bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Implications of NT-proBNP trajectory following Sacubitril/Valsartan initiation
Authors: Takigami Y , Ishii S , Iida Y , Ikeda Y , Nabeta T , Ako J , Nasu T , Kanaoka K , Kagiyama N , Kida K , Fujimoto W , Kikuchi A , Ijichi T , Shibata T , Matsumoto S 
Published: October 2024

Abstract

Introduction
Serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) values after initiating Sacubitril/Valsartan is considered as a favorable prognostic factor, and widely used for risk stratification in patients with heart failure (HF). However, the relationship between the trajectory of serially measured NT-proBNP values and cardiovascular events in patients with HF who are treated with Sacubitril/Valsartan remains uncertain.

Purpose
This study aimed to reveal the prognostic association of an NT-proBNP trajectory after initiating Sacubitril/Valsartan and subsequent cardiovascular outcomes.

Methods and Results
A Japanese nationwide multicenter study was conducted on HF patients who initiated Sacubitril/Valsartan. Out of the 995 patients enrolled, we excluded 561 patients who were undergoing assessment of BNP or who lacked a complete set of NT-proBNP measurement. Finally, 434 patients included this study, and were divided into three groups based on NT-proBNP trajectory as follows; the ‘sustained-responder’ group (n = 129, 30%) : which exhibited a reduction of NT-proBNP by ≥10% at 1 month and further reduction of ≥10% at 3 months; and the ‘transient-responder’ group (n = 161, 37%), with ≥10% reduction at 1 month but not at 3 months; and the ‘non-responder’ group (n = 144, 33%), which did not achieve ≥10% reduction at 1 month. The mean age was 68 years, with females comprising 29%. In the ‘sustained-responder’ group, the age was significantly younger, and the duration of heart failure was significantly shorter. There were no significant differences in the mean systolic blood pressure, mean Sacubitril/Valsartan dose at each measurement points among the 3 groups. During follow-up of 456 (IQR, 371-549) days, the primary endpoint, which was either cardiovascular death or hospitalization of HF occurred in 78 of 434 patients (18%). The Kaplan-Meier analysis showed that the ‘sustained responder’ group experienced significantly lower event rate among the 3 groups (Log-rank p&lt;.001). Additionally, an analysis that set a landmark time at 3 months post-initiation of Sacubitril/Valsartan showed that the ‘sustained-responder’ group experienced significantly fewer events than the ‘transient-responder’ group (Log-rank p=0.039) (Figure.1). Also, the ‘sustained responder’ was observed to have a better prognosis in a subgroup with LVEF&lt;50%, but not in patients with LVEF ≥50%. (p value for interaction=0.035) (Figure.2).

Conclusions
This study revealed that sustained reduction of NT-proBNP was associated with a reduced risk of cardiovascular death or hospitalization for HF. The periodic NT-proBNP monitoring and the patterns of NT-proBNP during treatment with Sacubitril/Valsartan may be helpful in optimizing HF therapy and understanding the prognosis of HF.Figure.1Figure.2
Health burden and costs attributed to the carbon footprint of health systems in the European Union
Authors: Chen-Xu J , Corda M O , Varga O , Viegas S 
Published: October 2024

Abstract

Background
Health systems have an environmental impact of around 4.6% of global emissions, contributing to aggravating the climate crisis. However, the health impact of the carbon emissions originated by health systems is not regularly assessed. We aim to estimate the health burden and associated costs of the carbon footprint of health systems across the European Union (EU).

Methods
We calculated DALYs and associated costs based on human health damage factors (DALYs/kg-CO2e) by considering four scenarios. Three scenarios for shared socioeconomic pathways (S1 - high growth, S2 - baseline, and S3 - low growth) represented variations of global society, demographics, and economics until 2100. A fourth scenario (S4) considered the current EU’s 55% reduction goal of greenhouse gas emissions. The healthcare sector’s emissions per capita (in CO2-equivalent) in 2019 were extracted from the Lancet Countdown, and population data were retrieved from Eurostat for the same year.

Results
In the EU, 365,047 DALYs (95%CI: 194,692-535,403) are expected to be caused by health systems’ emissions at baseline (S2). In an S1 scenario, the burden would slightly decrease to 315,374 DALYs (95%CI: 170,355-462,393), whereas a S3 scenario would increase 486,730 DALYs (95%CI: 243,365-681,422). If EU’s carbon goals are met, the burden could be substantially reduced to 164,271 DALYs (95%CI: 87,611-240,931). The monetisation of DALYs can result in costs amounting to 25.6 billion euros.

