bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using socioeconomic disparities in ACS mortality to identify opportunities for better cardiac care
Authors: Satokangas M , Arffman M , Lindell E , Manderbacka K , Reissell E , Lumme S , Antikainen H , Leyland A , Keskimäki I 
Published: October 2023

Abstract

Background
Though cardiac care in acute coronary syndrome (ACS) should be equitable, socioeconomic disparities in associated mortality persist. In this study we ask if problems in provision of cardiac care could be pinpointed by examining these disparities in mortality between different time-points of ACS care. Thus, we assessed how socioeconomic disparities in one-year coronary heart disease (CHD) mortality emerged in Finland both outside hospital and in three consecutive time-points after ACS hospitalisation.

Methods
We obtained individual data of incident ACS hospitalisation for those aged ≥40 in 2013-2017 from national hospitalisation registers. Respective data for CHD mortality, education, income, living alone and travel time to hospital were obtained from Statistics Finland and from Digiroad database. Comorbidity was measured with Charlson index. Two-level Poisson multilevel models provided incidence rate ratios (IRRs) separately in total CHD mortality (including prehospital deaths) and by the time of death after ACS hospitalisation (within 1-7 days, 8-28 d and 29-365 d). Variation between hospital districts was adjusted for with random effects.

Results
Of 31,902 CHD deaths 74.9% occurred prehospital, 9.0% within 1-7 d, 6.2% within 8-28 d and 9.9% within 29-365 d of ACS hospitalisation. IRRs for living alone were 1.25-fold (CI95% 1.22-1.29) for total CHD mortality but varied between 0.95-1.05-fold after ACS hospitalisation. A clear income gradient emerged favouring higher quintiles. In the highest quintile IRRs were constantly 0.53-0.56-fold (CI95% 0.43-0.73) to those of the lowest quintile. In other quintiles income disparities were fewer, especially within 1-7 d.

Conclusions
Though socioeconomic disparities in CHD mortality persisted throughout cardiac care, more focus should be given especially to subacute care and rehabilitation of vulnerable groups. Improving early identification of ACS in those living alone offers opportunities to decrease excess CHD mortality.

Key messages
• A detailed analysis of socioeconomic disparities in one-year mortality after acute coronary syndrome event can provide opportunities for improving provision of cardiac care.
• More focus should be given especially to subacute cardiac care and rehabilitation of vulnerable populations, as well as to early identification of acute coronary syndrome events in those living alone.
Socioeconomic differences in SARS-CoV-2-antigen contacts after one year of the vaccination campaign
Authors: Beese F , Bartig S , Wachtler B , Mercuri E , Schmid L , Schmid-Kuepke N , Poethko-Müller C , Gößwald A , Hoebel J ,   RKI-SOEP-2 study group
Published: October 2023

Abstract

Background
Evidence on the SARS-CoV-2 serological status of the German population by socioeconomic position (SEP) is still limited for the vaccine era of the pandemic, but could contribute to the understanding of the unequal risks of severe COVID-19. This study aims to evaluate the socioeconomic patterns of antigen contacts through infection, vaccination or both (‘hybrid immunity’) after one year of vaccination campaign in Germany.

Methods
We used nationwide serological and self-reported data from the population-based German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2, November 2021-February 2022) to estimate prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination (at least one dose of vaccine), basic immunization (at least two SARS-CoV-2 antigen contacts), and three antigen contacts by education and income. Estimates were derived from Poisson regression models adjusted for age, sex, migration status, urban-rural residence, federal state and date of participation.

Results
Across 10,448 adult participants, low-education groups had a 1.35-fold greater risk of SARS-CoV-2 infection compared to high-education groups (95% CI 1.01-1.82, p = 0.045). COVID-19 vaccination and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three SARS-CoV-2 antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65-0.84, p &lt; 0.001; PR low vs. high income: 0.66, 95% CI 0.57-0.77, p &lt; 0.001)

Conclusions
The results show socioeconomic inequalities in SARS-CoV-2 infections, COVID-19 vaccinations and antigen contacts, suggesting a lower level of protection against severe COVID-19 for individuals with low and medium SEP. The majority of the German population exhibits further prevention potential, which could be addressed via more targeted interventions. Future research, pandemic response and vaccination campaigns should address the specific needs and barriers of these groups.

