bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting food consumption using contextual factors: An application of machine learning models
Authors: Tran N R , Zhang Y , Leech R M , McNaughton S A 
Published: October 2024

Abstract

Background
Improving diet quality relies on making manageable adjustments to eating behaviours. Personalised nutrition interventions hold promise for modifying behaviour. Machine learning (ML) offers a novel approach to examining dietary behaviours in personalised nutrition by leveraging data on past behaviours and environmental contexts. This study aims to investigate whether contextual factors at eating occasions (EO) can predict food consumption to enhance diet quality.

Methods
Cross sectional data from the Measuring Eating in Everyday Life Study (MEALS) were analysed (n = 675, 18-35y). A smartphone food diary app recorded dietary intakes at EO for 3-4 non-consecutive days, also capturing social-environmental (e.g., activity) and physical-environmental factors (e.g., consumption location). Participant characteristics were collected via an online survey. Food groups intake (servings per EO) followed Australian Dietary Guidelines. This study benchmarked two established models, gradient boost decision tree and random forest, which have previously shown high performance in similar tasks. Performance was evaluated using 10-fold cross-validation, measuring mean absolute error (MEA), root mean square error (RMSE), and R squared. Feature importance analysis identified key variables for predicting food consumption.

Results
ML predicts most food groups at EO using contextual factors, with slight differences between actual and predicted consumption (&lt;1 serving per EO). For fruits, dairy, and meat, MEA values were 0.35, 0.34, and 0.56 servings, respectively (RMSE values: 0.61, 0.50, and 0.80 servings). Self-efficacy, age and consumption location were influential in most ML models.

Conclusions
ML offers insights into contextual factors and food consumption, suggesting directions for precision nutrition interventions. Future research should identify positive influences of contextual factors on dietary behaviours and incorporate these insights into interventions.

Key messages
• Machine learning can effectively predict food consumption based on contextual factors at eating occasions.
• Understanding the influence of contextual factors such as consumption location on food consumption can inform the development of precision nutrition interventions aimed at improving diet quality.
Associations between general practice and outpatient care continuity in people with multimorbidity
Authors: Beaney T , Clarke J , Woodcock T , Barahona M , Majeed A , Aylin P 
Published: October 2024

Abstract

Background
Relational continuity in primary and secondary care is linked to better health outcomes for patients, but it is unclear whether metrics of continuity in each setting are associated. Our study examined the association between relational continuity in general practice (GP) and continuity of hospital outpatient specialties in people with clusters of multimorbidity.

Methods
We used GP records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics outpatient records. Included were patients ≥18 years, with two or more of 212 Long-Term Conditions (LTCs), registered throughout 2019 and with at least three GP and three outpatient appointments. The Continuity of Care Index (COCI) was calculated separately for visits to the same i) GP and ii) hospital specialty, where 0 represents no continuity and 1 represents all visits to the same GP or specialty. We assessed the association between the indices using univariable and multivariable fractional logit regression. We calculated expected COCI scores for each LTC and assessed variation in the COCI between LTCs assigned to one of 15 clusters of co-occurring diseases derived previously. A sensitivity analysis repeated analysis using the Sequential Continuity (SECON) score, which captures longitudinal continuity.

Results
Of 1,135,903 patients, 56.2% were ≥60 years. The median (IQR) COCI in GP was 0.22 (0.11-0.40) and in outpatients was 0.33 (0.20-0.52). Although statistically significant (p &lt; 0.001) the relationship between the two measures was clinically insignificant in both univariable and multivariable models. No strong relationships were found between COCI scores and LTC clusters. Similar patterns were found using the SECON score.

Conclusions
We found no strong association between continuity of care in GP and outpatient settings, and no clear patterns with LTC clusters. This suggests that lack of continuity in secondary care is not compensated for by increased continuity of care in primary care.

