bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inequities in child health in Luxembourg
Authors: Seuring T , Ducomble T , Berthet F 
Published: October 2024

Abstract

Background
In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve.

Methods
We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles.

Results
We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits.

Conclusions
Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours.

Key messages
• Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health.
• Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.
The Africa CDC Guidance for Strengthening NCDI-MH Surveillance Systems: The role of HIS assessments
Authors: Kakunze A , Zobi M , Kabarega B , Moser F , Njobo Mamba D , Sarganas Margolis G , Alinon K , Abdulaziz M , Fehr A 
Published: October 2024

Abstract
Deaths due to NCDs, injuries and mental health conditions are expected to at least triple by 2063 in the region of the African Union. Population-based data for NCDI/MH and their determinants remain scarce in many AU MS; therefore, NCDI/MH surveillance is a flagship initiative in the Africa CDC NCDI/MH Strategy. In a survey conducted by Africa CDC and RKI in 2022 on the impact of COVID-19 on NCDI/MH in 10 AU MS, countries signaled the need for a continental guidance document. In 2023, Africa CDC and RKI performed desk reviews and facilitated peer-to-peer multi-country HIS assessment workshops, based on modified WHO and IANPHI tools. The first workshop took place in Zambia with experts from Botswana, Democratic Republic of Congo/DRC, Kenya and Zambia. The second workshop was hosted in Ghana and included DRC, Ghana, Morocco, Nigeria, Senegal and Sierra Leone. Participants came i.a. from ministries of health, national public health institutes or academia. The process included a virtual introductory meeting as well as half-day training sessions at the physical meeting for participants to familiarize themselves with the tools. Peer-to-peer assessment sessions took place on days 2 and 3. Day 4 was reserved for site visits to (public) health institutions of the hosting countries. On day 5, participants presented their findings to the plenary, which included high-level representations from host countries. The combined results from the survey, desk reviews and workshops informed the development of the continental Africa CDC Guidance for strengthening surveillance for NCDI/MH, launched at the 3rd Conference on Public Health in Africa. In four chapters, the Guidance covers recommendations on indicators, data sources and data types; surveillance system capacities; surveillance integration with existing systems; and data use. Implementation of the Guidance, including development of core health indicators, has been initiated by Africa CDC in 2024.
The EU project VAXaction: tacking effectively vaccine hesitancy in Europe
Authors: Signorelli C , Odone A , Barbati C , Cuciniello R , Lunetti C , Pennisi F , Viviani L , Correia T 
Published: October 2024

Abstract
The main objective of VAX-ACTION is to support EU Member States and relevant stakeholders to implement the results of tailored, evidence-based interventions aimed to reduce vaccine hesitancy. Based on the evaluation of effectiveness of these interventions, which will be conducted in selected target regions in EU member states, recommendations will be drawn through diverse dissemination strategies to allow scaling up good practices to other member States, but also to the USA and Canada, where gaps in implementation strategies also have prevented effective, evidence-based interventions aimed to better deal with vaccine hesitancy.
The first phase of the research involved some relevant systematic reviews with the aim of:
1. to map public health evidence and research results on large-scale vaccination programs in Europe and north America;
2. to map interventions aimed to address vaccine hesitancy regarding new and well-stablished vaccines and vaccination programs (Covid-19, mpox, national immunizations programs for children) in Europe and north America;
3. to identify successful and unsuccessful interventions designs aimed to address vaccine hesitancy, including challenges in the implementation, evaluation designs, and the feasibility of scaling-up solutions that are context-sensitive;
4. to identify significant similarities or dissimilarities in the designs and outcomes of interventions aimed to address vaccine hesitancy in northern countries where political and academic concern towards this phenomenon is growing;
5. to identify the extent to which ‘grounding’ (bottom-up) experiences aimed to address vaccine hesitancy are evidence-based, build on current international knowledge and guidelines, and whether they are internationally reported;
6. to systematize the mapping of interventions aimed to address vaccine hesitancy in the northern hemisphere in a way that can be shared and used by third parties.
This contribution will illustrate the results of the first phase of the project.
Unravelling COVID-19 social mortality patterns using conditional inference tree algorithm
Authors: Cavillot L , Van den Borre L , Vanthomme K , Scohy A , Deboosere P , Devleesschauwer B , Speybroeck N , Gadeyne S 
Published: October 2024

