bluuebunny/crossref_metadata_2025_split huggingface dataset:
When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease
Authors: Di Simone E , Panattoni N , Celiboni G , Renzi E , Di Muzio M , Villari P , Massimi A 
Published: October 2024

Abstract

Background
With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT.

Methods
A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included.

Results
105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity.

Conclusions
Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view.

Key messages
• Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity.
• The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.
Characterising users of community-based interventions designed to improve the food practices
Authors: Petre O , Allan J , Craig L , Douglas F , Kyle J , Stephen A , Thies F 
Published: October 2024

Abstract

Promoting affordable ways to help low-income families improve dietary behaviours and achieve a healthy weight represents a priority for UK public health policy. For such interventions to be appropriately tailored and targeted, it is important to better understand the intended recipients. The present study aimed to assess the dietary practices and psychosocial characteristics of users of Aberdeen City community-based interventions (e.g., food banks, pantries, social cafés) designed to support low-income communities in accessing food and engaging in healthier food practices. From January to June 2023, a cross-sectional survey was conducted employing convenience sampling among users of community-based interventions (N = 105; 73 females). The questionnaire assessed diet quality (SFFQ), household food insecurity (HFIAS), mental health (PHQ-4), well-being (Cantril Ladder), intention and self-efficacy toward healthy eating, and sociodemographic variables. Data were analysed using descriptive statistics, group comparisons, correlations, and regression analyses. Results indicated that community-based food provision users are highly vulnerable to food insecurity. Among participants, 53.3% reported severe food insecurity, and 18.1% reported moderate levels. Service users’ diets were high in discretionary foods and drinks (26% consume daily &gt;1 portion of fizzy juice, 18.2% sweets, 16.7% crisps vs. 11.5% fruits and 10.6% vegetables). The mean dietary quality score was 9.48 (SD = 1.90) from a possible 15. Higher food insecurity and lower diet quality were significantly associated with greater mental distress (r=.41, p&lt;.001; r=-.287, p=.005;) and poorer well-being (r=-.460, p&lt;.001; r=.19, p=.049;). This study is part of a larger project aiming to optimise community-based dietary interventions for low-income populations. The results provide a clearer picture of the intended beneficiaries of such interventions and highlight user needs that can be prioritised in optimisation efforts.

Key messages
• Community-based food provision users are highly vulnerable to food insecurity and related negative health experiences.
• The burden of poor diet and its associated health consequences disproportionately affect those living in the most deprived communities.
Health Impact Assessment (HIA): a tool to drive health in all policies?
Authors: Green L 
Published: October 2024

Abstract

Health Impact Assessment (HIA) is often promoted as a tool to implement ‘health in all policies’ and sustainable development approaches to improve health and equity outcomes. However, is this truly the case? Currently global HIA practice is variable. This paper shares learning from the development and implementation of HIA in Wales to date to understand how HIA has been, and can be, used to inform policies and decisions and reduce health inequalities. The research investigated if, and how, HIA can be used as a tool to mobilise HiAP in reality. It followed a mixed methodological approach and investigated the contribution of HIA to practically advancing HiAP viewed through the lens of Wales and internationally. Primary and secondary evidence and statistics were collected and analysed. A literature review, stakeholder interviews, online statistical questionnaires and case studies were conducted. Thematic and content analysis techniques used. Findings include the importance of conceptual considerations i.e. the perspective on health - social determinant an equity or environmental determinant driven - taken by those carrying out or commissioning a HIA; the importance of centres of expertise to learn from; and practical considerations such as the political and regulatory environment, workforce and organisational knowledge and capacity. Wales has a dedicated expert HIA Unit, an enabling political environment and has led to HIA influencing policies and plans over 20 years. It has transferrable learning for other nations and the research including the online survey has been replicated by others, led to collaborations with nations such as Portugal and contributed to the reviewed literature by providing case studies on a topics like climate change which have influenced decision makers. Tangible ways forward for policy makers, researchers and academics include the need to develop more cross collaboration and fill gaps in the evidence i.e. on institutionalisation of HIA.

Key messages
• HIA is a excellent process to drive Health in all policies approaches.
• HIA needs an enabling environment and workforce support such as that in Wales to thrive.
What are the challenges in the Health Technology Assessment of genetic and genomic applications?
Authors: Baccolini V , Isonne C , Siena L M , Sciurti A , Migliara G , Leone I , Marzuillo C , La Torre G , Villari P 
Published: October 2024

Abstract

Introduction
Evaluating genetic/genomic applications (GGAs) is crucial for their implementation in clinical practice but hindered by several issues, such as rapid development processes and unclear benefits. Since these challenges lack comprehensive discussion, this study aims to identify and analyze all barriers emerged in the Health Technology Assessment (HTA) of genetic/genomic tests, filling a gap in the current literature.