Key messages
• We found no meaningful association between measures of continuity of care in general practice and hospital outpatient settings.
• Our findings suggest that lack of continuity of outpatient care is not compensated for by increased continuity in primary care.
The Scourge of measles
Authors: Latif S 
Published: October 2024

Abstract
Once considered a disease of the past, the resurgence of measles in England has garnered significant attention in recent weeks and months. The uptake of routine childhood vaccines including the measles, mumps and rubella (MMR) vaccine is the lowest it has been in a decade and is well below the 95% uptake needed to protect the population and prevent outbreaks. This is giving this serious disease a chance to get a foothold in our communities. From having never seen a case of measles in their life time doctors in England are now notifying cases of measles based on clinical suspicion. Since October, we have seen a rapid increase in both measles cases and outbreaks of measles across England (the total number of cases confirmed since October 2023 to date is 1109) and it has been declared a national incident. The abstract highlights the consequences of vaccine hesitancy, illustrated by case studies of outbreaks of measles among susceptible populations such as schools and prisons and the steps being taken to control the spread. Social media misinformation, distrust in healthcare authorities, and concerns over vaccine safety are some of the factors shaping parental attitudes towards MMR vaccination. In response to these challenges, the abstract underscores the importance of targeted interventions aimed at addressing vaccine hesitancy, such as community engagement initiatives, tailored communication strategies, and healthcare provider training. By emphasizing the critical role of MMR vaccination in preventing measles resurgence, this abstract advocates for a collaborative approach involving healthcare stakeholders, policymakers, and the public to combat to combat this preventable yet persistent threat to public health.
Factors of mental health patients’ uptake in social prescribing: a mixed methods study in Portugal
Authors: Hoffmeister L , Gama A , Gonçalves B , Canas A M , Figueiredo C , Dias S 
Published: October 2024

Abstract

Successfully addressing mental health challenges demands comprehensive, community-driven solutions. Social prescribing (SP) emerges as an innovative approach, fostering integrated care by connecting healthcare patients to community resources. Research in this topic proved effects of SP in mental health and well-being promotion, but factors influencing patients’ uptake remain underexplored. This study examined the factors associated with the uptake in patients with mental health needs in SP project in Portugal. This mixed methods study examined registries data of 403 patients referred to SP for mental health needs. A logistic regression was used to analyse sociodemographic characteristics and referral details associated with SP uptake. Semi-structured interviews were conducted with stakeholders to explore challenges and facilitators of users uptake. Most users were female (71.7%) and elder (average age 64.4 years, SD ± 20.0). Mental health needs included social isolation, loneliness, anxiety, and depression. 43.7% of referred patients had diagnosed mental illnesses and 55.8% attended at least one SP appointment. SP uptake was more likely among patients referred for social and financial support (OR 2.02; 95%CI 1.32-3.07; p = 0.001) and referred during the Covid-19 period (OR 1.64; 95%CI 1.08-2.49; p = 0.020). increased the probability of SP uptake. In contrast, SP uptake was less likely among those having diabetes (OR 0.49; 95%CI 0.28-0.88; p = 0.016). Health professionals’ proactive engagement with patients facilitated uptake in SP, yet challenges arose from users’ complex needs, low awareness, motivation, and acceptance of non-traditional responses such as community-based activities, along with mistrust of their effectiveness. SP has the potential to foster mental health and well-being through person-centred holistic care, yet challenges in uptake related to health and psychosocial factors must be addressed to optimize the SP positive impacts.

Key messages
• Factors influencing the uptake of patients with mental health needs in SP initiative in Portugal involved need of social and financial support, pandemic period and health professionals’ attitudes.
• Despite SP potential, for effective implementation it is key to address challenges, like complexity of patients’ needs, awareness gaps and patient mistrust, to maximize its positive outcomes.
Birth registry-based cohort study of COVID-19 in pregnancy and adverse maternal outcomes in Georgia
Authors: Skhvitaridze N , Gamkrelidze A , Manjavidze T , Brenn T , Rylander C , Getsadze R 
Published: October 2024

Abstract

Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery. We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99-84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05-6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03-1.20).

Key messages
• Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission.
• Most pregnant women were not vaccinated against COVID-19 and these findings should alert stakeholders that adherence to public health preventive measures needs to be improved.
Understanding and monitoring vulnerability during pregnancy at population-level
Authors: Molenaar J , Struijs J , Kiefte-de Jong J C 
Published: October 2024

Abstract

Background
Detecting and addressing vulnerability during pregnancy is important to optimize the first thousands days of children’s lives and prevent health inequities. We aimed to gain insight into vulnerability during pregnancy and determine the best data to predict vulnerability.

Methods
In the Netherlands, two studies were done using nationwide routinely collected data and self-reported Public Health Monitor-data. The first study utilized all data to identify classes of vulnerability among 4172 pregnant women through Latent Class Analysis. The second study predicted multidimensional vulnerability at population-level using solely routinely collected data first, and step-by-step incorporating self-reported data. Random Forest (RF) analysis was employed, and model performance was assessed using Area Under the Curve (AUC) and F1-measure.

