bluuebunny/crossref_metadata_2025_split huggingface dataset:
A mixed-methods evaluation of a virtual coach for smoking cessation and physical activity in adults
Authors: van Vliet MHM , Versluis A , Chavannes N H , Scheltinga B L , Albers N , Penfornis K M , Baccinelli W , Meijer E ,   on behalf of the Perfect Fit consortium
Published: October 2024

Abstract

Background
Mobile health (mHealth) interventions with virtual coaches (i.e. AI conversational agents) offer scalable and cost-effective solutions for health behavior change. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to promote smoking cessation and physical activity simultaneously. Through innovative techniques (e.g. sensor technology) and iterative development involving end-users, we aim to overcome challenges faced by mHealth interventions, like insufficient personalization. This study examines Perfect Fit’s feasibility and acceptability.

Methods
A single-arm, mixed-method, real-world evaluation study was conducted with 100 adult smokers in the Netherlands. The intervention lasted approximately 16 weeks. Data were collected at baseline and post-intervention. Quantitative data included usage data and self-report questionnaires on feasibility, acceptability and participant characteristics (e.g. eHealth literacy). Qualitative data included semi-structured post-intervention interviews with a subsample of 12 participants. Descriptive analyses (quantitative) and the Framework Approach (qualitative) were used for data analysis, and quantitative and qualitative data were integrated during interpretation.

Preliminary results
Participants adapted the use of Perfect Fit to their preferences. Many participants were satisfied with the content but missed variations in conversations with the virtual coach. The coach offered anonymity, positively experienced by some (e.g. non-judgemental), but negatively by others (e.g. lower accountability). Many participants liked the combination of smoking cessation and physical activity enhancement.

Conclusions
Findings show the potential of interventions like Perfect Fit as a multiple health behavior change strategy in promoting public health and preventing chronic disease. Findings can inform intervention development and identify methods to foster feasibility and acceptability.

Key messages
• mHealth interventions with virtual coaches, like Perfect Fit, could promote public health.
• Targeting multiple behaviors, like low physical activity and smoking, simultaneously seems beneficial.
Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness
Authors: Malešević A , Čartolovni A 
Published: October 2024

Abstract

Background
According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context.

Methods
To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022.

Results
Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods.

Conclusions
The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media.

Key messages
• It’s crucial to align digital health implementation with the social & cultural context and capabilities.
• The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.
Knowledge and attitudes of the Italian population on sharing health data: a cross-sectional study
Authors: Toffanin C , Scaioli G , Lo Moro G , Mara A , Varì M G , Butnaru A M , Cataldo A , Lodin M , Bert F , Siliquini R 
Published: October 2024

Abstract

Background
Healthcare digitization enhances data accessibility but faces data management and privacy challenges. The study sought to explore the Italian public’s understanding and views on storing and sharing health data for treatment and research purposes, as well as factors influencing their attitudes toward health data management and sharing.

Methods
A cross-sectional questionnaire assessed socio-demographic information, knowledge about health data sharing, and attitudes toward sharing data for treatment and scientific purposes. Descriptive analyses and multivariable logistic regressions were performed to examine the associations between sociodemographic factors and knowledge/attitudes about data storage and sharing.

Results
A total of 1,389 citizens participated. Most respondents (65.4%) thought that healthcare providers could access personal health data nationwide, while 94% expressed willingness to share personal health data nationwide. A high percentage of respondents (73%) fully agreed that storing and sharing personal health-related data could improve research and quality of care. Males and younger individuals (&lt;41 years) were likelier to have higher data-sharing knowledge (adjusted Odds Ratio [adjOR] 1.50, 95% Confidence Interval (CI) 1.03 - 2.18, and adjOR 1.99, 95% CI 1.29 - 3.08 respectively). Lower educational-level respondents exhibited lower positive attitudes towards sharing health data for treatment and research purposes (adjOR 0.18, 95% CI 0.05-0.58 for high school, and adjOR 0.11, 95% CI 0.03-0.41 for middle school or lower, compared to those with a university degree).

