bluuebunny/crossref_metadata_2025_split huggingface dataset:
The updated nutrient profile underlying the Nutri-Score label and adult weight gain: A cohort study
Authors: Sarda B , Manneville F , Kesse-Guyot E , Srour B , Déschasaux-Tanguy M , Fezeu L K , Galan P , Hercberg S , Touvier M , Julia C 
Published: October 2024

Abstract

Introduction
Nutrient profiling systems are key tools in the development of nutrition-related policies. Their prospective associations with health outcomes are a crucial step in assessing their validity as public health measures. In 2023, the nutrient profiling system underlying the Nutri-Score -a nutrition front-of-pack label used in the European Union- was updated. The present study aims to investigate the updated nutrient profile’s association with weight gain, overweight and obesity.

Methods
The dietary and anthropometric data of 75,775 participants of the Nutrinet-Santé cohort study was retrieved for this study. Standardized dietary indices derived from both nutrient profiling systems (the 2015 NS-NPM DI (initial profile) and 2023 NS-NPM DI (updated profile)) were computed based on at least 3 24-hour dietary records upon the first two years of inclusion in the cohort. The associations between these indices and the risk of developing overweight and obesity were assessed using Cox proportional hazard models and weight gain using mixed models.

Results
Participants with a higher 2023 NS-NPM DI (i.e. a poorer nutritional quality of diet) were more likely to gain BMI over time (T3 vs. T1: +0.23% points of BMI/year, p &lt; 0.0001), had a higher risk of developing overweight (HR T3 vs. T1: 1.33 [95% CI: 1.24-1.43]) and obesity (HR T3 vs. T1: 1.29 [95% CI: 1.14-1.45]). Overall, the 2015 NS-NPM DI displayed similar associations and effect sizes with the outcomes and the predictive ability of the two indices on overweight and obesity risk was not significantly different (p = 0.32 for overweight risk, p = 0.09 for obesity risk).

Conclusions
These results constitute a step in the validation of the recently updated nutrient profiling system and help support its use in public policies for non-communicable diseases prevention.

Key messages
• The 2023 updated nutrient profiling system underlying the Nutri-Score was associated with weight gain and obesity, two important risk factors in the development of non-communicable diseases.
• The 2015 and 2023 NS-NPM DI showed similar prospective associations with overweight and obesity risk.
The state of primary health care systems in ten high-income countries
Authors: Gumas E , Lewis C , Horstman C , Gunja M 
Published: October 2024

Abstract

Primary care systems in high-income countries perform comparatively better than the U.S. system in large part due to decades of investment, an adequate workforce supply, and universal healthcare. This research identifies successes and areas of improvement of 10 high-performing primary care systems in four areas of care: 1) access, 2) continuity, 3) comprehensiveness, 4) and coordination. Cross-national comparisons using primary data from the 2022 CMWF International Health Policy Survey of Primary Care Physicians (N ranged from 321-2,092) and the 2023 CMWF International Health Policy Survey on the General Population (N ranged from 750-4,820). Countries included: Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, the U.K., and the U.S.
• More than 90% of adults in all surveyed countries reported having a regular primary care doctor except Sweden, the U.S., and Canada.
• Less than 5% of physicians reported high telehealth use in their patient encounters, except for in the U.K. and New Zealand where over 10% reported high use.
• Over a quarter of physicians in the U.S., Germany, and France report screening patients for social needs, compared to just 8% in the Netherlands.
• Care coordination with social services was a major challenge in all surveyed countries, with over 75% of physicians in the U.K., Australia, and France reporting major challenges.
Primary care systems in 10 other high-income countries outperform the U.S. system, particularly when it comes to access to care and care continuity. Policy options to consider for U.S. policymakers include narrowing the wage gap between generalist and specialist physicians and rewarding and holding providers accountable for continuity of care. On the other hand, countries like Sweden and the Netherlands can learn from the U.S. on how to adequately coordinate care between primary care physicians, specialists, and hospitals.