Methods
PubMed, Scopus and Web of Science were searched to identify studies that specifically discussed any challenge or barrier in the HTA evaluation of GGAs. No restriction was applied on evaluation aspect or study type. Challenges/barriers were then grouped into the domains outlined in the EUnetHTA Core Model. A narrative synthesis of the main findings was performed. This study was supported by the EC and MUR- PNRR-M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results
19 articles were included: one third involved experts from different countries, and about 50% were author perspectives. Articles either focused on one aspect only (37%) or were more general (47%). The most challenging domain was economic aspects (69%), followed by clinical effectiveness (47%) and social impact (42%), but issues were found in all domains. The lack of a standardized HTA approach, the paucity of evidence on clinical outcomes, the challenges in capturing all health benefits, and the difficulties in identifying the healthcare pathways triggered by the test were consistently mentioned across the HTA domains.

Conclusions
Our study systematically summarized challenges in the HTA evaluation of GGAS, providing a thorough analysis and categorization of these issues. Various challenges surfaced, notably related to the identification of costs, as well as clinical and non-clinical benefits. There is a need for exhaustive discussion on potential solutions to facilitate the assessment process of these technologies to ultimately foster their implementation in clinical practice.

Key messages
• There are multiple challenges in the HTA evaluation of genetic and genomic tests in clinical practice that impact every HTA domain.
• There is a need for concrete efforts in generating further evidence in relation to the definition of costs and benefits of the healthcare pathways triggered by genetic/genomic applications.
The efficacy of vaccination against respiratory syncytial virus across priority population subgroups
Authors: Domnich A , Bertola C , Lupi C , Vece M , Lorenzini E , de Waure C 
Published: October 2024

Abstract

Background
Respiratory syncytial virus (RSV) has recently become a vaccine-preventable disease as two vaccines have been approved for use and a third one is likely to become available by the end of the year. National Immunization Technical Advisory Groups as well as scientific societies across the world have issued recommendations on RSV vaccination that differ in respect to the identification of the target group. The latter has been identified in respect to age or underlying medical conditions mostly according to epidemiological data. In order to strengthen the evidence basis for future decisions, we performed a stratified meta-analysis of efficacy data considering all the three RSV vaccines currently or soon available.

Methods
We searched Randomized Controlled Trials (RCTs) assessing the efficacy of RSV vaccines in terms of reduction of RSV-related Lower Respiratory Tract Infection (LRTI). The research was conducted on PubMed and clinicaltrial.gov. The extraction of relevant data was stratified by pre-defined age groups (60-69, 70-79, 80+) and presence of underlying conditions increasing the risk for RSV.

Results
Three RCTs, one for each of the three vaccines, were considered for the quantitative analysis. Considering the overall 60+ population, the efficacy of RSV vaccines was 78% (95%CI 76-86%) in preventing LRTI. Considering the different age groups (60-69, 70-79, 80+), efficacy was respectively 72% (95%CI 53-84%), 90% (95%CI 66-97%) and 57% (95%CI 0-93%). The efficacy in healthy people and those with at least one underlying condition was similar, namely 77% (95%CI 60-87%) and 78% (95%CI 50-90%).

Conclusions
The available evidence shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. Further studies may contribute to better understanding if the efficacy may change according to individual characteristics, that could be highly relevant in the decision-making process.

Key messages
• The available evidence from RCTs shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups.
• National recommendations on RSV vaccination can be further informed for future studies investigating RSV vaccines efficacy across different subgroups.
Assessment of controlled assistance from e-bikes as a mitigation strategy for individual PM exposure
Authors: Bonardi A , Borgese L , Negro F 
Published: October 2024

Abstract

Background
While promoting active mobility and outdoor activities can benefit health (HLT), it also increases Exposure (EXP) to air pollutants, such as particulate matter (PM), due to the increased ventilation rate (VR) under physical activity. Traditional assessments of individual (IND) PM EXP involve costly equipment inaccessible to the public, but real-time low-cost sensors (LCS) are now emerging. This study presents a proof of concept to demonstrate the use of LCS for examining the real-time IND respiratory dose deposited (RDD) to PM cycling across the Brescia province.

