 8.8% of foreign-born MSM and 4.8% of Swedish-born MSM. The multivariable analysis showed that both selling and buying sex in the past five years increased the odds of reporting a positive HIV serostatus among all participants. Stratifying by transactional sex exposure and country of birth showed an HIV prevalence increase for all groups. Foreign-born selling or buying sex ever in the last five years had the highest prevalence of all groups (ranging from 17.8 to 19.1%). Other factors associated with a positive HIV status were age, outness, sex with a woman in the past twelve months, and condom use.

Conclusions
The relatively high reported HIV prevalence supports the need for HIV prevention, including the scale-up of access to pre-exposure prophylaxis to foreign-born MSM. A transparent discussion about risk factors and socioeconomic structures contributing to risk behaviors, including transactional sex, is needed.

Key messages
• Engaging in transactional sex increases the HIV risk among MSM in Sweden, particularly among foreign-born MSM.
• HIV prevention needs to address the socioeconomic factors contributing to risky behaviors, such as transactional sex.
The impact of parenthood on well-being: a qualitative study of mothers’ and fathers’ perceptions across European countries
Authors: Maia S , Pereira M , Mamelund S E , Amaro J , Fraga S , Leão T 
Published: October 2024

Abstract

Background
Parenthood significantly impacts the well-being of mothers and fathers. Yet, their experiences may differ according to societal roles and expectations. Parenthood can bring joy and fulfillment, but also emotional strain, particularly for mothers. Fathers’ involvement in caregiving has been recognized as crucial for family well-being, but studies on its health impact remain scarce. This study analyzed mothers’ and fathers’ perceptions of how parenthood affected their personal and professional well-being.

Methods
We conducted 30 semi-structured interviews with Portuguese mothers and fathers living in Portugal, Sweden, Norway, Germany, the Netherlands, the UK, Spain, and Italy. Thematic content analysis was performed to analyze the interviews.

Results
After becoming parents, male interviewees reported career benefits such as higher pay and career growth due to increased workload, while female interviewees reported greater family overload that spilled over into their professional lives. In Portugal, women faced work-life conflict as they felt more competent than their male partners in providing care and maintained their full-time paid work. In countries like Germany and Spain, women assumed the role of main caregivers but reduced their work commitments, either by working fewer hours or leaving the workforce. Self-reported health declined for both after parenthood, but differently. Some fathers engaged in less healthy behaviors, resulting in weight gain. In contrast, mothers, particularly in Portugal, were more prone to express emotions such as guilt, pressure, and anxiety due to role conflicts as workers, mothers, and wives.

Conclusions
Traditional gender norms still shape parental roles in work and family life, differently affecting women’s and men’s well-being. To address gender inequalities in parenthood, equal access to supportive measures such as shared parental leave is needed, as well as flexible working arrangements and childcare services.
Are prison settings included in national preparedness plans?
Authors: Alves da Costa F 
Published: October 2024

Abstract
With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.
Capability of ChatGPT to support the screening process of scoping reviews: A feasibility study
Authors: Nordmann K , Fischer F 
Published: October 2024

Abstract

Background
The time-consuming screening phase in health-related evidence syntheses is increasingly supported by artificial intelligence (AI). However, scoping reviews have not benefited as much as systematic reviews from such AI tools as they utilize conceptual rather than keyword-specific search strategies to address broad research questions. Context-understanding chatbots based on large language models could potentially enhance the efficiency of scoping review screenings. This study evaluates the performance of ChatGPT against an open-access AI tool used for abstract screening in systematic reviews and the costs involved.

Methods
Leveraging data from a prior scoping review, we compared the performance of ChatGPT 4.0 and 3.5 against Rayyan, using human researchers’ decisions as a benchmark. A random set of 50 included and 50 excluded abstracts was used to train Rayyan’s algorithm and to develop ChatGPT’s prompt. ChatGPT 4.0’s evaluation was repeated after 5-7 days to assess response consistency. We computed performance metrics including sensitivity, specificity, and accuracy.

