bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of life in people with multiple sclerosis vs general population: differences increase by age
Authors: Fricke L M , Krüger K , Krauth C 
Published: October 2024

Abstract

Background
To enhance health care for chronically ill people, it is crucial to understand the impact of their disease on health-related quality of life (HRQoL). More than 240,000 people in Germany live with multiple sclerosis (PwMS), the most common immune-mediated neurodegenerative disease of the central nervous system. Little is known about HRQoL in PwMS in comparison to the general population and by subgroups.

Methods
In 2021, 6,928 statutorily-insured PwMS aged ≥18 years and living in the federal state of Lower Saxony, Germany, were invited to take part in an online survey. The German EQ-5D-5L value set was used to analyse HRQoL by index values. Descriptive subgroup analyses were conducted (age, sex) and compared to a general German reference population (Grochtdreis et al. 2019, DOI: 10.1007/s10198-019-01054-1). Mann-Whitney-U- or Kruskal-Wallis-tests were performed as appropriate.

Results
Of 1,935 respondents (response rate 27.9%), 1,916 PwMS were included in the current preliminary complete case analysis. HRQoL is reduced in PwMS compared to the general population: Mean (M) 0.67 vs. M 0.88, respectively. While no significant differences by sex were found in PwMS (male: M 0.66 vs. female: M 0.68, p = 0.1), HRQoL decreased with increasing age (p &lt; 0.001). The reduction in HRQoL is more pronounced in PwMS than in the general population (difference between means 0.53 in 18-24 years old to ≥ 75 years old PwMS vs. 0.14 in the reference population, respectively).

Conclusions
PwMS report an overall lower level of HRQoL compared to the general population. Increasing age correlates with a substantial decrease of HRQoL in PwMS. Targeted research is needed to improve HRQoL of this vulnerable population.

Key messages
• The decline in HRQoL with increasing age is more pronounced in PwMS than in the general population in Germany.
• Further research should focus particularly on the extent to which MS-related factors are solely attributable for the considerable decline of HRQoL in PwMS.
The Role of Faith in Medical Decision-Making
Authors: Tur-Sinai A , Neriya-Ben Shahar R , Yuval F 
Published: October 2024

Abstract

Background
Ultra-Orthodox Israeli Jews face complex decisions when their doctors’ instructions contradict their rabbis’ advice. This study examines how their belief system affects their trust and decision-making in such situations, using socio-economic club theory and Gilligan’s listening guide.

Methods
Excerpts from 16 focus groups with 128 ultra-Orthodox Jews were analyzed to understand their perspectives on the relationship between doctors and rabbis. The socio-economic approach of Berman’s club theory was applied to explain their behavior, and Gilligan’s listening guide was used to analyze the focus group results.

Results
The strict behaviors in the relationships between doctors, rabbis, and patients function as social capital, raising the status of ultra-Orthodox Jews as members of an exclusive club. They balance critical health decisions with the social demand to obey religious leaders. However, listening to different voices (‘I,’ ‘we,’ and ‘they’) provides nuanced insights into their decisions, revealing dynamic changes in the community’s perceptions of the doctor-rabbi relationship and varying perspectives within the heterogeneous ultra-Orthodox community.

Conclusions
Combining Berman’s theory with Gilligan’s listening guide is an effective method for conducting in-depth qualitative research on sensitive issues with religiously strict groups. Understanding the belief systems underlying healthcare decisions is essential for providing culturally sensitive medical care to religious communities and training medical staff serving these communities.

Key messages
• Ultra-Orthodox Jews balance complex health decisions with social demands, revealing nuanced perspectives through strict doctor-rabbi relationships.
• Combining theories and qualitative methods effectively studies sensitive issues in religious groups, informing culturally sensitive healthcare.
An Innovative Public Health Solution with European Features for an American Problem
Authors: Maykrantz S , Diriker M 
Published: October 2024

Abstract

Problem
The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending.

Description of the problem
Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding.

Results
Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services.

Lessons
The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration.

Key messages
• Our approach aims to provide a practical solution to unnecessary healthcare spending.
• We must adapt to the changing tides to stay on course.
Formalizing the role of community key individuals in Utrecht, the Netherlands
Authors: Hintaran P , Sarolea C , El Loukili M , Bah M 
Published: October 2024

Abstract

Issue
The disconnect between (underserved) communities and governmental bodies in Utrecht, The Netherlands, has led to uneven access to (essential) healthcare services, increasing health inequalities. This gap is often bridged by key community individuals, whose roles have historically been informal. Key individuals are often seen as volunteers who are necessary to gain access to certain communities but are rarely seen as equals in a project team, resulting in mistrust and reduced collaboration on the long term on the side of the key individuals.