Conclusions
The findings offer valuable perspectives for European policymakers, healthcare practitioners, and researchers who aim to enhance data handling, foster cooperation, and maximize the benefits of health data for tailored care and scientific progress.

Key messages
• Italian citizens show strong willingness to share health data nationwide for treatment and research, suggesting a favorable environment for collaborative healthcare initiatives.
• Sociodemographic factors such as age and education level influence attitudes towards health data sharing, stressing interventions to ensure equitable access and participation in data-driven healthcare.
Different approaches to regulate digital health applications in seven European countries
Authors: Riedel M , Koisser L , Czypionka T 
Published: October 2024

Abstract

Background
Demographic ageing, shortages in health workforce and increased use of digital tools in daily life kindle decision makers’ interest to utilize digital health applications (DHA). While there are several reviews that provide an overview across remuneration frameworks, no synthesis between additional regulatory aspects and frequency of remuneration approval has been conducted.

Methods
European countries with either strong status in digital health in general or regulation for health apps in particular were chosen for analysis (BE, DK, DE, EE, EN, FR, NL). Country specific information was collected from scientific and grey literature, legal and stakeholder webpages. Semi-structured interviews were conducted with country experts via video call or e-mail and analyzed using Mayring’s structured, qualitative content analysis.

Preliminary results
We find three approaches concerning DHT-definitions: For BE, DE, FR, specific regulations define national remuneration requirements. EN and NL define only minimum requirements while decentralized payors make financing decisions. DK and EE fit DHTs into existing financing schemes. Among countries with a national financing framework, DE achieved the largest number of approvals, followed by FR, while BE has not yet issued a (lasting) financing approval. Evaluation requirements focus on clinical and economic outcomes, largely ignoring non-clinical improvements for patients.

Conclusions
The German regulation stands out with a peculiar definition that might help clarify evaluation criteria, increase the number of financing approvals but also empower patients while reducing the role of health workforce in their application. BE and NL regulations necessitate involvement of health workers, thus addressing structurally different applications.

Key messages
• Drawing lessons for DHT regulations across countries needs to address differences in national definitions and evaluation criteria.
• A standardization system for DHT may help to speed utilization of effective tools and clarify evaluation requirements.
Developing an mpox risk assessment matrix for social listening and infodemic insights generation
Authors: Pereira Ibrahim A , Machiri S , Ishizumi A , Nguyen T , Latinovic L , Bezbaruah S , Purnat T , Von Harbou K , Emiroglu N , Varaidzo Machiri S 
Published: October 2024

Abstract

Issue
Any effective response to an infodemic, requires prioritizing public health response on identified narrative themes that pose highest risk to health and well-being of populations. High-risk narratives often require more swift and far-reaching action and low-risk narratives require little or no response.

Description of the problem
Different countries are assigned different levels of risk to specific narratives or concerns, recognizing that for some issues there may be a large gap between the true public health threat and what is generating lots of conversations, concerns and press coverage that indicate a high degree of risk perception that may be unwarranted. WHO developed a risk matrix to apply to global analysis of questions, concerns and narratives about mpox, which resulted in biweekly infodemic intelligence reports that risk-assessed identified infodemic themes and corresponding recommendations for action.

Results
Risk assessment criteria were defined in the context of WHO’s global infodemic insights analysis for low, medium and high risk and positive sentiment in mpox global outbreak context before conducting the integrated analysis so that insights were reproducible and infodemic response actions were prioritized. This implemented the WHO/UNICEF training manual on 6 steps to produce an infodemic insights report, which includes tools on how to develop and apply a risk matrix for a specific public health question of concern and apply it in analysis.