Key messages
• Investment in primary care yields better health outcomes, greater equity and lower costs.
• Many high-income countries in Europe have high performing primary care systems, something the U.S. system can learn from.
Co-designing health literacy actions: Connecting the dots to create meaningful impact
Authors: Behan S , Geoghegan B 
Published: October 2024

Abstract
In closing the workshop, this presentation will bring together the participatory research recommendations for promoting and developing healthy literacy in Ireland, which will be led by Slaintécare Healthy Communities in practice, dissemination and scale up. In particular, a worked example from a third Slaintécare Healthy Community (Westmeath) will be presented; a healthy literacy “Train the Trainer” professional development course for local health literacy champions. In this presentation, we will also challenge attendees to offer suggestions of how to support and facilitate other recommendations suggested by our participants, and invite them to consider how this participatory action approach to a health literacy needs analysis could be utilised in their own contexts.
Using Machine Learning to identify the social determinants of the mid-life decline in mental health
Authors: Henking C 
Published: October 2024

Abstract

Background
The mid-life decline in mental well-being, depicted as a U-shaped pattern, is debated across disciplines. This study seeks to identify the social determinants of this decline and the overall contribution of social determinants to changes in mid-life mental health.

Methods
We use data from the 1970 British Cohort Study, from the ages 26, 34, and 42 (N = 6992, 51.5% female). Mental distress was measured using the 9-score Malaise Inventory. Mental distress increased from age 34 (M = 1.67) to 42 (M = 1.86; p &lt; 0.001), with 17.8% declining by at least 1 SD on the inventory. We contrasted this group of decliners with those exhibiting stable mental health. We included socioeconomic and family factors, as well as physical health and health behaviours as potential determinants of mental health decline (at ages 26, 34, or at birth). We combine Random Forest and logistic regressions.

Results
The Random Forest’s Variable Importance (VI; root Mean Squared Error (MSE)), revealed social class at birth (VI = 0.023), physical multimorbidity at age 26 (VI = 0.22), and income quintile at age 34 (VI = 0.022) as most important predictors. Regressions confirmed that low birth social class (OR = 1.51 [1.25-1.83]), high-income at age 34 (OR = 0.68 [0.53-0.88]), and physical multimorbidity at age 26 (OR = 1.25 [1.06-1.48]) predict mental health decline. For those with high income and social class, the predicted probability of mid-life mental health decline is 0.109 (CI = [0.08-0.139]), rising to 0.277 (CI = [0.227-0.324]) for high risk individuals. Social class does not predict changes in mental health between ages 26 - 34.

Interpretation
We show that various social determinants of health contribute to the observed decline in mental health during mid-life. Social class at birth, income, and physical health are the most relevant predictors; they reduce the risk of decline from up to 27% to 11%. The contribution of social class appears specific to mid-life, and it could help explain the U-shaped pattern.

Key messages
• Social Factors Matter: Social class, income, and health predict mid-life mental decline.
• Mid-life Class Impact: Social class uniquely affects mental health decline in mid-life.
Non-genetic risk factors for preeclampsia: an updated umbrella review
Authors: Giannakou K , Nikolaou A , Fakonti G , Vyrides A 
Published: October 2024

Abstract

Background
Preeclampsia (PE) is a common pregnancy disorder with complex mechanisms, and multiple risk factors may contribute to its development. Our objective is to update our literature search from our previous umbrella review, summarizing recent evidence on non-genetic risk factors associated with PE and assessing their credibility to identify those supported by robust epidemiological evidence.

Methods
We searched PubMed, EMBASE, Scopus, and ISI Web of Science up to June 2023. For each meta-analysis, we computed summary effect estimates, 95% confidence intervals, 95% prediction intervals, and assessed heterogeneity using I², while also examining small-study effects and excess significance bias. Quality assessment was conducted using the AMSTAR-2 tool.

