bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastrointestinal infections and ethnicity in the UK: a systematic review and narrative synthesis
Authors: Zahair I , Rose T , Clayton S , Oyebode O , Maden M , Ghosh I , Barr B 
Published: October 2024

Abstract

Background
Gastrointestinal (GI) infections exert a significant public health burden on healthcare services in the United Kingdom (UK). The literature suggests an association between ethnicity and health; however, we do not know the extent of inequalities in GI infection/disease in the UK. This systematic review aimed to identify studies that ascertain differences in the incidence or prevalence of GI infections between UK ethnic groups and explore possible explanations for heterogeneity observed within the literature.

Methods
MEDLINE, CINAHL Plus, Web of Science (Science Social Science Citation Index), and grey literature were searched from 1980 to 21st June 2023 for studies reporting an association between ethnicity and GI infections in UK population samples. Two reviewers independently screened the studies and conducted quality appraisals; data extraction was undertaken by one reviewer and verified by another reviewer. A narrative synthesis was undertaken and a harvest plot supported the textual synthesis to investigate potential sources of heterogeneity in effect estimates by GI pathogen and ethnic group.

Results
The searches identified 10028 studies, of which 16 met the inclusion criteria. 15 out of 47 effect estimates from a total of 16 studies found that GI infection risk was greater in Black and Ethnic Minority Groups, mainly of Asian ethnicity, compared to the majority White population. 13 studies reported a higher risk in ethnic minorities of Asian ethnicity, while one study described a higher risk in the Non-White ethnic group. One single study on STEC reported a higher risk of GI infection in the White population compared to the Non-White population, while another single study on norovirus found no significant difference by ethnic group.

Conclusions
This systematic review demonstrates that ethnic minority groups in the UK have a higher risk of GI infections than the general or White population.

Key messages
• There is a clear need to elucidate further the high incidence of GI infections in UK Indian, Pakistani, and Bangladeshi communities.
• Tackling ethnic inequalities requires a concerted approach and translating evidence into policy.
The shift from inpatient to outpatient settings of a surgical DRG for pediatric patients in Portugal
Authors: Grad D A , Souza J , Lopes F , Pinheiro V , Freitas A , Santos J V 
Published: October 2024

Abstract

Background
The shift of selected surgical procedures from inpatient to outpatient settings has been seen as a solution to improve health care provision. These shifts often occur under pay-for-performance schemes, pay-for-efficiency schemes, or other forms of financial incentives. For this study, we aimed to assess the effect of Decree 132/2009, implemented on February 1, 2009, which increased the relative weights of DRG 60 (“tonsillectomy and/or adenoidectomy, age &lt;18”) performed in outpatient settings, thus acting as a financial incentive.

Methods
We performed a quasi-experimental study and employed interrupted time series (ITS) and controlled interrupted time series (CITS) designs, using monthly pediatric data provided by The Central Administration of the Health System (ACSS), with discharges between January 2006 and February 2012 (having 37 months pre- and post-decree implementation) of inpatient and outpatient episodes for DRG 60 (affected group) and DRG 163 (“hernia procedures age &lt;18”, the selected control group). We used as study outcomes proportions (number of outpatient episodes divided by the sum of outpatient and inpatient episodes) to quantify increases in outpatient episodes and ratios (number of outpatient episodes divided by the number of inpatient episodes) to quantify decreases in inpatient episodes. Fourier terms were included to adjust for seasonality.

Results
We obtained statistically significant results only at the trend level for ratios when using the ITS model (0.01574) and for proportions only when using the CITS model (0.00310), although small non-statistically significant increases were obtained for the employed ITS as well as for the CITS design.

Conclusions
Decree 132/2009, which created financial incentives for the shift from inpatient to outpatient for DRG 60, showed low and non-statistically significant increases using both ITS and CITS models.

Key messages
• We analyzed the impact of Decree 132/2009 on the pediatric surgeries under DRG 60 performed in outpatient settings in Portugal using interrupted time series and control interrupted time series.
• The decree had a small effect at the national level for DRG 60.
Gendered trends in unpaid labour by educational level in Sweden 2004-2022
Authors: Molarius A , Granström F , Ervin J 
Published: October 2024

Abstract

Background
Unpaid labour has recently been recognised as an important yet neglected social determinant of health. Our aim was to investigate the gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30-49 years) from 2004-2022.

Methods
The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30-49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals.

Results
Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. For example, in 2022, 31% of women spent more than 20 hours per week in domestic work compared to 20% of men. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did.

Conclusions
As gender differences in unpaid labour/domestic work persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities.

