bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic inequalities in health-related functioning among people with Type 2 Diabetes
Authors: Meisters R , Albers J , Sezer B , de Galan B E , Eussen SJPM , Stehouwer CDA , Schram M T , van Greevenbroek MMJ , Koster A , Bosma H 
Published: October 2023

Abstract

Background
Type 2 Diabetes mellitus (T2DM) is a common chronic disease which disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c levels and a higher risk to develop T2DM complications compared to their high SEP counterparts. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people living with T2DM.

Methods
Cross-sectional and longitudinal data from 2,004 participants of The Maastricht Study with T2DM were used. SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the SF-36 and the Impact on Participation and Autonomy survey (scores 0-100). Associations of SEP and health-related functioning were studied over a 10-year period (baseline 2010-2018) using linear mixed methods adjusting for demographics, disease characteristics and lifestyle factors.

Results
Low SEP participants had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.00[CI 2.62;-5.38]), mental (-2.81[-1.52;-4.10]) and social functioning (-9.10[-6.35;-11.85]) compared to high-income participants. In addition, participants with a low education significantly declined more in mental (interaction estimate time -0.21[-0.05;-0.37]) and social functioning (-0.39[-0.02;-0.76]) compared to participants with high education.

Conclusions
In individuals with T2DM, socioeconomic health differences are apparent in health-related functioning. Moreover, differences in mental and social functioning widened even more between different levels of education. Beyond disease characteristics and lifestyle, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM, both in research and practice.

Key messages
• Among people with T2DM, those with a lower SEP have worse health-related function then individuals with a higher SEP, even with similar demographics, disease characteristics and lifestyle patterns.
• Additionally, people with T2DM and low education decline more over time in mental and social functioning than people with T2DM and high education.
Impact of implementation of a smoking prevention intervention on vocational students’ smoking status
Authors: Jensen M , Fredenslund Krølner R , Thygesen L C , Andersen S 
Published: October 2023

Abstract

Introduction
Smoking prevalence is high in vocational education across Europe. School-based programs to reduce smoking among older adolescents and young adults are sparse. School tobacco policies are often used though the evidence for their effectiveness is inconclusive. The implementation process of far-reaching smoking prevention initiatives such as tobacco policies can be challenging due to, e.g., nicotine dependency and attitudes towards smoking. We investigated the association between implementation of a smoking prevention intervention and students’ smoking status.

Methods
The “Focus” intervention combined a comprehensive school tobacco policy with educational activities and access to smoking cessation support. It was tested in a cluster-randomized controlled trial in 14 Danish vocational schools. Based on a conceptual model, we calculated an individual level implementation score for all students in the intervention arm, including schools’ delivery (principal and teacher surveys) and students’ receipt (student surveys) of the intervention components at 4-5 month-follow-up. We compared odds for smoking daily or weekly (regular smoking) for students with low, medium, and high implementation with students in control schools using multilevel logistic regression models (N = 1112).

Results
Students with high implementation had significantly lower odds for smoking compared to the control group (OR: 0.37, 95% CI: 0.18-0.78) whereas students with medium (OR: 1.72, 95% CI: 0.95-3.12) and low (OR: 1.26, 95% CI: 0.68-2.34) implementation had higher odds, although insignificant.

Conclusions
High implementation of the “Focus” intervention was associated with less smoking. Tendencies in the opposite direction for lower implementation may indicate a complex, non-linear relationship between implementation level and smoking behavior. This suggests that careful implementation efforts are needed to reduce smoking in older adolescent and young adult school settings.

Key messages
• Our study suggests that efforts to support implementation of smoking prevention interventions are needed to reduce smoking in vocational education and similar settings.
• To capture the complexity of the implementation process, we use an individual level measure of implementation based on a conceptual model and multiple data sources.
Exploring the Challenges in Delivering Sexual and Reproductive Healthcare in Iran
Authors: Azarmi D , Omar M , Sundar Budhathoki S 
Published: October 2023

Abstract

Background
Sexual and reproductive healthcare (SRH) is key to achieving sustainable development goal (SDG) 5 but remains a challenge for women in Iran. In 2012 the government discontinued funding for the Family Planning Programme which provided free contraception and recently mass civil unrest has swept country wide. Healthcare workers (HCWs) are legally inhibited with the care they can provide, with the population resorting to unsafe practices. This study aims to explore the challenges in accessing SRH services, provide insight into the barriers HCWs face, and guide policy recommendations to improve the delivery of SRH.

Methods
A mixed methods approach was conducted for this study: a scoping review was performed using Arksey and O'Malley's framework, and qualitative semi-structured interviews were conducted in English and Farsi remotely with HCWs who have practised in Iran in the last 10 years. An inductive and deductive approach was used to guide thematic analysis.

