bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of team-model on healthcare usage and treatment levels among people with type 2 diabetes
Authors: Lamidi M , Wikström K , Tirkkonen H , Rautiainen P , Laaninen M , Laatikainen T 
Published: October 2024

Abstract

Background
In North Karelia Finland, a team-based service model was implemented in some municipalities’ primary healthcare (PHC) centers during 2020. In this team-model, a healthcare customer contacts a nurse who initiates the service process immediately. Nurses can also consult or direct customers to other healthcare professionals and arrange physical appointments if needed. The aims of the model are improved customer and personnel experience and satisfaction, and improved quality and effectiveness of care. We assess the effect of this team-model on treatment levels, measurement activity, and health care usage among patients with type 2 diabetes (T2D).

Methods
Patients with T2D were identified using the ICD-10 code E11 from the regional electronic health records. The data include all patients diagnosed by 2016 who were alive and residing in North Karelia in 2023 (N = 6312). Diabetes-related contacts with nurses or doctors in outpatient PHC and specialized healthcare (SHC) were considered, along with measurement activity and levels of glycated hemoglobin (HbA1c) and low-density lipoproteins (LDL) between the years 2017 and 2022. Annual differences between areas were analyzed using logistic and linear mixed models.

Results
In 2017, patients’ mean age was 66 and age range 20-93. The proportion of men was 55% and 45% resided in team-model areas in 2023. The team-model increased T2D-related outpatient PHC remote contact with nurses for a couple of years. But eventually they decreased to a lower level than before. Additionally, the team-model reduced the number of other contacts. An increased difference between areas in measurement activity on HbA1c and LDL levels was also observed. But the difference between areas in proportion of those who achieved treatment targets stayed unchanged.

Conclusions
In the long-term, the team-model reduced the number of T2D-related contacts and increased the measurement activity of HbA1c and LDL, but it had no effect on treatment levels.

Key messages
• Team-based service models might potentially reduce service use in the long term.
• More research and evidence are needed on the effectiveness and cost-effectiveness of team-based service models.
Public trust in national electronic health record systems: A scoping review of qualitative studies
Authors: Papadopoulos K , von Wyl V , Gille F 
Published: October 2024

Abstract

Background
Having public trust in national electronic health record systems (EHRs) is essential for the successful implementation of electronic health records within a country’s healthcare system. Without trust, people are less likely to consent to sharing their health data through an EHR and government stakeholders will have difficulties promoting uptake and facilitation of EHRs. Research investigating public trust in EHRs is limited, however. In response, we conducted a scoping review in order to gain clarity on the influences and themes behind public trust in EHRs, which can support the implementation of EHRs.

Methods
We reviewed 27 qualitative studies focusing on public trust in EHRs. Studies were identified between January 2022 and June 2022 and were ascertained using an inclusive search method and guided by the PRISMA-ScR checklist. In an iterative process, conceptual themes were derived, and detail the promoters and outcomes of public trust in EHRs.

Results
Three major themes that describe the promoters of public trust in EHRs and two major themes that detail the outcomes once public trust in EHRs exists were ascertained from the literature. Additional findings bring forth the consequential role of healthcare actors in the public trust building process.

Conclusions
Results show comprehension, autonomy, and data protection are key concepts that help build and consolidate public trust in EHRs, while the public and the healthcare system benefit from public trust in EHRs. Furthermore, health system actors can be supportive or detrimental to the implementation of EHRs. Their effect is dependent on their activities within the health care system and how the public perceives those activities. Based on: Papadopoulos K, von Wyl V, Gille F. What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021. DIGITAL HEALTH. 2024;10. doi:10.1177/20552076241228024

Key messages
• This research clarifies the conceptualizations that make up the trust relationship between the public and EHRs.
• The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in EHRs.
A Review of Lifestyle Interventions in Weight Loss Programs for Community-Based Psychiatric Patients
Authors: Picardo G , Donnoli C , Liotta G 
Published: October 2024

Abstract

Background
Psychiatric patients face aggravated physical health issues and reduced life expectancy, primarily due to premature cardiovascular diseases. The intricate relationship between lifestyle factors, illness, and psychotropic medications contributes to this phenomenon. The focus of this research is to evaluate weight management interventions for individuals with Severe Mental Disorders through a comprehensive scoping review, focusing on diverse study designs, outcomes, and their clinical implications.

