bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood vaccinations in conflict-affected settings: a case study from a frozen conflict zone
Authors: Agopian A , Musheghyan L , Sargsyan Z , Abrahamian D , Lazaryan Z , Dorian A 
Published: October 2023

Abstract

Background
Disruptions in healthcare are common in conflict-affected settings, particularly in frozen conflict zones where an already fragile health system is affected by the uncertain geopolitical context. Childhood vaccinations are vital in such settings to prevent illness in an already vulnerable population. To better understand health services in a frozen conflict zone, we examined vaccination coverage among children in Nagorno-Karabakh.

Methods
Multistage cluster sampling was used to sample households in Nagorno-Karabakh during the summer of 2022. From each household, one woman between the ages of 18 and 49 participated in an interviewer-administered survey. Vaccination status was reported by mothers who had at least one child less than 5 years-old.

Results
Among the 299 mothers with at least one child under 5 years-old, 288 (96.3%) reported all children as vaccinated, 4 (1.3%) reported some as vaccinated, and 7 (2.3%) reported all as unvaccinated. Among those vaccinated, 279 (95.5%) reported their children as fully vaccinated while 12 (4.1%) were not up to date, mostly due to illness at time of vaccination (41.7%). Similarly, women with only some children vaccinated reported illness as the main reason (50.0%). Women whose children were unvaccinated cited lack of trust (42.8%) and general unwillingness (42.8%) as the main reasons. A majority of the mothers (94.6%) reported receiving a call from the local polyclinic to remind them of the next vaccination and most (91.0%) sought reliable information about vaccinations from physicians.

Conclusions
Vaccination coverage was high demonstrating the ability of Nagorno-Karabakh to provide health services. Most women were informed by the clinic and consulted with their physicians which should be utilized to enhance child health services. Future studies should examine vaccination access and delivery in Nagorno-Karabakh to provide a model for vaccination services and to bolster health security in frozen conflict zones.

Key messages
• Despite healthcare-related challenges in a frozen conflict zone, vaccination delivery services in Nagorno-Karabakh were effective, with almost all children under 5 years-old fully vaccinated.
• Reminders from clinics and trust in physicians likely influenced vaccination coverage in Nagorno-Karabakh and should be considered to build sustainable vaccination systems in frozen conflict zones.
Irish people’s views on electronic health records and data security
Authors: Flaherty S J , Barry O , Duggan C , Foley B , Flynn R 
Published: October 2023

Abstract

Background
Electronic health records (EHRs) can enhance the quality of care by ensuring timely and improved access to data and enabling linkage to facilitate better communication and coordination between healthcare teams. People differ in their views on EHRs, mainly due to perceived concerns relating to data security. It is important that people's views are considered in the design and implementation of EHRs to support successful implementation. The aim of this research was to explore public views on EHRs and data security to inform future policy in this area.

Methods
Qualitative secondary analysis of open-ended survey questions included in a National Public Engagement Survey on Health Information was conducted. A total of 433 respondents, from a nationally-representative sample of 1,228, provided a response that related to data security and EHRs. The national survey was carried out between October and December 2020 using a computer-assisted telephone interviewing (CATI) approach. Verbatim responses to the open-ended questions were captured and inductive thematic analysis was conducted.

Results
Four themes were identified: attitudes towards a move to eHealth; trust in relation to information security; technical infrastructure to support EHRs; and protective measures to safeguard EHRs. Most people view EHR implementation positively but cited concerns in relation to both the security of the electronic systems and the individuals that process this data and manage these systems.

Conclusions
As more countries introduce national EHRs, there is a need to establish and maintain a balance between the security of electronic systems and the competency of individuals that manage such systems. Equal consideration should be given to addressing both elements as the effectiveness of one is contingent on the other. A rise in cyber security attacks and growing public concern surrounding data breaches creates a sense of urgency to address such issues.

Key messages
• Trust was an important influence on people’s attitudes to electronic health records which was shaped by people’s trust in the individuals and organisations that have access to their health data.
• There is an interdependent relationship between security systems and the individuals that manage them; both must be equally considered to provide assurance to the public on data security.
Impact of digital intervention on antenatal paper records: results from audit of antenatal records
Authors: Das S , Radovich E , Karki S , Shakya R , Shrestha A , Karmacharya B , Penn-Kekana L , McCarthy O , Campbell O , Shrestha A 
Published: October 2023

Abstract

Background
Good recordkeeping is important in antenatal care (ANC). The mIRA study aimed to improve ANC quality through tablet-based electronic decision support systems (EDSS). Electronic data entry was implemented alongside existing paper-based ANC records, adding an additional record-keeping requirement for health care providers. This study assesses the impacts of the EDSS on paper-based ANC records.

