bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of adults with fatigue in Germany: results of the ‘German Health Update 2023’ study
Authors: Ordonez Cruickshank A , Poethko-Müller C , Schaffrath Rosario A , Sarganas G , Scheidt-Nave C , Schlack R 
Published: October 2024

Abstract

Background
Fatigue is a non-specific symptom complex associated with exhaustion, lack of motivation and concentration. It has high public health relevance due to impairments in quality of life and work ability and increased risk of accidents. Fatigue has increasingly gained attention as one of the most common post-acute consequences of SARS-CoV-2 infection. Fatigue is also common among non-infected people and there is a lack of population-based background data. Therefore, we investigated the prevalence and factors associated with fatigue in a population-based epidemiological study in Germany.

Methods
The analyses are part of the national population-based cross-sectional telephone survey ‘German Health Update’ (GEDA 2023) in adults (3/2023-2/2024). Fatigue was surveyed using the Fatigue Assessment Scale (FAS) and dichotomized into yes (at least mild/moderate) versus no fatigue. The FAS is an instrument for mild-to-moderate fatigue, which must be distinguished from chronic fatigue syndrome (CFS). Weighted analyses of the data from 9,766 adults were carried out descriptively and in multivariable Poisson models, considering sociodemographic and health-related determinants.

Results
The prevalence of fatigue in Germany was estimated to be 29.7% (95% CI 28.1-31.2) and was highest in 18- to 29-year-olds at 39.6% (35.0-44.4). The prevalence decreased up to 65- to 79- year-olds (20.6% (18.2-23.3)) and was again higher in people aged 80 and over (33.2% (28.9-37.7)). Women had a higher risk of fatigue than men (aRR 1.19 (1.08-1.32)). Lower education (aRR 1.29 (1.13-1.49)) and medium education (aRR 1.13 (1.01-1.27)) were associated with increased risk of fatigue. There were significant associations between fatigue and chronic illness, depressive symptoms and long COVID.

Conclusions
Fatigue is a common symptom among adults in Germany. Female gender, young and very old adulthood as well as lower education are associated with higher risk of fatigue.

Key messages
• The correlations between fatigue and socio-demographic variables as well as parameters of physical and mental health provide important indications of groups particularly affected by fatigue.
• The fatigue survey in GEDA 2023 is one of the few current European studies that describe the frequency of fatigue in the general population and analyzes health and sociodemographic determinants.
Wastewater-Based Epidemiology of Influenza Viruses: a systematic review
Authors: Viviani L , Pellegrinelli L , Vecchio R , Sandri L , Binda S , Pariani E , Odone A 
Published: October 2024

Abstract

Background
Influenza viruses (IVs) are responsible for annual epidemic outbreaks during the winter months. Beyond conventional surveillance systems, the circulation of these pathogens can be monitored using Wastewater-Based Epidemiology (WBE), an epidemiological tool that describes the health status of an entire community by analyzing the presence of pathogens within wastewater. Systematically reviewing existing experiences in this emerging field is crucial to highlight the best practices to establish a WBE surveillance system providing useful information for public health actions.

Methods
The study protocol for this systematic review has been registered on the PROSPERO website (registration ID: CRD42024532435). Three academic databases (PubMed, Web of Science and Scopus) were accessed to collect studies examining the presence of IVs in wastewater. Studies included were those reporting quantitative measures of viral concentration or detailing molecular/phylogenetic characterization of IVs in wastewater.

Results
Databases were searched on July 8th, 2024. After de-duplication and screening of the 400 remaining records, 42 were included in the review. IVs detection in wastewater was reported in all papers except from one, although with high variability in terms of positivity titers and concentration levels. More than half of the collected papers (52.4%) evaluated association between environmental viral concentration and clinical data, generally showing concordance between the two aspects. Moreover, 28.6% of papers described subtyping of IVs in wastewater through different methods (specific PCR assays being the most used).