Results
ChatGPT 4.0 and 3.5 achieved 68% accuracy, 11% precision, 99% negative predictive value, and 67% specificity. Sensitivity was high at 88-89% for ChatGPT 4.0 and 84% for ChatGPT 3.5. ChatGPT 4.0 showed a substantial interrater reliability between the two evaluations and moderate reliability compared to ChatGPT 3.5. The cost of deployment varied, with Rayyan being free, ChatGPT 3.5 costing $9.06 and ChatGPT 4.0 $505.72.

Conclusions
Given the exponential increase in publications, effective mechanisms to support the screening phase of scoping reviews are needed. Our feasibility study using ChatGPT to decide on abstracts’ inclusion or exclusion achieved good performance metrics. Given further positive evaluation, such chatbots might be incorporated in the standard screening process, possibly replacing a second screener, saving time and costs, and accelerating evidence synthesis.

Key messages
• ChatGPT performs well in supporting screening for scoping reviews, outperforming a traditional AI tool at reasonable costs.
• Employing chatbots like ChatGPT could potentially cut costs and time in scoping reviews.
Adverse childhood experiences and age-trajectories of depressive symptom for middle and older ages
Authors: Ren X , Li L , Demakakos P 
Published: October 2024

Abstract

Background
Adverse childhood experiences (ACEs) have lifelong impacts on health outcomes. Less is known about their effects on later outcomes (mental health). Moreover, associations of ACEs with age-trajectories of depressive symptoms and how they differ in different countries remain unclear. We investigated associations between ACEs and trajectories of depressive symptoms at mid-to-older ages in two distinct populations.

Methods
We used longitudinal data from English Longitudinal Study of Ageing (ELSA: n = 19602, ≥50y) and China Health and Retirement Longitudinal Study (CHARLS: n = 19561, ≥45y). Depressive symptoms were measured by Center for Epidemiologic Studies Depression scale at 10 waves (2002-2022) in ELSA and at 5 waves (2011-2020) in CHARLS. ACEs were retrospectively reported in both studies. We applied group-based trajectory modelling to identify distinct age-trajectories of depressive symptoms and multinomial regression to estimate associations between ACEs and trajectory groups.

Results
We identified three trajectory groups: in ELSA: high (12.3% in men and 14.7% in women), moderate (46.6% and 47.9%) and low (41.1% and 37.4%), and in CHARLS: high (9.3% and 13.2%), moderate (34.1% and 39.4%) and low (56.6% and 47.4%). Most ACEs were associated with increased risk of having moderate/ high trajectories of depressive symptoms after adjusting for other ACEs, sex, and childhood socioeconomic disadvantages. For example, for physical abuse, the adjusted relative risk ratio (RRRadj) for high and moderate trajectory groups was 2.09(1.99, 2.19) and 1.16(1.12, 1.20) respectively in ELSA. It was 1.34(1.23, 1.44) and 1.22(1.13, 1.32) in CHARLS. For domestic violence, the respective RRRadj was 1.90(1.65, 2.18) and 1.44(1.22, 1.70) in ELSA, and 1.33(1.22, 1.44) and 1.24(1.14, 1.35) in CHARLS.

Conclusions
ACEs have life-long effects on mental health at mid-to-older ages in both countries, highlighting the need of early intervention to improve mental health in later life.

Key messages
• Our work considered the distinct patterns of age-trajectories of depressive symptoms for adults at middle and older ages, capturing the changing process of mental health problems in later life.
• We also investigated the associations between childhood factors and trajectory of depressive symptoms, which helped to improve mental health for older people under the situation of global ageing.
Determinants of tuberculosis site among 1035 cases in Frankfurt, 2008-2023: does lineage matter?
Authors: Rachwal N , Idris R , Dreyer V , Richter E , Wichelhaus T , Wetzstein N , Götsch U 
Published: October 2024