Methods
20 studies were analyzed to understand the effectiveness of interventions and characteristics, such as duration, delivery, and professional involvement. Assessment criteria included weight modifications, BMI changes, and metabolic measures like blood pressure and lipid profiles.

Results
The total number of participants included in the 20 studies evaluated was 3886. All trials included individuals of all genders. The studies included patients with a weighted mean age of 44.37 (SD = 4.72) and a mean BMI of 34.7 kg/m2 (SD = 3.56). Varied interventions, mostly conducted in the US, showed promising weight reduction and cardiovascular risk management results among psychiatric patients. However, disparate methods used in the studies hindered the evaluation of outcomes. The studies which yielded more interesting results included Gaughran F. et al, 2017 who showed improvements in HDL cholesterol and metabolic indicators, (HR 0.085; 95% CI:0.007-0.16), and Bartels S. et al, 2015 who reported that 51% of participants achieved clinically significant reduction in overall cardiovascular risk.

Conclusions
Although interventions displayed potential benefits for beneficiaries, the lack of standardized protocols and non-uniform endpoints poses challenges in effectively addressing weight-related concerns in psychiatric patients. Clear guidelines and standardized assessments are necessary to implement psychiatric patients’ weight management interventions.

Key messages
• The health issues and reduced life expectancy of psychiatric patients is a major health burden. The mean BMI of 34.7 kg/m2, indicating a prevalence of Obese individuals needs to be addressed.
• Psychotropic medications are associated with increase in weight. More effort in increasing awareness and including mandatory nutritional educational classes when prescribing these drugs is needed.
Socio-economic gradients in urban green space access and respiratory health
Authors: Szabó D , Pikhart H , Bobák M , Kšiňan A 
Published: October 2024

Abstract

Background
This study investigates social disparities as one of the drivers influencing the access to green spaces and exposure to natural environments, potentially exacerbating disparities in respiratory health in children.

Methods
Longitudinal ELSPAC birth cohort study data included 4384 complete case participants born in cities of Brno and Znojmo, examined throughout the years 1990-2010. Estimates on socio-economic status (SES) scores of children’s parents and their education were used as socio-economical predictors. Tree cover density (TCD) calculated as mean canopy closure percentage in the individual walking distance neighbourhoods and the ownership and accessibility of a garden were used as indicators of green space accessibility. Multiple logistic regression models were employed to estimate odds ratios for predictors of respiratory health outcomes, controlling for several confounders.

Results
Parents’ SES was found to be positively associated with neighbourhood TCD, and this effect was even more pronounced for garden owners. Higher tree cover was then significantly negatively associated with development of acute bronchitis (OR 0.88, CI 95 % 0.84-0.94 for 1 SD of tree cover), while not having a garden (OR 1.81, CI 95 % 1.42-2.33) and living in area with lower tree cover (OR continuously decreasing from 1.88 to 1.68 for lowest and highest quartile respectively) was significantly associated with progression of acute bronchitis into chronic bronchitis in a fully adjusted model. Vice versa, higher tree cover was statistically significantly positively associated with development of allergic rhinitis (OR 1.09, CI 95 % 1.03-1.15), suggesting viability of the novel method of estimation of individual neighbourhood greenness.

Conclusions
The results suggest protective effect of access to urban green spaces against adverse respiratory outcomes in children. The socially uneven distribution of access emphasizes the importance of urban policies in promoting urban health. #NGEU

Key messages
• There is a significant protective effect of access to green spaces against respiratory diseases and their progression.
• There’s an unequal, but varied distribution of access to green spaces, and social gradient in health, highlighting the importance of urban green space distributive politics.
Outdoor living environment and cardiovascular disease risk: results from a Swedish cohort
Authors: Rebouillat P , Mattisson K , Gefenaite G , Nilsson P , Björk J 
Published: October 2024

