bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring violence in healthcare. A lesson from the pandemic
Authors: Magnavita N , Meraglia I , Viti G 
Published: October 2024

Abstract

Introduction
Violence against healthcare workers is a serious, underreported, and underestimated problem. Only a few healthcare companies have efficient violence monitoring systems and risk assessment is often entrusted to non-validated algorithms. The monitoring system implemented in 2005 in a public health company allowed for an accurate analysis of the phenomenon.

Methods
For the entire observation period (2005-2023), the one-year prevalence of violent incidents (physical assaults, threats, and harassment) has been reported by all during the periodic medical examination in the workplace. Furthermore, after each periodical inspection of workplaces, the occupational doctor requested a detailed description of violent events that occurred in the department, using the Violent Incident Form distributed online anonymously.

Results
In 2005/6 the one-year prevalence of physical assaults was 8.2%. Prevention efforts led to a moderate reduction in the rate (7.8% in 2011/12). A collapse in rates was observed in 2021 (3.2%). In 2022, physical violence rose again to 5.6%. Harassment affected 19.6% of workers in 2005/6, falling to 7.2% in 2021 and rising again to 21.6% in 2022. Physical violence perpetrated by patients was more frequent in psychiatric services (OR 25.7, CI95% 11.1; 59.6) and violence perpetrated by visitors in emergency and urgence services (OR 8.8, CI95% 3.8; 20.5) than in general services. Workers attributed the drop in attacks primarily to the filtering of access to work areas, which limited the presence of visitors and relatives. The lower demand for services had also resulted in an optimal ratio between staff and patients, improving the quality of care. Furthermore, in the very first pandemic phase, health workers enjoyed a very favorable consideration from the population, which had further reduced the causes of conflict.

Conclusions
The pandemic has shown that better relationships between patients/visitors and staff are effective in reducing violence.

Key messages
• Monitoring of violence against healthcare workers shows that it has decreased during the pandemic.
• HCWs believe that (i) limiting visitor access (ii) better balancing demand for services and (iii) better opinion towards HCWs were the causes of the reduced rate of violence.
Evaluating Genetic Testing: A Systematic Review of Assessment Frameworks
Authors: Baccolini V , Migliara G , Sciurti A , Kaminska A E , Anniballo A , Pistollato A , Pitini E , Marzuillo C , La Torre G , Villari P 
Published: October 2024

Abstract

Introduction
The assessment of the risks and benefits of genetic/genomic tests has long been addressed using various frameworks. They are mostly ACCE-based, focus on technical aspects, but often overlook economic and organizational considerations. The few HTA-based approaches, though more comprehensive, lack validation and implementation. This review’s purpose is to identify all evaluation frameworks for genetic/genomic tests and synthesize their key aspects.

Methods
PubMed, Scopus, Web of Science, and Google Scholar were searched. Inclusion criteria were documents describing evaluation frameworks for genetic/genomic tests, that were original, specifically created, and covering at least three assessment domains. This study was supported by the EC and MUR under PNRR - M4C2-I1.3 Project PE_00000019 ‘HEAL ITALIA’.

Results
Overall, 12546 unique records were screened, of which 67 documents were assessed for eligibility. A total of 29 studies were included, reporting 24 different frameworks. These frameworks were published between 2000 and 2019, mostly from USA (50%), Canada (13%) and UK (13%). There was substantial interest in the economic facets of the technology (92%), albeit without extensive detail, and high attention was given to its technical accuracy (70-90%). The clinical value was also consistently mentioned (70-90%), similarly to legal, ethical, and social considerations (70-80%). However, there was minimal emphasis on non-health outcomes (20-50%), and insufficient attention to organizational, educational, and implementation barriers (20-50%).

Discussion
A pressing need exists for a universally accepted evaluation framework for genetic/genomic tests. Applying a general HTA methodology, potentially based on the EUnetHTA core model, that can integrate solid theoretical and methodological principles, and result in a validated, comprehensive, and widely shared tool for genetic test evaluation, is a viable option to foster the implementation of these technologies.

Key messages
• Genetic/genomic test evaluations focus on technical accuracy and clinical value, often missing economic and organizational aspects.
• A universal, validated, HTA-based evaluation framework for genetic/genomic tests is needed to enhance their implementation in clinical practice.
BE-SAFE: Intervention to reduce benzodiazepine and sedative hypnotics in elderly with sleep problems
Authors: Tsoutsi V , Aubert C E , Maldonado L F , Wichniak A , Agoritsas T H , Callegari E , Macq J , Dikeos D , Rodondi N , Spinewine A 
Published: October 2024

Abstract

Introduction
Benzodiazepine and sedative hypnotics (BSH) may have significant adverse effects and associated costs, especially in older adults: increased risk of falls, fractures, hospitalisations, impaired functioning, delirium, cognitive impairment and mortality. Addressing BSH overuse is therefore an urgent priority to improve patient safety in Europe.