Abstract

Extrapulmonary tuberculosis (EPTB) presents with nonspecific symptoms which can pose a diagnostic challenge. Currently, there are no clear predictors for EPTB. We aimed to identify these factors for better diagnosis and disease control. We included tuberculosis cases reported in Frankfurt from 2008-2023, with available clinical and whole genome sequencing data. According to WHO criteria, cases with pulmonary or combined pulmonary and extrapulmonary symptoms were categorised as pulmonary tuberculosis, while exclusively extrapulmonary symptoms were categorised as extrapulmonary tuberculosis. We assessed the association between EPTB and M. tuberculosis lineage, comorbidities and demographic characteristics using logistic regression, calculating crude and adjusted odds ratios (aOR). Of the 1035 reported tuberculosis cases, 272 had exclusively extrapulmonary disease and 136 had both pulmonary and extrapulmonary disease. In the univariable analysis, lineages 1 and 3 were significantly associated with extrapulmonary disease compared to lineage 4. However, this association was not observed in the multivariable analysis. In the final regression model, females were more likely to develop EPTB than men (aOR: 1.65, CI: 1.19-2.27). The odds of developing extrapulmonary disease were higher among patients born in the South-East Asian (aOR: 6.48, CI: 3.72-11.43) and Eastern Mediterranean (aOR: 5.54, CI: 3.41-9.11) than in other regions. Among the comorbidities, diabetes was found to be negatively associated with extrapulmonary disease (aOR: 0.50, CI: 0.26-0.91). Our results indicate that host factors such as geographic origin and sex are stronger predictors for extrapulmonary presentation of tuberculosis than a specific lineage. We recommend increasing physicians’ awareness of the nonspecific presentation of EPTB and adapting screening programmes, particularly for patients from South-East Asian and Eastern Mediterranean regions to foster more effective tuberculosis control measures.

Key messages
• Our study highlights the importance of considering host factors in predicting extrapulmonary tuberculosis, indicating their stronger influence compared to specific M. tuberculosis lineages.
• Increased physicians’ awareness of the nonspecific symptoms of EPTB and targeted screening programs for high-risk populations are crucial for enhancing tuberculosis control measures.
Relationship of serum vitamin D levels with atrial fibrillation incidence: The HUNT Study
Authors: Jiang L , Sun Y Q , Malmo V , Mai X M 
Published: October 2024

Abstract

Background
Evidence on the association between serum vitamin D levels and incidence of atrial fibrillation (AF) was inconclusive. To elucidate the nature of the association, we studied the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and AF incidence in the Norwegian Trøndelag Health (HUNT) Study using both conventional observational and Mendelian Randomization (MR) approaches.

Methods
3394 adult participants without AF diagnoses were followed up from HUNT3 (2006-2008) to 2021 in a prospective cohort. Average serum 25(OH)D levels over ten years between HUNT2 (1995-1997) and HUNT3 were calculated and categorized into &lt;50 and ≥50 nmol/L as exposure. AF diagnoses were retrieved from hospital registers and validated by medical doctors. Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Furthermore, a one-sample MR was conducted among 36,554 adults who participated in both HUNT2 and HUNT3. An externally weighted genetic risk score based on 19 vitamin D-related genetic variants, chosen for their clear biological functions in serum vitamin D transport, synthesis and metabolism, was used as instrument. We applied the Wald ratio method to assess the causal effect.

Results
During a median 13-year follow-up, 303 AF cases were diagnosed in the prospective cohort. Serum 25(OH)D level &lt;50.0 nmol/L was associated with a 26% reduced incidence of AF (HR 0.74, 95% CI 0.58 to 0.95), compared to serum 25(OH)D ≥50 nmol/L after adjustment for confounders. Genetically determined 10 nmol/L decrease in serum 25(OH)D level was associated with a 7% reduced incidence of AF (HR 0.93, 95% CI 0.86 to 1.00) in the MR analysis. Sensitivity analyses supported this positive association.

Conclusions
We found a consistent positive association between serum 25(OH)D level and AF incidence in the Norwegian HUNT population using both observational and MR approaches.

