bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why is care use declining? Changes in residential long-term care between 1999 and 2018 in Finland
Authors: Korhonen K , Moustgaard H , Murphy M , Martikainen P 
Published: October 2023

Abstract

Background
Residential long-term care (LTC) coverage has declined in many countries over the past decade. However, it is unclear to what extent the decline is attributable to a smaller proportion of older people entering or shorter time spent in LTC, and if the change has been similar across sociodemographic groups. This study analysed changes in life expectancy in LTC at age 65, the proportion ever entering, and years spent in LTC among those who entered, and quantified the contributions of changing rates of admission, mortality and exit to the change in life expectancy in LTC.

Methods
We analysed linked population register data that covered all Finnish residents aged 65+ between 1999 and 2018 (n = 2,016,987) on dates of entries to and exits from LTC, dates of death, and sociodemographic characteristics. We estimated transition rates between home, LTC and death, and calculated multistate life tables by sex, marital status and education across four periods 1999-2003, 2004-2008, 2009-2013 and 2014-2018.

Results
Life expectancy in LTC increased from 0.75 to 0.89 years among men and from 1.61 to 1.83 years among women between 1999-2003 and 2003-2008. The increase was mainly attributable to declining rates of exit from LTC, and thereby longer time spent in LTC for those who entered. Life expectancy in LTC started declining in 2009-2013 and reached 0.80 years among men and 1.51 years among women in 2014-2018. The decline mainly related to an increasing death rate in LTC. In all periods, declining mortality in the community contributed to an increase in life expectancy in LTC, but this was offset by steady declines in admission rates. Life expectancy in LTC changed similarly across marital status and education groups.

Conclusions
Recent declines in LTC use - driven by lower rates of entry and higher mortality in LTC when entered - imply that across sociodemographic strata it is has become more difficult to find LTC placement and older people enter LTC in ever worse health.

Key messages
• Overall LTC use increased in early 2000s despite declining admission rates. The increase was mainly due to declining exit rate from LTC indicating longer time spent in LTC for those who entered.
• The recent shortening of life expectancy in LTC derives from entering LTC at a later stage and closer to death, indicating greater level of disability and worse health at the time of entry.
Community-centred yet little community health: The paradoxes of the German health system
Authors: Cassens M 
Published: October 2023

Abstract
Due to its history of development since the middle of the 19th century, the German health care system is almost exclusively dominated by pathogenesis and the resulting reactive treatment. Insiders dub it “repair medicine”. The situation of community health in Germany is very heterogeneous: On the one hand, the community is referred to as the ‘mother of all settings’. In health services research, it is also referred to as the third pillar of the health care system, alongside inpatient and outpatient care. On the other hand, it cannot and must not be ignored that public budget cuts hit public health structures very hard. Ultimately, the COVID-19 pandemic exposed the deficits caused by thirty years of consistent austerity policies. National surveys shows that the already weak public image of the community health structures has once again suffered a massive loss of confidence among the population during this period. The OECD points out that the health behaviour of the population in Germany deteriorated significantly more during the pandemic than was the case in countries which have had strong health promotion structures for decades. The municipality as the ‘mother of all settings’ could and should have intervened here - but did not. In the context of the ‘Public Health Service Pact’ the German government is currently implementing nationwide so-called ‘health stores’ with a focus on socio-economic hotspots in large cities. Concerned here are low-threshold offerings across the entire spectrum of health promotion and prevention. In this regard, we are also currently involved in an Erasmus KA 203 project with the title ‘Family Health Advisor’. From the German perspective, the project sustainability will depend on the extent to which we manage to transfer the project contents into community health structures, which the ‘Public Health Service Pact’ will bring with it in the next few years.
Evaluation of a city-region initiative to galvanise a community response to gambling-related harms
Authors: Jenkins C , Mills T 
Published: October 2023

Abstract

Background
Community interventions have an important role in public health strategy for gambling harms yet many interventions are shaped by stigmatising notions of individual responsibility. This presentation describes a process evaluation of an intervention for galvanising community-level innovation, administered by a city-region government. The intervention comprised 12 community projects, a Lived Experience Advisory Panel and a Community of Practice.

Methods
The process evaluation focused on refining a coproduced logic model. Data collection consisted of n-42 qualitative interviews and a short survey (n-21) with stakeholders, including commissioner-facilitators, project leads and people with Lived Experience, during intervention delivery. Thematic analysis and complex intervention modelling were carried out with the outputs of this refined through consensus discussion.