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. While sociodemographic, dietary and lifestyle factors have been well documented in relation to CVD, environmental factors have been less studied. However, considering the ongoing biodiversity, climate, and health crises, it is imperative to better understand the interplay between the environment and health. This study aimed to examine the associations between green qualities of the residential environment and CVD. The Malmö Diet and Cancer study is a prospective cohort initiated in the 1990s in the city of Malmö (southern Sweden). At baseline, participants were invited to a health screening, including extensive questionnaires about socioeconomic conditions, lifestyle and diet, clinical examination and blood sampling. The residential coordinates of the participants at baseline were linked to the Scania Outdoor Environment Database comprising scores for a range of perceived qualities of the neighbourhood outdoor environment. Three greenness-related dimensions (serene, natural, diverse) were selected for this substudy. Information on incidence of CVD until 2019 was retrieved from Swedish registers. Adjusted Cox proportional hazards models were used to estimate associations between green-related qualities and cardiovascular diseases (major adverse coronary events). Approximately 27000 participants were included, of which 60% were women. The average age at baseline was 58 years old (±8). Mean follow-up was 20 years (±7) and 4318 cases of major adverse coronary events were identified. Preliminary results suggest that several sociodemographic and lifestyle factors, as well as some aspects of neighbourhood greenness, were associated to increased cardiovascular incidence. Neighbourhood greenness might play a role in major adverse coronary events incidence. Further investigation on underlying mechanisms is required.

Key messages
• Identifying environmental risk factors for cardiovascular disease is of importance for public health.
• Neighbourhood greenness might play a role in cardiovascular disease incidence, and underlying mechanisms need to be investigated further.
Changes in anxiety among youth with and without disabilities before, during and after the pandemic
Authors: Lehtola SMH , Holm M E , Kiviruusu O , Sainio P , Lundqvist A 
Published: October 2024

Abstract

Background
Disabled youth are a vulnerable group that have faced challenges during the pandemic. Research about mental health and its changes of disabled youth during and after the pandemic is limited. Thus, this study examined changes in anxiety symptoms among youth with disabilities compared to those without disabilities before, during, and after the pandemic.

Methods
We analyzed population-based cross-sectional data from the Finnish School Health Promotion study (SHP) of youths with an age range of 12-29 years obtained in before (2019; n = 155,166), during (2021; n = 160,796), and after (2023; n = 151,224) the pandemic. Disabled youth were identified based on the Child Functioning Module (CFM). Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7). Logistic regression models were applied to investigate population-level changes in anxiety.

Results
Over the years, the prevalence of anxiety symptoms was higher among youth with disabilities (10.2%, CI95% 10.1-10.4) compared to youth without disabilities (40.1%, 39.9-40.4), females having more symptoms than males. Prevalence of anxiety increased significantly during the pandemic (Before: 31.7% 95%CI 31.2-32.3 & During: 41.8%, 41.4-42.3) and continued to increase slightly after (44.4%, 43.9-44.9) among disabled youth. The same trend was seen in non-disabled youth (Before: 7.5%, 7.4-7.7, During: 11.4%, 11.2-11.6 & After: 12.0%, 11.8-12.2).

Conclusions
The prevalence of anxiety among disabled youth increased during the pandemic and has continued to increase even afterward, highlighting the inequality among youth with disabilities. The results indicate that it is important for educators and stakeholders to target measures and resources to support the mental health of youth with disabilities during and after a crisis, improving their equality in schools and society.

Key messages
• Youth with disabilities experienced anxiety symptoms four times more often than non-disabled youth, and this difference has remained quite stable during the pandemic and afterwards.
• Decision-makers should be aware of this weaker mental health condition of youth with disabilities while planning preventive actions and interventions.
Intersectional inequalities in child social-emotional health: a case for proportionate universalism
Authors: Rosenberg A , Ivarsson A , Pulkki-Brännström A M , Lindkvist M , Silfverdal S A , Vaezghasemi M 
Published: October 2024

Abstract

Background
Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications.

Methods
This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy.

Results
Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities.

Conclusions
This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness.