Key messages
• Multiple antigen contacts, especially through vaccination, are less prevalent in groups with low or medium socioeconomic position.
• Potential to prevent severe COVID-19 exists in the majority of the German population after one year of vaccination campaign.
Findings of the German COVID-19 Health Literacy school principal study
Authors: Meyer M , Dadaczynski K , Messer M , Okan O 
Published: October 2023

Abstract

Background
The education sector faced tremendous challenges during the Covid-19 pandemic, requiring adjustments to meet the needs of an unprecedented public health emergency, while also maintaining school health promotion measures. School principals are key actors to lead, drive, and implement school health promotion activities in their setting. Higher school principal health literacy is known to be a predictor for the implementation of school health promotion. The international COVID-HL school principal study was implemented to assess corona-specific health literacy of principals and investigate assocaitions with school health promotion.

Methods
Findings from Germany, that were generated by employing an online survey in school principals during the third infection wave from March to April 2021 in four federal states, will be discussed. Sociodemographics, health literacy, and implementation of school health promotion were measured using self-report tools. Descriptive statistics and variance analyses were conducted.

Results
The survey was completed by N = 2186 school principals. While 60.5% showed an adequate health literacy level, 31.4% showed problematic, and 8.1% even inadequate levels. For the subscale finding, 75.4% showed an adequate level, whereas only 50.5% demonstrated adequate levels regarding information appraisal. Welch's ANOVA indicated significant differences between the health literacy levels and the implementation rate of school health promotion and prevention measures regarding students (p &lt; 0.001; η2=0.054), school staff (p &lt; 0.001; η2=0.015) and school (p &lt; 0.001; η2=0.017).

Conclusions
School principals demonstrated adequate corona-specific health literacy. The most difficulties were indicated when appraising health information in the context of the pandemic. Principals with higher health literacy are more likely to implement school health promotion measures than those with lower levels, making health literacy an important public health and education target.
Organizational health literacy of schools in Germany: a cross-sectional study in schools
Authors: Krudewig C , Kirchhoff S , Okan O 
Published: October 2023

Abstract

Background
Organizational health literacy facilitates health literacy by creating health-literate settings. The school setting is an important venue for the promotion of health literacy of children and adolescents. Within the Health-Literate Schools project (HeLit-Schools), a concept for organizational health literacy of schools was developed, with eight standards informing a questionnaire. This study aims at assessing the implementation status of organizational health literacy of schools in Germany.

Methods
School principals from primary and secondary schools in Germany were invited to take part in an online survey that was launched in winter 2022/23. The implementation status of organizational health literacy was measured using a 48-item self-report questionnaire (OHLS-Q), based on the HeLit-schools concept. Sociodemographics of principals and schools, as well as other health-related variables were assessed. Descriptive statistics were conducted using SPSS.

Results
The preliminary sample from two federal states comprises N = 482 principals (71% female, Ø 52.3 years old). Of the schools, 44% were primary, 41% secondary, and 15% special education schools. Overall, two-thirds of the items reflecting organizational health literacy were rated as partly or fully implemented while across the individual standards a great variance was found. Schools already participating in school promotion programs or networks (28%) reported a higher implementation status of organizational health literacy.

Conclusions
This was the first ever assessment of organizational health literacy of schools based on a novel concept and questionnaire. The findings provide insights into resources and barriers for the implementation of school health literacy. German schools show a relatively high overall implementation status of organizational health literacy. Nevertheless, potential for improvement could be identified. The survey is currently ongoing and more states will provide useful data to be analysed.
'smart life’ implementation as a best practice in tackling child obesity
Authors: Kuusipalo H 
Published: October 2023

Abstract
Smart family targets families expecting a baby, or having children aged 0-12 years aims to help public health nurses and other professionals to bring up lifestyle issues with families without arousing guilt and to identify their strengths in their health habits. Since launch in 2008, 5000 health professionals, mostly public health nurses, have been educated to use the method method does not require resources for public health nurses since it is integrated in their everyday work. Municipalities need to cover expenses for education families highly appreciated that the nurse made visible and acknowledged the family's existing strengths in healthy lifestyle.
Did the COVID-19 pandemic affect depressive symptoms? Longitudinal analysis of health worker data
Authors: Hoffmann S , Schulze S , Löffler A , Becker J , Gremmels H D , Holmberg C , Rapp M A , Entringer S , Spallek J 
Published: October 2023

Abstract

Background
Health workers play a vital role in response to outbreaks under pandemic circumstances, but are also highly vulnerable to stress-related mental health issues (e.g., due to pandemic workload). There are knowledge gaps regarding temporal development of the emergence of depressive symptoms among health workers during the COVID-19 pandemic and their determinants. This study examined the trajectory of depressive symptoms and their association with a) stress perception, b) own COVID-19 infection and c) COVID-19 exposure at work.

