bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cohort retention in a pandemic response study: Lessons from the SIREN study
Authors: Howells A , Munro K , Kamal A , Haywood J , Aquino E , Russell S , Foulkes S , Islam J , Hopkins S , Hall V 
Published: October 2024

Abstract

Background
Cohort studies represent an important research-tool, yet participant retention is difficult. SIREN followed a cohort of healthcare workers across 135 NHS sites in the UK during a pandemic. We designed an evolving retention programme, underpinned by our Participant Involvement Panel (PIP). We aimed to evaluate cohort retention over time and identify learnings.

Methods
Mixed method evaluation of our evolving retention programme in the 12 and 24-month cohort. We described cohort retention by demographics and site, using odds ratios from logistic regression. Withdrawal reasons were collected by survey. We collected participant feedback via cross-sectional survey using a behavioural science approach. We conducted focus groups with research teams and conducted thematic analysis.

Results
37,275 (84.7%) participants at 135 sites completed 12-months of follow-up. 12,635 (85.5%) participants at 87 sites completed 24-months. Retention increased with age (24-months: &gt;65 vs &lt; 25 years OR = 2.92; 95%CI: 1.78-4.88; p &lt; 0.001) and was highest in the Asian and Black ethnic groups (24-months OR = 1.78; 95%CI: 1.42-2.25; p &lt; 0.001, and OR = 2.12; 95%CI: 1.41-3.35; p &lt; 0.001, respectively, Ref=white). SIREN scored highly in participant feedback. Lessons for future studies include the need to monitor changing participant motivation; using inclusive and comprehensive communication; acknowledging the contributions of participants and investing in the skillset of research teams.

Conclusions
Despite challenges to running a large multicentre cohort study in an evolving pandemic, retention in SIREN has remained very high. Some factors impacting retention were outside of study control, including the altruistic motivation of participants. Participant feedback was positive, suggesting SIREN methodology will provide useful learning for future retention programmes. Site feedback provided learning for future multicentre research studies, offering insights into key facilitators and common challenges.

Key messages
• Cohort retention is difficult. Mixed methods evaluation shows SIREN achieved high retention while following a cohort of healthcare workers across 135 NHS sites in four UK nations during a pandemic.
• Lessons learned include the need to monitor changing participant motivation; using inclusive communication; acknowledging participants contributions and investing in the research team skillset.
Assessing the contribution of smoking to the disease burden in Belgium, 2013-2020
Authors: Nayani S , De Pauw R , Devleesschauwer B , Guariguata L 
Published: October 2024

Abstract

Tobacco use remains a challenge given its substantial role in contributing to disability and premature death globally. Understanding its impact on population health, as an attributable burden, can help monitor progress on the effectiveness of tobacco policies. In this study, we used the Comparative Risk Assessment (CRA) method to estimate the share of the disease burden due to smoking in Belgium from 2013 to 2020. Population attributable fractions (PAF) were computed for risk-outcome pairs by age, sex, and region in Belgium for 2013-2020. Exposure estimates were extracted from a time series of the Belgian Health Interview Survey. Dose-response curves or relative risk estimates were drawn from the Global Burden of Disease Study 2019. In Belgium, smoking-related deaths decreased from 12,851 deaths (PAF=11%) in 2013 to 9,413 deaths (PAF=7%) in 2020. Deaths among men (2013: PAF=18%, n = 9859; 2020: PAF=11%, n = 7041) were three times higher than among women (2013: PAF=5%, n = 2991; 2020: PAF=3%, n = 2341). Over time, larynx cancer (2013: PAF=72%, n = 185; 2020: PAF=63%, n = 125), trachea, bronchus, and lung cancer (2013: PAF=60%, n = 4,899; 2020: PAF=60%, n = 3,682), other pharyngeal and oropharyngeal cancers (2013: PAF=47%, n = 118; 2020: PAF=40%, n = 100), mouth cancer (2013: PAF=37%, n = 172; 2020: PAF=30%, n = 122), and aortic aneurysm (2013: PAF=40%, n = 268; 2020: PAF=33%, n = 209) emerged as the primary contributors to smoking-related deaths in Belgium. While the ranking of contributing causes stayed mostly consistent in both genders over the years, cervical cancer (2013: PAF=23%, n = 53; 2020: PAF=21%, n = 64) ranked fourth instead of mouth cancer (2013: PAF=22%, n = 28; 2020: PAF=14%, n = 15) among women. Despite decreasing trends over time, smoking remains a significant contributor to cancer deaths in Belgium, particularly among men. Results from this study can help inform the development of strategies for smoking prevention and reinforce the need for continued efforts in prevention initiatives.