Lessons
The approach resulted in rapid, systematic, reproducible and evidence-driven decision-making to respond to the infodemic accompanying the mpox global outbreak. Risk matrices must be adapted to the context of the public health event and the mandate of the health authority taking action. An mpox risk matrix for narratives included adaptation to reflect high-risk from stigmatizing narratives, as well as narratives circulating around or within LGBTQI+ communities.

Key messages
• A risk matrix must be developed and adapted to the context of each health emergency and level of health authority action.
• Prioritization for rapid infodemic response based on a risk assessment is that it facilitates more effective response in a health emergency.
Poultry farms as a One health priority for Aspergillus section Fumigati surveillance
Authors: Gomes B , Dias M , Pena P , Cervantes R , Viegas S , Viegas C 
Published: October 2024

Abstract

In poultry production environments, particulate matter (PM) is considered one of the harmful air pollutants [2]. Considering potential biological pathogens, the genus Aspergillus in particular, Aspergillus fumigatus, is a widely recognized human and animal pathogen [3]. Hot-humid farm environments could contribute to the proliferation of these fungi [4]. Therefore, poultry production workers, besides animals [4], may be at a higher risk of inhaling fungi spores [4,5]. This study aimed to determine particulate matter (PM) contamination and analyze the prevalence of Aspergillus section Fumigati in air samples from poultry pavilions. Indoor and outdoor air samples were taken in the 1st, 2nd and 3rd weeks of birds growth cycle (n = 58). Air was collected through the impaction method (MAS-100) onto polycarbonate filters, set at 100 L/min, for 5 min. Followed by DNA extraction, and real-time PCR detection of Aspergillus section Fumigati. For PM evaluation, portable direct-reading equipment (Lighthouse, model 3016 IAQ) was used. Particle concentrations were measured (n = 67) at five distinct fractions during 5 min. Considering particles fractions, PM10 and PM5 where prevalent in 1st (58% PM10; 28% PM5), 2nd (63% PM10; 26% PM5) and 3rd (64% PM10; 25% PM5) weeks. These results evidence that coarse particles (between 2.5 and 10 µm) are the most relevant PM present in this setting. Regarding fungal detection, Aspergillus section Fumigati was widespread inside poultry pavilions (62%, 26 out of 42), highlighting this environment has a potential reservoir of microbial pathogens [7]. Furthermore, PM can act as a host of biological fragments [6]. Overall, in addition to molecular analysis, future studies should consider using culture-based methods to assess the viability of pathogenic microorganisms and their infection potential [3]. From a One Health perspective, quantitative and qualitative research is required to fully understand this environment.

Key messages
• This study evidence that coarse particles (between 2.5 and 10 µm) are the most relevant PM present and Aspergillus section Fumigati is widespread in poultry pavilions.
• A One health intervention should be considered in future studies.
What are the health system impacts of engaging with global health activity? A qualitative study
Authors: Haywood J , Smyth J , Goldstone R 
Published: October 2024

Abstract

Background
Global health partnerships between high-income health systems and low- and middle-income countries (LMICs) are becoming more common as there is an appreciation of the need for collaboration to solve global health issues through knowledge and skill exchange. However, partnership evaluations largely focus on the benefits to individual participants and recipient systems, with little evidence of the impacts on the high-income system. Therefore, the aim of this study was to explore the health system-wide impacts of engaging with global health activity and consider the arguments for and against adopting these partnerships.

Methods
We carried out semi-structured interviews with individuals from three UK health systems that engage with global health activity to explore their motivations to in doing so. Transcripts were thematically analysed.

Results
We found that engagement in global health activity can contribute to workforce recruitment, retention, development, and upskilling, benefiting the system. Examples were also given of system-wide clinical, reputational, and economic benefits. However, this activity impacts short term staffing and can cause personal emotional issues that systems need to support.
We also explored facilitators of engaging in global health work which included operational support, supporting healthcare staff to engage, and system acceptance. Barriers included lack of senior buy-in, opportunity access inequities, operational challenges, and the current UK health system challenges.