Key messages
• Serum vitamin D levels appeared to be positively associated with the incidence of AF.
• Vitamin D supplementation should be prescribed with caution, especially for people at high risk for AF.
The state of pandemic preparedness in four European countries
Authors: Forjaz M , Hocevar A , Rodríguez Blázquez C , Falcón M , Romay-Barja M , Sinko M , Murphy R , Deegan A , van Dijk M , Sanders J 
Published: October 2024

Abstract
One of the lessons learned from the COVID-19 pandemic is that monitoring determinants and behaviour can improve policy and communication strategies. To improve countries’ capacity to respond in a hot phase of a pandemic and build a resilient society, suitable monitoring in a cold phase of various behaviours and determinants that could become important in future pandemics is key. In March 2024 we launched the first round of the Pandemic Preparedness and Behaviour (PPb) survey in four European member states: Spain, Slovenia, Ireland and The Netherlands (N = ∼1000 per country). In this presentation we start by showing key findings. For example, we found that overall, approximately one third of participants believe their government is prepared if a new pandemic would occur next month. Next, we discuss similarities. For example, we find that in all four countries, perceived preparedness of self is higher than perceived preparedness of one’s government. We also address key differences, such as distinct patterns in perceived risk of a highly contagious outbreak in the next 5 years (whereas in Spain 26% perceives of participants an outbreak as probable, this is 43% in Slovenia) or differences in self-reported adherence to hygiene behaviours (i.e. handwashing after coughing or sneezing in elbow is markedly higher in the Slovenian sample than in the Netherlands). Next, we explore which determinants of these patterns are generalisable, and which are specific to two of the four countries: Spain and Slovenia. We follow up by comparing insights for policy and practice in their given contexts, as well as lessons learned with respect to use and development of the monitor. We conclude that monitoring individual behaviours and its determinants helps to develop joint efforts in developing effective public health policies across Europe regarding pandemic preparedness.
A scenario study on disaster preparedness behaviours
Authors: Kuehnhanss C , Nohlen H 
Published: October 2024

Abstract
Europe has faced several crises over recent years, including the COVID-19 pandemic and the war in Ukraine. Additionally, the climate crisis has led to an increase in the occurrence of extreme weather events and natural disasters. Getting citizens on board when it comes to being prepared for the changing risk landscape in the EU is essential in building societal resilience. The importance of the population’s preparedness to deal with disasters has also been underlined by the Commission’s identification of the Union Disaster Resilience Goals (2023/C 56/01). One of these goals focuses on increasing risk awareness and the adoption of risk prevention and preparedness measures among the population. Research has shown that simply advising people of potential risks in their region is not necessarily sufficient to motivate them to prepare. Yet, preparation is key to an adequate responses in emergency situations and improving preparedness may thus be a powerful tool to support the population’s ability to respond in times of crisis. The EC JRC’s Competence Centre on Behavioural Insights will present a study conducted in five member states (N = ∼1000 per country), which investigates the effect of envisioning a disaster situation, and therefore explicitly eliciting personal affectedness, on individuals’ self-reported preparedness intentions and preparedness behaviours. The study uses multiple measures for intentions and preparedness behaviours, including click-through to external information and an incentivised preparedness game.
WHO Regional Office for Europe Behavioural and Cultural Insights Unit qualitative studies with refugees from Ukraine, May 2022-September 2023
Authors: Scherzer M , Habersaat K , Alpatova P , Zub T , Mazhnaia A 
Published: October 2024

Abstract
The Russian invasion of Ukraine led to the movement of millions of people. As neighbouring countries opened their borders and made services available to those fleeing war, it became imperative to understand the refugee perspective. To gain insights into refugees’ health-service access, needs and behaviours, the WHO Regional Office for Europe Behavioural and Cultural Insights (BCI) Unit conducted qualitative interviews with Ukrainian refugees residing in Czechia, Poland, Romania, Slovakia and Slovenia. Ukrainian researchers interviewed refugees online, recruiting participants through social media channels and outreach activities. The findings were discussed in high-level meetings, stakeholder workshops and webinars, and informed action by partners, governments and WHO. As examples, refugee clinics were initiated in Czechia, Poland and Romania. Cultural mediators were engaged in Romania to support health-care access at local level, and nongovernmental organizations were supported in providing tailored assistance. In Poland, the telephone hotline for Ukrainian health workers was expanded to include a line for general information, and Slovakia extended health coverage for all refugees under the age of 18.