Objectives
To present the 5-year research project BE-SAFE, funded by the European Commission (HORIZON Europe) and by the Swiss State Secretariat for Education, Research, and Innovation. BE-SAFE aims to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSH used by older adults for sleep problems.

Methods
BE-SAFE involves seven inter-related work packages and six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland) as well as experts from Canada; it proposes an interdisciplinary and inter-sectorial approach with experts in guidelines, implementation, dissemination, case studies, geriatrics and sleep. BE-SAFE will develop an intervention comprising trustworthy clinical guidelines, implementation recommendations and patient-centred material. This intervention will be tested in a cluster randomized controlled trial; 470 patients (65 years old and above) and 62 prescribing physicians in hospital and outpatient settings.

Results
BE-SAFE is expected to result in reduction of BSH use. Its toolkit, encompassing setting-specific implementation recommendations, will enable healthcare professionals (HCPs) to identify, evaluate and prevent risks of BSH use. The BE-SAFE approach could also be expanded to cover reduction of use of other medications.

Conclusions
Through BE-SAFE, patient safety is expected to improve; BE-SAFE project will reach a wide-ranging audience, including general population, informal carers, older adults, HCPs, healthcare system leaders and decision makers. Authors acknowledge the significant input of J. Grimshaw and W. Levinson, Canada.

Key messages
• Deprescription of benzodiazepine and sedative hypnotics, especially in older adults, is a priority due to their side effects, particularly in this age group.
• The European project BE-SAFE aspires to create easy-to-use guidelines to this aim, improving thus patient safety and healthcare.
Genetic and other omics-based information in the most-cited recent clinical trials
Authors: Russo L , Farina S , Siena L M , Pastorino R , Boccia S , Ioannidis JPA 
Published: October 2024

Abstract

Introduction
Since the genomic revolution, the utilization of genetic and omics technologies has undergone considerable expansion within clinical studies, employed in design, analysis, and interpretation.

Methods
A recent study of Siena et al. developed a database containing the 600 most cited clinical trials published from 2019 to 2022. Building on this database, the aim of our study is to assess how frequently genetic and other omics-based information has been used in the design, analysis, results or conclusion of these recent influential trials.

Results
132 out 600 (22%) trials used genetic or other omics. These trials were more likely to be oncology trials (76%vs34%), having industry funding (59%vs47%), and having industry authors (75%vs54%) than others. Overall, genetics and genomics were present in 75% of the trials (100/132), and oncology was the predominant medical field (76%, n = 101). The prevailing use was detection of specific mutations (n = 99), often (n = 60) used as eligibility criterion. These mutations were mostly somatic (n = 85), while 14 were germline. Other applications included transcriptomics (20.4%), proteomics (10.6%), metabolomics (8.3%) and metagenomics (8.3%). 36 studies (27%) employed multiple applications. Genetics or other omics were used in 10% of the studies (14/132) for randomization stratification and in 63% (83/132) to conduct subgroup analysis. Among the latter, in 48% (40/83) the presence of a somatic mutation was significantly associated with the investigated health outcomes, while germline mutation or other omics only in the 12% (10/83). In the trials conclusions, authors addressed the relevance of the genetic or omics information in 62.1% (82/132) of the trials.

Conclusions
A sizeable proportion of the most-cited clinical trials use genetics or omics-based information, but the large majority pertains to cancer mutations in oncology trials. Use of genetics and omics needs to become more common in other clinical trial fields.

Key messages
• Genetic profiling and omics applications should be incorporated into trial design.
• Genomic research is mostly oncology related and it needs to be expanded to other medical fields.
Is confidence in knowledge related to childbirth fear and mode of birth among Polish women?
Authors: Surma P , Micek A , Bednarek-Chałuda M , Stoll K , Nenko I 
Published: October 2024

Abstract

Background
In Poland, cesarean section (CS) rate is 48% what means that it is one of the highest rate among OECD countries and the highest in the European Union. WHO has considered that CS rates higher than 15% at the population level are not associated with reductions in maternal and newborn mortality rates. Fear and attitudes towards childbirth are shaped years before the first pregnancy. Yet, little is understood about how young people’s knowledge, attitudes and fears concerning the birth process shape their healthcare preferences around birth. Thus, the aim of the study was to examine whether confidence in knowledge was associated with childbirth fear prior to pregnancy and preference for CS.