Key messages
• Amongst Swedish adults aged 30-49 years, the gender gap in unpaid labour has declined during the last two decades, but this is only due to women reducing their domestic work time.
• For men, prevalence of high domestic work time was consistently greater among those with higher educational levels, whereas no difference was observed among women.
The impact of garbage codes on the quality of death coding in Belgrade in 2010, 2015, and 2020
Authors: Šantrić Milićević M , Rosić N , Stamenković Ž , Todorović J , Branković B , Stevanović A , Tamburkovski G , Miltenović S , Janković-Mladenović S , Wengler A 
Published: October 2024

Abstract

Background
Accurate data on the causes of death (CoDs) is the foundation for analyzing the health situation and developing health policy in various countries. The percentage of garbage codes (GCs) indicates the quality of the CoDs data. Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Improved Surveillance), we evaluated the impact of the four levels of GCs on the quality of mortality data of Belgrade.

Methods
In a retrospective study, we examined the underlying CoDs of Belgrade residents by age and sex and the change in GCs’ share in the CoDs in 2010, 2015, and 2020. We used anonymous individual mortality data and population age and sex annual data from the electronic databases of the City Institute of Public Health of Belgrade, as well as the list of GS levels 1-4 from the 2019 Global Burden of Disease Study.

Results
Over the observed years, the percentage of all GCs in underlying CoDs was approximately 20%. The GCs with profound policy implications level 1 accounted for 52% of all GCs in 2020, higher than those recorded in previous years - 46.3% in 2010 and 45.1% in 2015. The total number of GCs per 100,000 inhabitants in Belgrade was the highest in 2020, with a rate of 325.2/100,000 (males: 374.4, females: 301.3). This rate has increased by about one-third since 2010 (both sexes: 245.4, males: 269.2, females: 221.1) and by about two-fifths since 2015 (both sexes: 235.8, males: 262.7, females: 211.8).

Conclusions
This research has revealed a significant decline in the quality of data related to the causes of death in Belgrade. One-fifth of the recorded causes of death are inaccurate or unreliable. The study highlights the importance of maintaining strict protocols for data collection, analysis, and management to ensure the accuracy and reliability of CoDs data in developing effective public health policies.

Key messages
• The rate of total garbage codes per 100,000 inhabitants of Belgrade has increased by about two-fifths since 2015.
• Failure in quality, accuracy, and reliability of causes of death can lead to suboptimal health policymaking.
The burden of sepsis in Italy: an analysis of treatable mortality trends
Authors: Guarducci G , Golinelli D , Sanna A , Fabbri G , Nante N 
Published: October 2024

Abstract

Background
The burden of sepsis, a life-threatening condition triggered by the body’s extreme response to infection, remains a critical global healthcare concern. Sepsis-related deaths often result from delayed recognition, insufficient treatment, or gaps in healthcare delivery. The study aims to analyze treatable mortality for sepsis in Italy and its regions.

Methods
A retrospective study was conducted on data of treatable mortality for sepsis in Italy and its regions. According to joint OECD/Eurostat list, we included sepsis deaths with the ICD-10 codes A40 (excl. A40.3 [sepsis due to Streptococcus pneumoniae]) and A41 (excl. A41.3 [sepsis due to Hemophilus influenzae]) from 2006 to 2019. Through data on the resident population two-year age-standardized rates by region were calculated.

Results
From 2006/7 to 2018/9 an overall increase was observed in Italy, from 1.6 to 2.2 age-standardized mortality rates with a maximum peak in 2014/5 (+46.7%). This trend was confirmed for Lombardy (+47.8%), Veneto (+48.8%), Emilia-Romagna (+49.3%), Tuscany (52.0%), Marche (+58.4%%), Abruzzo (39.4%), Molise (26.7%), Apulia (+57.0%), Sicily (+57.2%), and Sardinia (+46.8%). Aosta Valley (+72,5%) had a maximum peak in 2010/1, while Piedmont (+42.5%), Autonomous Province (A.P.) of Bolzano (+27.8%), A.P. of Trento (+45.0%), Friuli-Venezia Giulia (+23.3%) in 2012/3, Calabria (+46.4%) in 2016/7 and lastly Campania (+52.9%) and Basilicata (+73.0%) in 2018/9. Liguria (+49.8%), Latium (47.2%) and Umbria (49.3%) showed two maximum values, one in the 2012/3 and the other in the 2014/5.

Conclusions
We observed an overall increase in age-standardized mortality rates throughout Italy, with a peak in 2014/5. This trend was resumed in ten regions, while three regions showed multiple peaks, indicating fluctuations in mortality rates. These findings underline the importance of targeted health interventions and policy initiatives to address region-specific health challenges.

Key messages
• Regional disparities in mortality rates highlight the necessity for customized health interventions and policy measures between Italian regions.
• Recognizing fluctuating mortality trends in specific regions is crucial to effectively address various health challenges.
Fast lane for decision making: The PHIRI Rapid Exchange Forum
Authors: Habl C , Weiss J 
Published: October 2024

Abstract

Issue & Problem
The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice.

Lessons
Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute G&Ouml;G had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum).

Key messages
• The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges.
• Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.
Development of health care expenditures in Finland up to 2040
Authors: Reinikainen J , Pihlava M , Härkänen T , Honkatukia J 
Published: October 2024

Abstract

Background
Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments.

