bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between heart failure diagnosis and the incidence of cancer: a longitudinal analysis of the United Kingdom Biobank
Authors: Gomez Ochoa S A , Levinson R T 
Published: October 2024

Abstract

Background
Heart failure (HF) and cancer represent prevalent chronic conditions with a high burden of disease worldwide. Several studies have shown a high frequency of coexistence of these two entities, highlighting a potential bidirectional association. However, few longitudinal studies have explored whether patients with HF have a significantly increased risk of cancer and if comorbidity profiles affect this risk.

Purpose
To explore the association between incident HF diagnosis and cancer development in UK Biobank participants after adjustment by potential confounders.

Methods
We conducted a retrospective cohort study in UK Biobank. HF and cancer diagnoses were determined using diagnoses and patient reports. We evaluated breast, liver, lung, prostate, colorectal, uterus, and hematological cancer. Individuals with a history of HF or cancer diagnosed before the baseline assessment were excluded. The primary exposure was incident HF diagnosis after enrollment, and the primary outcome was incident cancer during follow-up. Multivariate Cox proportional hazard regression models using time-varying covariates were used to calculate hazard ratios (HR) for the explored associations with overall cancer and by major cancer type. A Bonferroni-corrected p-value &lt; 0.003 was considered statistically significant to control for family-wise error rate.

Results
476,652 patients were analyzed (mean age: 56.3 years; 57.8% females). Over a median follow-up of 13.7 years, 12,461 (2.6%) developed HF, and 34,452 (7.2%) were diagnosed with cancer. Incident HF was significantly associated with increased overall cancer risk (HR 1.34, 95% CI 1.22–1.48. p&lt;0.001), as well as lung (HR 1.30, 95% CI 1.18–1.43), and hematological cancers (HR 1.54, 95% CI 1.25–1.91. p&lt;0.001) (Figure).

Conclusion
Despite sharing multiple comorbidities and risk factors, incident HF remained significantly associated with a higher cancer risk even after multivariable adjustment by relevant confounders. Nevertheless, confounding bias and especially detection bias, cannot be ruled out in the present analysis. Further research is necessary to validate these findings and elucidate the mechanisms underlying this association.Figure
Assessment of right ventricular ejection fraction cut-point for predicting mortality and heart failure hospitalization in asian patients with heart failure and reduced ejection fraction (HFrEF)
Authors: Buraphat P , Boonyasirinant T 
Published: October 2024

Abstract

Background
Left ventricular ejection fraction (LVEF) has been well established as a predictor of morbidity and mortality in heart failure patients (HF). Meta-analyses have confirmed that right ventricular systolic dysfunction (RVSD) identified by cardiac MR predicts adverse outcomes in HF patients. However, the cut-point and predictive value of right ventricular ejection fraction (RVEF) in Asian patients remain unknown.

Objectives
To evaluate the RVEF cut-point for RVSD and demonstrate the association between RVSD by cardiac MR and a composite endpoint consisting of HF hospitalisation and/or all-cause mortality in HFrEF patients (LVEF ≤40%).

Materials & Methods
A retrospective chart review of 370 consecutive HFrEF patients who underwent cardiac MR between 01 June 2009 and 31 December 2013 was done. The primary outcome was defined as all-cause mortality and/or HF hospitalisation. Receiver Operating Characteristic (ROC) analysis was done to explore the most accurate RVEF as a cut-point for RVSD. Multivariate Cox regression analysis was calculated.

Results
Patients were followed for a total of 1,989 patient-years with an average of 5.4 ± 2.9 years. The primary outcome occurred in 112 patients (30.3%). ROC analysis demonstrated that RVEF &lt;48% provided the most accurate prognostic value (specificity 52%, sensitivity 70%) with an area under the curve of 0.62 (95% CI 0.55 – 0.69). Multivariate Cox analysis showed that RVSD was a significant independent risk factor (hazard ratio 1.71; 95% CI 1.10 – 2.66; p=0.018) for the primary outcome, in addition to age (p&lt;0.001), New York Heart Association functional class (p&lt;0.001), and diabetes mellitus (p=0.014), regardless of LVEF.

