bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic inequalities in cervical cancer screening in sub-Saharan Africa: Decomposition analysis
Authors: Ahinkorah B , Aboagye R , Okyere J , Essuman M , Seidu A , Wongnaah A 
Published: October 2024

Abstract

Background
Cervical cancer remains prevalent in sub-Saharan Africa (SSA). Despite global efforts to eliminate this disease, its incidence continues to rise due to barriers in screening, vaccination, and treatment access. While studies address access barriers, little has explored inequality, often limited to single countries. Here, we examine socioeconomic inequalities in cervical cancer screening in SSA.

Methods
Data from the Demographic and Health Surveys of 10 SSA countries was used for the analysis. We stratified the study by wealth index and educational attainment as a measure of socioeconomic status. Socioeconomic status inequalities in cervical cancer screening were constructed using concentration curves. We then computed the concentration index to quantify socioeconomic inequality. To examine the factors associated with high socioeconomic inequality in cervical cancer screening, a decomposition analysis was conducted.

Results
Concentration curves showed screening uptake skewed towards the wealthy and educated across all countries, reflected by positive concentration indices (CIX=0.21; p-value&lt;0.0001) except in Burkina Faso and Mauritius. Decomposition analysis revealed significant positive concentration indices for women with complete secondary (CIX=0.74) and higher education (CIX=0.91), those in the richest wealth index (CIX=0.35), separated women (CIX=0.08), currently working women (CIX=0.02), as well as those who were exposed to reading newspaper/magazine (CIX=0.19), listening to radio (CIX=0.10), and watching TV (CIX=0.44).

Conclusions
Cervical cancer screening in SSA exhibits pro-rich and pro-higher educational inequalities. Urgent interventions are needed to restructure existing screening programs to prioritize accessibility and inclusion, particularly for women from poorer households and with a lower level of education. These findings are vital for policymakers and public health practitioners to address cervical cancer screening disparities in SSA.

Key messages
• Addressing socioeconomic inequalities in cervical cancer screening is crucial for improving public health in sub-Saharan Africa.
• Combatting socioeconomic disparities in cervical cancer screening is critical for achieving health equity in sub-Saharan Africa.
Institutionalising guideline development in a new universal healthcare system: a study in Cyprus
Authors: Kolokotroni O , McGuire H , Kyriakou M , Kouis P , Sioftanos A , Yiallourou A , Achilleos H , Yiallouros P , Nikolopoulos G 
Published: October 2024

Abstract

Issue
Guideline development is a lengthy and diligent process that involves the assessment and interpretation of evidence by a committee. Whilst the implementation of high quality healthcare guidelines ensures consistency and quality in healthcare delivery, many countries worldwide, including Cyprus, lack the capacity and resources to develop de novo guidelines.

Description of the problem
Guidelines developed by internationally recognised organisations, such as NICE, are a valuable resource for countries like Cyprus. The collaboration between NICE and the newly established healthcare system in Cyprus introduced a process for guideline institutionalisation, taking advantage of existing human resources and building guideline development capability in Cyprus.

Results
This process involved recruiting local professionals to form a guideline secretariat. The secretariat, supported by NICE, is responsible for overseeing the guideline development process including technical expert committee (TEC) recruitment and stakeholder consultation. The TEC contextualise an existing NICE guidelines to reflect local considerations. NICE provides quality assurance to ensure changes are contextual in nature and consistent with the underpinning evidence. Despite initial challenges, getting stakeholder buy-in and engaging healthcare professionals in the TEC, one contextualised guideline has been produced and two others are at the final stage.

Lessons
Guideline contextualisation is an efficient and sustainable way of building guideline development capability to institutionalize guidelines in settings with limited capacity.

Key messages
• De-novo guideline development is time consuming and demanding and many countries require an alternative process for producing locally relevant guidelines, capitalising on existing resources.
• Support by an established organisation ensures quality, is less resource intensive, and builds capability for the sustainability of the process.
In at the Deep End: Innovative approaches to engaging underserved communities in Northern England
Authors: Jeffries J , Wearn A , Hassan S , Fryer K , Mitchell C , Sowden S 
Published: October 2024

Abstract

Background
People living in socio-economically deprived communities have greater health needs, but worse access and outcomes from care. A growing international movement of Deep End (DE) general practice networks established to promote health equity, address challenges posed by the inverse care law and advocate for increased research involvement. Researchers, community members and practitioners in the North of England are exploring ways of engaging with underserved communities and addressing low levels of inclusion in research.

Methods
DE research i) co-designing the North East and North Cumbria (NENC) DE network with practitioners to prioritise service investment, research activities and initiatives for local communities; ii) Deep End Research Alliance Yorkshire and Humber (DERA-YH) and Participatory Action Research to increase research capacity and reflect upon the evolution of a novel primary care Community Research Link Worker role (CRLWs).