Conclusions
WBE is a promising approach for surveilling viral circulation, and IVs represent a high value target for implementing this innovative system. Systematically reviewing previous experiences can be useful to obtain information for the establishment of a novel environmental surveillance system of Influenza Viruses

Key messages
• Nucleic acids belonging to Influenza Virus are detectable in wastewater, even though we report high levels of variability in sampling techniques, laboratory methods and data management systems.
• Association between environmental data and number of clinical cases is reported to be generally strong in collected papers; subtyping of IVs present in wastewater is also feasible.
A methodology to map chains of general practices in the Netherlands
Authors: Jansen L , Timans R , Batenburg R , van Tuyl L 
Published: October 2024

Abstract

Background
Commercial entities are increasingly interested in acquiring Dutch general practices (GPs). They see profitable opportunities in upscaling by forming chains. Chain organizations integrate business processes of GPs within one organizational unit. The governance structure of these chains can be complex, leading to opacity and difficulties to see conflicts of interest and market power. To investigate how this development may have an impact on quality and accessibility of care, it is first needed to establish the ways in which these chains are formed. By mapping the chain structure in a data-driven way, impact monitoring becomes possible. For the Netherlands we investigated how chain structures of GPs can be empirically identified.

Methods
Background data of approximately 4,800 Dutch GPs from the Nivel Healthcare Professional Registries was linked with data from the Chamber of Commerce’s Trade Register. This enabled the determination of the legal form, business location, ownership, and director identification for all GPs. By this data-driven manner, the variation in organizational structures of all Dutch GPs was mapped and analyzed.

Results
Four different chain variants of Dutch GP chains were identified based on three types of relations between the chain organization and their GPs: ownership, location and the composition of the board of directors. Based on ownership, two ‘top-down’ chain variants were identified. Two ‘bottom-up’ chain variants were found based on location and board composition: (1) a chain organization acquires a seat on the board of the GP, and (2) the GP and the chain organization share the same business address. Combining these variants provides a new typology of GP chains in the Netherlands.

Conclusions
Our methodology enables to empirically map chain formation in primary care. By developing a new typology in a systematic way, a foundation is created to monitor organizational developments and their impact on quality and accessibility of care.

Key messages
• A typology of Dutch GP chains was developed based on three relations: the ownership, composition of the board and the establishment location of the chain organization and its practices.
• Our methodology was put into practice to map different chain structures of GPs in the Netherlands, but it is not limited to primary care and can also be applied in other sectors and countries.
Sociodemographic disparities in depression and anxiety symptom severity among young adults in Sweden
Authors: Granvik Saminathen M , Brolin Låftman S , Östberg V 
Published: October 2024

Abstract

Background
Young adults are disproportionately affected by mental health problems such as depression and anxiety. While previous studies have identified sociodemographic predictors using the four-item Patient Health Questionnaire (PHQ-4), differences in symptom severity remain less explored. This study aimed to evaluate the sociodemographic predictors of different levels of depression and anxiety symptoms among young adults in Sweden.

Methods
Survey data from a population-based sample of Swedish adults aged 20-21 (n = 3,226) was used. Symptom severity was categorized into three levels: normal/mild, moderate, and severe, based on established cutoff scores on the PHQ-4. Gender, parental education and birth country, and upper secondary education were assessed through linked registry information. Multinomial logistic regression was used.

Results
Females had a higher risk of moderate (RR = 1.8, 95% CI 1.5, 2.2) and severe (RR = 2.3, 95% CI 1.8, 3.1) symptoms (compared to no or mild symptoms) relative to males. Among males, the risk of moderate symptoms was higher without a secondary degree (RR = 1.9, 95% CI 1.0, 3.4) compared to an academic degree. Males with parents born abroad faced elevated risks of moderate (RR = 1.9, 95% CI 1.3, 2.9) and severe (RR = 2.2, 95% CI 1.3, 3.7) symptoms relative to males with Swedish-born parents. Among females, parental tertiary education was associated with a lower risk of moderate symptoms (RR = 0.7, 95% CI 0.5, 0.9) compared to lower education. Further, females having a vocational (RR = 1.5, 95% CI 1.1, 2.1) or no secondary degree (RR = 3.6, 95% CI 2.1, 6.1) had an increased risk of severe symptoms compared to females with an academic degree.

Conclusions
This study identified sociodemographic predictors for moderate and severe symptoms of depression and anxiety among young men and women in Sweden. Mental health promotion and prevention should specifically target young adults at elevated risk of experiencing moderate to severe symptoms.