Conclusions
CO2 emissions from health systems are expected to significantly impact human health. It is therefore of the utmost importance to ensure that EU climate policies for healthcare buildings are in line with the Paris Agreement. This will require the implementation of climate mitigation programmes within the health sector and a review of clinical practices at the local level.

Key messages
• The carbon footprint of health systems is estimated to significantly impact health, with high economic burden.
• EU climate policies for healthcare buildings and procurement must be aligned with the Paris Agreement.
The NHS London Legacy and Health Equity Partnership: Evaluation of an equity lens framework
Authors: Zuriaga-Alvaro A , Inskip J , Johnson E , Kamau L , Wilson J , Weil L G 
Published: October 2024

Abstract

Background
Disparities in COVID-19 vaccination uptake emphasised stark inequalities linked to ethnicity and deprivation, highlighting lack of trust and access barriers. London health leaders committed to create a community-centred legacy through the development of the NHS Legacy and Health Equity Partnership (LHEP); A novel 2-year programme aiming to close the equity gap in vaccinations, screening and access to health, focused on underserved communities, delivered in collaboration with London partners and communities. LHEP focused on 12 unique programmes with a key role of system leadership. Outputs included 15 reports, 6 conference presentations, 7 academic publications, 6 community workshops and 5 toolkits including development of an overarching LHEP framework aiming for long-term legacy.

Methods
An evaluation was designed to assess the benefits and limitations of the programme and framework through 16 semi-structured interviews and 5 focus groups delivered with key stakeholders. Ethical approval was obtained from the UKHSA Research Ethics Group. Data was coded inductively and drawn into themes.

Results
LHEP was said to add value through a) a dedicated team championing health equity and visible focus of leadership within the equity space b) fostering community engagement enabling dialogue between health systems and communities c) advocating co-production, building trust, focusing on communities in vulnerable circumstances d) programme innovation and agility d) drawing from COVID-19 lessons and disseminating learning. Interviewees stressed a legacy beyond vaccinations, establishing London as a blueprint for others.

Conclusions
Lessons were drawn into the ‘LHEP Approach for Health Equity’, a concise framework to guide partners to embed health equity, gathering 4 key tenets to ensure ‘no community is left behind’; data, evidence and learning; commitment from leaders and strong partnerships, allow for innovation and consider sustainability and communities at the centre.

Key messages
• Legacy and Health Equity Partnership is a 2-year multistakeholder programme aiming to tackle inequalities for the diverse communities of London that built evidence and led system change.
• Evaluation stressed the impact of establishing London as a blueprint to follow and a framework to guide and support partners striving for health equity.
Novel approach to combining interview and register data – Case: social security and pediatric cancer
Authors: Näsi E , Teittinen A , Perkiö M , Kokkinen L 
Published: October 2024

Abstract

A parallel examination of interview data and register data provides a more holistic overall picture of social security needs and use than any one type of data alone. In our study, we aimed to build a comprehensive understanding of the benefit and service needs of parents whose child is diagnosed with cancer. Conducting solely interviews would have provided subjective perceptions of individuals in the midst of a challenging life situation, but the data would have lacked information of the participants’ documented use of social security benefits and services. On the other hand, utilizing solely register data, would have provided an objective overview of actual service use. However, register data alone would not have shed light on whether the benefits and services received were sufficient from the recipients’ point of view. In our study, parents’ interviews and their register data from the Social Insurance Institution of Finland (Kela) offered complementary perspectives on the same life situation. Parents’ interviews provided information on support needs, service experiences as well as service deficits. The same families’ register data was used with their permission producing exact data on the insurance benefits and services that the family had applied for and received. The interviews were analysed as chronologically progressing narratives while the data received from Kela was depicted on timelines. When conjoined, the interview and register data formed a comprehensive picture of the benefit and service needs and use of families, whose child had cancer. In addition, this kind of triangulation revealed service deficits that were acknowledged by the interviewees and identified also through the register data. We argue, that combining subjective interviews together with institutional register data allow researchers to identify issues in the service system, which require improvements from the recipients’ and the system’s perspective.

Key messages
• The use of multiple types of data allows researchers to construct a holistic understanding of individuals’ social security needs and use.
• Combining interview and register data allows researchers to identify issues in the service system, which require improvements.
Sick-leave trajectories among people sickness absent with stress-related diagnoses; cohort studies
Authors: Gemes K , Petterson E , Farrants K , Friberg E , Nilsson K , Sjölund Andoff S , Alexanderson K 
Published: October 2024

Abstract

Background
Stress-related disorders are common sickness absence (SA) diagnoses in many Western countries. Knowledge of SA and disability pension (DP) patterns among people with such SA is needed. Thus, the aim was to identify future SADP trajectories among people with a new SA spell due to stress-related diagnosis and to examine sociodemographic and health-related factors associated with identified trajectories.

