bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hand grip strength in older and very old people: Results of the study Gesundheit 65+
Authors: Fuchs J , Gaertner B 
Published: October 2024

Abstract

Background
Functional capacity decreases with increasing age. Hand grip strength (HGS) is considered as an objective general measure of health and a parameter of muscle strength, a component of functional capacity and is part of the evaluation of frailty. HGS is important for many everyday functions, such as holding heavy objects or supporting oneself to prevent a fall. Low HGS is associated with a higher mortality risk. In our study we describe HGS in people aged 66 to 101 years in Germany and identify groups with low HGS.

Methods
Gesundheit 65+ is a longitudinal epidemiologic study of the health status of persons 65 years and older in Germany by the Robert Koch Institute. In 2022/23, one year after baseline, isometric HGS was measured during the examination part of the study using a hand-held dynamometer (Smedley, Scandidact, Denmark, 100 kg). Two values were recorded for each hand. Maximum HGS from all attempts was used for analyses. Weighted prevalence estimates and 95% confidence interval (CI) for grip strength are reported by sex, age-group, height, self-rated health, chronic conditions, and difficulties in activities of daily living (ADL).

Results
HGS was measured in 1,457 persons aged 66 to 101 (48% women). Mean maximum HGS was 28.8 kg (CI 28.4-29.3). HGS was significantly related to sex (men: 35.4 kg, CI 34.8-36.0, women 21.8 kg, CI 21.4-22.2) and age (66-79: 31.0 kg, CI 30.1-31.9, 80+: 23.9 kg, CI 23.0-24.7). In both sexes, shorter persons and persons with bad self-rated health, chronic conditions or difficulties in ADL showed lower HGS than their reference group.

Conclusions
HGS was reduced in very old people, people with support needs, and people with poor health or chronic diseases, identifying these people as important risk groups for preventive measures. These should aim to improve not only endurance but also strength in older and very old people. In the long term, this could also maintain independence and reduce serious injuries from falls.

Key messages
• We found sex and age-related differences in hand grip strength in older people in Germany.
• Based on the results, planning of prevention and intervention could be enhanced.
Significant pre-post effects on a patient-reported outcome measure in inpatient rehabilitation
Authors: Marquardt M , Utsch M , Zembic A , Basedow F , Garuffi G , Tobler S 
Published: October 2024

Abstract

Background
We conducted a pilot study for the Swiss National Association for Quality Development in Hospitals and Clinics (ANQ) in the inpatient rehabilitation setting. The aim was to assess the suitability of a generic health-related quality of life patient-reported outcome measure (PROM) as an outcome quality indicator for public reporting across all rehabilitation domains on a national level.

Methods
In a multi-stage expert-based selection process, the PROMIS Global Health 10 was selected for piloting. We collected data from 29 rehabilitation clinics from April to December 2023. Mean T-scores and effect sizes were analysed across different rehabilitation domains. Patients’ need for assistance in completing the questionnaire was also assessed.

Results
A dataset of 2261 cases yielded a cleaned sample of 2083, with 1217 complete cases. Mean T-scores for physical health (PHS) and mental health (MHS) significantly differed (p &lt; 0.001) at admission and discharge across all rehabilitation domains. The largest effects were observed in PHS for pulmonary (38.9(7.3); 46.0(7.6); dz = 0.95) and cardiologic rehabilitation (41.7(7.4); 47.9(7.2); dz = 0.85), and in MHS for internal medicine (44.1(6.9); 49.1(5.6); dz = 0.80) and psychosomatic rehabilitation (36.0(7.2); 45.2(8.2); dz = 1.19), while the smallest effects were noted in PHS for paraplegia (36.3(7.2); 39.8(7.2); dz = 0.50) and in MHS for the musculoskeletal rehabilitation domain (46.2(7.9); 48.7(7.4); dz = 0.33). Of all complete cases, 40.5% needed assistance in filling in the PROM and support needs were distributed unequally across rehabilitation domains, ranging from 10.0% in psychosomatic to 70.3% in geriatric rehabilitation.