Key messages
• Cancers are the primary cause of smoking-related deaths in Belgium, with a decline in the death toll over time.
• Understanding the role of smoking on population health as an attributable burden can improve health monitoring.
Creating good career prospects for professionals in the infectious disease control in the Netherlands
Authors: Hop-Boxhoorn M , Krijgsman N , de Munter A , Linthorst M 
Published: October 2024

Abstract

Background
A strong public health system in the Netherlands requires sufficient and motivated professionals. In preparation for new large outbreaks and pandemics, a strong workforce is essential. Providing good career prospects is crucial to attract, engage and retain professionals at the 25 Dutch Regional Public Health Services (RPHSs). However, it is unclear what opportunities and barriers professionals experience concerning their career prospects in the infectious disease control.

Methods
We aimed to identify these barriers and opportunities using focus groups with infectious disease medical doctors, nurses and assistants. Tangible solutions to address barriers and strengthen facilitating factors were gathered using in-depth interviews with key figures within the board, management, training coordinators and human resources of the RPHSs.

Results
Forty-six professionals participated in six focus groups. Barriers and opportunities for good career prospects included whether or not professionals experienced: personal development opportunities, achievement appreciation, and opportunities for (financial) growth. Interviews with key figures identified solutions to career prospect barriers, which were grouped into five themes: 1) Engage in conversations about career prospects, 2) Provide sufficient achievement appreciation, 3) Ensure connectivity between RPHSs, 4) Develop a perspective on career prospects, 5) Improve the image of RPHSs.

Recommendations
A guideline was developed for RPHSs to improve the career prospects of infectious disease control professionals including 17 recommendations. Implementation of these recommendations will contribute to the attractiveness of working in the public healthcare.

Key messages
• Addressing barriers and encouraging opportunities for good career prospects is essential to captivate, engage and retain public health professionals for pandemic preparedness.
• Career prospects can be improved by developing and communicating a perspective on career prospects, increasing appreciation of achievements, and improving the image of working in public health.
From Data to Decisions: Analyzing PaRIS for Health Policy Insights
Authors: Groenewegen Peter 
Published: October 2024

Abstract
To inform countries on how well they perform from the perspective of people living with chronic conditions in comparison with other countries, we propose an analytical framework for the data collected in the PaRIS survey, detailing how the data will be analysed in a multilevel approach for cross-country comparison. The data structure of the PaRIS survey represents three levels: countries/health systems, primary care practices and patients. Multilevel analysis is used because of its accuracy in estimating country-level outcomes, its flexibility in modelling relationships, and its opportunities in connecting to relevant policy questions. Country-level outcomes will be estimated to facilitate cross-country comparison and (future) within-country comparison over time. A first indication for areas for cross-country learning and policy making is the distribution of variation over patients, care providers and countries. Characteristics of patients that potentially explain variation in patient-reported outcomes and experiences can be linked to primary care practice and country/health system characteristics. The second indication for areas for cross-country learning and policy making is the variation in the slope of the association between patient and practice characteristics and patient-reported outcomes and experiences. This makes it possible to address policy-relevant questions relating, e.g., to whether some health systems or providers are better able to produce positive outcomes and experiences for (e.g.) older patients, and to the impact of chronic care management on patients with a specific chronic condition. To ensure fair cross-country comparisons, all outcomes will be estimated for an OECD (age and sex standardised) reference population, also including case-mix adjustment where necessary. Analyses will be repeated using a country-specific standard population.
The EU Health Task Force, supporting preparedness and response in the European Union and globally
Authors: Romani Vidal A , Severi E , Cauchi D , Obach D , Lof E , Forato S , Hofmann T , Lefevre V 
Published: October 2024

Abstract
The COVID-19 pandemic revealed shortcomings in the European Union (EU) mechanisms for managing public health threats. In 2022, the European Centre for Disease Prevention and Control (ECDC) was mandated to establish the EU Health Task Force (EUHTF) to strengthen preparedness and response at country, EU and global levels. The EUHTF is coordinated by an ECDC Permanent Capacity and relies on pools of experts including ECDC experts, ECDC fellows and European public health experts that can be mobilized for specific assignments or broad public health emergencies. Members from EU/ Economic European Area (EEA) countries, EU agencies, the European Commission, WHO and non-profit organizations advise ECDC on the EUHTF establishment. From May 2023 to April 2024, the EUHTF addressed 13 requests for support from seven EU countries and three non-EU countries. The requests were related to preparedness (e.g. after-action reviews, simulation exercises, mass gathering preparation, capacity building) and emergency response activities (e.g. risk assessment, operational research during crisis, emergency and outbreak response). The EUHTF is operational and able to mobilize expertise from ECDC, the ECDC fellowship and EU/EEA countries. The EUHTF Pool of External Experts, comprised of public health professionals across various levels and institutions of the EU/EEA, is poised to offer comprehensive and robust expertise. Through these resources, the EUHTF is collaborating with and reinforcing the work of EU institutions and other international partners in strengthening preparedness and response.
The EUHTF is a new and structured EU-level approach to public health crises, ensuring tailored in-country support to EU and non-EU countries in preparedness strengthening and crisis response.
Policies and programs on children’s health promotion in the EU in the context of the JA Health4EUKids
Authors: Giusti A , Di Stefano V , Scardetta P , Zambri F , Palermo V , Di Nolfi A , Dittami A , Martelli G , Cattaneo C ,   Health4EUKids Joint Action Group
Published: October 2024