Methods
The audit was conducted in 19 primary healthcare facilities in Nepal. We examined pregnant women's records before (n = 136) and after (n = 138) EDSS implementation. For eight selected indicators in the ANC card and ANC register, we estimated the percentage completeness (any value recorded) and agreement (whether values matched), comparing results before and after intervention, additionally examining EDSS records.

Results
Completeness of paper ANC records was high before intervention (&gt;90% for all indicators, except for tetanus toxoid vaccination). There was general trend towards variables being more complete after implementation of the EDSS for both the ANC card and the ANC register. There was &gt;15% improvement in completeness and in agreement of tetanus toxoid vaccination date records in ANC cards and ANC registers after the intervention. Completeness of variables in the EDSS was low, suggesting recordkeeping in ANC cards and ANC registers was prioritized. Percentage agreement increased slightly in all eight indicators after intervention. Amongst the selected eight indicators, only women's age records showed &gt;90% agreement both before and after the intervention.

Conclusions
EDSS did not have a negative impact on paper-based ANC records. Digital records are widely being used in high-income countries and the increasing implementation of electronic health records in low-resource settings increases the demand for evidence to understand the feasibility and impacts of digital health interventions in real-world settings.

Key messages
• The additional recordkeeping required by the EDSS resulted in general improvements in the completeness and agreement of ANC paper records.
• Large-scale EDSS implementation should consider how to integrate digital and paper-based records to decrease burden on healthcare providers, and improve the standard of records.
Sex differences in disease burden in Norway: an analysis of the Global Burden of Disease Study 2019
Authors: Forthun I , Clarsen B , Knudsen A K 
Published: October 2023

Abstract

Background
Sex differences in premature mortality is well documented, but we have less knowledge about sex differences in disability, how this varies across the life course, and what risk factors attribute to these differences. Using data from the Global Burden of Disease Study (GBD) 2019, we examined sex differences in diseases burden in Norway.

Methods
Data for years of life lost (YLLs), years lived with disability (YLDs) and the sum of these two; disability-adjusted life-years (DALYs), were extracted from GBD 2019 by sex and age groups, in addition to data on risk factors (data will be updated upon the release of GBD 2021).

Results
In 2019, the age-standardized DALY rate was similar in males (18 901, 95% CI 16 338-21 823) and females (18 165, 95% CI 14 875 - 21 791) in Norway. However, in women, a larger proportion of the disease burden was due to causes leading to years lived with disability (YLD), compared to in men. This was found across all age groups, starting in adolescence. A larger proportion of the disease burden among males could be attributed to known and preventable risk factors (41.0%, 95% CI 38.3-43.7) compared to in females (32.4%, 95% CI 29.3-35.6%).

Conclusions
The total burden of disease is equally shared by men and women in Norway. However, women have a larger share of the total burden of years lived with disability. As we know much less about what contributes to disability compared to premature mortality, we also have less knowledge about the causes of disease burden in women. This in turn, affects our ability to develop targeted and effective health policies to address sex differences in disease burden.

Key messages
• Women carry a larger share of the total number of years lived with disability, while men have higher premature mortality.
• We know less about how to prevent disease burden in women than in men.
Healthy lifestyle in the first 1000 days and childhood overweight and obesity in 4 European cohorts
Authors: Aubert A M , Lecorguillé M , Schipper M C , Douglass A , Kelleher C C , Murrin C M , Lioret S , Heude B , Gaillard R , Phillips C M 
Published: October 2023

Abstract

Background
The high prevalence of overweight and obesity in young children suggests the involvement of early life exposures. Based on the Developmental Origins of Health and Disease paradigm, we investigated associations of healthy lifestyle (HL) behaviours around the first 1000 days of life with adiposity and weight status throughout childhood.

Methods
Cohort-specific analyses were conducted in four European birth cohorts (EDEN, Elfe, France; Generation R, the Netherlands; Lifeways, Ireland), implementing a harmonized data and analysis approach. Composite HL scores were calculated during pregnancy (maternal/parental) and infancy periods based on parental diet quality, BMI, smoking status, alcohol consumption; and for infant score breastfeeding, age of solid food introduction and exposure to passive smoking. Associations with child BMI (measure of overweight and obesity) and waist-to-height ratio (WHtR, measure of abdominal obesity) at age 5 and 9 were assessed using linear (BMI z-scores and WHtR) and logistic regression (IOTF categories).

