bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing new methods for patient care pathway assessment for breast cancer patients in Hungary
Authors: Surján C , Surján G , Horváth Z , Dombrádi V , Belicza É 
Published: October 2024

Abstract

Issue
The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care.

Description of the problem
Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals.

Results
Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations.

Lessons
Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies.

Key messages
• Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design.
• The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.
Sarcopenia and associated factors among older adults at high risk of dementia
Authors: de Sousa D , Costa A R , Vicente M , Cruz V T , Padrão P 
Published: October 2024

Abstract

Background
Sarcopenia and dementia share pathophysiological pathways and risk factors, including advanced age, physical inactivity, unhealthy diet, smoking and diabetes. Older adults at high risk of dementia may face increased susceptibility to sarcopenia, which can also exacerbate cognitive decline. Thus, this study aims to estimate the frequency of sarcopenia and its associated factors within this vulnerable population.

Methods
This cross-sectional analysis includes data from a subset of older adults (≥65 years of age) enrolled in the MIND-Matosinhos randomized controlled trial, a community-based cognitive decline prevention program. Per the European Working Group on Sarcopenia in Older People, probable sarcopenia is defined as low muscle strength (handgrip strength &lt;16 kg for women and &lt;27 kg for men). Sociodemographic, lifestyle and health-related data were collected via structured questionnaires. To assess factors associated with sarcopenia, odds ratios (OR) and respective confidence intervals (95% CI) were estimated using logistic regression.

Results
A total of 157 participants (58.6% female), with a median age of 73 years (range: 65 to 85 years), were included. The overall prevalence of sarcopenia was 21.7% (n = 34). After adjusting for sex, age and education, inadequate adherence to Mediterranean Diet (MD) (OR = 10.90; 95% CI:1.41-84.52), current smoking status (OR = 5.06; 95% CI:1.06-24.18) and poorer self-perceived health (OR = 2.74; 95% CI:1.03-7.28) were positively associated with sarcopenia. No other statistically significant associations were found.

Conclusions
The observed sarcopenia frequency underscores the need for enhanced screening and management of this condition in community settings and among those at dementia risk. Inadequate adherence to MD, smoking and poor self-perceived health, seem to be associated with sarcopenia in older adults at high risk of dementia. Sarcopenia prevention should involve a holistic approach to promoting a healthy lifestyle.

Key messages
• Sarcopenia was observed in 21.7% of older adults at high risk of dementia, indicating a significant burden on this vulnerable population.
• Inadequate adherence to the Mediterranean diet, smoking and poor self-perceived health were associated with sarcopenia.
Effect of climate change on West Nile virus transmission in Italy: a systematic review
Authors: Lorenzon A , Granata M , Verzelloni P , Tommasi L , Palandri L , Paduano S , Bargellini A , Righi E , Malavolti M , Filippini T 
Published: October 2024

Abstract

Background
West Nile Virus (WNV) is a pathogen transmitted by mosquitoes of the Culex genus, affecting both humans and animals such as horses and birds. The prevalence of WNV infection has increased dramatically in recent years in Europe, especially in Italy, and has been related to climate and environmental changes linked to global warming. Our review aims to assess the relation between the spread of WNV in Italy and the different climate change-related factors.

Methods
We conducted a literature search in the PubMed, Web of Science, Embase and Scopus databases, actualised as of 20 February 2024, using as search terms WNV, its vectors and climate change, and limiting our analysis to studies conducted in to avoid an overly heterogeneous setting. We registered the review in PROSPERO (CRD42023430636).

Results
Of the 252 unique records retrieved, we eventually included 25 articles after full-text screening. These studies were published between 2011 and 2023 and evaluated the distribution of WNV or its vectors according to various climatic and environmental factors. Despite rather heterogeneous results, we found a consistently positive association with temperature, especially spring temperature, agricultural land use, demography, and soil moisture, and a negative one with evapotranspiration and wind, while the relationship with other environmental variables and water cycle-related factors was weak, null or conflicting.

Conclusions
Despite some inconsistencies in the results, likely related to differences in study methodologies as well as complex environmental interactions, we found unequivocal evidence that climate change-related factors, such as the lengthening of the warm season, extensive farming, and invasive human activities towards natural environments, favour WNV spread in Italy. Consequently, actions against global warming and preservation of natural environments may counteract the WNV epidemic.