Abstract

Background
Overweight and obesity prevalence are a global public health challenge. The prevalence is rapidly increasing, with significant health risks such as cardiovascular disease, type 2 diabetes, and cancer.

Objectives
To describe the state of the art of policies and programs (PPs) on children’s health promotion and responsive parenthood (children 0-12 years) in the EU, and to identify their gaps.

Methods
A cross-sectional study was carried out through an online survey, as part of the Health4EUKids Joint Action (JA) (HADEA n.101082462), between October and December 2023, targeting all EU member states (MSs) involved.

Results
The survey collected information about 74 PPs from 11 EU MSs of the JA. The PPs are primarily focused on healthcare (62.1%), education (24.1%), and social sectors (10.3%), with a focus on children aged 6-11 years. The settings for PPs include primary schools, communities, secondary schools, and healthcare services. The PPs are characterized by different degrees of innovation, controversy, equity, transferability, and sustainability, although the structural or systemic impact and public visibility appear to be lower among other characteristics. The formulation and design of PPs include problem analysis (73%), based on national or local data and on stakeholder consultation. As for implementation, most PPs are implemented upon release, but recommended action and allocated human resources are not fully adequate. Regular monitoring and evaluation (47.3%) are based on defined outcomes, standards, and indicators (63.5%). The results are disseminated to decision-makers and stakeholders (37.8%), through media, and to the general population (32.4%).

Conclusions
Most PPs are variable and context-dependent. It is necessary to align the policies with the implementation, in all its aspects, and to strengthen monitoring, evaluation, and communication with the relevant stakeholders, which currently appear to be the most lacking aspects.

Key messages
• Most European policies and programs are context-dependent, mainly in healthcare. Yet, a cross-sectoral trend involving health, education, and social sectors emerges.
• The study stresses the need for better alignment between policy formulation and implementation to enhance the effectiveness of EU children’s health programs.
Exercise interventions for Long COVID: a systematic review of randomised controlled trials
Authors: McDowell C , Tyner B , Shrestha S , McManus L , Comaskey F , Harrington P , Walsh K , O’Neill M , Ryan M 
Published: October 2024

Abstract

Background
Long COVID is prevalent and costly. There is much debate around the effectiveness and tolerance of exercise among people with Long COVID due to the potential to exacerbate symptoms. Therefore, this systematic review aimed to examine the effectiveness and tolerance of exercise interventions among people with Long COVID as part of a wider project to inform updates to the Irish Health Service Executive’s Long COVID interim model of care.

Methods
Medline via EBSCOhost, Embase, and CENTRAL were systematically searched on 28 February 2023. Inclusion criteria were: (1) participants with Long COVID; (2) random assignment to either an exercise intervention or a comparison group; (3) a quantitative measure of at least one of 12 core Long COVID outcomes. Two reviewers independently extracted data and assessed study risk of bias using the Cochrane Risk of Bias tool.

Results
In total, 4,394 studies were identified, 569 full texts were screened, and eight studies were included. Follow up periods ranged from two to 28 weeks (mean=8.5 weeks). Sample sizes ranged from 39 to 119 (mean=56). All studies were in adults (mean age=49.9 years) and both sexes (mean female proportion=53.9%). Four studies were at low risk of bias, two unclear, and two high. The evidence suggests that exercise interventions led to short-term improvements in dyspnoea, fatigue, physical function and the physical domain of quality of life. Of the five studies that reported adverse events, rates were low and, when reported, mild. Of the seven studies that reported sufficient information, one of 252 participants who received exercise discontinued the intervention due to tolerance-related issues.

Conclusions
Available evidence suggests that exercise interventions may have short-term benefits and be tolerable among some people with Long COVID. However, the evidence base consists of a limited number of studies with small sample sizes and short follow-up periods.