Methods
An e-bike was ridden 33 times between 2022 and 2023 wearing a LCS for PM concentration [PM] linked to a GPS. Respiratory dose deposited(RDD) was calculated for six different locations within each route based on experimental PM and various VR.

Results
The LCS allows for the study of the spatial and temporal variability of [PM], revealing a significant difference (p &lt; 0.01) according to the heating system operation and no significant difference (p &gt; 0.05) depending on the location. RDD increases with [PM] and VR. Real-time and integrated RDD is calculated for routes with high (&gt; 50 µg/m3), medium (25 µg/m3), and low (&lt;10 µg/m3) [PM2.5]. The e-bike assistance is activated when the WHO interim target 4 of [PM] is reached to reduce VR, which corresponds to a shift to a lower physical activity intensity. The RDD calculated using the e-bike assistance over the path reduces RDD by about 23% and 11% over the high and medium [PM], while it never activates for the low [PM].

Conclusions
This study demonstrates that the use of LCS allows the estimation of IND RDD, and the implementation of mitigation strategies based on controlled assistance from e-bikes would enable the reduction of PM individual EXP.

Key messages
• The integration of HLT data from wearable and air quality LCS enables the promotion of active mobility and outdoor activities controlling the EXP to air pollutants.
• Establishing generalized guidelines based on this mitigation strategies for individual exposure reduction may also inform policy recommendations for promoting active and green mobility.
BEST-COST project: a scoping review on the use of multiple deprivation indices in Europe
Authors: Mogin G , Gorasso V , Baravelli C M , Idavain J , Lepnurm M , Delaunay-Havard S , Luyten A , Corda M 
Published: October 2024

Abstract

Background
A Multiple Deprivation Index (MDI) is a composite measure designed to comprehensively evaluate the socio-economic status of individuals within a population. While various countries have employed their own versions of MDI to assess deprivation, none have been developed at the European level thus far. The BEST-COST project (www.best-cost.eu) aims to integrate the dimension of social inequalities in the assessment of the burden of environmental stressors, using a new MDI. Therefore, the objective of this study is to conduct a scoping review to identify and assess current MDIs while extracting details on the methodologies employed in their development.

Methods
We conducted a scoping review on deprivation indices in European countries, encompassing three databases (Medline, Embase and Web of Science). Following screening of all the articles based on inclusion criteria, we specifically examined the methodological choices made across the development of the MDIs, such as the choice of the underlying indicators, geographical scales, data source used, and if and/or how indicator weighting was applied in creating a composite score.

Results
In total, 22 MDIs were identified from 195 articles. 42% of these indices were developed from census data at the municipality level or finer. About half of them (55%) employed weighting of indicators, thereby reflecting their relative importance within the index’s score. From these 22 MDIs, a total of 156 individual indicators were extracted. These indicators encompass several domains such as basic amenities, crime, education, employment, family structure or income. The extensive variety of indicators can be attributed to cultural differences within the EU, data availability and the specific time period during which each index was developed.

Conclusions
Several European countries have separately developed their own MDI, showcasing significant variability in both the included individual indicators and the methodologies applied.

Key messages
• This review highlights the variability of existing indices and which methodologies could be used for the development of a Europe-wide multiple deprivation index.
• It further emphasizes the importance of considering cultural differences and data availability across countries in this process.
A Conceptual Model for Health Impact Assessment of Personalized Prevention Policies
Authors: Costa C , Lopes F , Costa A , Cardoso M L , Gris A V , Kannan P , Garvão F , Perola M , Boccia S , Vicente A M 
Published: October 2024

Abstract

Background
Personalized prevention and pharmacogenomics are emerging fields in global health, promoting tailored approaches to disease prevention and individualized drug therapy, based on the individuals’ genetic profile. However, adoption of these technologies in public health is challenged by the possibility of health disparities. Health Impact Assessment (HIA) is a useful tool to address this issue, by examining how policies differentially impact population groups, guiding stakeholders to more equitable and inclusive outcomes. Solid frameworks for assessing health impacts are needed to avoid heterogeneity when accounting for equity outcomes in HIA. This study tested a conceptual model for HIA in personalized medicine, using a case study in pharmacogenetics to map potential impacts and outcomes, with a focus on health equity.