Abstract

Background
The COVID-19 pandemic led to significant excess mortality in 2020 in Belgium. By using microlevel cause-specific mortality data for the total Belgian adult population in 2020, three outcomes were considered in this study aiming at predicting sociodemographic (SD) and socioeconomic (SE) patterns of 1) COVID-19 specific death compared to survival; 2) all other causes of death (OCOD) compared to survival; 3) COVID-19 specific deaths compared to all OCOD.

Methods
Multivariable logistic regression models were fitted for the three outcomes. In addition, we computed conditional inference tree (CIT) algorithms, complementing regression models, to identify and rank the strongest SD and SE predictors of the three outcomes.

Results
Older people, males, people living in collectivities, first-generation migrants, and deprived SE groups experienced higher odds of dying from COVID-19 compared to survival; living in collectivities was identified by the CIT as the strongest predictor followed by age and sex. Education emerged as one of the strongest predictors for people not living in collectivities. Overall, similar patterns were observed for all OCOD except for first- and second-generation migrants having lower odds of all OCOD compared to survival; age group was identified by the CIT as the strongest predictor. Older people, males, people living in collectivities, first- and second-generation migrants, and people with lower levels of education had higher odds of COVID-19 death compared to all OCOD; living in collectivities was identified by the CIT as the strongest predictor followed by age, sex, and migration status. Education and income emerged as the strongest predictors among people not living in collectivities.

Conclusions
This study identified important SD and SE disparities in COVID-19 mortality underlying the importance of implementing preventive measures, particularly within the most vulnerable populations, in infectious disease pandemic preparedness.

Key messages
• Living in collectivities appeared to be the strongest predictor of COVID-19 death across all age groups, highlighting the importance of preventive measures in reducing the transmission of the virus.
• Poor education plays a crucial role in predicting COVID-19 death among people not living in collectivities, highlighting the importance of targeting preventive measures towards low educated groups.
COVID-19 vaccine effectiveness and hybrid immunity in the respiratory season of 2022-23 in Hungary
Authors: Oroszi B , Horváth J K , Túri G , Krisztalovics K , Kristóf K 
Published: October 2024

Abstract

Background
There has been an increase in COVID-19 vaccine hesitancy among the general population, accompanied by a decline in confidence that vaccines provide adequate protection. We estimated the effectiveness of the COVID-19 vaccines (CVE) and hybrid immunity against medically attended COVID-19 during the 2022-2023 respiratory season in Hungary.

Methods
We conducted a test-negative design study involving 68 GPs. Patients aged ≥18 years presenting with acute respiratory infection were swabbed. Cases and controls were patients testing positive and negative for SARS-CoV-2 by RT-PCR, respectively. Exposure was defined as having received at least one COVID-19 booster dose, taking into account the time since the last vaccination. CVE was estimated using logistic regression, adjusted for symptom onset date, age, chronic condition and sex.

Results
We included 247 cases and 1073 controls in the analysis. 196 samples were sequenced, and Omicron BA.5, BQ.1 and XBB.1 were the most frequent sub-variants. The CVE was 52.9% (95% CI: 15.2-73.9%), and 72.3% (95% CI: 32.0-88.7%) in the 18-59, and 60+-year-old population who received the final dose within the past year, respectively. Self-reported COVID-19 in the previous 60-365 days did not confer protection against reinfection, however, when combined with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: −28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively.

Conclusions
Booster vaccination within one year after the last dose confers significant protection against symptomatic infection, particularly among the elderly. Those who have previously been infected with SARS-CoV-2 may also benefit from booster vaccinations.

Key messages
• COVID-19 booster campaigns must be intensified, focusing mainly on the elderly.
• Providing clear guidance on the timing and target groups of vaccination and emphasising the benefits of vaccination can help to achieve higher coverage.
Sex differences at different ages in 30-day survival of COVID-19 hospitalized patients in Israel
Authors: Magid A , Niv Y , Green M S 
Published: October 2024

Abstract

Background
Sex differences in mortality from COVID-19 have been described. It is not clear to what extent sex is an independent risk factor for mortality or is confounded by co-morbidities and whether it varies by age. It is also not clear whether it is constant over time since diagnosis. We studied sex differences in 30-day mortality rates in patients hospitalized with COVID-19, after controlling for co-morbidities.