Results
Prioritisation activities in the NENC DE network, uncovered the volume and complexity of clinical and social need, leading to the co-design and evaluation of initiatives to improve mental health care, increase childhood immunisations, tailor deprescribing, support training, and increase patient inclusion in research. In the DERA-YH, the CRLW model increased participation in research from ethnic minority communities regarding prostate cancer, lung health, dementia, and contraceptive services. Community leaders stated that sharing resources and power in the research process builds trust and interest in research in their communities.

Conclusions
DE networks in Northern England have driven innovative approaches to engage underserved communities in research, fostering empowering and enduring relationships to address health and care inequalities. Co-design methodologies and CRLWs integration into research teams had a transformative impact on the accessibility of research for communities and for the researchers’ positionality.

Key messages
• Deep End networks are advancing approaches to meaningful engagement and partnership working with underserved communities, to address health, care and research participation inequalities.
• We recommend co-design by default and CRLW models to build capacity and embed reflective practice, mutual respect, and power sharing across the research team.
Unmet health needs during COVID-19 pandemic in Serbia
Authors: Jakovljevic M , Matejic B , Cirkovic A , Mladenovic Jankovic S 
Published: October 2024

Abstract

Background
The COVID-19 pandemic made health care access more difficult. This study provides insight into significant individual factors associated with unmet needs in 2021 in Serbia.

Methods
The study is a secondary analysis of SILC data, conducted on a sample of 13,855 respondents aged 16 + (source: Statistical Office of the Republic of Serbia). The outcome variable is self-reported unmet need for physician service in last 12 months (yes/no). Multivariate logistic regression is used to identify factors significantly related to unmet needs. Demographic, socioeconomic factors and health needs, which have been found to be significant for outcome in univariate logistic regression, are entered in final analysis.

Results
It was shown that age, marital, employment status, income and health needs were significant factors for unmet needs. Compared to 16-24 age group, aged 65+ were more likely to report unmet needs, OR = 3.5(CI = 2.1-5.6); for 45-64 years old OR = 3.4(CI = 2.1-5.3); for 25-44 OR = 2.0(CI = 1.3-3.1). Separated/divorced had higher odds for unmet needs than married ones, OR = 1.4(CI = 1.2-1.8); as well as unemployed, OR = 1.4(CI = 1.2-1.6), and retired, OR = 1.2(CI = 1.0-1.5), than employed. Those from the 1st quintile, based on equalized disposable household income, were more likely to report unmet need compared to the 5th quintile, OR = 1.8(CI = 1.5-2.1). A gradient across all quintiles was proven (for 2nd quintile OR = 1.6(CI = 1.3-1.9), for 3rd OR = 1.4(CI = 1.1-1.7), for 4th OR = 1.3(CI = 1.1-1.5)). Compared to participants with very good/good health, those who perceive own health as very poor/poor had 3 times higher odds (CI = 2.5-3.5) to report unmet need; for those with average health OR = 1.7(CI = 1.5-1.9). Suffering from chronic illness increases odds 2.2 times (CI = 1.9-2.5).

Conclusions
The highest probability for unmet needs was established across most vulnerable groups, which is significant for preparing for future public health crises and preventing increase in health inequalities during them.

Key messages
• During the pandemic,there was a higher probability of unmet health needs among the most vulnerable groups.
• Strategies need to be put in place to prevent health inequalities deepening in a future crisis.
Association of CETP gene polymorphisms and haplotypes with acute heart rate response to exercise
Authors: Pikó P , Al Ashkar H , Kovács N , Veres-Balajti I , Ádány R 
Published: October 2024

Abstract

Background
Polymorphisms in the cholesteryl ester transfer protein (CETP) gene are known to be strongly associated with increased cardiovascular risk, primarily through their effects on the lipid profile, and consequently on atherosclerotic risk. The acute heart rate response (AHRR) to physical activity is closely related to individual cardiovascular fitness. This study aimed to investigate the effect of CETP gene polymorphisms on AHRR.

Methods
Our analysis examines the association of five single nucleotide polymorphisms (SNPs; rs1532624, rs5882, rs708272, rs7499892 and rs9989419) and their haplotypes (H) known to be associated with cardiovascular risk in the CETP gene with AHRR in 607 individuals from the Hungarian population. Individual AHRR in the present study was assessed using the YMCA 3-minute step test and was measured as the difference between resting and post-exercise heart rate, i.e. delta heart rate (ΔHR). To exclude the direct confounding effect of the CETP gene on the lipid profile, adjustments for TG and HDL-C levels were applied in the statistical analyses.