Conclusions
In Asian HFrEF patients, RVSD defined by RVEF &lt;48% by cardiac MR can predict adverse events and provide a prognostic parameter for risk stratification.
Evaluating health system resilience testing; what makes this practice successful?
Authors: Zimmermann J , Haywood P , Karanikolos M , Cylus J 
Published: October 2024

Abstract

Issue
Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test.

Description of the problem
Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing?

Results
Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants.

Lessons
Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process.

Key messages
• Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts.
• Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.
Effectiveness of a school- and primary care-based HPV vaccination intervention (the PrevHPV study)
Authors: Bocquier A , Michel M , Chevreul K , Gilberg S , Gauchet A , LeDuc-Banaszuk A S , Gagneux-Brunon A , Mueller J E , Giraudeau B , Thilly N 
Published: October 2024

Abstract

Background
HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. The components were ‘education and motivation’ of adolescents in schools, ‘at-school vaccination’, and ‘general practitioners’ (GPs) training’. We evaluated the effectiveness of the intervention two months after it ended.

Methods
We carried out a pragmatic cluster randomized controlled trial with incomplete factorial design in 14/25 French school districts (July 2021-April 2022). The cluster was the municipality (n = 91). The outcome was HPV VC (≥ 1 dose) two months after the intervention ended among 11-14-year-olds living in participating municipalities (data from the French national reimbursement database and from the trial). We performed two types of analyses: (1) without considering the dose of intervention received, using a linear model with one fixed effect per component, adjusted for baseline HPV VC; (2) a post hoc on-treatment analysis, rerunning the linear model by replacing the fixed effects with a quantitative ‘dose of intervention’ variable calculated for each component using data collected during the trial.

Results
For the three intervention components, estimates of the effect on VC at two months were greater for the on-treatment analyses than for the analysis that did not consider the intervention dose. For the ‘at-school vaccination’ component, the estimate increased from 5.50 percentage points (pp; p &lt; 0.001) to 11.25 pp (p &lt; 0.001). The ‘GPs’ training’ component reached significance (from -1.46 pp, p = 0.150 to 3.56 pp, p = 0.049). In both types of analyses, no significant effect was observed for ‘education and motivation’ (from -0.08 pp, p = 0.950 to 2.58 pp, p = 0.241).

Conclusions
Increasing HPV VC among adolescents requires the involvement of various stakeholders and could be achieved by combining interventions in both schools and primary care settings.

Key messages
• The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France.
• Offering free HPV vaccination at school significantly increased HPV VC; providing GPs with training and a dcision-aid tool helped increase HPV VC if the GPs completed the training.
Estimated number of COVID-19 deaths averted by vaccination in Belgium
Authors: Stouten V , Van Evercooren I , Vernemmen C , Braeye T , Billuart M , Catteau L , Bustos Sierra N , Vermeiren E , Nasiadka L , van Loenhout J 
Published: October 2024

Abstract

Background
Vaccination campaigns have been rolled out globally to limit the impact of COVID-19 on severe health outcomes, including mortality. We aimed to estimate the number of averted deaths by COVID-19 vaccination in the Belgian population aged ≥65 years, between January 2021 and January 2023.

Methods
Nationwide data on COVID-19 infections, vaccinations and all-cause mortality were individually linked. We estimated Vaccine Effectiveness against COVID-19 mortality (VE) in persons having received a vaccine dose in the last 6 months using a Cox proportional hazards model adjusted for age, sex, time since vaccination, previous infection, comorbidities, province and income. COVID-19 death was defined as a death within 1-7 weeks after a positive SARS-CoV-2 laboratory-test. Based on obtained VE estimates, vaccine coverage and national COVID-19 mortality data, we estimated the number of averted deaths (expected deaths without vaccinating minus the reported deaths).

Results
By January 31st 2023, 11,033 COVID-19 deaths have been reported in Belgium. The average vaccine coverage was 48% during alpha, 85% during delta and 63% during omicron dominance. VE was estimated at 0-59 days after vaccination, for 65-79 year and ≥80 year-olds respectively, at 65% (58%-60%) and 35% (28%-41%) during Alpha, at 84% (82%-87%) and 79% (77%-81%) during Delta and at 83% (80%-85%) and 71% (68%-73%) during Omicron dominance. We estimated 10,042 deaths averted (range: 8,917-11,188) among the Belgian population aged ≥65 years, representing a 48% reduction (range 45%-50%) in the expected deaths. Out of 10,042 averted deaths, the majority was averted during Delta (47%; 4,670) or Omicron dominance (43%; 4,366), compared to during Alpha dominance (10%; 1,006).