Methods
Using microdata from nationwide registers, we included all people living in Sweden with a new SA spell &gt;14 days due to stress-related diagnoses (ICD-10 code F43) in 2011 (N = 32,417) or 2018 (N = 65,511), respectively. These two cohorts were followed prospectively for 13 months from the SA spell start, to identify trajectory groups of mean SA/DP days/month using group-based trajectory modeling. We used multinomial logistic regression to explore associations between sociodemographic and health-related predictors and trajectory membership.

Results
We identified the following SA/DP trajectories in both cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011, respectively); fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). Compared to the steep drop trajectory, individuals in the other trajectories were more likely women, older, and had prior SA/DP or secondary outpatient healthcare visits. Starting the SA spell full-time was the strongest predictor for the slow decrease and constant high trajectory, and previous SA or diagnosis of other mental disorders were predictors of the constant fluctuating and constant high trajectory.

Conclusions
The similarity of the identified trajectories in the two cohorts is a strength. The results reveal the diversity of future SA/DP in this patient group, indicating the importance of identifying patients at risk of long-term SA who might need further interventions early in the process.

Key messages
• In two population-wide cohorts with a new sickness absence (SA) spell with stress-related diagnoses, six trajectories of SA/disability pension days were identified during the 13-month follow-up.
• Most of those in the cohorts had trajectories that ended with no SA/DP after 13 months, while two trajectories, including 15-19% of individuals, showed high or varying SA/DP days during the follow-up.
A Multi-Modal Approach for A Healthier Weight and More Active Lifestyle
Authors: Ochieng B 
Published: October 2024

Abstract

Background
Obesity and overweight has been increasing globally and in the UK over the last few years, bringing along a wide array of challenges in health and wellbeing. Not only do they take a heavy toll on those affected, but obesity and overweight-related ill-health is costing the UK National Health Service £6.1 with projected costs to run up to £9.7 billion in 2050. This project aimed to apply artificial intelligence to identify the predictive indicators for obesity and co-create an intervention with public health practitioners and stakeholders.

Methods
Using health and wellbeing public health population data from the 2015, 2018 and 2022 from a city in the East Midlands, we applied artificial intelligence that uses machine learning techniques to discover insights, find hidden patterns and discover relationships in the data about engaging in physical activity and a healthy diet. The data on dietary choices and physical activity preferences were further analysed using advanced machine learning techniques.

Results
The outcomes from our machine learning process revealed patterns of physical activity engagement and diet from specific locations, along with a range of demographic variables that influence individuals’ patterns of physical ability and dietary practices. These findings, which will be presented in detail, have been integrated into a comprehensive city map. This map not only showcases opportunities for engaging in a healthy lifestyle but also aids in prioritising interventions in areas of greatest need.

Conclusions
The AI technology we employed allowed us to parameterise and generalise our findings with the possibility of scaling up the machine learning approach to other similar datasets. The findings facilitated the development of bespoke training for public health officers working with underserved communities, further demonstrating the impact of applying AI to inform the design of public health interventions.

Key messages
• Applying Artificial Intelligence to public health data has the potential to inform the development of effective interventions and increase precision.
• Using AI in public health data can generate new insights into population health and well-being and inform public health policy.
Health impacts methodology in the European Commission
Authors: Van Rij V C , Schaefer A 
Published: October 2024

Abstract
The state of play in the implementation of health impacts methodology within European Commission impact assessments reveals both advancements and challenges. The Commission has acknowledged the significance of assessing health impacts and has provided a generic methodological description, as outlined in Tool #32 of the Better Regulation guidelines. However, translating this guidance into practical application encounters obstacles stemming from challenges intrinsic to the policy in question, a lack of skills and knowledge, data gaps, and complexities in establishing causal links. In EU policymaking, health impacts are consistently appraised in relevant Impact Assessments across various policy areas, but the methodological intricacy varies. In the fields of public health, occupational safety, and environmental protection, econometric modelling is often employed to quantify potential health impacts rigorously. This involves sophisticated analytical tools designed to capture the complexity of the interactions. Conversely, in areas where the link between policies and health outcomes is less direct (e.g. food safety) or where data limitations pose challenges, a more qualitative appraisal is applied. This acknowledges the limitations in precisely quantifying health impacts and focuses on providing a nuanced understanding of potential health effects based on available information.
Digital Health Interventions’ Impact on Health Literacy: A Systematic Review
Authors: Causio F A , Fakhfakh M , Kaur J , Sert B , Gandolfi S , Di Pumpo M , De Angelis L , Berionni A , Mackey T , Cascini F 
Published: October 2024