Methods
We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures.

Results
The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively.

Conclusions
Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system.

Key messages
• Notable increases are expected in health care expenditures up to 2040.
• Impacts of demographic changes varies markedly between health care sectors.
Viral pathogen surveillance in wastewater using metagenomic approaches: obstacles and prospects
Authors: Seabra S G , Santos A F , Nunes M , Manjate F , Silva A , Crespo T , Pimentel V , Libin P , Abecasis A B , Parreira R 
Published: October 2024

Abstract

Background
Wastewater monitoring offers an important tool for pathogen detection and tracking within large populations at a minimized cost and labor. Untargeted metagenomic approaches for the detection and sequencing of viruses still face limitations. In this study we tested the application of the sequence-independent single-primer amplification (SISPA) protocol in conjunction with nanopore sequencing to the study of viromes in wastewater samples.

Methods
Influent wastewater was collected from four Wastewater Treatment Plants located in the Lisbon region and Alentejo, Portugal in 2019 and 2023. Samples were processed with different methods including filtration, flocculation, Nanotraps or absorvent tampons. We applied the SISPA protocol, that includes a random amplification step, followed by nanopore sequencing on flow cells R9.4.1. We used the CZ ID (https://czid.org) pipeline for metagenomic analysis and taxonomic reporting.

Results
A large heterogeneity was found between samples in sequencing output (ranging from 17 thousand to 12 million reads) and the proportion of sequence reads classified as viral (ranging from 0.06% to 4% per sample). Viral taxa with higher number of reads were Picornavirales, dsDNA and ssDNA phages, Mimiviridae and Circoviridae. Known viral pathogens included Rotavirus A, Orthopoxvirus, Human betaherpesvirus and Avian orthoavulavirus.

Conclusions
Metagenomic studies of environmental samples generally exhibit a low proportion of viral reads, even after viral enrichment. A substantial sequencing effort is thus required to achieve a comprehensive virome characterization. As alternative, a more targeted approach, e.g. to target families of viruses of interest, may be considered. Funding: Fundação para a Ciência e Tecnologia (FCT): GHTM - UID/04413/2020; LA-REAL - LA/P/0117/2020; https://doi.org/10.54499/CEECINST/00102/2018/CP1567/CT0040 to SGS. Research council of the Vrije Universiteit Brussel (OZR-VUB): OZR3863BOF to PL.

Key messages
• Enrichment for viruses in metagenomic approaches remain challenging in very complex samples as are influent wastewaters.
• Virome characterization still necessitates high sequencing efforts but may be used as a complementary environmental survey tool integrated with more targeted approaches.
Emergency department frequent users in the paediatric population: a retrospective analysis in Rome
Authors: Vinci A , Barbara A , Chierchini P , Maurici M , Damiani G , De Vito C 
Published: October 2024

Abstract

Background
Recent studies have reported the increasing utilisation of the Emergency Departments (EDs) for non-urgent attendances by people aged &lt;18 years. The aim of this study is to describe the characteristic of the paediatric frequent user (FU) population, highlighting the differences between FUs and non-FUs, and to identify factors linked to appropriate ED attendance, comparing the level of variability attributed to the geographical and family physician components.

Methods
A retrospective cohort study was carried out of the ED attendances in 2022 in the 8 EDs of the Local Health Authority Roma 1 geographical area, in Rome. The cohort was enrolled from the regional Healthcare Emergency Information System. Records included information on number of attendance, age and gender, usage of emergency medical service (EMS), triage code, appropriateness of attendance. Multivariable nested logistic regression was performed to identify the characteristics of FU and non-FU attendances and the predictors for appropriateness of attendances.

Results
In 2022, the total number of children with at least 1 ED attendance is 24.824 and a total of 35.691 attendances were recorded. The regression analysis highlights that the appropriateness of attendances is associated to the female gender (OR male: 0.84), age &lt;1 year (OR: 2.06), the usage of EMS (OR: 2.00), high triage code and being a FU (OR FU: 1.53). The family physician group have a greater influence of District group but lower influence of single patient characteristics group to determine the appropriateness of paediatric ED attendances (MOR District: 1.73; MOR PCP: 1.84; MOR single patient characteristics: 2.75).

Conclusions
Frequent use of the ED is partially associated with an inappropriate use of EDs, mostly due to the specific patients’ characteristics. It is therefore necessary to adopt strategies to improve the appropriate use of health service resources in order to provide quality health solutions to real health needs.

Key messages
• This is the first study that defines an ED paediatric FU profile in Italy.
• It compares the level of variability attributed to the geographical component and family physician components.
Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy
Authors: Van Der Zanden B , Nemer L 
Published: October 2024

Abstract

Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity.

Key messages
• The EPHF framework as an innovative tool to strengthen public health in border regions.
• Take the geographical living space of citizens in a border region into account to achieve health equity.