Results
89 meta-analyses were identified, providing data on 219 associations. Of these, 151 (69%) showed statistically significant findings at P &lt; 0.05, with 52 (24%) remaining significant at P &lt; 10-6. Large or very large heterogeneity was observed in 121 (55%) associations. Evidence for small-study effects and excess significance bias was found in 27 (12%) and 29 (13%) associations, respectively. Only 16 (7%) presented convincing evidence: Polycystic Ovary Syndrome (PCOS), PCOS (adjusted), Obstructive Sleep Apnea (OSA), Obesity (adjusted), Chronic Kidney Disease (CKD), Pregnancy Intrahepatic Cholestasis, SARS-CoV-2 infection (adjusted), Oocyte donation (OD) vs. In vitro fertilization (IVF), Fresh embryo transfer vs. spontaneous conception (SC) (singleton), Frozen embryo transfer vs. SC, OD vs. SC (singleton), IVF-OD vs. IVF-AO, IVF-OD fresh ET vs. IVF-AO fresh ET, NC frozen embryo transfer vs. AC frozen embryo transfer, Fetal sex (term), and Smoking.

Conclusions
Maternal health conditions like PCOS, along with reproductive interventions such as OD and IVF, as well as lifestyle factors like obesity and smoking, showed convincing associations with PE.

Key messages
• Maternal health conditions, reproductive interventions, and lifestyle factors showed compelling evidence of association with preeclampsia.
• Our findings emphasize the multifactorial nature of preeclampsia and suggest potential avenues for further research and clinical intervention.
Risk of long COVID in migrants and the contribution of vaccinations, disease severity, social inequalities and preexisting health: A nationwide register study in Sweden
Authors: Cederstrom A , Rostila M 
Published: October 2024

Abstract

Background and aim
A number of studies have found higher COVID-19 infection rates, hospitalizations and deaths in migrants and ethnic minorities throughout the Corona Pandemic. Some recent evidence also suggests higher risk of long COVID in migrants although less is known about the risk factors for long COVID in this population. The objective of our study is to examine the risk of long COVID in migrants and to examine whether preexisting health conditions, disease severity, social inequalities and vaccinations contribute to the association.

Methods
We used linked Swedish administrative registers to estimate the risk of a long COVID diagnosis in the population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios between the Swedish born and migrant groups. Adjustments for preexisting health conditions, disease severity, vaccinations and social inequalities were separately introduced.

Results
Higher risks of long COVID were found among migrants from Africa, Asia, Eastern Europe, Finland, Middle-East and South America. While the contribution of vaccinations and social inequalities were modest, we found that disease severity (i.e. whether the person was hospitalized or treated in an intensive care unit) primarily contributed to the higher risk of long COVID found in migrants.

Conclusions
The greater exposure and impact of the COVID-19 virus among migrants during the pandemic also affected the longer-term consequences of infection in this at-risk population.
Metabolic syndrome prevalence has increased in Finland from 2000 to 2023
Authors: Lehtoranta L , Jääskeläinen T , Palosaari T , Männistö S , Sääksjärvi K , Lahti J , Lundqvist A 
Published: October 2024