Methods
We recruited 782 women aged 18 - 35 (mean 24.7, sd = 3.19) who had never been pregnant but wished to have at least one child in the future. The women answered questions about: (i) socio-economic situation, (ii) confidence in knowledge and educational needs related to pregnancy and childbirth; (iii) fear of childbirth prior to pregnancy; (iv) preferred mode of birth in the hypothetical pregnancy in which there are no medical indications for cesarean section.

Results
Almost one in four women (22.1%) preferred CS in a hypothetical low-risk pregnancy. In addition, most often young women gained knowledge on pregnancy and birth from experiences and stories of family members (62.3%). Women with moderate and high level of confidence in knowledge had respectively lower odds of high level of childbirth fear prior to pregnancy comparing to women with low level of confidence in knowledge (OR = 0.57, 95% CI: 0.39-0.83 and OR = 0.54, 95% CI: 0.33-0.88, respectively).

Conclusions
Increasing knowledge about pregnancy and childbirth among young women might lower childbirth fear and thus, indirectly, lower rates of CS in the future.

Key messages
• The results of this study may solve very important public health problem i.e. the growing rates of cesarean section.
• Confidence in knowledge may be an important factor associated with the level of childbirth fear.
Prenatal exposure to phthalates and children’s mental health trajectories: Rhea Cohort, Greece
Authors: Mouatsou C , Margetaki K , Kampouri M , Psoma S , Roumeliotaki T , Vafeiadi M , Chatzi L , Kogevinas M , Koutra K 
Published: October 2024

Abstract

Background
Accumulating evidence suggests that phthalate exposure affects neurodevelopment, including emotional and behavioral outcomes. Our aim was to investigate if prenatal phthalate exposure affects the developmental course of internalizing and externalizing symptoms from early childhood to adolescence.

Methods
Concentrations of seven phthalate metabolites were measured in first-trimester maternal spot urine samples, and DEHP, and high and low molecular weight phthalate concentrations were calculated (HMW and LMW, respectively). Mothers reported internalizing and externalizing symptoms via the Strengths and Difficulties Questionnaire at 4 years and the Child Behavior Checklist at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 546 participants of the Rhea Cohort (Crete, Greece) into 4 distinct groups (Stable low, Stable high, Low-Increasing, and High-Decreasing symptoms). We evaluated the association of prenatal phthalate exposure with the odds of an adverse (Stable high, Low-Increasing, and High-Decreasing) internalizing and externalizing symptom trajectory in 150 children using multivariable-adjusted logistic regression (reference group: stable low).

Results
Only for girls, exposure to DEHP and HMW phthalates was associated with higher odds of being grouped in an adverse internalizing symptoms trajectory (OR [95%CI]: 1.52 [1.03, 2.25] and 1.57 [1.03, 2.39], respectively). Regarding externalizing symptoms, interactions with gender emerged for DEHP (p = 0.024) and HMW (p = 0.028) phthalates, and increased odds of being grouped into an adverse trajectory were observed in girls, whereas boys showed the opposite trend, albeit none reached statistical significance.

Conclusions
The findings suggest programming effects of prenatal phthalate exposure on the developmental course of emotional symptoms in girls. Further research is needed to clarify the association between in utero phthalate exposure and behavioral symptoms.

Key messages
• Phthalate exposure is linked to adverse trajectories of emotional symptoms, emerging from preschool age and up to adolescence.
• Phthalate effect on internalizing and externalizing symptoms varies by gender.
Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022
Authors: Myhr A , Vesterbekkmo R K , Sund E R 
Published: October 2024

Abstract

Background
Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents.

Methods
This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).

Results
The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p &lt; 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period.

Conclusions
Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors.

Key messages
• The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls.
• While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.
The association between screen use, psychological distress and sleep among adolescents in Norway
Authors: Steigen A M , Bonsaksen T , Stea T H , Leonhardt M , Lien L , Kleppang A L 
Published: October 2024

Abstract

Background
Today’s adolescents dedicate a significant portion of their time to screens. Concerns have arisen regarding the lasting impact of screen use on adolescent health, making it a crucial public health topic. Previous studies have presented both positive and negative outcomes associated with screen use. Further insight is required into various forms of screen use and the influence on adolescent health. The objective of this study is to examine the relationship between gaming, social media use, psychological distress, and sleep among adolescents.

Methods
This study is based on cross-sectional data from the Ung-HUNT4-study, a health study conducted among adolescents 13-19 years old in Trøndelag municipality in Norway from 2017-2019 (n = 8066). Binomial logistic regression was used to analyse the association between gaming, social media, psychological distress and sleep. Analysis was controlled for gender, age, family economy and having friends.