Results
Current results are based on the Lifeways data; other cohort-specific analyses are ongoing. Depending on the period, up to 50% of the sample had unfavourable lifestyle factors, determined by a HL score of less than half of the possible points. Lower maternal and parental pregnancy HL scores, indicating lower adherence to HL factors, were associated with a higher child BMI at age 5 and 9. Associations with WHtR were non-significant. A low infancy HL score was strongly and consistently associated with both a higher child BMI and WHtR at age 5 and 9.

Conclusions
A low adherence to HL factors around the first 1000 days of life was associated with a higher risk of childhood obesity. If confirmed in the other birth cohorts, these findings will inform the development of future early family-based lifestyle obesity prevention interventions.

Key messages
• Low adherence to healthy lifestyle behaviours around the first 1000 days of life is associated with a higher risk of childhood obesity and abdominal adiposity.
• If confirmed in the other cohorts, these results call for further research exploring family and multi-behavioural approaches to prevention of childhood obesity.
Mortality burden due to COVID-19 in 14 countries or regions in Southeastern Europe and Central Asia
Authors: Cawley C , Glushkova N , Santric-Milicevic M , Terzic N , Fedorchenko V , Cilovic Lagarija S , Gabrani J , Kalaveshi-Osmani A , Kazanjan K , Wengler A 
Published: October 2023

Abstract

Background
Between 2021 and 2023, an international collaboration to estimate the burden of disease due to COVID-19 in 14 countries and regions in Southeastern Europe, the Southern Caucasus and Central Asia was funded by the German Federal Ministry of Health, under its Global Health Protection Programme. As part of the project, the indicators Years of Life Lost (YLL) and Excess Mortality (EM) were estimated in order to compare the mortality burden of COVID-19 across countries and regions.

Methods
Data on COVID-19 deaths, all-cause mortality and population numbers were collected by all partner institutions for the period March 2020 to December 2021. YLL were calculated using standard burden of disease methodology, disaggregated by sex, age and month. EM was calculated in Excel using exponential smoothing, taking trend and seasonality into account. The EM estimates generated were compared to existing estimates published by the WHO, in order to explore similarities or differences.

Results
In nearly all countries, YLL rates per 100,000 were higher among men than women, and among those aged 60 and older compared to younger age-groups. YLL rates per 100,000 were also higher in most countries in Southeastern Europe and in the Southern Caucasus as compared to Central Asia. In general, the YLL burden was considerably greater in 2021 compared to 2020. In most countries, the highest YLL rates were seen in the autumn and winter months. However in some countries, peaks were also seen in spring or summer. WHO estimated EM rates were largely in line with our own, except in Ukraine, Türkiye and Azerbaijan, where WHO estimates were substantially higher.

Conclusions
A significant mortality burden due to COVID-19 was observed, particularly in 2021, and among men and older individuals. The disaggregation of data over time facilitates the use of burden of disease metrics in pandemic monitoring, providing an additional tool in response efforts.

Key messages
• The mortality burden due to COVID-19 was significant in the regions investigated, particularly in 2021.
• Data disaggregations over time facilitate the use of burden of disease indicators in pandemic monitoring and response.
The right of transgender people to be resilient!
Authors: Verguchten J , Demeyer C , Vanoverbeke I , Vandenbussche O K , Kerckhof M 
Published: October 2023

Abstract

Background
Anti-trans violence has become the focus in European and international policy as stipulated in the LGBTIQ Equality Strategy 2020-2025. Despite the legal European anti-discrimination law, transgender people are still unable to be themselves without risks of social exclusion, feeling threatened, bullying at school, gender-related violence and hate crimes which negatively impacts their mental health (suicidality, hiding the trans identity).

Methods
Instead of making society more ‘trans sensitive', this study aims to strengthen the resilience of transgender youth (16-25 years old) bottom up, using a co-creative research approach. Inspired by the Lundy Model of child participation, transgender youth received a voice, platform and safe space to influence society. Thematically-analyzed data was gathered through focus groups (using creative techniques) in a co-creation session at the university hospital of Ghent.

Results
To increase their resilience, transgender youth want to (1) provide training for educational staff, develop didactic material and create safe coming-out environments, (2) participate in social activities focusing on gender expression, create social scripts, (3) improve self-confidence with techniques like Rock and water and self-defense programs, (4) participate in creative workshops to cope with stress and anxiety, (5) tell positive stories to tackle stereotypes. Based on this input from the co-creation session we will set up modules to strengthen their resilience.