Results
37 studies exploring barriers of accessing SRH in Iran were identified. Six qualitative semi-structured interviews were conducted. Main emerging themes included 1) Lack of education in SRH leading to knowledge gaps, 2) “Fear and shame” culture created by sociocultural taboos, resulting in unsafe abortions, 3) Gender inequality with increasing violence during civil unrest and 4) Inadequate investment in public health, with financial burden on patients.

Discussion
The basic SRH needs of women in Iran are not being met with a concerning regression in women's rights over the last decade. Socio-political factors underpin a lack of education, inadequate public health and gender inequality. Policy recommendations include ratification of women's rights to health protected by legislation, commitment to investment into preventative services for SRH and formal education. Empowerment of women and commitment to building a strong public health system will greatly facilitate the attainment of SDG 5.

Key messages
• SRH barriers are inadequate legalisation, poor education and lack of universal health coverage. This results in harmful practices, like unsafe abortions, and over-reliance on costly private health.
• To sustainably fulfil the SRH needs there must be a realisation of women's rights, restoration of state-funded reproductive health programmes and implementation of formal SRH education.
On the problem of communication in a diverse society
Authors: Kumar B , Bhopal R S 
Published: October 2023

Abstract
At present, beyond occasional guidelines for international meetings such as those of the GSMERH (Global Society for Migration Ethnicity Race & Health) and debates between academics, there is very little international debate about the issue of terminology and diversity. This may stem from the apparent hegemony of English and a lack of capacity to debate terms across or between languages. In general, there is a tendency to shy away from discussing how language can be discriminatory, distressing or damaging. There is more commonly, at least in political life, a discussion about “woke” or “politically correct” language, as if this represented an unacceptable brake on the use of terms that the proponents of such arguments would espouse. Alternatively, it is argued that these are the “scientific or appropriate technical terms” as if there were no room for debate or development in the use of language. And yet lists or directories such as the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the United States MESH terms are recognised as essential tools in communication between professionals. And the Disability movements have certainly been active in arguing for non-stigmatising use of terms such as “blind” and “deaf”, “handicapped”, and the like, while there is a lively debate around the labelling and categorisation of gender, sexual orientation, race and ethnicity. These, however, have barely touched the consciousness, we argue, of the health scientific community and public health. This workshop with Bernadette Kumar, Norwegian Institute of Public Health, Mark Johnson, De Montfort University Leicester and Raj Bhopal, University of Edinburgh seeks to raise the level of debate and start the process of movement towards a more informed and useful conversation that will facilitate and improve communication and respect between the “describers” and the “described”, as well as in scientific usage.
Sugar content of soft drinks, breakfast cereals, and yogurt: Results from the German product monitoring in the European context
Authors: Wolff D , Dittmann A , Gréa C , Roser S , Storcksdieck genannt Bonsmann S 
Published: October 2023

Abstract

Introduction
The German food reformulation initiative is guided by an annual monitoring of selected groups of packaged food. One selection criterion is a high contribution to sugar intake, as is the case for soft drinks, breakfast cereals, and yogurt. For these groups, the respective industry associations have self-committed to reduce sugar content by 15-20 % by 2025, largely focusing on products targeted at children (PTAC).

Methods
Labelled sugar content of soft drinks, breakfast cereals, and yogurt on the German market was assessed at group and subgroup level in 2016/2018, 2019, and 2022. Data were presented as mean, median, quartiles, and range. PTAC were analysed in separate subgroups. Welch's ANOVA with post-hoc test was used to examine significant changes over time. The results were compared to those of other European countries.

Results
In 2022, the monitoring included 2.579 soft drinks, 1.499 breakfast cereals, and 975 yogurts, with the share of PTAC ranging from 15 % in breakfast cereals to 5 % in soft drinks and yogurt. For soft drinks overall, median sugar content was 6.5 g/100 ml. At subgroup level, soft drinks showed significant sugar reductions as well as increases. For breakfast cereals, median sugar content was 15.1 g/100 g, with a 20.3 % drop from baseline and the highest reduction seen in PTAC (-38.4 %). For yogurt, median sugar content was 12.1 g/100 g, with a reduction of 12.7 % for the overall group and 20.2 % for PTAC. Compared to data of Portugal, Belgium, and UK, sugar reductions were in a similar range or higher for breakfast cereals and yogurt but lower for soft drinks.