Results
The modelling exercise revealed a highly complex intervention that was suited to the poorly understood, hidden and stigmatised issue of gambling-related harms. The Community of Practice fostered group identity, collaboration and learning, with commissioner-facilitators expanding this to support the sustainability of the community projects. The Lived Experience Advisory Panel helped develop project outputs and non-stigmatising health messages although impact on the community projects varied. Stigma and commercially-driven gambling normalisation presented challenges to projects with the greatest impact evident on skill development among professionals and community actors. The city-region government adapted its gambling harms strategy based on learning generated.

Conclusions
The findings suggest the combination of a Community of Practice, Lived Experience and commissioner-facilitation effectively galvanised a community response to gambling harms, generating vital learning for the field. Public health actors should explore applying the approach for other emerging and contested public health issues.
Community Health Workers in Spain: a missing strategy to tackle hepatitis in migrant populations
Authors: Picchio C , Nicolàs A 
Published: October 2023

Abstract
Community health workers (CHWs) are health care providers which live and serve in the community and are responsible for the provision of health education to their communities, promoting healthy habits and lifestyles, diagnosing common illnesses, and encouraging the use of health services by linking people to health services. CHW programmes have been formally included as part of national health systems in many low- and middle-income countries (e.g., Ethiopia or Brazil), along with some high-income countries (e.g., Canada). Despite the major contribution CHWs have proven to make in health systems globally, Spain has yet to introduce a law acknowledging their role in the health system. The introduction of CHWs allows for the decentralization of health services and their extension beyond the regular forms of health service delivery (e.g. primary health centres or hospitals) as additional strategies for equity and person-centred care. CHWs have the capacity to reach underserved and vulnerable populations, including marginalized populations, which often encounter barriers to engage with their health systems. Migrant communities in Spain are an example of communities which are often marginalized and struggle to have their health needs met through their host health system. For instance, studies have reported a significantly higher prevalence of chronic infection of Hepatitis B virus (HBV) among migrants in comparison to the general Spanish population and late presentation to care in this population has been reported. CHWs have the potential to reach these underserved communities and provide culturally and linguistically appropriate health information, emphasizing the importance of HBV prevention, management and treatment, and vaccination. Ultimately, CHWs can offer decentralized and accessible health care and lead in co-creation processes for effective viral hepatitis - including HBV vaccination- services in community spaces and facilitate linkage to higher levels of care.
Self-endangering work behaviour of Polish school principals during the COVID-19 pandemic
Authors: Leksy K , Gawron G 
Published: October 2023

Abstract

Background
During the COVID-19 pandemic, the work-related demands of school principals grew incredibly, and many experienced overwork and stress. This study focuses on three self-endangering work behaviour (SEWB) subscales - work extensification (EW), intensification (IW), and quality reduction (QR) - among Polish school principals during COVID-19 and its association with respondents’ well-being (WHO), exhaustion (EXH), and psychosomatic complaints (PC). Taking care of the health of school principals and teachers is particularly important in the context of European public health as they are crucial models of health attitudes for students as future citizens.

Methods
The results come from an online survey among school principals in Poland. The survey was conducted in 8 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire. Descriptive statistics, Kendall's Tau correlation, and regression models were conducted. Sociodemographic characteristics (gender, age, and type of school) were considered the control variables.

Results
The study confirmed increasing respondents’ EW (62.6%) and IW (52.5%) during the COVID-19 pandemic. The rise in EW was associated with lower WHO (τ = -0.25), greater EXH (τ = 0.29), and PCs (τ = 0.23). The more respondents intensified their work, the lower well-being declared (τ = -0.36). With the increase in IW and QR, WHO decreased, and the level of EXH and PC grew. Male and older school principals less frequently felt PC.

Conclusions
The study suggests that SEWB presented by Polish school principals during the COVID-19 pandemic was associated with respondents’ WHO, EXH, and PC. These findings could be a baseline for policymakers for multidimensional interventions to reduce school principals’ SEWB and prevent overwork and burnout in Polish school principals.
School principals stress, wellbeing, and health literacy during the Pandemic
Authors: Meyer M , Dadaczynski K , Messer M , Okan O 
Published: October 2023

Abstract

Background
Mental health of school principals is poorly researched in public health, despite principals being critical to the success of sustainable school development. They are the key agents enabling and leading the implementation of school health promotion, which elevates the importance of their mental health state. Evidence shows that principals are more likely to suffer from work-related stress and psychological strain, but given the additional stress during the Covid-19 pandemic, their mental health was more at risk. Health literacy could be an asset in the interplay of mental health and stress. The aim of this study is to examine the associations between principals’ corona-specific health literacy and their perceived stress, wellbeing, and psychosomatic complaints.