Conclusions
The study presents a nuanced understanding of HRQOL across various rehabilitation domains, with notable effects observed across all domains, alongside significant assistance needs.

Key messages
• PROMIS-GH10 shows significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation, with notable effects observed across all domains.
• Observable barriers in implementation are evident due to substantial assistance requirements.
Monthly Tracking of Infant Mortality in Portugal: Post-COVID Trends
Authors: Nogueira P , Elias C , Camarinha C , de-Araújo-Nobre M , Bacelar-Nicolau L , Furtado C , Oliveira M M , Costa A S 
Published: October 2024

Abstract

Background
The Infant Mortality Rate (IMR) is a fundamental health indicator that reflects the overall well-being of populations. Recognizing the need for more timely data to inform public health strategies, the authors have presented a novel method for monitoring IMR monthly instead of traditional annual reporting. Our work aims to increase further the robustness of a novel method for monitoring IMR monthly.

Methods
This new approach leverages the Portuguese E-Death Certification System (SICO) and Statistics Portugal (2016-2024) data. It provides the most recent insights into IMR trends in Portugal, highlighting the post-pandemic period. This method allows for the analysis of cumulative deaths under one year of age against live births over the previous 12 months, offering a more responsive metric to guide interventions.

Results
The updated analysis reveals a continued pattern influenced by the dynamic public health landscape of the COVID-19 pandemic, including the phasing out of restrictions and the end of mandatory mask usage. The pandemic has significantly impacted IMR trends, with Portugal experiencing a decline in IMR during the stringent phases, reaching historically low levels. This trend slightly reversed following the lifting of restrictions, underscoring the urgent need for understanding the complex interplay between public health policies and infant mortality. In the post-pandemic period, the IMR increased until October 2023, showing a later (up to February 2024) global decreasing trend within the range of 2.5 and 2.9 deaths per 1000 live births.

Conclusions
Recent updates confirm the effectiveness of real-time IMR monitoring as a vital tool for policymakers and health professionals. Portugal’s experience underscores the importance of real-time health indicators in managing public health crises. It stresses the need for further research to understand factors affecting IMR and to continue reducing infant mortality.

Key messages
• COVID-19 restrictions correlated with a historical low in Portugal’s IMR, showcasing the impact of stringent public health measures.
• Post-lockdown, the rise in IMR after the phasing out COVID-19 restrictions and later stabilization underscores the challenges and the necessity for dynamic health policies.
Health behaviour and well-being in the Faroe Islands prior to and during the first COVID-19 lockdown
Authors: Honnudóttir V , Veyhe A S , Mohr M , Mohr M , Strøm M 
Published: October 2024

Abstract

Detrimental effects on health and well-being were reported during the COVID-19-induced lockdown periods in several countries, but these associations have not been studied in small-scale island societies. This study aimed to examine the lockdown period’s impact on health behaviour, social media use and measures of well-being in the Faroe Islands. We used cross-sectional data from two extensive population-based surveys of public health conducted in November 2019, the pre-COVID survey (n = 2906), and 4-6 weeks into the first national lockdown, the lockdown survey (n = 1204). A larger proportion of participants in the lockdown vs. pre-COVID survey people reported high physical activity levels (42.1 vs 30.7% p &lt; 0.001), while nutritional habits were rated worse and social media usage increased. Furthermore, the proportion displaying excellent/very good self-rated health was larger in the lockdown vs. pre-COVID survey (68.1 vs 62.0% p &lt; 0.001), and the same pattern was observed for reporting good quality of life (85.7 vs 82.7% p &lt; 0.05). These associations remained statistically significant in a logistic regression model after adjusting for characteristics for which varying impact of the pandemic has been shown. Indicators of health behaviour showed that larger proportions of participants kept active during the lockdown vs pre-COVID survey, and these differences were statistically significant for physical, mental, and spiritual activities (p &lt; 0.001). On the other hand, similar stress levels in the pre-COVID/lockdown periods were observed, but stratified analysis showed that participants with a high-stress level displayed better self-rated health in the lockdown period compared to the pre-COVID period (p = 0.001).