Conclusions
The monitoring shows significant sugar reductions for soft drinks, breakfast cereals, and yogurt. Judged against the WHO Europe nutrient profile model, however, further reduction efforts appear desirable for public health. Observed results were in a range similar to other European countries, but more harmonized monitoring methods would aid better comparability.
Building public trust and confidence in secondary use of health data in Ireland
Authors: Bedenik T , Bennett K 
Published: October 2023

Abstract

Background
Secondary use of health data can drive research and healthcare improvements with implications for policy and practice. However, relevant legislation, implementation of technical safeguards, and ethical data management are essential. Existing evidence suggests general public support for secondary data use, but with specific concerns about privacy, confidentiality, misuse of data and trust. The aim of this study is to explore key stakeholders’ perspectives on secondary health data use in Ireland, and mechanisms to build a culture of trust.

Methods
The study adopts a qualitative cross-sectional approach. Participants include academics and researchers, healthcare professionals, data controllers and ethics experts, industry, and patients and public, recruited through purposive sampling. Data is collected through focus groups discussions, and reflexive thematic analysis is employed.

Results
The preliminary results suggest that benefits of secondary data use include access to large datasets, streamlined research, reduced bias, and cost-effectiveness, which may lead to improved patient outcomes. Barriers include an underdeveloped national data infrastructure, difficulties with access and linkage, complex ethical regulation, and narrow predetermined indices of health. Concerns related to data sharing are context-dependent, and influenced by patients’ socio-demographic characteristics. Trust appears to be both a bottom-up and top-down process, facilitated through clear communication, organizational openness, transparency, accountability, fairness, respect, and patient and public involvement (PPI).

Conclusions
The study identifies strong support for secondary health data use among the stakeholders, notwithstanding an identified need for structural improvements, strong safeguards, education and training, and meaningful PPI. This research helps inform public health practice and policies towards building a culture of trust pertaining to secondary data use.

Key messages
• This study produces novel insights to help advance research and policy on the barriers and facilitators to building trust and confidence in the access and use of health data for secondary purposes.
• This study contributes to qualitative research methods related to eliciting people's views and perspectives in a safe, collaborative and efficient manner.
Audit&Feedback in emergency care: a pre-post intervention study in Lazio (Italy)
Authors: Agabiti N , Angelici L , Acampora A , Angioletti C , de Mattia E , Pinnarelli L , Colais P , De Belvis A G , Davoli M 
Published: October 2023

Abstract

Background
Within EASY-NET Italian Programme (NET-2016-02364191), we evaluated the effectiveness of a structured Audit & Feedback (A&F) intervention in improving care quality for ST Elevation Myocardial Infarction (STEMI).

Methods
A&F intervention involved sending periodic reports via e-mail to participating hospitals in Lazio Region (about 5 million inhabitans). Volume, process and outcome indicators were calculated by hospital through Health Information System, compared with regional mean and target values. Health managers and clinicians were feedback recipients. Study design: pre-post intervention with control group (web-based regional periodic publication of indicators). Proportion of STEMI treated within 90 minutes with Percutaneous Transluminal Coronary Angioplasty (PTCA) was calculated in 2021 (pre) and in 2022 (post). Patients level adjusted Difference-in-Difference model (DID, 95% CI) was applied. Stepwise procedure identified individual (e.g. age, sex, clinical conditions) and hospital (e.g. hospital type) covariates entering in the model.

Results
A total of 19 hospitals were evaluated, 8 as controls. The number of analysed STEMI was 5084 (2651 in 2022) of which 3272 (1731 in 2022) in exposed hospitals. Overall, mean age 66 years, males 74.7%. Proportion treated with PTCA within 90 minutes in 2021 was 55.1% in exposed hospitals, and 57.9% in controls; in 2022 60.0% in exposed hospitals 66.4% in controls. Adjusted percentage difference in post/pre change between exposed and non-exposed hospitals was not significant in univariate and multivariate model (-3.6%, p = 0.218 and -4.4% p = 0.126).

Conclusions
These results cannot demonstrate a difference between exposed and not exposed hospitals. Possible explanations could be the short follow-up evaluated and the influence of covid-19 pandemic. In fact, several hospitals in both exposed and control group still had entire hospital wards dedicated to covid-19 management in 2021.

Key messages
• A&F methodology designed and implemented in EASY-NET project represents a challenging instrument to promote quality of care.
• Monitoring hospital performance through periodical reporting allows continuous quality improvement.
Family caregivers’ subjective poverty: the effect of nutritional guidance on their quality of life
Authors: Savela R M , Nykänen I , Koponen S , Suominen A L , Schwab U , Välimäki T 
Published: October 2023

Abstract

Background
Family caregiving may increase the risk of poverty, whereas poverty increases the risk of adverse health outcomes, creating health inequalities. Although the issue is significant, family caregivers’ social determinants of health are little assessed in the previous intervention studies. Therefore, we aimed to assess the effects of individually tailored nutritional guidance on financially vulnerable family caregivers’ quality of life and nutritional status.