Conclusions
This study demonstrated the potentially significant system-level benefits of engaging in global health activity. These focused on improved workforce, which is a major public health issue worldwide. We have also identified system characteristics, such as buy-in and operational support, which influence success. We hope this work provides a building block demonstrating there are benefits to be had for donor health systems, but barriers must be overcome.

Key messages
• The potential benefits and drawbacks that may arise from high-income health systems engaging in global health, as well as facilitators and barriers, are explored.
• This study creates a foundation to understand donor-system benefits and encourages further research, particularly in systems who do not engage with global health activity to understand why this is.
Role of epidemiology in the EU policy formulation of chemicals
Authors: Chinchio E , Di Novi C , Martín-Olmedo P , Bopp S 
Published: October 2024

Abstract

Over the past 50 years, the European Union has built a robust legal framework for managing chemicals. This framework balances the benefits of using chemicals for societal well-being and economic prosperity with the need to protect human health and the environment from potential risks. As part of the EU’s Zero Pollution ambition in the context of the Green Deal, the European Commission adopted in 2020 the Chemicals Strategy for Sustainability, with the aim to better protect human health and the environment from harmful chemicals, while boosting innovation by promoting the use of safer and more sustainable chemicals. Assessing quantitative health impacts within the EC Better Regulation guidance typically involves indicators measuring the environmental burden of disease (EBD), providing a useful mean for legislators to evaluate the benefits of policy actions both in terms of health gains and cost. While such analyses are common in air pollution studies, challenges arise in the chemical legislation area, particularly in non-occupational settings, where the population is exposed to low concentrations of many chemicals through multiple exposure routes. In such contexts, the intrinsic complexities linked to exposure characterization and to the assessment of causality between the exposure and the health outcome may hinder the estimation of benefits of legislative actions. Debates may arise regarding the reliability of the underlying epidemiological studies, making challenging for policymakers to ascertain the robustness and generalizability of the findings of such analyses. Our work provides a summary and analysis of recent case studies in the context of chemicals. We focus on how epidemiological evidence was used in conducting EBD analyses in supporting better formulation of EU polices of chemicals.

Speakers/Panelists
Marleen Bekker
Wageningen University & Research, Wageningen, Netherlands
Equity of continuous glucose monitoring in young people with type 1 diabetes: a systematic review
Authors: Howard Dicks J , McCann L , Tolley A L , Barrell A , Johnson L , Kuhn I , Ford J 
Published: October 2024

Abstract

Background
Socioeconomic (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are widespread. There is concern that unequal access to technologies, such as continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in access to CGM for children and young people (CYP) and outcomes for CGM users.

Methods
MEDLINE, Embase, and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-plus criteria for T1D patients under 26. Reports based in low- or middle-income countries or ≤ 500 participants were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from extracted data, though heterogeneity precluded meta-analysis. The protocol was pre-registered with PROSPERO (CRD42023438139).

Results
Of the 3,369 unique studies identified, 27 met inclusion criteria. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured, and minority ethnic, especially black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were generally associated with poorer outcomes, there was no significant association between domains of disadvantage and higher HbA1c for CGM users, excepting parental education.

Conclusions
There are significant SES, ethnic, and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This is contributing to outcome inequalities. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities.

Key messages
• There are significant SES, ethnic, and education inequalities in continuous glucose monitoring use for young people with T1D. Inequalities are more marked when technology is not reimbursed.
• Increasing access to CGM may reduce outcome inequalities, as evidence suggests that young people benefit equally from CGM use, regardless of ethnicity or SES.
Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries
Authors: Keller Celeste R , Guarnizo-Herreño C , Costa F , Ayo-Yusuf O , Barros A J , Fritzell J , Peres M A , Watt R G 
Published: October 2024

Abstract

Aim
To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism.

Methods
We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested.

Findings
Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63).

Interpretation
Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities.

Key messages
• Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies.
• A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.