Results
Preliminary results showed that the odds for having psychological distress were higher for those who spent more than 3 hours on social media after school (OR: 1.31, 95% CI: 1.10-1.57), and on weekends (OR: 1.45, 95% Cl: 1.22 - 1.73), and on gaming in weekends (OR:1.30 Cl: 1.08-1.55) compared to those who spent 3 hours and less. The odds for sleeping &lt; 8 hours per day on weekdays were higher for those who spent more than 3 hours on gaming after school (OR: 1.27 Cl:1.07-1.52), and more than 3 hours on social media after school, (OR:1.41 Cl:1.20-1.67) or on weekends (OR:1.39 Cl: 1.19-1.62), compared to those who spent 3 hours or less.

Conclusions
More than 3 hours spent on social media after school and on weekends was associated with significantly higher odds for psychological distress and less sleep on weekdays. More knowledge about the impact of different types of screen use on adolescents’ health is needed, and new public health strategies to secure safe screen use should be developed.

Key messages
• Screen use is associated with psychological distress and less sleep.
• Awareness on various types of screen use and its influence on health in adolescence, is important in public health policy and practice.
Antibiotic use in the first 1000 days and maternal-infant outcomes: results from the MAMI-MED cohort
Authors: Barchitta M , Maugeri A , Magnano San Lio R , Favara G , Campisi E , Di Liberto E , Ojeda-Granados C , La Mastra C , La Rosa M C , Agodi A 
Published: October 2024

Abstract

Introduction
Antibiotic use within the initial thousand days of life could potentially lead to a range of negative health outcomes for both mothers and infants. This study seeks to identify the primary factors influencing antibiotic use and examine the associations with adverse neonatal outcomes, specifically focusing on neonatal intensive care unit (NICU) admissions.

Methods
Data were gathered from pregnant women and their offspring enrolled in the ‘MAMI-MED’ study at ARNAS Garibaldi Nesima in Catania (Italy), from December 2020 to January 2024. Information regarding antibiotic exposure and maternal-infant health outcomes was collected through follow-up questionnaires administered at birth, one year, and two years postpartum.

Results
Among 1492 women (average age: 31 years) included in the study, 20.4% reported using antibiotics during pregnancy. The mean age of antibiotic users during pregnancy was significantly higher compared to non-users (p = 0.008). Among the 304 women who used antibiotics during pregnancy, 45.5% did so during the third trimester, 41.4% during the second trimester, and 13.1% during the first trimester. Furthermore, 47.1% of women reported antibiotic use at delivery or postpartum. Of the 904 children studied, 63% were administered at least one antibiotic between birth and the first year of age. A greater proportion of newborns admitted to the NICU were born to mothers who used antibiotics during the second trimester of pregnancy compared to those who used antibiotics during other trimesters (p = 0.013).

Conclusions
Comprehensive research is needed to delve deeper into the intricate factors influencing maternal antibiotic use. This should thoroughly explore socio-demographic variables, such as income level, education, and access to healthcare. Understanding these multifaceted influences can provide valuable insights into designing tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy.

Key messages
• Different factors influence maternal antibiotic use.
• Tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy are needed.
Big bang in the middle of a storm: Lessons from implementing health system reform in Finland
Authors: Tynkkynen L 
Published: October 2024

Abstract

Introduction
Finland is often defined as a Nordic welfare state, characterised by universal access to healthcare and an emphasis on national and local politics in the governance of the system. In 2023, the Finnish health system was reformed by centralising organisation (purchasing and service delivery) to regional entities, as well as funding and overall governance to the state from 200 local organisations. The aims of the reform were to improve accessibility, decrease inequities, promote population health and curb growing costs. In the Finnish health system, as in other fields of society, we “find a huge number of very small changes, and a very small number of huge changes” (Cairney 2016). This makes the Finnish health system reform a rare opportunity to use a large-scale reform as a context for a study on reform implementation.

Methods
This research is based on document analysis and interview data collected from top regional managers. The data was analysed using a political determinants of health framework and thematic analysis.

Findings
The Finnish reforms were introduced by a left-centre government but implemented by a right-wing government with strong opposition to the reforms, which made full implementation challenging. The results highlight the importance of political commitment to implementation, demonstrate that reforms shape power relations at all levels of the health system and highlight how health system reforms are essentially about redistributions of power between different actors. The results also highlight the importance of contextual factors and suggest that large-scale reform should be treated as a system shock for which health systems need to prepare.

Conclusions
Understanding the political determinants of health and political commitment to reform is essential to implementation, as is the importance of resilience and preparedness to unexpected circumstances either due to reform-related factors or to external and contextual factors.