Methods
The data were collected between June 2019 to June 2020. Study participants (n = 113) were randomized into intervention (n = 63) and control (n = 50) groups and further divided into those experiencing subjective poverty (n = 36) or financial security (n = 77). The intervention group received individually tailored nutritional guidance. Paired samples t-test, McNemar's test, or alternatives were used to assess the intervention's effectiveness on quality of life and nutrition.

Results
The preliminary results show that family caregivers who experienced subjective poverty had a lower overall quality of life (p &lt;.001, 95% CI -12.1, -5.3), physical health (U = 1824, p = .004), psychological health (U = 1780, p = .013), and environmental quality of life (U = 2262, p &lt;.001) at baseline. However, after the intervention, their overall quality of life improved (p = .010, 95% CI -15.9, -2.3). Similarly, there was an improvement in their psychological health (Z= -2.0, p = .047) and environmental quality of life (Z= -2.4, p = .017). Their risk of malnutrition also slightly decreased, and daily fruit and vegetable servings increased without statistical significance.

Conclusions
Individually tailored nutritional guidance improved the quality of life of family caregivers experiencing subjective poverty. The results may guide healthcare in narrowing health inequalities.

Key messages
• Individually tailored nutritional guidance can narrow quality of life inequalities among family caregivers of different financial groups.
• Healthcare should enable nutritional guidance to family caregivers.
The role of working conditions in educational differences in ischemic heart disease mortality
Authors: Almroth M , Hemmingsson T , Falkstedt D , Thern E 
Published: October 2023

Abstract

Background
The educational gradient in cardiovascular mortality is well established, but still not completely understood. One important mechanism may be working conditions. This study aims to investigate the extent to which job control and heavy physical workload explain educational differences in ischemic heart disease (IHD) mortality while also accounting for risk factors established in childhood and adolescence.

Methods
This register-based cohort study is based on men who completed their mandatory conscription (age 18-20) for the Swedish military in 1969/1970. This includes 37,419 men who also had a registered occupation in 2005. IHD mortality was measured in the cause of death register. Educational differences in IHD mortality, followed between 2006 and 2019, were measured using Cox proportional hazards regression models. Models were first adjusted for socioeconomic, cognitive, health and behavioral factors measured in childhood and during conscription. Models were further adjusted for physical workload and job control in 2005 (measured during mid-50s). These occupational exposures were measured using Job Exposure Matrices (JEM). Percent attenuation in hazard ratios (HR) after adjustment were calculated using the formula ((HR crude-HR adjusted)/(HRcrude-1))*100.

Results
Crude models showed a clear educational gradient regarding IHD mortality (HR 2.67, 95% confidence interval 2.08-3.42 for the lowest educated compared to the highest educated). Adjusting for earlier risk factors resulted in a 39-50% reduction in HR estimates. Further adjusting for physical workload and job control resulted in around 75% reductions compared to the crude model.

Conclusions
Physical workload and job control explained around 25% of the increased risk of IHD mortality in those with lower education. Improvement of the physical and psychosocial work environment could lead to a reduction in IHD mortality and smaller educational differences.

Key messages
• Physical workload and job control played an important role in educational differences in IHD even when accounting for a variety of early life risk factors.
• Improving the physical and psychosocial work environment could lead to a lower incidence of IHD deaths and reduced educational inequalities.
Use of the WHO Nutrient Profile Model in Germany: feasibility and public health implications
Authors: von Philipsborn P , Holliday N , Leibinger A , Huizinga O , Klinger C , Okanmelu E , Geffert K , Rehfuess E 
Published: October 2023

Abstract

Background
Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM), published as second edition in March 2023. The German government plans to use this model in new food marketing legislation, but it has not yet been tested in Germany.

Methods
We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market from Open Food Facts, a product database. We calculated the share of products permitted for marketing to children under current market conditions and for hypothetical reformulation scenarios. We assessed practical challenges in applying the WHO NPM and the effects of model adaptations.

Results
The median share of products permitted for marketing to children across the 22 categories was 20% (interquartile range (IQR) 3-59%) and increased to 38% (IQR 11-73%) with model adaptations proposed by the German government. With targeted reformulation (i.e. a 30% reduction in fat, sugar, sodium, and/or energy) the share increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt, convenience foods, and savoury plant-based foods), but changed less in others. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others.

Conclusions
The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with adaptations and procedural provisions.

Key messages
• The practical application of the WHO Europe Nutrient Profile Model 2023 edition to a random sample of food and beverage products on the German market was found to be feasible.
• With targeted reformulation, the share of products permitted for marketing to children under the WHO Europe Nutrient Profile Model increases substantially.