Methods
Data on patients hospitalized with COVID-19 were extracted from the majority of general hospitals in Israel during 2020 to 2022. The outcome variables were death during 30 days from onset of hospitalization. Sex differences in survival rates were assessed using Cox proportional hazards models controlling for age, heart disease, cancer, respiratory disease, diabetes and hypertension.

Results
Mortality rates in women were significantly lower than in men in all age groups. There was an approximate 5-6 year lag in the mortality rates between men and women.

Conclusions
Sex was an independent predictor of 30 day mortality from COVID-19 with women experiencing better survival. This advantage was not explained by differences in co-morbidities or the magnitude of the differences in survival by age. The sex differences in the 30-day mortality of hospitalized patients are compatible with the male dominance in the incidence rates of many infectious diseases. Poorer survival of men hospitalized for COVID-19 is likely to be part of the disease mechanism and should be explored further.

Key messages
• Poorer survival of male COVID-19 patients seems to be part of the disease mechanism and should be explored further.
• Sex differences in disease should be included in personalized management of disease.
Molecular Tumor Boards impact on patients’ health: towards a policy brief in the Can.Heal project
Authors: Giacobini E , Russo L , Osti T , Cacciuttolo M G , Lentini N , Pastorino R , Specchia M L , Kamal M , Boccia S 
Published: October 2024

Abstract

Background
Molecular Tumor Boards (MTBs) are pivotal in the current management of oncological patients, integrating molecular diagnostics with clinical expertise to tailor precise treatments. Within the framework of EU-funded ‘Building EU Cancer and Public Health Genomics platform’ (Can.Heal) project that aims at streamlining genomics implementation in public health, we are developing a policy brief to promote MTBs’ adoption across the EU.

Methods
A two-step approach was employed to delineate strategies for MTB implementation. Firstly, we conducted a systematic review and meta-analyses (if feasible) up to November 2023, on studies assessing the MTBs’ clinical impact. Secondly, based on the results of the review, we conducted an expert consultation to identify key areas to improve MTBs implementation and impact.

Results
48 studies were included, whose results were heterogeneous in terms of organizational aspects and number of experts involved (mean n: 6, range: 2-19). Average implementation rate of the recommendations issued by the MTB was 43.1% (3.2%-92%), with a turnaround time from testing to recommendation of 36 days (15-58). By pooling data from 12 studies (n = 1623), a favorable overall survival [HR = 0.63 (95% CI 0.53-0.76), I2 42.0%] was reported for patients managed in hospitals with MTBs versus not. Similar estimates were reported when the outcome was progression free survival [HR = 0.63 (95% CI 0.54-0.72), I2 = 0.0%], based on 8 studies (n = 1106). The subsequent expert consultation identified 5 key areas for MTB implementation: genetic data sharing, standards for results’ interpretation, equitable access to MTB, optimization of the testing process, and funding and reimbursement.

Conclusions
The policy brief underscores the significant clinical benefits of MTB-recommended therapy, improving patients’ outcomes. Nevertheless, addressing resource allocation and infrastructure development is essential to optimize MTB utilization and enhance patient outcomes.

Key messages
• Our results highlight that MTBs-recommended therapy translates into tangible clinical benefits.
• More fundings and resources are needed to optimize and fully implement MTBs in clinical practice.
Improving data quality by implementing an electronic medical record seems to depend on the context
Authors: Wurster F , Hansen T , Jaschke J , Köberlein-Neu J , Okumu M R , Pfaff H , Rusniok C , Karbach U 
Published: October 2024

Abstract

Background
The European healthcare system is reliant on its digital transformation to deal with challenges like rising expenditures or workforce shortage. The digital transformation is inevitably accompanied by the implementation of electronic medical records (EMR) and the ongoing adaptation of existing ones. Systematic reviews indicate that this process can have an impact on medical records data quality (DQ) [1]. At micro level, DQ is essential to ensure high quality of care. At macro level, sufficient DQ is a prerequisite for big data analyzability. In this field, completeness is a commonly analyzed dimension of DQ and empirical results indicate that completeness can improve but also deteriorate as a result of the described implementation or adoption of EMRs [2]. The aim of this work was to investigate the implementation of EMRs in comparable settings and to observe and discuss possible differences in the change in DQ.