Conclusions
Vaccinating against COVID-19 led to an important reduction in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance, underscoring the effectiveness of vaccines against mortality.

Key messages
• Vaccinating against COVID-19 led to an important reduction of 48% in COVID-19-related mortality among the Belgian population ≥65 years, in particular during Delta and Omicron dominance.
• Vaccine effectiveness against COVID-19 mortality was estimated as high in the Belgian population ≥65 years (range: 71-84%) during Delta and Omicron dominance, also among elderly over 80 years.
Who are the superheroes? A cross-sectional study on the determinants of healthy ageing
Authors: Mosconi G , Stival C , Amerio A , Fanucchi T , Iacoviello L , Lugo A , Vigezzi G P , Gallus S , Odone A 
Published: October 2024

Abstract
People who reach old age while enjoying good physical and mental health are, in a sense, ‘superheroes’ (of health): in fact, they not only have a relatively low impact on health care spending but are also advantaged in playing an active role in society and achieving their aspirations (and perhaps helping others to do so). The aim of this study was to assess the prevalence and determinants of being ‘physical superheroes’ (i.e., lacking the 10 major chronic conditions plus obesity), ‘mental superheroes’ (i.e., lacking major mental symptoms) and ‘superheroes’ (i.e., both mental and physical superheroes). We used data from a telephone-based cross-sectional study (LOST in Lombardia) conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥65 years from the Lombardy region, Northern Italy. All the participants provided data both during and before the COVID-19 pandemic. Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥80 years. Multivariable analysis showed that, besides female sex, higher age, and disadvantaged socio-economic status, ever tobacco smoking (adjusted odds ratio, aOR=0.71), alcohol drinking (aOR=0.77), and physical inactivity (p for trend&lt;0.001) were inversely related to being superheroes. Participants with feelings of hopelessness showed an extremely low presence of “superheroes” (OR = 0.17). The COVID-19 pandemic reduced by 16.3% the proportion of superheroes. Given a steadily ageing population, public health policies should aim to ensure that people reach old age in the best possible state of health by preventing risky behaviours and paying special attention to inequalities derived from economic and social factors.
Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)
Authors: Alves T , Papadakaki M , Strukcinskiene B , Silva S , Braz P , Aniceto C , Vagionaki K , Chliaoutakis J , Matias-Dias C 
Published: October 2024

Abstract

Background
The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions.

Methods
A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents.

Results
A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%).

Conclusions
The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.
Accessibility of digital healthcare in 2023: insights from a Dutch national survey study
Authors: Van Tuyl L , Keuper J , Standaar L , Alblas E , Keij B 
Published: October 2024

Abstract

Background
Digital technology is reshaping healthcare, offering potential improvements in accessibility, efficiency and quality. However, to realize potential benefits, ensuring equal access for all is crucial. We investigated digital healthcare usage and studied differences in use across age groups and educational backgrounds in the Netherlands.

Methods
Surveys were conducted among general healthcare users (n = 837, any citizen living in the Netherlands with access to healthcare) and healthcare users with chronic conditions (n = 1437). We studied their digital skills (can you independently use a computer, tablet or smartphone; digital applications; email and apps?) and their use of digital selfcare (did you use websites for health-related information or treatment?). Findings are stratified for educational level (low/medium/high) and age (15 -39, 40-64, over 65 years). Data collection occurred between April and August 2023, focusing on the twelve months preceding the survey.

Results
The majority of respondents use digital devices independently (range: 78-91%), but these percentages vary between subgroups, from 48-65% for users with lower education vs 86-99% for users with higher education. Similar differences exist across age groups: 98-100% of users aged 15-39 use a computer, tablet or smartphone, in contrast with 59-78% in the over 65 years age group. Similarly, the use of websites for health information is 22-31% among lower educated users to 68-70% among higher educated users; and 36-48% among those ≥65 years to 73-75% among respondents aged 15-39.