Methods
This cohort study with 91 health workers (90% female, x¯=45 years) from a German general hospital included (1) medical, nursing and therapeutic staff and (2) administrative staff. Data were collected longitudinally every month from July to December 2020. Linear multilevel models were used to evaluate associations between trajectories of depression scores (German ‘General Depression Scale’) with perceived stress (‘Perceived Stress Scale’). Laboratory-confirmed COVID-19 infection was tested as a moderator of depressive symptom development. Trajectoires of depressive symptom modalities (e.g., somatic, emotional) were analysed stratified by COVID-19 exposure at work.

Results
Depression scores increased across the study period (b=.03, .02-.05). Perceived stress was associated with depression scores (b=.12, .10-.14). The presence of health workers’ own COVID-19 infection was associated with a higher increase (b=.06, .01-.10). Somatic symptoms of depression increased over time only among health workers directly exposed to COVID-19 patients at work (b=.25, .13-.38).

Conclusions
The increase in depressive symptomatology among health workers exposed to COVID-19 in the workplace points to the need for further research. Since the infection with COVID-19 is associated with an increase of depressive symptoms across time, awareness should be raised about measures to protect against virus transmission, especially during a pandemic.

Key messages
• Perceived stress and own infection during the COVID-19 pandemic are additively linked to depressive symptoms among health workers.
• Exposure to COVID-19 in the workplace is associated with increased somatic depressive symptoms.
6.E. Workshop: Evaluating progress in adaptation in the European public health sector
Authors:   Organised by: ENBEL, EUPHA-ENV,   Chair persons: Sari Kovats (UK), Marija Jevtic (EUPHA-ENV)
Published: October 2023

Abstract

Most national climate adaptation plans and strategies mention risks to human health. However, this is not often translated to specific policies, measures or targets to reduce these risks. The ENBEL project, funded by the European Commission under the H2020 program LC-CLA-22-2020, aims to support European policy making on climate change and health. In this workshop we present the results of recent research on the implementation of adaptation measures in Europe and review the evidence needs of EU, national and international decision makers. The workshop aims to support evidence translation for adaptation that prioritises health protection and equity. The workshop will include presentations on stakeholder mapping and interviews with key decion makers, as well as a comparison of current policies in health adaptation. We review the recent European policies on COIVID recovery and evaluate whether these will benefit adaptatoin. Economic evaluations are important for decision making and we review economic assessments for local climate action and for climate services for health.

Key messages
• Public health professionals can support adaptation actions through intersectoral working.
• Post-COVID recovery is missed opportunity to improve adaptation in Europe.
Digital Public Health in Ireland
Authors: Staines A 
Published: October 2023

Abstract
Before COVID-19 Ireland had a very limited digital health infrastructure. There are no unique health identifiers, and it is common for patients to be on the books of multiple providers, be that general practitioners, or hospital waiting lists, so capacity analysis beyond actual hospital admissions, is very limited. There are separate systems used to manage child development and vaccine delivery. Infectious disease reporting is done, feeding into a 25-year-old central system. General practice (GP) is the only sector that uses electronic records widely, which support a messaging system, to return hospital test results to the GP. Prescriptions were commonly handwritten on paper or typed, specifically on three-layer fan-fold paper, using obsolete printers for fully state-funded prescriptions. The patient transferred these to the pharmacist. COVID-19 shook this system to the foundation. It became necessary to set up contact tracing systems and vaccination systems for the entire population. These were built very quickly as free-standing systems. In addition, hospital activity data, which had been typically available a month after the date of discharge, was needed daily to manage bed capacity. Pharmacists had to receive prescriptions online, and e-prescribing was brought in. All of this worked and often worked well. More embarrassingly, as COVID-19 case numbers rose, the recording system did not scale, and reported case numbers were substantially too low for a time. Now that the acute pandemic response is over, very little has changed. Hospital prescriptions are still paper-based, although GP prescriptions use the new system. Contact tracing is shut down, and the vaccination system is scaled back. There is still no health identifier in use. Few of the lessons of the pandemic response have been learned, and the opportunity to make more significant changes in public health systems has been missed. A ‘good’ crisis was wasted.
Perioperative patient safety recommendations: best practices derived from a systematic review and a multidisciplinary expert consensus
Authors: Martinez-Nicolas I 
Published: October 2023