Methods
A conceptual model for a HIA was developed to map expected impacts and outcomes of a health policy, aimed at enforcing DPYD genotype-guided dosing to prevent fluoropyrimidine toxicity in colorectal cancer patients. The conceptual model was developed based on literature reviews and consultation with stakeholders. Identification of relevant impacts guided selection of indicators and quantitative impact assessment using a Markov chain model.

Results
Impact pathways were identified using a three-tiered reference framework encompassing individual and population perspectives, organizational factors, and overarching health system considerations. The final diagram outlined key outcomes in four categories: health, organizational, economic and equity. HIA projections using this model were obtained for the DPYD testing policy.

Conclusions
In the rise of personalized medicine and pharmacogenomics, health inequalities challenges need to be addressed before implementation in healthcare. This study provided a novel HIA conceptual model for personalized prevention policies based on genomic information, with an emphasis on equity.

Key messages
• HIA is an adequate tool to evaluate potential health inequalities resulting from personalized medicine policies in healthcare.
• This study provides a validated framework for HIA of personalized prevention policies grounded in genomic data.
Rapid health technology assessment to inform policy: a case study with respiratory syncytial virus
Authors: Byrne D , Power V , Bergin A , Panaro A , Cardwell K , Teljeur C , Walsh K A , Harrington P , Ryan M 
Published: October 2024

Abstract

Background
Respiratory syncytial virus (RSV) can cause severe acute respiratory tract infection in infants and older adults. However, until recently, no immunisation interventions were available to reduce the burden of RSV disease in the general population. New health technologies have now been authorised in Europe for infants (a long-acting monoclonal antibody (nirsevimab) and a maternal vaccine (RSVpreF)), and two vaccines for adults aged ≥60 years (RSVPreF3 and RSVpreF). A rapid health technology assessment (HTA) was requested by the Irish Department of Health to support an interim decision on RSV immunisation.

Methods
The rapid HTA commenced in January 2024, and comprised description of technology, a summary of international practice, national and international epidemiology and burden of disease, and a costing analysis. The summary of international practice (including underpinning evidence) was undertaken rather than a systematic review of effectiveness and safety due to the rapidly changing evidence base and short timeline within which information was required.

Results
While new recommendations regarding immunisation against RSV are emerging internationally in response to recently authorised technologies, implementation and funding strategies are not currently widespread. Compared with a full HTA, a rapid HTA enabled an efficient and flexible approach to producing a high quality evidence synthesis to inform a temporary policy decision, taking approximately 6 months to complete rather than 12 months or longer. A full HTA is planned to inform long-term decision-making on this topic, but would not have been feasible to inform an interim decision.

Conclusions
This rapid HTA will inform a temporary decision on immunisation policy for a single RSV season in Ireland. Conducting a rapid HTA prior to a full HTA has enabled timely decision-making, with implications for Ireland’s national healthcare system and people at risk of severe RSV-related disease.

Key messages
• Innovations in immunisation against RSV are leading to changes in policy across Europe.
• Rapid HTA can support timely, evidence-based public health decision-making in a fast-evolving field.
Enhancing preparedness by developing robust implementation
Authors: Kaag F , Koeck J F 
Published: October 2024

Abstract
In EUVABECO, a goal is defined as a public health objective that motivates a vaccination practice. A vaccination practice encompasses specific methods or approaches used in vaccination efforts, while a tool refers to a tangible resource or software developed to support the implementation of these practices. EUVABECO is undertaking a series of structured activities from January 2024 until mid-2026. These include mapping innovative practices, deriving requirements for tools and validation plans, developing implementation plans, and facilitating their adoption by European MS. The project will also evaluate, validate, and verify these plans to ensure their efficacy and sustainability. EUVABECO’s methodology is informed by the Systems Development Lifecycle (SDLC) framework, utilizing the V-model to ensure a strong linkage between the development and testing phases, thereby guaranteeing a cohesive workflow. Each implementation plan developed will feature comprehensive policy recommendations and a workplan that covers the necessary organizational, technical, legal, and ethical aspects required for the tool’s deployment. Additionally, these plans will include tailored strategies to enhance the tool’s functionality during outbreaks, criteria for verifying implementation effectiveness, and financial considerations critical for supporting adoption. The implementation plans will undergo a rigorous validation process to assess their suitability, transferability, and sustainability across MS. The ultimate goal is to disseminate validated plans whilst ensuring a parallel multistakeholder engagement approach to ensure MS are actively involved in key project phases, thus, facilitating rapid uptake of said plans across EU MS and a transformation of the vaccination ecosystem across Europe.