Description of the problem
This practice describes the start of a new foundation in Utrecht that formalizes and compensates key individuals’ roles in public (health) projects. The aim was to empower them and to encourage continued participation.

Effects
In 2024, the foundation supported key individuals in three government projects, including a childhood vaccination awareness campaign. Interviews revealed that key individuals felt more empowered and equally valued compared to other project members. They also felt a strong responsibility for project success. However, some noted that formal structures could be restrictive. The government felt more convenience working with a formal foundation.

Lessons
Empowering key individuals is crucial for effective collaboration in public health. There needs to be a balance between formal structures and the flexibility of informal approaches to prevent barriers for key individuals to participate in government projects.

Key messages
• Formalizing key individual roles enhances public health interventions.
• Fair compensation to key individuals fosters sustainable collaboration.
Regional variations in breast cancer screening uptake and its associated factors in Ghana
Authors: Wongnaah F , Aboagye R , Storph R , Seidu A , Adnani O , Ahinkorah B 
Published: October 2024

Abstract

Introduction
Timely identification of breast cancer is critical for successful treatment and prevention, reducing its burden. Despite its significance, breast cancer screening services in Ghana are underutilized, with considerable regional variations in uptake rates. We examined the regional differences in breast cancer screening uptake and its associated factors in Ghana.

Methods
We analyzed data from 15,014 women of reproductive age from the 2022 Ghana Demographic and Health Survey. Spatial mapping illustrated regional variations in screening uptake. Multilevel logistic regression was employed to examine the factors associated with breast cancer screening uptake.

Results
National breast cancer screening prevalence was 18.4%, with regional variations observed across the 16 regions. Eastern, Western, Brong Ahafo, and Greater Accra had the highest screening uptake. The likelihood of breast cancer screening was higher among women aged 45-49 (aOR = 3.59; 95% CI = 12.52, 5.12), Married women (aOR = 1.44; 95% CI = 1.17-1.77), Higher education, employment, health insurance, recent health facility visits, media access, and wealth index (middle: aOR = 1.45, 95% CI = 1.08, 1.94; richest: aOR = 1.91, 95% CI = 1.36, 2.70). Islamic and African Traditional affiliations decrease screening likelihood (aOR = 0.77; 95% CI = 0.63, 0.95; aOR = 0.46; 95% CI = 0.22, 0.97). Rural residence and specific regions (Ashanti, Oti, Savannah, Upper West) reduce odds, while living in North East increases odds (aOR: 1.86; 95% CI = 1.14-3.03).

Conclusions
Cost-effective breast cancer screening services are crucial, particularly in rural areas with geographical disparities. Culturally and religiously sensitive protocols are needed to address regional and religious differences. Expanding Ghana’s national health insurance to cover preventive measures like breast cancer screening is essential. Promoting awareness through conventional and digital platforms is crucial for advocating screening.

Key messages
• Addressing geographical and cultural differences crucial for equitable breast cancer screening in Ghana.
• Expanding health insurance and raising awareness vital to promote screening access and reduce disparities.
Prioritizing health, well-being, active ageing needs in Lithuania: insights from stakeholders
Authors: Domeikiene A , Danuseviciene L , Sileikiene L , Paulauskiene J 
Published: October 2024

Abstract

Background
The rate of aging in Lithuania is faster than the EU average. The number of long-term health problems in older (65+yrs) people increases, posing changes in societal needs. The aim of our study was to identify the most important needs of older people in Lithuania.

Methods
Generic qualitative inquiry employed purposeful sampling of stakeholders in Lithuania: policymakers, administration, academia, civil society, health care, social service, public health, organizations of elderly. 43 experts, engaged in online focus groups, generated a list of needs for health, wellbeing, active ageing in elderly; they deliberated to prioritize top 5; scientific team condensed a list of 10 for voting to determine final 5 national needs. Research was done within project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)”, 2020.

Results
Top needs identified were: shaping healthy lifestyle habits and motivation for change (72%) / age friendly environment and virtual assistive technologies (72%); person centred care (domiciliary care, residential care and nursing, social activities and etc. depending on the needs and wishes of the older person) (58%); increasing and maintaining physical capacity (56%); intersectoral collaboration and integration of social and health services (53%); establishment of positive public attitudes towards elderly people (50%). All stakeholders indicated that “Establishment of positive public attitudes towards elderly people” is the corner stone of all priorities for action to healthy ageing in Lithuania.