Key messages
• There is much debate around the effectiveness and safety of exercise among people with Long COVID due to the potential to exacerbate symptoms.
• The available evidence suggests that appropriate exercise interventions may have short-term benefits and be tolerable. However, there are notable limitations among the evidence.
Investigating the Mental Health Outcomes and Treatment Gap Among Sexual Minorities in Czechia: A National Cross-Sectional Study
Authors: Pitonak M , Formánek T , Potočár L 
Published: October 2024

Abstract

Aims
This study aims to (1) estimate the prevalence and relative risk of mental disorders, (2) assess the severity of mental health symptoms, and (3) investigate the treatment gap for mental disorders within SM.

Methods
Data from a cross-sectional, nationally representative survey of 3,063 Czech adults (response rate = 58.6%) were utilized. The Mini-International Neuropsychiatric Interview was employed to screen for mental disorders. In those identified with mental disorders, help-seeking behaviors over the past 12 months were examined. The severity of mental health symptoms was evaluated using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. Prevalence rates of mental disorders associated treatment gaps, and relative risks of mental disorders were calculated.

Results
The prevalence of mental disorders among heterosexual, gay or lesbian, bisexual, and more sexually diverse individuals was 18.9% (17.4-20.3), 52.3% (36.9-67.6), 33.3% (19.5-47.2), and 25.9% (13.9-38), respectively. Suicidal thoughts and behaviors were reported in 5.7% (4.9-6.6) of heterosexual individuals compared with 25.0% (11.7-38.3) in gay or lesbian, 22.9% (10.6-35.3) in bisexual, and 11.1% (2.5-19.8) in more sexually diverse individuals. After adjusting for confounders, gay or lesbian individuals demonstrated an increased risk of having at least one current mental disorder compared with heterosexual people (OR = 3.5 95% CI(1.8-6.8)). Bisexual and more sexually diverse individuals demonstrated risks consistent with a null effect. No substantial differences in treatment gap were detected between heterosexuals and SM who scored positively for at least one current mental disorder.

Conclusions
The findings underscore the urgent need for systemic changes to improve the mental health outcomes of Czech SM. Addressing structural stigma and ensuring sensitive care are imperative to mitigate the health disparities faced by Czech SM.
Calculating potential impact fractions to assess the impact of tobacco control policies
Authors: Mons U 
Published: October 2024

Abstract
This presentation will provide a straightforward and accessible method for evaluating the effectiveness of various tobacco control policies in reducing the smoking-associated disease burden. To estimate numbers and proportions of potentially avoidable disease cases under different policy intervention scenarios (such as cigarette tax/price increases, comprehensive marketing ban, and plain packaging), this approach entails the calculation of age- and sex-specific potential impact fractions, representing the percentage change in disease risk following changes in exposure to smoking. The approach can account for lag and latency periods between reductions in smoking prevalence and declines in disease excess risks. The future disease burden is estimated by combining data on the incidence or mortality of the disease of interest, published effect sizes of tobacco control policies, and national smoking prevalence data. Intervention scenarios are compared against a status quo scenario that assumes the continuation of recent smoking trends. The presentation will outline the approach, using the example of smoking-associated cancer, and discuss model assumptions, required data, and sensitivity analyses. This straightforward modelling framework enables the comparison of different health policy measures’ impacts, providing valuable insights for policymakers and public health officials regarding the potential public health impact of tobacco control policy measures.
The status of health information systems and digital transformation in the European Region
Authors: Verschuuren M , Novillo Ortiz D 
Published: October 2024

Abstract
Although there have been investments in health information systems (HIS) and digitalization, WHO/Europe’s work with Member States (MS) shows that much can be improved still. Typically, there is a strong focus on data collection, but less on analysis and knowledge translation, resulting in available data not being optimally used to support decision making. Standards for data exchange and interoperability have not yet been fully implemented. Efforts are underway to train healthcare professionals, yet only half of MS have developed policies for digital health literacy. Fewer still have implemented a comprehensive digital inclusion plan, leaving disadvantaged populations at risk of falling behind. In line with the traditionally strong focus on HIS strengthening in WHO’s work, the European Programme of Work 2020-2025 (EPW) emphasises the need for MS to improve and modernise their HIS to ensure that decisions are data driven. One of the EPW flagship initiatives is Empowerment through Digital Health, promoting the leveraging and scaling up of digital transformation for better health. The Regional digital health action plan for the WHO European Region 2023-2030 outlines the strategic actions needed to achieve this, while fully respecting the values of equity, solidarity and human rights. Collaboration with MS and international partners is vital in this work. WHO/Europe has established several MS-driven health information networks in the past, most notably the European Health Information Initiative (the EHII). The EHII in 2023 has made a restart in the form of the European Health Information Network (HIN). The HIN will guide the work under the EU-funded action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’, which will be implemented by WHO/Europe. This strong European Commission and WHO/Europe partnership will be a main catalyst for HIS improvement in the Region the coming years.