Methods
As part of the international COVID-HL school principal survey, an online study among German school principals in four federal states was conducted during the third infection wave (Mar-Apr 2021). Health literacy, perceived stress, wellbeing, and psychosomatic complaints were measured using self-report tools. Descriptive statistics, variance with subsequent post-hoc analyses and effect sizes were computed.

Results
A total of N = 2186 principals completed the survey, with 60.5% showing an adequate, 31.4% a problematic and 8.1% an inadequate health literacy level. Welch's ANOVA indicated significant differences between the health literacy levels and perceived stress (F(2, 423.734) = 69.51, p &lt; 0.001; η2 = 0.06) as well as wellbeing (F(2, 407.343) = 33.463, p &lt; 0.001; η2 = 0.034). One-way ANOVA showed significant differences between health literacy and psychosomatic complaints (F(2, 1775) = 15.94, p &lt; 0.001; η2 = 0.018).

Conclusions
The findings emphasize that health literacy could be an asset for principals’ mental health, suggesting to include health literacy more frequently to public mental health promotion interventions. This will require an acknowledgment from public health and educational policies.
Risk-benefit assessment of foods – status, challenges, and opportunities
Authors: Thomsen S T 
Published: October 2023

Abstract
Evaluation of tradeoffs between toxicological and microbiological risks and nutritional risks and benefits associated with food consumption is a relatively new research field. Several initiatives have been taken to develop and harmonize approaches to assess health risks and benefits of foods in an integrated assessment - risk-benefit assessment. Today, the pool of published risk-benefit assessments of foods is still very heterogeneous with respect to e.g. evaluation of weight of evidence, methodology and degree of quantification and integration of risk and benefits. It is a research area in continuous development and has the potential to support decision making in food safety and nutrition. This presentation will set the scene for the workshop by introducing the concepts of RBA of foods and provide an overview of different methods to make such assessments based on examples of previous studies and ongoing research within the field. Emphasis will be put on the various measures of health risk-benefit balance, ranging from qualitative to quantitative approaches, and their individual strengths and weaknesses. The presentation will round off with a discussion of current challenges in RBA and highlight opportunities for further developments in the field.
Holistic approaches for risk-benefit assessment
Authors: De Matteu Monteiro C 
Published: October 2023

Abstract
Moving towards holistic approaches that assess trade-offs among health, sustainability, and economics is imperative to minimize emergent risks and drivers of environmental degradation associated with food systems. Health risk-benefit assessments provide informative outputs to support decision-making within the public health domain. However, integrating indicators from different dimensions requires tailoring current risk-benefit methods. In this context, multicriteria decision analysis methodologies can be relevant to account for different factors and weighing trade-offs of real-life scenarios of changes in food systems. In addition, further research building on initiatives attempting to integrate frameworks within health (e.g., risk analysis) and environment (e.g., Life-Cycle Assessment and linear programming) or health and economics (e.g., cost-benefit and cost of illness), is needed to establish a holistic risk-benefit assessment framework. This presentation will introduce current efforts in the development of holistic assessment methods that evaluate impacts beyond the health risk and benefits perspective. In addition, the presentation will highlight the potential gains of such methods in policymaking.
The impact of COVID-19 on the demand of arthroplasty
Authors: Guarducci G , Dragoni L , Golinelli D , Messina G , Nante N , Carbone S 
Published: October 2023

Abstract

Background
Nowadays healthcare systems are affected both by a growing demand for prosthetic surgery, and by an increase of patients’ migration who are seeking a place of care more suited to their needs. This study aims to evaluate the impact of COVID-19 on patients’ migration for lower limb arthroplasty in Italy's regional healthcare systems.

Methods
We conducted a cross sectional study on Hospital Discharge Cards provided by the Italian Ministry of Health from 2015 to 2020. We considered hospitalizations for lower limb arthroplasty (Diagnosis Related Groups 544; 545 and 471). We analyzed the interregional patients’ migration, comparing the average number of admissions in the years 2015-2019 with that of 2020. Regional data of Residents, Attractions and Escapes, were graphically represented through Gandy's Nomogram (GN).

Results
In years 2015-2019, the GN shows that all regions satisfied care needs of their Residents, except for Basilicata, for which the number of Escapes is greater than the number of residents hospitalized in their own region. However, only Piedmont, Lombardy, Veneto, E.Romagna, Tuscany, Abruzzo, and the Autonomous Province (A.P.) of Bolzano showed an Attractions minus Escapes positive balance. However, A.P. of Bolzano had a negative balance in 2020, while in Liguria and Molise, the number of Escapes exceeded the admission of residents to regional hospitals. During studied period, Attractions increased for Piedmont, A.P. of Trento, Veneto, Friuli V.G., E.Romagna, Marche, Apulia, and Calabria, while Escapes decreased for Piedmont, A.P. of Trento, E. Romagna, Tuscany, Marche, Lazio, Abruzzo, Campania, Apulia, Calabria, Sicily, and Sardinia.