Abstract

Obesity presents a metabolic burden that leads to increased non-communicable disease (NCD) morbidity with metabolic syndrome (MS) as a pathway. The aim was to examine the trends in the obesity and MS prevalences. The study included health examination survey data collected in 2000 and 2023 (n = 7 258, 20-64 years). Examination measurements, blood samples, questionnaires, and register data were collected. MS criteria (ATPIII/AHA) included at least 3 of the following: increased waist circumference, elevated fasting glucose or medication, elevated triglyceride or medication, elevated blood pressure (BP) or medication, and decreased HDL-cholesterol or medication. Participants were divided according to BMI (normal weight 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, obesity 30.0-34.9 kg/m2, severe obesity = &gt;35.0 kg/m2). Weighted prevalence and 95% confidence intervals (CIs) of MS and obesity were calculated considering sampling design and non-response. Prevalences of normal weight decreased from 2000 (men 32%, 95% CI 30-35; women 45%, 95% CI 43-47) to 2023 (men 26%, 95% CI 23-28; women 34%, 95% CI 32-37) and obesity increased from 2020 (men 17%, 95% CI 15-18; women 15%, 95% CI 14-17) to 2023 (men 20%, 95% CI 18-22; women 18%, 95% CI 16-20) as did severe obesity (in 2000: men 4%, 95% CI 3-5; 6%, 95% CI 5-7 - in 2023 men10%, 95% CI 8-12; women 13%; 95% CI 11-14). The prevalence of MS increased from 37% (95% CI 34-39) to 45% (95% CI 43-48) in men and 30% (95% CI 28-32) to 37% (95% CI 34-39) in women. The prevalence of MS with obesity varied from 2000 to 2023 from 73-77% in men and 69-61% in women and with severe obesity from 88-91% in men and 79-76% in women. From 2000 to 2023, no MS components remained stable with normal weight (men 29-25%, women 44%) and obesity (both sexes &lt;1%). The prevalence of MS has increased in the last 20 years. Obesity is a major risk factor for MS that increases the future burden MS and, consequently, of NCD on societies.

Key messages
• Metabolic syndrome has increased in Finland from 2000 to 2023. At the same time, the prevalence of those with normal weight has decreased and severe obesity increased.
• The global obesity pandemic will further increase the burden of NCD’s in the future. This is already visible with increasing metabolic syndrome prevalence.
Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review
Authors: O’Shaughnessy E , San Lazaro Campillo I , O’Donoghue K , Leitao S 
Published: October 2024

Abstract

Background
Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications.

Methods
This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools.

Results
A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge.

Conclusions
This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown.

Key messages
• TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided.
• Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.
Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients
Authors: Schmitt T , Habimana K , Gottlob A , Habl C , Plomariti C , Farmaki A , Bogiatzidis P , Leclercq V , Delnord M , Van den Bulcke M 
Published: October 2024

Abstract

Background
Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer.

Methods
Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective.

Results
20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences.

Conclusions
Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services.

Key messages
• Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services.
• Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.
A CDSS based Integrated Pathway for Influenza Vaccination Across Primary and Secondary Care
Authors: Specchia M L , Beccia F , Cacciuttolo M G , Tona D , Di Pumpo M , Porcelli M , Lontano A , Corona V F , Boccia S , Pastorino R 
Published: October 2024

Abstract

Background
In Italy, influenza vaccination coverage in people ≥ 65 years is unsatisfactory (56.7%), underlining the need to improve current vaccination strategies. The objectives of this study have been: to define a novel pathway to increase influenza vaccination adherence among ≥ 65 years population in the Lazio region; to provide a predictive estimate of the epidemiological and economic pathway’s potential impact.

Methods
A multidisciplinary working group (WG) featuring cross-sectoral expertise was created and WG periodic meetings were held to define the patient journey and its flow-chart representation. The pathway’s potential impact was assessed through epidemiological and economic indicators and scenario analyses.

Results
An integrated pathway across primary and secondary care was defined, based on the active patient in-Hospital recruitment and vaccination and enhanced by a Clinical Decision Support System relying on a digital algorithm to identify eligible patients. Assuming an increase of influenza vaccination coverage from the current rate of 60% (scenario 1) to 65% (scenario 2) in ≥ 65 years population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, influenza- or pneumonia-related hospitalizations and influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients visits of up 2,367,310 euros. Setting the vaccination coverage at 70% (scenario 3), an increase of 16% in avoided influenza cases, hospitalizations and outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients’ visits of up to 4,833,259 euros.

Conclusions
Alongside offering a predictive estimate of the relevant pathway’s potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level.

Key messages
• The proposed pathway, offering the option of receiving flu vaccination within the Hospital, supports the paradigm shift towards primary prevention pathways in secondary care settings.
• Another relevant aspect of the integrated pathway is the adoption of an Artificial Intelligence tool to identify suitable patients and improve their recruitment and adherence to vaccination.