Key messages
• Understanding sociodemographic predictors of depression and anxiety symptoms in young adulthood is essential for public health work.
• Mental health promotion and prevention needs to include appropriate interventions for young men and women from diverse socioeconomic and cultural backgrounds.
Fidelity of the Face-it health promotion intervention for women with recent gestational diabetes
Authors: Husted Jensen N , Dahl-Petersen I K , Nielsen K K , Timm A , O’Reilly S , Maindal H T 
Published: October 2024

Abstract

Introduction
According to the 2021 British Medical Research Council 2021 framework, a feasibility study aims to assess intervention-specific progression criteria. Fidelity is a critical criterion because it concerns how an intervention is implemented as intended. Fidelity conceptualisation has expanded beyond intervention adherence to encompass participant engagement, i.e., how well they receive and enact the intervention, but these latter aspects achieve little attention. We aimed to assess the fidelity of the Face-it intervention, a health promotion intervention for women with a history of gestational diabetes mellitus and their families. The intervention consisted of three home visits and health technology delivered by health visitors/coaches. Our fidelity assessment included: i) training of the health visitors/coaches ii) the delivery, iii) receipt, and iv) enactment of the intervention.

Methods
The National Institutes for Behaviour Change Consortium’s (NIHBCC) framework for fidelity was used to assess four elements of fidelity. Data were collected from 150 women using intervention checklists, health technology logs and the virtual climate care questionnaire, which measured autonomy supportiveness from the intervention.

Results
The health visitors/coaches received four training days before the implementation and 16 hours throughout the intervention delivery. 73.3% of women completed three home visits, and 91.3% of women registered as health technology users. The participants perceived the intervention to be autonomy supportive, encourage health behaviour change and provide effective possibilities for health behaviour change, even though the delivery of the health technology varied greatly.

Conclusions
The Face-it intervention was largely implemented as intended. Using the NIHBCC framework, we expanded our fidelity conceptualisation and gained important insight into the feasibility of the intervention and interplay between delivery, receipt, and enactment.
Sex differences in mortality associated with heatwaves: a systematic review and meta-analysis
Authors: Pinho-Gomes A , Mcintosh A , Woodward M 
Published: October 2024

Abstract

Introduction
The existence of sex and gender differences in the mortality associated with heatwaves remains unclear.

Methods
A systematic review and random-effects meta-analysis of population-based studies that investigated the mortality associated with heatwaves and reported results stratified by sex/gender was conducted (PROSPERO registration CRD42023430208). Bibliographic databases Medline and Embase were searched from inception to May 2024 with MESH terms for heatwaves/extreme heat and mortality. This was complemented with hand-searching of reference lists of relevant studies. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute critical appraisal tool.

Results
In total, 931 studies were identified, of which 32 studies were included in the qualitative review and 11 in the meta-analysis. Most studies (20/32) reported a higher risk of heat-related death for women than men even after adjusting for or stratifying by age. Twelve studies showed statistically significant higher risks of death for women than men and 7 studies identified an increased risk of death for women, but the wide confidence intervals precluded making definite conclusions. Two studies reported a higher risk of death for men in comparison to women but only one was statistically significant. The remaining 10 studies found comparable risks for women and men. For the 11 studies included in the meta-analysis, women had an 8% increased risk of death in comparison to men (RR 1.08, 95% CI [1.02 to 1.14]). There was significant heterogeneity (I2=69%, p = 0.001) due to the variability in the definition of exposure, population, and setting. Most studies had a low to moderate risk of bias.

Conclusions
Women appeared to have an increased risk of death associated with heatwaves in comparison to men. Further research is warranted to understand the underlying factors and ensure the health protection response considers the gendered impact of heatwaves.
Methods for projecting health workforce planning in Ireland: a collaborative approach
Authors: Myers C , Segerstrom V , McDonnell A , De Vore-Merriman A , Johnston B 
Published: October 2024

Abstract

Background
Health workforce planning (HWFP) is the process of analysing, forecasting, and planning workforce supply and demand, assessing gaps, and determining target workforce to ensure that health systems are prepared for future demand. HWFP elicits recommendations that are ideally utilised by the health system to support medical workforce over a defined time.

Methods
The objective of this project is to inform intake for medical and surgical specialties in Ireland to reach the necessary consultant workforce by 2038. A literature search was conducted to help inform the methodology for this project. The most common approach was a needs-based model, and additional reviews discussed the integration of medical engagement into the modelling approach.