Key messages
• WNV epidemic seems to be linked to specific climate change-related factors, such as the lengthening of the warm season, extensive farming, and invasive human activities towards natural environments.
• Actions against global warming and preservation of natural environments may counteract WNV spread.
Climate change health challenges – a study on heat health-related adaption measures in Germany
Authors: Grewe H A , Kind C 
Published: October 2024

Abstract

Problem
Increasing extreme heat events of summer 2003, 2010 and 2015 induced a rising impact on heat health morbidity and mortality in Germany. A considerable proportion of urban population is affected by thermal discomfort due to the urban heat island burden during summer, particularly vulnerable people at risk. Concerted action to develop appropriate heat health adaptation measures is needed.

Description
As part of the National Adaptation Strategy to Climate Change an expert working group published ‘Recommendations for Action for the Preparation of Heat Action Plans’ for Germany in 2017. A first country-wide project had been conducted between 2019 and 2023 which investigated the status and impact of current or planned Heat Health Action Plans (HHAP), and adaptation measures appropriate to protect and prevent human health. As part of this project an online survey was conducted in May/June 2020 on the awareness and degree of use of the 2017 recommendations and the development and implementation of HHAP.

Results
This survey had been carried out to assess the current state of affairs as well as factors of success and barriers in the development and implementation of HHAP, with a particular focus on municipal environment and health administrations. In total 116 questionnaires had been responded, mainly by participants from the environment sector (53%), and 32% from the public health sector. More than half of the respondents indicated to be aware of the recommendations (very well-known at the federal state level: 90%, at county level known by 43%), which were identified as very helpful by 81%. Respondents from large cities (&gt; 100 000 inhabitants) were main contributors to the study (41 of 81 large cities replied; 34 rural counties responded).

Key messages
• The 2017 recommendations had been identified and used to start with HHAP.
• Decision makers should develop structures for regulations that anchor HHAP as a nationwide instrument to be established timely.
Finding cool spaces in Frankfurt/Main–a heat protection measure for the population of a major city
Authors: Duggan K , Christ A , Maraslioglu M , Sauer A , Böddinghaus B 
Published: October 2024

Abstract

With the European continent heating up faster than ever, cities are facing major challenges protecting their population from the effects of climate change. Heat can have devastating effects on people’s physical and mental health with particular significance for the known vulnerable groups - the elderly and young children, people with pre-existing conditions, those who are pregnant and those who cannot protect themselves sufficiently for various reasons plus of course people working outdoors. Following the 2003 heat wave, the city of Frankfurt/Main registered a significant rise in mortality and morbidity, leading the Health Protection Authority to be increasingly concerned with heat-related health problems in the Frankfurt metropolitan area. The city has since developed various systems to protect the population from extreme heat and developed an all-encompassing climate change action plan (CCAP). Part of the CCAP is the provision of cool spaces to provide refuge from the heat for the public and implementation of this project started in the summer of 2022. However, with no legislative basis on which to build such a platform, some creative measures were required to ensure its success. Here, we will not only present the challenges we faced but the solutions we found - and the results of our currently ongoing evaluation of the actual use of our cool spaces to help other cities make their journey to similar measures easier. Starting with a brief overview of the CCAP, we will show the cool spaces’ place within the strategy, followed by our original plan of action and what happened when this plan came into contact with the reality of life in a large and diverse city. We will touch on climate injustice and the difficulties in reaching those parts of the population who actually need protection the most. Finally, we present our evaluation strategy and results together with the adjustments we are considering in moving forward with this climate change protection measure.

Key messages
• (Establishment of) climate change adaptation measures should urgently be enshrined in law.
• Health inequality corresponds to climate inequality and continiously challenges adaptation measures.
Contributing to healthier populations by reducing energy poverty via innovative financial models
Authors: Costa Ruiz B , Lucas R , Ferrando Garcia M 
Published: October 2024

Abstract

Issue/problem
Energy poverty is a major challenge affecting 9.3% of the EU population (EUROSTAT 2022). Health problems attributable to energy poverty include respiratory diseases, heart attacks, stroke, and mental disorders. Governments must act quickly and intervene with policies and programmes that reduce energy poverty and promote citizens' health and well-being.

Description of the problem
We propose Social Impact Bonds (SIBs), a new family of instruments that address serious social challenges, to finance interventions targeting energy poverty,improving the health and well-being of households in a context of limited public resources. For this purpose, data from interventions to increase energy efficiency and combat energy poverty implemented during one year in 6 pilot sites in the framework of the EU project WELLBASED are used. First, a compliance check will be carried out, followed by an estimation of the costs, savings, and benefits of the application of SIBs to finance energy poverty reduction interventions with an impact on health.