Results
Among the five SNPs examined, two showed a significant association with lower ΔHR (rs1532624-Cdom: B = -8.15, p &lt; 0.001; rs708272-Gdom: B = -8.09, p &lt; 0.001) and reduced the risk of adverse AHRR (rs1532624-A: OR = 2.26, p &lt; 0.001; rs708272-A: OR = 2.17, p &lt; 0.001). Among the ten haplotypes, two showed significant association with lower ΔHR (H3 - CAGCA: B = -6.79, p = 0.003; H9 - CGGCG: B = -14.79, p = 0.014) and lower risk of adverse AHRR (H3 - CAGCA: OR = 0.58, p = 0.038; H9 - CGGCG: OR = 0.05, p = 0.008) compared to the reference haplotype (H1 - AGACG).

Conclusions
Our study is the first to report a significant association between polymorphisms and their haplotypes in the CETP gene and AHRR. It also confirms that the effect of the CETP gene on cardiovascular risk is expressed through the acute heart rate response to physical activity, in addition to its effect on the lipid profile.

Key messages
• Certain polymorphisms and haplotypes in the CETP gene show a significant association with AHRR.
• The CETP gene polymorphisms exert their effect on cardiovascular risk not only by altering the lipid profile, but also by modifying the heart rate response to physical activity.
Family function, psychological distress and burden in informal caregivers of people with dementia
Authors: Nemcikova M , Katreniakova Z , Timkova V , Nagyova I 
Published: October 2024

Abstract

Background
Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables.

Methods
We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data.

Results
The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for &gt;40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p &lt; 0.001), anxiety (β = 0.52; p &lt; 0.001), family dysfunction (β = 0.36; p &lt; 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p &lt; 0.001). This association weakened (0.47; p &lt; 0.01) when family function was added to the final model (β=-0.22; p &lt; 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified.

Conclusions
Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587].

Key messages
• Dementia caregiving is a global public health priority.
• The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.
Cadmium exposure and hypertension: a systematic review and a dose-response meta-analysis
Authors: Giuliano V , Verzelloni P , Vinceti M , Filippini T 
Published: October 2024

Abstract

Background
Since the shape of the relation between Cd exposure and risk of HTN has not been previously investigated, we aimed to perform a systematic review with dose-response meta-analysis in epidemiological studies.

Methods
After registration of the review in PROSPERO database (ID: CRD42022382030), we searched for eligible articles in online databases using Mesh-terms/keywords related to Cd, HTN, and BP. Eligible criteria were: adult population, assessment of exposure through Cd concentrations in blood or urine, risk estimates for HTN, observational design. Whenever possible, we computed summary odds ratio (OR) with 95% confidence interval (CI) and performed a dose-response meta-analysis on overall studies and subgroups.

Results
We eventually included 8 articles for both the qualitative and quantitative analysis published between 2006-2023 almost of cross-sectional design, 7 and 4 assessing blood and urine Cd concentrations, respectively. Comparing the highest versus lowest exposure, we found increased risk of HTN for both blood (OR = 1.12, 95% CI 0.92-1.36) and urine assessment (OR = 1.09, 95% CI 0.94-1.28). Dose-response meta-analysis showed an almost linear increased risk for blood Cd concentrations until 1.5 µg/L above with it plateaued. In contrast when using urine concentrations for exposure assessment, risk started to increase above 0.5 µg/g creatinine.

Conclusions
Our results confirm the recent findings of non-linear relation between Cd exposure and risk of both CVD and diabetes and the subsequent need to lower Cd exposure on a public health perspective.

Key messages
• Cadmium exposure showed positive association with risk of hypertension.
• Public health efforts should be implemented to lowed cadmium exposure to decrease CVD risk.
Patterns of overeating in middle-aged Chinese from Hong Kong
Authors: Kim J , Sze K , Poon P , Qi F , Wong A 
Published: October 2024

Abstract

Background
Obesity is one of the most important risk factors for non-communicable diseases worldwide. Overweightness may be attributable to a wide spectrum of overeating behaviours. However, the various types of overeating behaviors are under-studied in Asia, particularly in non-adolescent age groups. This study aims to estimate the prevalence and factors associated with various overeating patterns among middle-aged Chinese adults.

Methods
A random telephone survey was conducted in 2023 on Hong Kong Chinese adults between 35 and 59 years or age (n = 785). An instrument composed of modified Positive-Negative Emotional Eating (EE) Scale, Night Eating Questionnaire-Chinese (NEQ), Binge Eating Disorder Screener (BED-7), Depression Anxiety and Stress Scales (DASS-21), demographic factors, BMI and number of reported gastrointestinal (GI) conditions was used. Multiple regression analyses were conducted to test the association of demographic factors, BMI, GI conditions as well as dysphoric mood with overeating behaviors.