Methods
Data was collected on three surgical clinics of a German academic teaching hospital before and after the implementation of an EMR. Paper-based and electronic medical records were compared. Analysis focused on ten items that were commonly documented in both record types (e.g. pain). T-tests and χ²-tests were used to compare average completeness per record type and percentage of completeness per item.

Results
A total of N = 659 records was analyzed. Overall, results show a significant improvement in completeness from an average of 6.0/10 items in the paper-based record type to 7.2/10 in the EMR (p&lt;.05). At clinic level, improvement rates vary from 0.9 to 1.4. At the level of the specific items, significant deteriorations are visible in certain clinics.

Conclusions
Results suggest that DQs variability is context-dependent (e.g. on the clinic’s turnover rate or its patient’s length of stay). Due to the unavoidable digital transformation, a detailed context and needs analysis involving all stakeholders should be carried out before any changes are made.

Key messages
• The application of advanced analytics such as big data or AI training is reliant on the availability of high-quality datasets.
• Electronic medical records have been demonstrated to enhance data quality, but it remains uncertain how and why improvements appear to be context-dependent.
Safety in Teletriage by Nurses and Physicians in the US and Israel - a Tale of 2 Systems
Authors: Haimi M , Wheeler S Q 
Published: October 2024

Abstract

Background
The safety of telemedicine in general and telephone triage (teletriage), in particular, have been a focus of concern since the 1970s. Inadequate telehealth systems may compromise patient safety.

Objectives
Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions.

Methods
We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems’ respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach.

Results
The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering non-medical factors and patient preferences (Shared Decision-Making).

Conclusions
Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. There is a need identifying safe systems to guide developers and clinicians about needed improvements.

Key messages
• Patient safety and safe professional practice are extremely important in the field of teletriage.
• We need to guide developers and clinicians about needed improvements in teletriage systems.
Trustworthiness of EHRs: Key Factors from a User-Centered Study in Germany
Authors: von Kalckreuth N , Kopka M , Schmid C , Kratzer C , Reptuschenko A , Feufel M 
Published: October 2024

Abstract

Background
The integration of digital technologies, particularly Electronic Health Records (EHRs), promises substantial improvements in patient care and cost reductions. However, the success of EHRs depends heavily on patient trust and usage, which are influenced by their control over data visibility, storage, and sharing. Identifying the factors that enhance the perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings.

Methods
Participants (N = 30) first interacted with an interactive EHR prototype, then evaluated its trustworthiness and suggested improvements during semi-structured interviews. These interviews were transcribed and analyzed using thematic analysis to identify key themes affecting perceptions of the EHR’s trustworthiness.

Results
Through thematic analysis, we developed a categorical system encompassing five principal themes: provider reputation, information quality, system characteristics, user control, and user feedback. The analysis revealed that deficiencies in design and usability indirectly affect perceptions of privacy and data security.

Conclusions
Our study underscores the critical role of contextual factors-including provider reputation, strategic IT partnerships, and user feedback-in cultivating trust in Electronic Health Record (EHR) systems. Addressing privacy concerns and bolstering user trust necessitates not only a professional approach to design and usability but also clear communication about adherence to rigorous data privacy and security standards. In Germany’s tightly regulated environment, clearly communicating EHR security standards is crucial. Enhancing trust also involves robust customer support, user control over their data, and leveraging social proof like high download rates or positive reviews. These approaches could significantly improve EHR acceptance and trust in digital health across the country.

Key messages
• The perceived trustworthiness of EHRs is essential for increasing their reliability and acceptance in healthcare settings.
• Effective communication and design are critical for building trust in digital health technologies. Trust in EHRs grows with transparent data policies and empowering user controls.