Key messages
• Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3.
• Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.
Depressiveness in German higher education students – a systematic review and meta-analysis
Authors: Heumann E , Palacio Siebe A V , Stock C , Heinrichs K 
Published: October 2024

Abstract

Introduction
Evidence shows that German higher education students are vulnerable to depressive symptoms. However, there is no recent review compiling these findings. Thus, our study aims at describing the extent to which higher education students in Germany are affected by depressive symptoms.

Methods
We searched three databases for suitable publications using three core concepts (‘depressive symptoms’, ‘students’, and ‘Germany’). The inclusion criteria were: (a) the population studied consisted of students from higher education institutions, (b) data was assessed at higher education institutions in Germany, (c) information on depressive symptoms were pro-vided as outcome of instruments assessing depressive symptoms, (d) articles were published in peer-reviewed journals, in (e) English or German and (f) between 2002 and 2023. Random effects models were used to calculate both general and subgroup-specific pooled prevalence rates. Subgroups were formed based on the included literature (e.g. gender, before or during the COVID-19 pandemic, study phase and programme).

Results
The literature search resulted in 992 articles. After the removal of duplicates and the two-stage screening process, prevalence data was extracted from 60 articles. The overall pooled prevalence rate was 21.1% (95% CI: 17.6% - 24.6%). Medical students (13.2%; 95% CI: 9.9% - 16.4%) and first-year students (11.0%; 95% CI: 7.7% - 14.3%) were less likely to be affected than students in general. Women (29.0%; 95% CI: 21.4% - 36.5%) were more prone to depressive symptoms than men (23.1%; 95% CI: 16.5% - 29.6%). In samples collected during the COVID-19 pandemic, the pooled prevalence rates were higher than in pre-pandemic times (30.6%; 95% CI: 22.1% - 39.1% vs. 18.0%; 95% CI: 14.7% - 21.2%).

Conclusions
This analysis emphasizes the pressing need to address the mental health of higher education students both at the policy level and within universities.

Key messages
• German higher education students show alarming levels of depressive symptoms, demanding immediate action.
• During the pandemic mental health was even poorer than before, highlighting the need for tailored interventions and support in challenging times.
Exploring anxiety and depression trends: insights from the BELHEALTH cohort 2022-2024 in Belgium
Authors: Duveau C , Hermans L , Bruggeman H , Nélis G , Charafeddine R , Dispas M , Demarest S , Gisle L 
Published: October 2024

Abstract

Background
The swift impact of the COVID-19 pandemic and ensuing restrictions on the mental health of the Belgian population prompted the need for a sustainable system to monitor its evolution. Repeated COVID-19 surveys were conducted between 2020 and 2022 to address this issue, followed by the launch of the BELHEALTH cohort project. Our study aims to analyze the trajectory of anxiety and depression at the post-pandemic period, using data from five waves of the BELHEALTH longitudinal surveys from October 2022 to March 2024. High-risk groups and the potential of social support and resilience to mitigate anxiety and depression were explored.

Methods
The BELHEALTH follow-up cohort of around 7,300 Belgian residents uses online surveys to assess anxiety (with the GAD-7), and depression (with the PHQ-9). The analyses were performed using linear mixed models on the 3,676 individuals who participated in all five waves.

Results
Preliminary results indicated that more people were affected by anxiety in October 2022 (16%) compared to June 2023 (14%), while depression rates were lower in October 2022 (13%) compared to February 2023 (14%) and March 2024 (15%). However, the trajectory of mental health varied across demographic subgroups, with worse outcomes observed among unemployed and younger individuals, as well as those living alone, in the Walloon Region (South of Belgium). Overall, people with a low level of resilience or a low level of social support exhibited higher odds of experiencing depression.

Conclusions
Reducing these social inequities in mental health necessitates the development of structural prevention measures and interventions at the regional level. These measures should target factors such as unemployment, which is particularly prevalent among younger individuals and those living in Wallonia. Additionally, fostering protective factors such as social support and resilience is crucial for mitigating mental health inequalities over time.

Key messages
• Monitoring mental health and its determinants remains crucial to identify and address social inequities, tailor interventions, and support vulnerable populations.
• Unemployed, younger people, and those residing in the Walloon region are at particular risk.