Conclusions
The central question in research and practice should be how to take what they believe is necessary to become more resilient, take their challenges into account and how to use this to raise awareness on transphobia among trans people and international (trans)organizations.

Key messages
• To strengthen resilience in transgender youth by listening to their voices.
• To increase awareness, knowledge and skills of professionals regarding transgender people.
Social categorisation of asylum seekers: Free-listing by professionals in German reception centres
Authors: Ziegler S , Bozorgmehr K 
Published: October 2023

Abstract

Background
Newly arriving asylum seekers in Germany mostly live in large reception centres. Goods and services are provided by professionals. Their social categorisations may impact discretionary decisions and determine the scope of access to health and social services. We sought to explore what social categories were mostly applied to asylum seekers in that context.

Methods
We conducted a modified, verbal free-listing with health care, security, translation, social work and administrative staff in two German reception centres, asking what kind of asylum seekers were there. After qualitative content analysis, categories were quantitatively mapped using the Excel Macro “Flame” showing frequencies, ranks and salience of those social categories.

Results
40 professionals listed on average 16 items (min = 4, max = 31). In total 624 items were analysed. Categorisations were of individual, interactional, professional, and societal nature. Professionally relevant categories like needs were not mentioned with the highest frequencies. The leading social categorisations of asylum seekers referred to asylum seekers attitudes professionals derived from their behaviour mostly in combination with socio-demographic variables, such as countries and regions of origin and sex. The most relevant social categories were “demanding and expectant” and “polite and friendly” behaviour, also the effort to adapt to the German environment was often evaluated. The category “economic refugees” ranked forth.

Conclusions
Social categorisation is permeable to public and political discourses related to motives for flight, or integration efforts and chances, impacting on negotiations of deservingness. Since categorisation structures perception, it potentially influences interaction and decision-making, it can trigger empathy and support as well as rejection and discrimination. Free-listing provides a suitable tool, to explore real world categorisation without leaning on pre-given social categories.

Key messages
• Public health studies on bias, racism and discrimination could benefit from free-listing as useful methodological tool to explore real world social categorisation without using pre-given categories.
• Health sciences should foster awareness on political and societal discourses about migrant and minority populations seeping into professional cognition, which can trigger support or discrimination.
Counting the Cost: The Economic Toll of Discrimination Against LGBTQAI+ Individuals in Italy
Authors: Altamura G , Lontano A , Nurchis M C , Raspolini G M , Heidar Alizadeh A , Santoli G , Laurenti P , Damiani G 
Published: October 2023

Abstract

This study investigates the financial consequences of perceived discrimination towards LGBTQAI+ people in Italy, focusing on psychological support and medication costs. It highlights the burden of discriminatory experiences, emphasizing the need for policies to minimize costs. A cost analysis was performed according to the NHS perspective. A purposive sample was recruited through a web-based survey spread on Italian researchers’ social networks, asking any LGBTQAI+ readers to answer about discriminatory experiences, access to psychological support, and medication use. Costs of health services use were estimated according to the Italian NHS tariffs and Italian Psychologists’ Board. The time horizon was set at one year and discounting was not necessary. Robustness was checked by a one-way sensitivity analysis. A total of 75 LGBTQAI+ people completed the survey. Most of them (aged 26-35 years, 85%; residing in big cities, 70%; unaffiliated with LGBTQAI+ associations, 88%) reported discriminative actions (60%), with 15% seeking psychological help soon after being victim of a single discriminatory act. Verbal and physical abuse were reported by 88% and 6% respectively. 40% of respondents claimed to have resorted to psychotherapy sessions because of the discomfort felt after acts perceived as discriminatory or violent, amounting to 810 total therapy hours. The total therapy cost was €72,900, of which 60% paid as out-of-pocket expenses, and 40% partially covered by regional Local Health Units. Additionally, 12% of respondents used SSRI or benzodiazepines, costing the National Health System an esteemed €3054. The sensitive analysis confirmed the robustness of results. The study demonstrates the significant economic burden of discrimination against LGBTQAI+ individuals in Italy, emphasizing the need for inclusive policies and accessible mental health support. Further research is required to explore indirect costs, for a comprehensive understanding of the total economic impact.

Key messages
• Discrimination against LGBTQAI+ individuals in Italy causes significant financial burden due to costs of psychological support and medication.
• Inclusive policies and accessible mental health support are needed to address the economic impact of discrimination against LGBTQAI+ individuals in Italy.