Conclusions
Substantial variation exists in the use of digital tools and digital selfcare across ages and educational levels. These findings underscore the urgency of addressing inequalities in access to digital healthcare, serving as a call to action for policymakers, healthcare providers, and developers to collectively strive for an accessible (digital) healthcare system for all.

Key messages
• Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.
• Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.
Sustainability in the Next Generation Hospital. Needs and Requirements collection from healthcare infrastructures supply chain stakeholders with One Health approach
Authors: Brambilla A , Mangili S , Dolcini M , Capolongo S 
Published: October 2024

Abstract
Technological, demographic, epidemiological, environmental and social changes require investment in new sustainable hospital infrastructure; there is a lack of guidelines and interaction between Stakeholders. In February 2022, the Joint Research Platform Healthcare Infrastructures (JRP HI) was established consisting of Hospital Strategic Directions and Industrial Partners in Italy. Starting from the WHO Techincal Brief “Hospitals of the Future”, a national survey was carried out via web-survey and semi-structured interviews with a sample of 30 stakeholders to collect the main drivers and constraints for innovation and the framework from a One Health perspective and in terms of sustainability. The main needs to be addressed through the guidelines refer to digitalization (27%), flexibility (32%), environmental sustainability (36%) and economic sustainability (27%) as well as flow management (18%) and hospital infection (14%). The participants consider SDG-3 ‘Good Health and Wellbeing’ to be the most relevant for development activities. Hospital managers prioritize SDG-8 ‘Decent Work and Economic Growth’ (23%); vice-versa the industrial partners suggest SDG-11 ‘Sustainable Cities and Communities’ and SDG- 13 ‘Climate Actions’ (32%) as topics to be addressed. Furthermore, 57% of the respondents state that they lack adequate training, budget or leadership to apply innovative strategies in the day-to-day management of the healthcare organization. The survey highlighted a lack of initiatives, budget, and standardization for enhancing environmental sustainability in healthcare infrastructures. The sustainability of building systems depends on factors such as energy consumption, alternative energy sources, thermal comfort, water usage, waste management, ventilation, lighting efficiency, air quality, and construction materials. Ensuring the adoption of monitoring systems and harmonized standards of performance measurement is crucial for increasing the environmental sustainability.
Intersecting Pathways: Understanding Dementia, Hearing Loss, and Health Disparities
Authors: Stonkute D 
Published: October 2024

Abstract

Background
Dementia is a major public health concern, affecting care dependency and disability in older ages. In Europe, around 14.1 million people live with dementia, a number that is expected to increase to 15.9 million by 2040. Hearing loss (HL), followed by education, has been proposed as the most important modifiable risk factor for dementia. This study aims to investigate how sex, educational attainment and HL intersect to influence dementia-free life expectancy (DemFLE) in older adults.

Methods
Using population register data covering all Finnish residents aged 50 years or older from 2010 to 2019, we apply discrete-time multistate Markov models. Transition probabilities between states, such as HL and dementia, are estimated with multinomial logit models stratified by sex and education. Multistate life tables are used to compute sex- and education-specific DemFLE.

Results
We identified 316,361 individuals with a diagnosis of dementia and 317,115 individuals with a diagnosis of HL, representing 1,449,873 and 2,738,970 person-years respectively. 14% of individuals with HL were eventually diagnosed with dementia, compared to only 8% of individuals without HL. We hypothesise that DemFLE will vary significantly by sex and education, with additional modulation by the presence of HL. Specifically, we expect that the presence of HL will further reduce DemFLE, and that the magnitude of this reduction will be relatively greater among those with lower educational attainment.

Conclusions
This study contributes to the emerging literature on the impact of hearing loss on dementia. While both dementia and hearing loss are irreversible health conditions, hearing loss can be managed by hearing aids. If we find evidence that hearing loss is associated with different levels of risk of dementia by educational attainment, it would suggest avenues for effective interventions and public health policies to ensure more equal ageing processes in the population.

Key messages
• Hearing loss may intersect with education and sex in the risk of dementia, providing evidence for the importance of addressing hearing health inequalities in dementia prevention efforts.
• Understanding the interactions between hearing loss, education and sex can inform policies to promote healthy ageing and reduce the burden of dementia on individuals and health systems.