Conclusions
Findings indicate that self-reported health and quality of life improved during the early phase of the COVID lockdown, and individuals reported higher activity levels associated with good mental health during the COVID-19-induced lockdown period.

Key messages
• Physical activity improved, but dietary habits worsened during initial COVID-19 lockdown in the Faroe Islands.
• Measures of wellbeing and quality of life improved during initial COVID-19 lockdown in the Faroe Islands, while there was no overall difference regarding stress levels.
The normalised mortality, a new measure to ensure valid conclusions from cardiovascular mortality
Authors: Stolpe S , Kowall B 
Published: October 2024

Abstract

Background
The quality and efficacy of health systems is assessed by comparing age-standardised mortality (ASM) from cardiovascular diseases (CVD), as they are regarded avoidable by health care. Differences in CVD mortality in West-Europe are surprising and hard to explain: in 2018, ASM for CVD in Germany was much higher (women: 102, men: 155/100,000) than in the Netherlands (65 and 97). Yet, these differences do not root in health system quality, but in different shares of CVD deaths among all deaths (DE: 39%, NL: 25%), which strongly effect CVD mortality. We developed a mortality measure less sensible to differences in shares of CVD deaths to increase plausibility of comparisons and validity of conclusions.

Methods
WHO data on sex-specific all and CVD deaths, ASM for CVD and all-causes for 2000-2018 for Western-European countries was used to calculate the share of CVD deaths among all deaths. ASM for CVD was divided by the share of CVD deaths resulting in a mortality measure normalized for 1% of CVD deaths. ASM and normalized mortality for CVD were used in comparative analyses. Strength of linear association between total and (normalized) ASM for CVD was estimated (adj. R²).

Results
Normalised CVD mortality ranked from 2.0 (CHE in women) to 4.9 (SVN in men) in 2018. While ASM for CVD was lowest in Danish women and Dutch men, Switzerland leads both rankings using the normalised CVD mortality. While ASM for CVD was much higher in Germany than in the Netherlands, the countries had the same normalized CVD mortality (2.6). ASM for CVD was moderately associated with all-cause mortality only in men (adj. R² 0.33; in women: -0.06). Using the normalized CVD mortality yielded an adj R² of 0.66 in women and 0.94 in men. The normalised CVD mortality ensures reliable comparisons of CVD mortality eliminating the effect of different shares of CVD deaths. It yields plausible results and enables valid conclusions about health system quality and better decisions for public health.

Key messages
• Age-standardised CVD mortality rates are effected by different shares of CVD deaths in countries and hinder valid conclusions on health systems efficacy and quality of health systems.
• The normalised mortality rate eliminates the effect of different shares of CVD deaths in countries and allows to validly compare CVD mortality.
Analysis of the mpox outbreak in Europe in 2022: vaccination rollout in the most affected countries
Authors: Paiva Pessoa M , Figueiredo Augusto G 
Published: October 2024

Abstract

Background
The mpox virus spreads through contact with infected material and causes flu-like symptoms and skin lesions. Common in Central and West Africa, a global rise in mpox cases in 2022 was observed, affecting mainly men who have sex with men.

Methods
The study analysed vaccination policies in the most affected WHO-EURO countries during the mpox outbreak, including the Netherlands, France, UK, Spain, Germany, Belgium, Portugal, and Switzerland. Epidemiological data from May to October 2022 (first wave) were compared. Additionally, the role of EU health institutions in assisting member states in controlling virus spread across the region was examined.