Results
The results of the analysis will show whether the intervention to reduce energy poverty meets the necessary characteristics for a SIB to be implemented. In addition, the possible key actors that could lead its implementation are identified.

Lessons
If the interventions for the reduction of energy poverty carried out under the WELLBASED project are successful, SIBs could be considered as a valuable alternative to finance interventions that combat energy poverty and increase the well-being of citizens. Key knowledge on how to apply SIBs makers to tackle a serious social issue with important consequences on health will be at disposal of (EU and worldwide) local authorities and policy.

Key messages
• Energy poverty is a public health issue, requiring urgent support measures.
• SIBs fund interventions via public-private collaboration to fight energy poverty and boost citizen wellbeing.
The role of Public Health during an emergency: the 2023 flood in the Emilia-Romagna Region
Authors: Monti M , Fabbri M , Silvestrini G , Golfera M , Angelini R 
Published: October 2024

Abstract

Issue
Major meteorological events like floods are a primary issue for public health. In May 2023, the Emilia-Romagna Region (Italy) was hit by a major rainfall: more than 4.5 billion m3 of rainwater, more than 30 rivers overflowed, 36.000 displaced people, 17 casualties. Public health is called upon to mitigate health consequences with an epidemiological approach in the pre-disaster phase to better address the population; through rapid need assessment during the response phase; and through health surveillance and tracking systems in the post-disaster phase.

Description of the problem
A continuous epidemiological approach throughout the emergency was applied. Rescue: coordination for rescue and sheltering of displaced people (especially from flooded healthcare structures); veterinarian intervention for livestock assistance; carcass removal. Assistance: hygienic controls in shelters; distribution of a handbook with instructions for flooded residents and volunteers to prevent potential injuries and infectious disease outbreaks; immunization campaigns, primarily against tetanus and HAV. Health surveillance: monitoring of ER accesses and hospitalizations, notification of communicable diseases, syndromic surveillance. Post-emergency management: VBDs monitoring and preventive treatment, waste management, bathing water surveillance.

Results
A rapid need assessment was critical for the coordinated effort with other intervention forces, like the Civil Protection. A prompt risk communication ensured simple and clear information, mitigating the risks of exposure to floodwater. More than 10.000 vaccine doses were administered. The syndromic surveillance proved valuable in monitoring post-flood health trends.

Lessons
Several measures were implemented thanks to healthcare workers and volunteers. Nonetheless, a better and faster reaction is possible if disaster management protocols are already available. This experience must increase future preparedness of PH services.

Key messages
• Public health intervention is crucial in all phases of an emergency, to take care of the affected population and to prevent further health issues.
• The public health response needs to be well-timed, long-lasting, and supported by a clear and well-defined risk communication to population and health workforce alike.
Cross-sectoral interventions to promote health-supportive urban environments
Authors: Longo G , Angelini P , Chiaranda G , Comini S , Dorato E , Ganapini M S , Monti M , Nerozzi B , Soracase M , Venturelli F 
Published: October 2024

Abstract

Background
As dealing with the complexity of urban living conditions becomes more and more evident and urgent, it is fundamental to promote cross-sectoral interventions that allow cities to become more inclusive and supportive of health. The Emilia-Romagna region, Italy, has promoted a participatory initiative to structurally integrate health into urban planning tools, identifying a framework of tailored urban indicators linked to locally perceived population health issues.

Methods
Through internal discussion and systematic literature research, a set of urban planners, epidemiologists, and public health experts from regional offices, local health services, universities, and environmental protection agencies identified the urban and health dimensions most suitable for embedding population health into city planning. The result was summarised in a preliminary working paper, which included a matrix of associations between urban features and health dimensions framed according to the DPSEEA framework. Its applicability was then tested in a participatory process (March-May 2024) involving urban planners and public health departments of 7 different sized municipalities.

Results
A group of epidemiologists identified local-level computable indicators for the health dimensions already included in the matrix or added at request. Each municipality focused on specific topics based on local priorities: 3 groups assessing their already-approved urban plans and looking for computable urban indicators; the others integrating their under-construction plans with local health indicators.

Conclusions
The need for professional contamination and cross-sectoral interventions is significant. Epidemiological support is pivotal in integrating different professional languages and reading health data. The outputs of this experience will contribute to a technical document outlining how to incorporate health promotion into urban planning tools and practice while actively considering the local context.