Results
Five vulnerability-classes were found: ‘healthy and socioeconomically stable’, ‘high care utilization’, ‘socioeconomic vulnerability’, ‘psychosocial vulnerability’, and ‘multidimensional vulnerability’. Women in the ‘multidimensional vulnerability’-class shared multiple risk factors across domains and lacked protective factors. They more often had adverse outcomes such as premature birth. In the next study, the initial RF-model achieved an AUC of 0.98 in distinguishing multidimensional vulnerability, with an F1-measure of 0.70. Adding self-reported data improved model performance. Strong predictors were self-reported health, socioeconomic characteristics and healthcare utilization.

Conclusions
Several vulnerability classes can be distinguished among pregnant women. The co-existence of risk factors and lack of protective factors leads to more adverse outcomes. Effective public health strategies should include both medical and social care and support. Next, it seems possible to predict multidimensional vulnerability using data that is readily available, providing a foundation for longitudinal monitoring and policy formulation.

Key messages
• Considering the combination of both social risk and protective factors related to vulnerability during pregnancy is necessary.
• Routinely collected data could provide insight in the prevalence, geographical distribution and trends in multidimensional vulnerability during pregnancy at population-level.
Associations between maternal origin, breastfeeding and health service use: a mediation analysis
Authors: Muhumed I , Meinilä J , Klemetti R , Adebayo F , Virtanen S , Erkkola M 
Published: October 2024

Abstract

Background
The influence of maternal health utilization on breastfeeding practices is well established. However, research shows that immigrant women tend to face challenges in accessing maternal health services. Our aim was to examine any variation in maternal and child health service utilization between immigrant and native-born mothers as well as to examine potential mediation roles of service utilization on the association between maternal origin and breastfeeding practices.

Methods
We used a nationwide FinChildren (2020) survey on parents with infants focusing on Somali (n = 29), Arabic (n = 81) and Russian speaking (n = 181) parents and their infants. We compared them with native Finnish speakers (n = 7508). We used Process Macro to conduct mediation analysis.

Results
Almost 25%/ of Somali-/Arabic-speaking mothers reported not taking their infants to routine child health clinic visits. The proportion was 0.4% for native-born mothers and 1.6% for Russian-speaking mothers (p &lt; 0.001). Around 18% of Somali-/Arabic-speaking mothers and only 0.6% of the native-born mothers reported not utilizing child health clinic services in the past year (p &lt; 0.001). Somali-/Arabic speaking mothers were more likely to receive breastfeeding support from maternity clinics and native-born mothers from maternity hospital or peer support groups. Russian-speaking mothers were most satisfied with the received child healthcare services while Somali/Arabic-speaking mothers were least satisfied with these services (p &lt; 0.001). Only participating in breastfeeding peer support groups had mediation effects on association between maternal origin and breastfeeding practices.

Conclusions
This study shows that immigrants mothers, particularly Somali/Arabic speaking mothers use less the maternal health services particularly routine health visits. It is essential to encourage them to use the services to be able to monitor the health of both mother and the child.

Key messages
• Somali-/Arabic-speaking mothers are in a vulnerable position when it comes to utilizing healthcare services.
• This study call for more research exploring factors contributing to this.
Workers’ experiences of pregnancy loss: qualitative insights from a mixed-methods study
Authors: Kelly-Harrington R , Hennessy M , Leitao S , O’Sullivan M , Dalton-O’Connor C , Donnelly M , Murray C , Nuzum D , O’Donoghue K 
Published: October 2024

Abstract

Background
Pregnancy loss affects approximately one in four pregnancies. The workplace is an important context to consider in pregnancy loss experiences as most women of reproductive age are in paid employment. Currently in the Republic of Ireland (ROI) there are no statutory leave entitlements if a pregnancy ends &lt;24 weeks. Given the lack of research in this area internationally, we aimed to explore workplace experiences of early pregnancy loss.

Methods
In 2023, we conducted an online mixed-methods survey study (Mar-Apr), followed by qualitative interviews (Jun-Sept). People who experienced a pregnancy loss &lt;24 weeks-whilst working and living in ROI in the preceding five years-were eligible to participate. The survey was distributed through professional/social networks and contained quantitative and qualitative questions-addressing pregnancy loss, experiences of workplace supports, and desired supports. Survey participants were asked to indicate their willingness to participate in a follow-up interview and were purposively sampled. The interview topic guide focused on specific aspects of workplace experiences which required further exploration following preliminary analysis of survey responses. Qualitative data were analysed in NVivo using reflexive thematic analysis.