Conclusions
Hospitalization for lower limb arthroplasty decreased in most of the regions during the COVID-19 pandemic. Piedmont, A.P. of Trento, E.Romagna, Marche, Apulia, and Calabria showed to be the most “resilient” regions, increasing the Attractions, and decreasing the Escapes at the same time.

Key messages
• Mapping flows by type of healthcare service is essential to identify the lack of supply so as to strengthen it in critical areas.
• Italian Regions have responded to the impact of COVID-19 pandemic on hospital activity in different ways.
The impact of the covid-19 pandemic on the subjective well-being of the Belgian population
Authors: Claes S , Vandepitte S , Annemans L 
Published: October 2023

Abstract

Background
Data from European studies suggest that well-being declined during the first year of the COVID-19 pandemic. However, the pandemic's consequences on an overall nations’ well-being remains inadequately explored, especially over time. This study aims to map the long-term impact of the pandemic on the subjective well-being (SWB) of Belgian citizens.

Methods
Using a repeated cross-sectional study design, data were collected in representative samples of the Belgian population at 5 different time points during the period from February 2020 until December 2022. Life evaluation was measured with the Cantril ladder. Positive and negative affect were assessed with the short version of the Positive and Negative Affect Schedule. ANOVA were used to evaluate the evolution in SWB. Moderation analyses were performed to investigate the differential impact of the pandemic for different age categories.

Results
Our results show that the pandemic negatively impacted the SWB of the Belgian population. Life evaluation (F(4,7605)=18.12, p&lt;.001) and positive affect (F(4,7605)=16.83, p&lt;.001) significantly decreased during the second wave and after the fourth wave compared to before the pandemic with a decline of .52 and .37 points respectively for life evaluation and a decline of .18 and .42 points respectively for positive affect (both on a scale between 0 and 10). No statistically significant differences in negative affect were found (F(4,7605)=1.08, p = 0.363). Citizens over the age of 50 appeared to be more resilient than younger citizens as the negative impact of the pandemic was either smaller or delayed in this group for all SWB indicators.

Conclusions
The COVID-19 pandemic clearly impacted the SWB of the Belgian population, and particularly the well-being of younger individuals suffered. We urge policymakers to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society.

Key messages
• The COVID-19 pandemic and its related measures negatively impacted the well-being of the Belgian population, with younger individuals being more susceptible to the negative effects of the pandemic.
• We urge policymakers and governments to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society.
Problems in accessing health care and child survival in 49 low- and middle-income countries
Authors: Kim J , Kim R 
Published: October 2023

Abstract

Background
Access to health care remains suboptimal in many LMICs and continues to hinder children's survival. We aimed to systematically assess the association between problems accessing health care (PAHC) and U5M at the global-, regional-, and country level.

Methods
Data came from the latest Demographic and Health Surveys of 49 LMICs (2013-2021). Child mortality data were available on 721,658 live births born to mothers aged 15-49 years within the five years preceding the survey. Three domains of PAHC were defined for women who identified the following reasons as PAHC for themselves when they are sick: “money needed for treatment” (economic), “distance to health facility” (physical), “getting permission” or “not wanting to go alone” (socio-cultural). Multivariable logistic regression models were used to estimate the association between PAHC (any and by each type) and U5M.

Results
In our pooled sample, 4.7% of children died before age of five and 58.4% of mothers reported experiencing PAHC (ranging from 43.2% in Europe & Central Asia to 71.0% in Latin America & Caribbean). Economic PAHC was the most prevalent (42.7%), followed by physical (36.9%) and socio-cultural (35.2%). After adjusting for a comprehensive set of covariates, children of mothers with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.01, 1.08), and this association was especially significant in Sub-Saharan Africa. Of the different domains of PAHC, socio-cultural PAHC was found to have the strongest association with U5M.

Conclusions
Our findings suggest the need to improve access to health care in LMICs by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers to encompass marginalised populations.

Key messages
• More than half of mothers in low-and middle-income countries had problems accessing health care, and it was associated with increased risk of under-five mortality in children.
• To improve child survival in low-and middle-income countries, economic, physical, and socio-cultural barriers to health care should be improved.