Conclusions
The main issue hindering active and healthy ageing in Lithuania - negative image of ageing in the society. Recommendations on the public health actions included promoting intergenerational conversation, reducing stigmas around ageing, strengthening social inclusion, generating age-friendly environments, and creating a safe space for self-realization and development.

Key messages
• The main issue hindering active and healthy ageing in Lithuania – negative image of ageing in the society.
• The change in the population requires the transformation of health care and social care systems building age friendly environments in Lithuania.
Associations between diabesity and mortality over 7 years: a Maltese population-level case study
Authors: Cuschieri S , Grech E , Cuschieri A 
Published: October 2024

Abstract

Introduction
Diabesity presents a growing global epidemic. Demographic and socioeconomic associations have been documented, yet, the literature on mortality risk associated with diabesity is scarce. The aim of this study was to assess whether diabetes and/or diabesity increas the risk of all-cause mortality across a period of 7 years at a population level.

Methods
A nation-wide health examination survey in Malta was conducted between 2014 and 2016. This collected sociodemographic information, bio-anthropometric measurements (waist circumference, body mass index [BMI], body adiposity index [BAI]) and blood samples. Mortality information was acquired in 2021 by cross-referencing with the national mortality register. Statistical analysis was conducted using chi-square tests and Cox proportional hazard models.

Results
A mortality rate of 1.67% was observed (n = 3947), with diabetes and obesity being responsible for 6.06% and 3.03% of deaths, respectively. Examining the deceased individuals alongside their baseline characteristics (2014-2015) revealed that 25.76% (CI95%: 16.75 - 37.44) had diabetes, and 30.30% (CI95%: 20.55 - 42.22) were obese. Diabetes was associated with significant mortality risk (HR: 2.65 CI95%: 1.20 - 5.85; p = 0.02), while diabesity showed borderline significance (p = 0.06). After adjustment for potential confounding factors the mortality risk linked to diabetes remained significant and BAI was the only anthropometric measurement positively associated with mortality.

Conclusions
These findings emphasise the urgency for comprehensive public health policies targeting the concurrent prevention and management of diabetes and obesity at a population level. Our results also indicate that incorporating body adiposity index (BAI) into risk assessment protocols may provide valuable insights into mortality risk prediction and inform tailored interventions.

Key messages
• Diabetes and a high BAI score were significantly associated with mortality in the Maltese population, while diabesity had moderate significance, emphasising the urgency of tackling this epidemic.
• These findings call for broad health policies to address diabesity at a population level and suggest integrating BAI into risk assessment for better mortality prediction and tailored interventions.
Joint Action JACARDI: a context analysis on CVDs and diabetes policies and practices
Authors: Di Girolamo C , Turatto F , Destefanis C , Formenti B , Armocida B , Lionello L , Jehlicka L , Costa G , Savoia C , Onder G 
Published: October 2024

Abstract

Issue/problem
Non-communicable diseases are the leading cause of death and disability in Europe, with 63 million people living with cardiovascular diseases (CVDs) and 32 million with diabetes (DM) in 2019. The EU-co-funded Joint Action on CVDs and diabetes (JACARDI), with 76 partners from 21 countries, aims to reduce CVDs and DM burden at European level through 142 pilot projects.

Description of the problem
For an effective and tailored pilots’ implementation, a preliminary step is to assess the current state of strategies and services for CVDs and DM prevention and management in Europe. We adopt the Gap Analysis methodology aiming to evaluate the gap between the current and the ideal state, the latter defined according to scientific evidence, best-practices, guidelines, and expert’s opinions. For this purpose, 12 questionnaires, one for CVDs and one for DM for six different thematic areas, were developed through a participatory approach that fostered the collaboration between the scientific coordination team and the project members.

Results
Questionnaires were sent to National Focal Points for health covering 29 European countries. We anticipate receiving responses from each country covering aspects related to the legal and strategic framework, the intersectoral and equity-oriented approaches, the funding and the service delivery and capacity for CVDs and DM. This information will be collected across each of the six thematic areas corresponding to six technical Work Packages (WP): health literacy, data, screening, integrated-care pathways, patients self-management, labour participation. The survey will be completed by June 2024, and results by WP and country will be presented.