Results
By the end of May 2022, three countries (The Netherlands, France, and UK) initiated post-exposure vaccination shortly after the first case identification. Portugal, one of the most affected countries, implemented pre-exposure prophylaxis for high-risk groups by September, followed by Switzerland in November. Vaccination access for non-exposed priority groups varied, with France not requiring a medical prescription. EU cooperation in health was pivotal during the outbreak, with vaccines distributed through the EU4Health program budget via HERA to ensure preparedness. However, detailed information remains limited.

Conclusions
Countries’ responses to the mpox virus outbreak varied significantly, with discrepancies not always aligning with epidemiological data. These differences could stem from various factors, such as behavioural patterns, prior immunisation rates, and neighbouring countries’ policies. However, the unequal access to vaccines across the region underscores existing health disparities, particularly affecting stigmatised populations. Data on immunisation records were notably scarce in most countries, hindering thorough analysis of policy implementation and effectiveness. Additionally, further exploration is warranted into the role of LGBT associations and evidence of stigma surrounding the outbreak.

Key messages
• The mpox 2022 outbreak in Europe provides an important picture of cross-border health policies and public health responses for future emergences in a European cooperative environment.
• Most national authorities provided limited information during the mpox 2022 outbreak; data on immunisation records and vaccine access is pivotal to assess countries’ health policies.
HiCorr: an influenza surveillance model using over-the-counter sales from community pharmacies
Authors: Teixeira Rodrigues A , Duarte Pereira R , Rodrigues N , Moreno J , Mendes Z , Vasconcelos R , Tato Borges G 
Published: October 2024

Abstract

Background
In large-scale community transmission, such as seasonal influenza, monitoring geographic trends and estimating the transmission intensity are critical to support public health decision-making. Previous studies have successfully used sales data from over-the-counter (OTC) products in community pharmacies to detect and monitor different epidemiological outbreaks, developing surveillance systems that are able to anticipate the load on primary care services and hospitals by up to 3 weeks.

Methods
The subset of OTC products sold in Portuguese community pharmacies was selected by correlating sales data to primary care attendance in previous flu seasons. This data pertained to daily coded episodes of influenza-like-illness (International Classification of Primary Care, 2nd Edition, code R80) in the Portuguese health cluster Oeste Sul. By fitting a moving epidemic method to historical sales data and then applying it to daily collected sales data, the developed index was used to anticipate the relative load to the primary care system as well as the start and the peak of epidemic activity for the current flu season. Results were compared to the public health data available on respiratory infections in Portugal.

Results
The model pinpointed the onset of the 2023-2024 flu epidemic in week 47 and its peak in week 52. The index curve showed a high correlation with the data published by the Portuguese national health service, with no time lag. However, the availability of consolidated public data was delayed, on average, by approximately two weeks.

Discussion and conclusions
Data from community pharmacies significantly enhance the early detection of seasonal flu trends, while reflecting population distribution. This underscores their invaluable contribution to public health assessments and the potential for improving the timeliness and accuracy of seasonal flu surveillance.

Key messages
• Community pharmacy data significantly enhance the early detection of seasonal flu trends.
• Real world sales data maybe useful to support epidemic surveillance in public health.
Examining Cycle Threshold values in Repeat SARS-CoV-2 Cases: A Retrospective Analysis in Ireland
Authors: Kumawat J , Butler F , Jalal R , Codd M , Gormley E , Loughrey J , Conyard K , Wall P 
Published: October 2024

Abstract

Background
Effective public health management during the COVID-19 pandemic requires accurate differentiation between re-infections and residual viral RNA detections in repeat positive cases. This study investigates cycle threshold (CT) trends in repeat SARS-CoV-2 cases to discern between persistent viral remnants and active infections. Collaboration between contact tracing and laboratories is essential for shaping robust public health strategies.

Methods
A retrospective analysis was conducted on 427 individuals with repeat positive PCR tests. Data was collected at a contact tracing centre from March to August 2021. Key variables including age, gender, and biomedical markers (test intervals, CT values) were examined. Regression and correlation techniques assessed CT trends and their implications.