Results
This project will employ a collaborative approach, combining mathematical modelling and a combination of quantitative and qualitative inputs, including the following phases: 1. The research phase will estimate baseline supply and demand data across medical and surgical specialties in Ireland using statistical models; 2. The presentation phase will include input from clinical leads to allow for more accurate assumptions in the baseline of each model; 3. Review of projections will include feedback from the clinical leads to help clarify and improve the initial model; 4. Presentation of the revised projection will include further collaboration with clinical leads to finalise the model.

Conclusions
The robust methodology for this HWFP project will ideally inform medical and surgical specialities in Ireland through 2038. Specific and extensive predictions of health workforce supply and demand will enhance strategic preparation, which is a key priority for the Health Service Executive in Ireland.

Key messages
• A collaborative approach to HWFP is essential for health service preparation and improvement.
• The project will be finalised by the end of 2024, and the methodology for conducting similar HWFP projects can be adapted by other EU states.
Training for outbreak response through the Global Outbreak Alert and Response Network
Authors: Karo B 
Published: October 2024

Abstract
The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.
Impact of loneliness and social support on leisure physical activity in adolescents in Luxembourg
Authors: Lopes Ferreira J , Mendes F G , Catunda C 
Published: October 2024

Abstract

Background
Healthy lifestyle includes a regular practice of vigorous physical activity in adolescents’ leisure time. Engaging in physical activity (PA) depends on individual, social and environmental factors. Previous literature has showed that social support and loneliness can influence the practice of PA. The study aims to analyse the relation between PA during leisure time and social support and loneliness among adolescents in Luxembourg.

Methods
The study includes 7049 adolescents from the Health Behaviours in School-aged Children (HBSC) Luxembourg 2022 survey. PA in leisure time was categorised according to WHO recommendations for vigorous physical activity. Perceived social support (friends, family, teacher, and classmate) was dichotomised in high support and in low/medium and loneliness in feel often lonely and not feel often lonely. It was executed a binomial logistic regression to analyse the PA levels in leisure time by loneliness and social support, controlling by age, migration background, perceived wealth, and family structure, split by gender.

Results
In Luxembourg, boys who perceived high support from most of the sources and didn’t feel often lonely had higher chances to reach WHO recommendations for PA during leisure time (e.g. loneliness: OR = 1.38, CI95%[1.11-1.74]; family support: OR = 1.31, CI 95%[1.10-1.56]), except for teacher support (OR = 0.79, CI95%[0.67-0.93]). In contrast, girls who only perceived high support from classmates (OR = 1.21, CI95%[1.05-1.4]) and teachers (OR = 1.19, CI95%[1.01-1.38]) had higher chances to be physically active.

Conclusions
This is the first study to investigate the impact of social support and loneliness among adolescents in Luxembourg. Future research should investigate social-related barriers and facilitators of PA during leisure time.

Key messages
• Understanding adolescents social support can guide towards effective strategies that promote physical activity during leisure time.
• Boys benefit from several social support sources, while girls thrive with encouragement from classmates and teachers to stay physically active in leisure time.
A method for interactive collaboration between different actors: theory of change workshops
Authors: Wendt J , Scheller D A , Müller-Stierlin A 
Published: October 2024

Abstract
It is well recognised that the involvement of different actors in health research is crucial to the success of projects and interventions, as it increases the likelihood that they will be relevant, impactful and applicable in practice. However, researchers and policy makers often lack tools for the participatory involvement of actors. One way of actively involving actors is the Theory of Change (ToC) method. A ToC is a model of a change process that describes how and why an intervention leads to the intended change or outcome in a given context. It describes the path along which change is expected to occur and provides a framework for investigating whether and how change takes place. It is a systematic methodology that can be used both prospectively and retrospectively for the planning, implementation and evaluation of interventions. The approach recognises that changes in socio-ecological systems are complex and challenging and that the causal processes are often non-linear and intertwined. A ToC workshop begins with the formulation of a clear vision for the desired change and the long-term goal of the intervention. Starting from the long-term goal, the necessary medium-term and short-term goals are then defined in a backward mapping process. Next, indicators, activities and assumptions are defined for each intermediate goal. The results of a ToC workshop can be visualised in a ToC map, which shows the causal pathways, relationships, and connections between the different components of the ToC. This visual representation helps the actors to understand the logic, connections, and assumptions underlying the ToC. This in turn facilitates a shared understanding, collaboration, and ownership among all actors involved. Overall, successful involvement of actors using the ToC method can not only enrich the research process, but ultimately also increase the health benefits of interventions and health policies.