Results
Hong Kong Chinese middle-aged adults reported the following past-month prevalence of overeating behaviors: positive EE (26.1%), general overeating (12.4%), negative EE (9.2%), binge eating (6.0%) and night eating behavior (1.8%). Nightshift work, mental stress, being single and younger age were common risk factors for the various overeating patterns among middle-aged men. Anxiety, high/low educational levels and younger age were common risk factors among middle-aged women. Obesity was associated with binge eating and positive EE in men (OR: 1.7-4.0) and associated with negative EE and general overeating (OR:2.3-2.7) in women.

Conclusions
This study noted that binge eating, night eating, positive/negative EE, and GOB were distinct eating patterns requiring different clinical approaches. The significant association between various overeating behaviors with BMI, indicates that these individuals should be prioritized to receive healthy eating interventions.

Key messages
• Adult overeating is not a singular behavior but represents an array of different eating patterns with different risk factors.
•  Like their Western counterparts, overeating behaviors in Chinese adults are often linked to dysphoric mood, therefore treatment of obesity may require psychological counseling.
Gene Expression Changes in CAD Patients Due to Smoking Using Matched Samples
Authors: Merzah M , Póliska S , Balogh L , Sándor J , Szász I , Natae S , Fiatal S 
Published: October 2024

Abstract

Background
Smoking is a well-known risk factor for coronary artery disease (CAD). However, the effects of smoking on gene expression in the blood of CAD patients in Hungary have not been extensively studied.

Aim
To identify differentially expressed genes associated with smoking in CAD patients.

Methods
Eleven matched samples, based on age and gender, were selected for analysis in this study. All patients were non-obese, non-alcoholic, non-diabetic, and non-hypertensive and had moderate to severe stenosis of one or more coronary arteries, confirmed by coronary angiography. Whole blood samples were collected using PAXgene tubes. Next-generation sequencing was employed using the NextSeq 500 system to generate high-throughput sequencing data for transcriptome profiling. The differentially expressed genes were analyzed using the R programming language.

Results
The median age of patients was 67 years (range: 54-75). RNA sequencing was performed on two groups: smokers and non-smokers. After quality control and filtering, gene expression data were obtained for all samples. Using DESeq2, we identified 279 differentially expressed genes with a p-value ≤ 0.05 and a log2 fold change ≥1. Of these genes, 160 were upregulated in the smokers, and 119 were downregulated compared to non-smokers. Gene ontology analysis revealed that the upregulated genes were enriched for pathways related to immune responses and activities (FDR&lt; 0.03). Specifically, upregulated genes were involved in keratinocyte differentiation, cornification, and epidermis development. The downregulated genes were enriched for cell-cardiac muscle cell adhesion (FDR= 0.004) and epithelium development (FDR= 0.001) pathways.

Conclusions
This research illuminates smoking’s biological effects, aiding personalized medicine for predicting and treating smoking-related diseases.

Key messages
• Smoking alters gene expression in CAD patients’ blood, identifying 279 differentially expressed genes, revealing smoking’s biological effects.
• The study underscores gene expression profiles’ role in personalized medicine, predicting smoking-related disease risks and tailoring CAD patient treatments.
A Bundle of the “Top 10” Outpatient Parenteral Antimicrobial Therapy Publications in 2023
Authors: Childs-Kean Lindsey M , Beieler Alison M , Cortés-Penfield Nicolás , Keller Sara C , Rivera Christina G , Ryan Keenan L , Yoke Leah H , Mahoney Monica V 
Published: October 2024

Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has become more common in infectious diseases practice settings. Similarly, OPAT-related publications have also increased. The objective of this article was to summarize clinically important OPAT-related publications from 2023. Eighty-one articles were found on initial search, with 52 meeting inclusion criteria. A survey containing the 19 articles that had at least 1 citation was sent to an email listserv of multidisciplinary clinicians with OPAT experience. This article summarizes the “top 10” 2023 OPAT articles from the survey results.
Debtor (Non-)Participation in Sovereign Debt Relief: A Real Option Approach
Authors: Cassimon Danny , Essers Dennis , Presbitero Andrea F 
Published: October 2024

Abstract
Developing countries have recently proved reluctant to participate in sovereign debt moratoria and debt relief initiatives. This paper argues that debtors’ (non-)participation decisions can be understood through the lens of real options. Eligible countries compare the net benefits of participating in a debt relief initiative now with the value of waiting to potentially execute their participation option later, when they may have more information on benefits and costs. The analysis corroborates the real option framing with anecdotal evidence and through a survival analysis showing that debtor countries with larger expected debt service savings or higher pre-existing risks of debt distress were quicker to apply for the Debt Service Suspension Initiative, which provided temporary debt moratoria during the COVID-19 pandemic. The paper discusses policies that can make participation in debt relief initiatives more attractive to debtor countries.