Abstract
Surgery care has one of the highest pooled prevalence of preventable patient harm. Many clinical practice guidelines have been developed around the world to overcome this safety and public health concern. Moreover, clinical practice guideline (CPG) recommendations may efficiently provide a sound source of evidence-based practices for quality indicator development. However, the question is which healthcare processes should be measured. The “Improving quality and patient SAFEty in surgical care through STandardisation and harmonisation of perioperative care in Europe” (SAFEST) project aimed to reach a Europe-wide consensus on perioperative patient safety recommendations for adults that will be further transformed in quality measures and guide implementation activities. To achieve such a goal, a systematic review of CPGs was performed, identifying more than 250 CPGs and more than 2600 recommendations; eventually selected and synthesized into 99 recommendations. Then, we recruited an expert panel including organisations from the European Region, and focusing on a balanced representation of geographical location, clinical and non-clinical expertise, and gender. A two-round online Delphi was conducted, and a Consensus Conference was held in Brussels. During the entire process, some recommendations were reworded, separated, merged, added or removed. Additionally, feasibility and equity concerns emerged and were further explored in-person during the conference. Finally, a list of 101 perioperative patient safety recommendations was agreed. These evidence-based practices incorporate clinical and managerial experts’ considerations as well as patient representatives’ reflections. In conclusion, this presentation will explore the relationship between recommendations and quality of care indicators. We will discuss the usefulness of SAFEST evidence-based recommendations, and their pros and cons as process and structure quality measures.
Gender-specific differences in at-risk alcohol consumption among older German adults
Authors: Geigl C , Spagert L , Janssen C 
Published: October 2023

Abstract

Background
At-risk alcohol consumption can lead to serious health effects among older adults for several reasons. Older adults generally tolerate alcohol less well due to a slower metabolism, and interactions with medications are more common (as the likelihood of being dependent on medication increases with age). In addition, older people have an increased risk of falling. This analysis examines alcohol consumption among older German adults as well as gender differences in alcohol consumption and at-risk consumption.

Methods
Cross-sectional data of adults aged 65 and older were collected through a community-based full-population postal survey in Puchheim, Germany (n = 1687, 33% response rate, 52% female). The validated AUDIT-C screening instrument was used to assess at-risk alcohol consumption. Gender-specific analyses of average alcohol consumption (t-test) and at-risk alcohol consumption (chi-square test) were performed. Binary logistic regressions were conducted separately by gender to estimate the likelihood of at-risk alcohol consumption depending on socioeconomic status.

Results
Older men had a higher average in alcohol consumption than older women, t(1491) = 11.18, p &lt; .001, d = .6. However, in at-risk alcohol consumption, older women (26%) were more often affected than older men (21.4%), χ2(1) = 4.13, p = .042, φ =.05. Higher socioeconomic status increased the likelihood of at-risk alcohol consumption among older women, OR = 1.08 (95%−CI[1.011, 1.153], p = .022), but not among older men.

Conclusions
At-risk alcohol consumption among older German adults affected one in four women and one in five men. Surprisingly, more older women reported at-risk alcohol consumption than older men, and it was associated with a higher socioeconomic status only in older women. This information is important for developing targeted interventions, especially for older women.

Key messages
• One in four older women and one in five older men are affected by at-risk alcohol consumption.
• There is a higher likelihood of at-risk alcohol consumption among older women who report a higher socioeconomic status.
Costing the mental health harms of sexual and physical violence in adulthood: a prevalence-based analysis
Authors: McManus S , Barbosa E C , Walby S 
Published: October 2023

Abstract

Background
When economists estimate how much violence ‘costs’, they rarely address the longer-term mental health harms resulting from sexual violence or the combined impact of sexual and physical violence, nor have most gender-disaggregated costs.

Methods
We applied prevalence-based modelling techniques to estimate the annual cost of experience of violence in adulthood, in terms of reduced quality of life and health service costs. Data were drawn from multiple sources, including the general population probability sample Adult Psychiatric Morbidity Survey. Prevalence and duration estimates used weighted data. Adjusted marginal effects for limiting mental health conditions and substance dependence were estimated for experience of sexual violence, physical violence, and sexual and physical violence combined. Disability weights were applied to estimate associated reduced quality of life and relative risks applied to health service delivery costs.

Findings
The estimated cost in 2019 of long-term reduced quality of life adults in England experienced because of violence during their adult years was £3,767 mil (€4,290 mil), with associated healthcare costs of £4,130 mil (€4703 mil). Both the costs of long-term lost quality of life and healthcare were higher in women than men. The costs associated with combined sexual and physical violence were particularly high, with an estimated 96% of these costs resulting from experiences of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim.

Conclusions
Sexual and physical violence both have substantial and independent associations with long-term mental distress, substance dependence and treatment and service use. Violence reduction interventions have the potential to reduce health service costs and increase population level quality of life. Future costings of sexual violence should fully incorporate the long-term impacts on mental health and gender-disaggregate estimate.