Abstract

In the digital era, health literacy is crucial for informed health decisions and outcomes. This systematic review evaluates the effectiveness of digital health interventions (DHIs) in enhancing health literacy, as defined by the World Health Organization. We included a variety of studies, such as cross-sectional studies, surveys, and case reports, focusing on interventions like mobile health apps, online platforms, and telehealth services. Our search, adhering to PRISMA guidelines, spanned databases like PubMed, IEEE, and ACM, covering publications from 2013 to 2023. From 1,029 initial articles, 58 met our inclusion criteria after rigorous screening and duplicates removal. Our findings highlight that DHIs, including multimedia tools and remote sessions, significantly bolster health literacy across diverse populations. However, the impact varies due to the digital divide, influenced by factors like age and socioeconomic status. This review underscores the potential of DHIs in public health and the necessity to address accessibility to reduce health disparities. The full synthesis of data and methodological details will be discussed in the presentation, aiming to guide future digital health strategies and policies.

Key messages
• Digital Interventions Enhance Health Literacy Across Diverse Populations.
• Addressing the Digital Divide to Ensure Equitable Access to Health Benefits.
Curricular innovations to address inequalities in global health education
Authors: Sbaiti M , Abbara A , Al-Haffar M , Budhathoki S , Wihba K , Cardoso Pinto A , Streule M 
Published: October 2024

Abstract

Background
Global Health education (GHE) has expanded dramatically, with new degrees and expanded competencies in medical curricula. Yet, Global Health (GH) is also going through significant reckoning and debate around inequalities in the field. GH degrees are predominantly based in high-income countries and inaccessible to most global majority students. Some suggest GH education itself contributes to reproducing inequalities in GH. Thus, both educators and policy-makers require evidence and tools to support more representative and authentic educational experiences which can adequately equip our future graduates.

Objectives
To present educational innovations which gesture towards responding to the stark inequalities in Global/Public Health education. These include a unique project that experiments with disrupting current power dynamics through co-design and co-delivery of a curriculum on Syrian healthcare by colleagues with lived experience, and a student-staff partnership to integrate self-reflexivity and positionality (SRP) in curricula at Imperial College London (UK).

Results
Qualitative data shows that the Syrian Curriculum has resulted in enhanced student experience, being consistently cited as a highlight of the curriculum, whilst alsoenhancing inclusivity for many students. SRP supplemented this by providing students with tools to engage in open, respectful discussions and critically reflect on personal biases that impact class dynamics.

Conclusions
These projects provide tools for educators and policy-makers across European universities to address current challenges in GH education. Nonetheless, these innovations should principally be seen as tools to reflect and advocate for fundamental changes towards more representative structures in GH.

Key messages
• Curriculum innovations offer key tools to address inequalities in GHE, enhancing student experience/inclusivity.
• Yet, these remain limited without fundamental change towards a more representative sector.
Lesson learned from a co-designed vaccination initiative with undocumented people in the Netherlands
Authors: De Vos Klootwijk L , Kersten C A 
Published: October 2024

Abstract

Issue/ problem
‘The coronavirus does not take document status into account’. The COVID-19 pandemic highlighted the importance of equal healthcare access for all. Yet, undocumented people face numerous personal and practical barriers in accessing health. Ensuring the protection of the most vulnerable is a global concern.

Description of the problem
In 2021, a regional initiative aimed to remove barriers and create a trusted environment for undocumented people to receive vaccinations. This collaborative effort included public health departments, NGO’s, community groups, (self) organized migrant organizations, GP’s and embassies. Regular meetings identified the population’s needs. A medical doctor was made available 24/7 to address questions and concerns. Actions were undertaken to build trust, foster collaborations between health authorities and communities and to improve vaccine service access and design.

Results
Working in partnership fostered trusted, multi-sectorial relationships, resulting in a vaccination initiative that met the diverse needs of the undocumented people. Widespread community-driven outreach through flyers and social media reached those who normally are not reached. Supported by over 40 volunteers, three vaccination events were organized in which 693 doses were administered. All parties made their contribution, e.g. with different migrant communities providing hot meals. The initiative began at the grassroots level in the communities and was then executed in partnership with the involved parties, making it highly successful.

Lessons
Inclusive engagement, addressing concerns and sharing clear information not only supports trusted relationships but also strengthens social cohesion. Collaborating directly with the communities ensured the initiative was tailored to their needs, thereby lowering the barriers for accessing healthcare. Achieving this success required a foundation of trust, mutual respect and a collective commitment from all involved.

Key messages
• Codesigning vaccination initiatives with the communities is essential for success.
• Trusted partnerships, community involvement and mutual commitment were key elements for lowering barriers to accessing health.