Key messages
• Although the development of a common vocabulary can be difficult, multidisciplinary collaboration is essential in promoting a model for integrating health promotion into urban planning.
• Local municipalities’ involvement in the experimentation can improve the model’s applicability by taking into account territorial specificities.
Eco-friendly treatment: a win-win for patients, health systems, and the planet. Rapid scoping review
Authors: Piso B , Kien C , Klerings I , Grandt L , Daxenbichler J , Harlfinger J , Toromanova A , Sommer I 
Published: October 2024

Abstract

Background
As the fifth-largest CO2 emitter globally, the healthcare industry must act to mitigate its environmental impact. This includes de-implementing low-value care and adopting eco-friendly innovative treatment alternatives. Our study aims to explore existing research on the environmental effects of these actions and the outcome measures utilized.

Methods
We conducted a rapid scoping review following a pre-published protocol, searching Ovid MEDLINE® and Scopus (Elsevier) from January 2015 to June 19, 2023. Initially, dual abstract and full-text screening was performed, followed by a single review. Data extraction was cross-checked by a second reviewer. Findings were narratively described using summary statistics.

Results
We analyzed 182 articles, primarily life cycle assessments and modeling studies (92 out of 182), with only one study being a randomized controlled trial. The research covered various healthcare practices, including consultation methods/telemedicine (32%), surgical and medical device usage (26%), medication (25%), surgical procedures (19%), as well as diagnostic tests, screening, and imaging (13%). The main sustainability strategies mentioned were ‘Rethink’ (99%) and ‘Reduce’ (81%), with ‘Reuse’ (32%), ‘Recycle’ (19%), and ‘Refuse’ (10%) being less utilized. Environmental outcomes reported included global warming (88%), resource consumption (27%), and chemical hazards (23%). Most studies were conducted in Europe (48%), followed by the USA (37%), with 75% published after 2020.

Conclusions
The environmental impact of healthcare is a pivotal area for public health action and fortunately, it is also emerging as a significant research field. Utilizing methodological approaches less common in evidence-based healthcare research underscores the necessity for innovative interdisciplinary collaboration and capacity building. The most pressing research gap lies in the impact of de-implementation strategies (“refuse”) targeting low-value care practices.

Key messages
• Measuring the environmental impact of healthcare demands the development of novel cross-disciplinary research methods and collaborations.
• De-implementing low-value care represents a future win-win scenario for patients, the financial viability of healthcare systems, and global environmental sustainability.
Long-term exposure to PM2.5 and mortality among Japanese community-dwelling adults
Authors: Michikawa T , Nishiwaki Y , Nitta H ,   IPHS Ibaraki Prefectural Environmental Health Study Group
Published: October 2024

Abstract

Background
Long-term exposure to PM2.5 (particulate matter with a diameter of 2.5 μm or smaller) is a risk factor for mortality and cardiovascular disease including stroke. However, there was limited evidence for the association between PM2.5 exposure and stroke in Asia where the major cardiovascular disease is stroke. Additionally, the causal association between PM2.5 and respiratory disease is still unresolved. The aim of this study was to investigate the association between long-term exposure to PM2.5 and all-cause, cardiovascular, and respiratory disease mortality in a Japanese community-based prospective cohort.

Methods
This study included 46,974 participants (19,707 men; 27,267 women) from the second cohort of the Ibaraki Prefectural Health Study. The participants were followed up from baseline survey (in 2009) to 31 December 2019. We confirmed underlying causes by death certificates. Using the PM2.5 concentrations estimated by the inverse distance weighting methods based on ambient air monitoring data, administrative area level concentrations were assigned to each participant. The hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality using a Cox proportional hazard model were presented.

Results
We identified 2,789 all-cause deaths during the 470,178 person-years of follow-up. PM2.5 exposure had no significant association with all-cause and cause-specific mortality. The multivariable-adjusted HRs per 1 μg/m3 increase in the PM2.5 concentration were 0.94 (95% CI = 0.80-1.12) for coronary heart disease, 0.92 (95% CI = 0.81-1.04) for stroke and 1.09 (95% CI = 0.97-1.23) for non-malignant respiratory disease.

Conclusions
We observed little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5 whose concentrations ranged from 8.3 to 13.1 μg/m3. A somewhat increased trend for non-malignant respiratory disease mortality may not be negligible.

Key messages
• We found little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5.
• Somewhat increased tendency for non-malignant respiratory disease mortality associated with PM2.5 exposure was observed.