Results
Younger individuals (&lt;60 years) occasionally exhibited significantly lower CT values in subsequent tests, suggesting potential re-infections, while older adults generally displayed higher CT values indicative of residual RNA. These age-specific CT trends were statistically significant and instrumental in refining testing protocols and isolation guidelines. Further analysis is expected to strengthen these findings

Conclusions
Collaborative approaches between contact tracing and laboratories are vital in shaping robust public health strategies for distinguishing between types of repeat infections. Revision of health policies is imperative to prevent unnecessary isolation and optimise healthcare workforce allocation during ongoing transmission periods.

Key messages
• Decisive decision-making skills are crucial in managing repeat SARS-CoV-2 infections.
• Revised health policies align testing and isolation practices with empirical CT data, enhancing public health efficacy.
The practice of defensive medicine among Italian physicians: a cross sectional study in Rome
Authors: Furia G , Alizadeh H A , Sapienza M , Tarsitano M G , Patrizi C , Capelli G , Damiani G , De Vito C 
Published: October 2024

Abstract

Background
To identify the perception and the reason of defensive medicine among Italian physicians, and identify the socio-demographic and work-related determinants of the increased practice of defensive medicine.

Methods
This study is a cross sectional web survey. A questionnaire was sent by e-mail to all the physicians registered to the Order of Physicians and Dentists of the Province of Rome. The collection period was from mar 2024 to may 2024. Descriptive analysis and multivariable linear regression models were conducted to describe differences between groups and to estimate the relationships between variables.

Results
A total of 291 physicians completed the survey and were included in this analysis. Almost 60% of respondents feel under pressure due to the possibility of legal disputes. 73,8% adopted defensive medicine behaviours during the last year. More than 80% are aware that defensive medicine represents a limitation for their profession and a unfavourable factor for patients. Who answered that they practice defensive medicine think that it is a factor limiting their professional activity (OR: 2.3) and an unfavourable factor for the patient’s health (OR: 1.1).

Conclusions
Defensive medicine is an important factor in health care costs without increasing the benefits to the patient. The study contributes to a deeper understanding of the perception of defensive medicine among physicians. Defensive medicine practice is common among physicians with concerns about increasing pattern in the future.

Key messages
• Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice.
• The study contributes to a deeper understanding of the perception of defensive medicine among physicians.
ERIMS assessment Tool Enhances Emergency Response in WHO Europe Region
Authors: Monteiro H , Shapiro M , Tran Ngoc M , Elamein M , Matos C , Smallwood C 
Published: October 2024

Abstract

Issue/problem
The implementation of an Emergency Response Information Management System (ERIMS) assessment tool improves health emergency responses within the World Health Organization - European Region. The tool’s deployment aims to refine data management processes and bolster preparedness strategies. Managing health information systems (HIS) effectively during emergencies is a persistent challenge, as technologies keep innovating and potential challenges are constant. The ERIMS assessment tool addresses this by offering a structured approach, ensuring improved emergency responses and system resilience.

Description of the problem
Adopting a systems approach, the ERIMS tool was designed to be flexible, allowing adaptation to various HIS architectures and emergency coordination mechanisms. Its design and development process included consultations with digital health and emergency management experts and field testing across three WHO member states.

Results
Field applications of the ERIMS assessment tool demonstrated its capacity to evaluate, including, digital capability and knowledge management with focus on emergency scenarios. The tool identified systemic gaps, offered strategic guidance on enhancing data processes, and fortified decision-making protocols. These outcomes not only highlighted the tool’s utility in assessing HIS readiness but also its impact in improving emergency response mechanisms.

Lessons
The deployment of the ERIMS assessment tool enhanced HIS by providing an evaluation of emergency preparedness and response capabilities with a focus at the national perspective level. The tool’s application showcased its role in advancing public health emergency preparedness, illustrating how assessments can lead to substantial improvements in health information management and emergency response readiness.

Key messages
• ERIMS assessment implementation improves emergency data management.
• Better preparedness relies on boosting digital capabilities and knowledge management.