Lessons
The context analysis, based on the Gap Analysis methodology, allows to identify gaps between the current and ideal state in CVDs and DM prevention and management. This will guide JACARDI’s pilots to address gaps and serve as a roadmap to inform European policy-makers.

Key messages
• The context analysis will provide an invaluable overview of the current European state of CVDs and DM prevention and management.
• The context analysis will support JACARDI’s pilots in addressing identified gaps and policy-makers in shaping public health responses.
Primary prevention of type 2 diabetes in the EU: A systematic review of interventional studies
Authors: Lovas S , Soares Andrade C A , Mahrouseh N , Chamouni G , Shahin B , Wangeshi Njuguna D , Israel F , Awad Mustafa Eltayeb O , Aisul Muhlis A N , Varga O 
Published: October 2024

Abstract

Background
The GBD 2019 study revealed that type 2 diabetes caused over 109.000 deaths and accounted for 5.3 million Disability Adjusted Life Years in the EU, with an estimated annual cost of EUR 300 billion in 2014. Interventions for primary prevention are pivotal in preventing diabetes, providing a structured approach to implementing lifestyle modifications or community-based programs. The objective of this study was to demonstrate the effectiveness of primary prevention interventions to prevent or delay the onset of type 2 diabetes in the EU member states.

Methods
A systematic review on six databases was conducted for relevant interventional studies carried out in the EU-28. The main outcome of the studies was determined by changes in the incidence of type 2 diabetes.

Results
The search yielded 18.885 records, of which 18 met the eligibility criteria. The following studies reported significant incidence reduction in the intervention groups: The Finnish Diabetes Prevention Study by individualised lifestyle intervention (HR: 0.614, 95%CI: 0.478-0.789), the Spanish CORDIOPREV Study through increased plant protein intake (HR: 0.64, 95%CI: 0.43-0.96), the Spanish PreDE trial by promoting healthy diet and physical exercise (RR: 0.68, 95%CI: 0.47-0.99), the Norfolk Diabetes Prevention Study with intensive diet-exercise counselling (OR: 0.57, 95%CI: 0.38-0.87), the Spanish PREDIMED and PREDIMED-Reus trials by mediterranean diet supplemented with extra virgin olive oil or mixed nuts (HR: 0.60, 95%CI: 0.43-0.85; HR: 0.49, 95%CI: 0.25-0.97; HR: 0.48, 95%CI: 0.24-0.96), and the Dutch SLIM Study with advices on diet and physical activity (RR: 0.53, 95%CI: 0.29-0.97).

Conclusions
Significantly decreasing the incidence of diabetes is feasible within primary healthcare settings through intensive lifestyle interventions targeting individuals at high risk. Therefore, it would be beneficial to incorporate these findings into the European guidelines for preventing type 2 diabetes.

Key messages
• Primary care plays an important role in the prevention of type 2 diabetes.
• Well-defined primary lifestyle interventions are capable of slowing the progression from prediabetes to diabetes.
Oral health related cardiovascular disease risk factors: a cross-sectional study
Authors: Németh N O , Móré M M , Nagy A N 
Published: October 2024

Abstract

Background
Hypertension, cardiovascular disorders, and hypercholesterolemia represent significant public health concerns. This research presentation examines the impact of various oral health indicators, such as bleeding gums, untreated dental decay, loose teeth, and missing teeth, on these conditions within Hungary.

Materials and methods
This study utilized data from 5,603 individuals participating in the 2019 Hungarian European Health Interview Survey. Predictor variables were chosen using elastic net regularization and k-fold cross-validation to enhance the performance of weighted logistic regression models. Sensitivity analysis underpinned the robustness of the results.

Results
Significant associations emerged between deteriorating oral health and the prevalence of various cardiovascular conditions. An increased likelihood of hypertension was observed in individuals with multiple tooth removals, showing an odds ratio (OR) of 1.67 with a 95% confidence interval (CI) of [1.01-2.77]. The use of dental prosthetics presented an OR of 1.45 [1.20-1.75]. Additionally, presence of gum bleeding corresponded to elevated odds for both cardiovascular disease (OR = 1.69 [1.30-2.21]) and hypercholesterolemia (OR = 1.40 [1.09-1.81]).

Conclusions
enhancing oral health could potentially mitigate chronic cardiac conditions, highlighting the importance of integrating dental care in comprehensive disease management strategies.

Key messages
• Poor oral health is linked to higher hypertension and heart disease odds.
• Dental care is crucial in cardiac disease prevention and management.