Results
Most survey participants (N = 913) were female (74%), employed full-time (86%) and experienced a first-trimester miscarriage (75%). We conducted interviews with 13 people, across a range of demographics. Three initial themes were identified: (1) Personal experiences of pregnancy loss and dealing with emotional and physical impacts at work; (2) Challenges with the social side of pregnancy loss-disclosure and workplace interactions; (3) Workplace supports (4) Public policy and awareness.

Conclusions
Our analysis highlights the need for statutory leave, appropriate workplace policies and procedures, and education and training to better support workers who experience pregnancy loss.

Key messages
• There is a gap between workers’ needs and workplace supports regarding pregnancy loss &lt;24 weeks gestation. Statutory leave, workplace policies and procedures, and education and training, are needed.
• There is a need to discuss pregnancy loss in workplaces and society, to raise awareness and reduce the stigma/taboo on the topic. Recognition from Government is crucial to promote this.
Experiences of access to care, diagnosis and rehabilitation among a multiethnic patient population with long-COVID in Denmark
Authors: Goldschmidt M , Torensma M , Beune E , Agyemang C , Rostila M , Benfield T , Norredam M , Bredmose E 
Published: October 2024

Abstract

Background and aim
The aim of the study was to explore the experiences of accessing care, diagnosis, and rehabilitation among patients with long-COVID in a multiethnic population in Denmark.

Methods
Qualitative research using semi-structured interviews among a purposive sample of 18 people diagnosed with long-COVID, according to the NICE guideline, in the Capital Region of Denmark. Participants were sampled to secure variation in sex, age, ethnicity, migration status and education. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, and member checked, and subsequently analyzed using thematic framework analysis and NVivo software.

Results
The analysis generated four categories: i) living with long-COVID, ii) access to care, iii) experiences in the healthcare system, and iv) experiences with rehabilitation. A main category was identified from these categories: limited knowledge of COVID resulting in uncertainty, which challenged nearly all aspects of access to diagnosis, care and rehabilitation among the informants. In particular, ethnic minorities experienced that their motives for seeking care were questioned or had the experience of differential treatment. In general, participants perceived to be themselves responsible of recovering, while also struggling with the mental, social and work-related consequences of their long-COVID.

Conclusions
Our study demonstrated how the emergence of a new viral disease with unknown long-term sequelae results in a group of patients who to a great extend carry the burden of getting better themselves. More research into relevant diagnosis, care and support for long-COVID patients is needed, especially among ethnic minorities.
Differences in incidence, nature of symptoms, and duration of long COVID among hospitalised migrant and non-migrant patients in the Netherland: a retrospective cohort study
Authors: Chilunga F , Appleman B , van Vugt M , Klaverda K , Smeele P , van Es J , Wiersinga W J , Rostila M , Prins M , Stronks K 
Published: October 2024

Abstract

Background and aim
Comprehensive data on long-COVID across ethnic and migrant groups are lacking. We investigated incidence, nature of symptoms, clinical predictors, and duration of long-COVID among COVID-19 hospitalised patients in the Netherlands by migration background.

Methods
We used COVID-19 admissions and follow up data (January 2021-July 2022) from Amsterdam University Medical Centers. We calculated long-COVID incidence proportions by migration background and assessed for clinical predictors via robust Poisson regressions. We then examined associations between migration background and long COVID using robust Poisson regressions and adjusted for derived clinical predictors, and other biologically relevant factors.

Results
1886 patients were included. 483 patients had long-COVID (26%, 95% CI 24-28%) at 12 weeks post-discharge. Symptoms like dizziness, joint pain, and headache varied by migration background. Clinical predictors of long-COVID were female sex, hospital admission duration, intensive care unit admission, and receiving oxygen, or corticosteroid therapy. Long-COVID risk was higher among patients with migration background than Dutch origin patients after adjustments for derived clinical predictors, age, smoking, vaccination status, comorbidities and remdesivir treatment.

Conclusions
There are significant differences in occurrence, nature of symptoms, and duration of long-COVID by migration background. Studies assessing functional limitations and access to post-COVID healthcare are needed to help plan for appropriate and accessible healthcare interventions.