bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socioeconomic inequalities in smoking and drinking in adolescence: social network dynamics
Authors: Rado M K , Kisfalusi D , Laverty A A , van Lenthe F J , Been J V , Takács K 
Published: October 2023

Abstract

Background
Network-based interventions have the potential to prevent socioeconomic inequalities in health behaviors but require a good understanding of the underlying social network mechanisms. We investigated whether (1) adolescents selected friends with a similar socioeconomic status (SES), (2) smoking and alcohol consumption spread in networks, and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.

Methods
We applied Stochastic Actor Oriented Models to the complete social network data (“Wired into Each Other” data) of 253 adolescents in eight Hungarian secondary school classes over three waves between 2010 and 2013. SES was measured based on entitlement to an income-tested regular child protection benefit.

Results
High SES adolescents were most likely to form friendships with peers from their own SES group (odds ratio [OR] = 1.1, 95% Confidence Interval [CI] = 1.0-1.1). Adolescents adjusted their smoking behavior (OR = 24.0, 95% CI 1.3-454.9) but not their alcohol consumption (OR = 1.6, 95% CI 0.6-4.4) to emulate the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 1.0, 95% CI 0.9-1.1), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.2, 95% CI 1.0-1.3), but this association was not significantly different according to SES.

Conclusions
Socioeconomic inequalities in health behaviors were driven by preferences to form friendships within their own SES group and the spread of smoking and alcohol consumption in the network. These inequalities were not amplified by SES differences in encouraging smoking or drinking.
Main messages: In three waves of observations in a Hungarian adolescent cohort, the study found social network effects for inequalities in smoking and alcohol consumption.

Key messages
• Inequalities in health behaviors arise because adolescents with high socioeconomic backgrounds selected each other as friends and smoking/alcohol consumption spread in networks.
• Inequalities were not due to socioeconomic differences in encouraging harmful behaviors.
6.M. Workshop: Private equity investment in Europe’s primary care sector
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Bernd Rechel (European Observatory)
Published: October 2023

Abstract

This workshop explores the growing role of private equity funds in Europe's primary care sector. Based on a rapid response report of the European Observatory on Health Systems to the French National Health Insurance Fund (Caisse nationale de l’assurance maladie, CNAM), it offers a platform for sharing examples from across Europe, facilitating cross-country learning through country presentations and audience participation. Private equity investments in Europe’ health sector have increased exponentially in recent years, including in primary care, but this trend has so far received very little attention. This is surprising, as this development has the potential to change the healthcare landscape in Europe dramatically. The short investment and resale horizon of private equity funds and the emergence of practice chains and monopolistic structures are of particular concern. Ultimately, the growing private equity involvement in Europe's primary care sector could undermine equitable access to health care, reduce physicians’ autonomy, affect local or regional cooperation, erode data protection and raise health care costs. However, private equity investments may also be associated with benefits, such as providing needed capital or enabling employment for young physicians who want to work part-time or do not want to run a practice as entrepreneur. So far, there is little transparent information on ownership structures and very little research on the impact of private equity investments on outcomes, such as equity, access and quality of care. This workshop aims to provide a snapshot of trends in Europe and to inform current debates on how regulators should best respond. It provides an overview of the situation in four European countries (Germany, the Netherlands, Ireland and Sweden) and of policy responses so far. The workshop will provide opportunity for the audience to comment on and discuss the country presentations, share experience in their own countries, and consider policy options in Europe to improve transparency on ownership structures and ensure the interests of patients, the public, and health workers are protected. The workshop will be of interest to researchers, practitioners and policy-makers working on primary care in Europe.

Key messages
• The workshop provides a forum for discussing the growing role of private equity investment in Europe's primary care sector.
• It explores regulatory options to safeguard the interests of patients, health workers and the public.
Private equity investment in Germany's primary care sector
Authors: Tille F 
Published: October 2023

Abstract

Background
A major reform of the primary care sector in Germany that included a new law on health system financing in 2004 introduced new tools to be used by “entrepreneurial doctors”. These new tools provided opportunities for corporate investments into primary care, including through private equity funds (PEFs). Since then, there has been a stark increase of private investments.

Methods
A review of academic and grey literature, media reports and relevant organizational websites.

Results
Investments by PEFs in Ambulatory Health Care Centres (in German: Medizinische Versorgungszentren, MVZs) have increased continuously in recent years, and latest estimates suggest that in 2020 about 750 of overall 3800 MVZs were owned by PEFs. However, exact and robust data on how many MVZs are owned by PEFs do not exist, as there are no (legal) requirements for disclosures of these investment and ownership structures in Germany. Often, investors are located in tax havens, making the identification of ownership difficult. In addition, a PEF investing into an MVZ may include one health care facility, several dozens or over 100, depending on how well developed the network is (sometimes including long-term care facilities), further complicating an understanding of ownership status. The public debate on private equity investments in Germany's health system has been intensifying in recent years and a number of concerns have been raised, leading to calls by medical chambers for stricter regulation. Federal Minister of Health, Karl Lauterbach, announced in late 2022 that a law prohibiting private equity acquisitions of MVZs would be forthcoming in 2023.

Conclusions
The involvement of PEFs in Germany's ambulatory health care centres has increased substantially in recent years, leading to increasing public concerns and calls for stricter regulation.
Commercial general practice chains in the Netherlands
Authors: Groenwegen P , Timans R 
Published: October 2023

Abstract

Background
Traditionally, Dutch GPs are self-employed professionals who run a general practice either alone or in cooperation with other GPs. This traditional governance model of general practices has recently been supplemented with new models that involve private investors and general practice chains, with different ownership conditions, different relationships with health workers, and different earnings models.

Methods
We conducted a review of academic and grey literature and of media reports. We also analysed the dataset on general practitioners and general practices held by the Netherlands Institute for Health Services Research (Nivel) where we are based.

Results
The number of practices that are part of a commercial provider is highly uncertain. Our analysis of the Nivel dataset on general practitioners and general practices found 120 practices that were staffed with locums only. These could potentially be part of for-profit chains. However, it is likely that this also includes different forms of not-for-profit cooperations between GPs. Moreover, we found 108 practices which employed practice holders as salaried employees and were not registered as (non-profit) foundations. We estimate that the number of commercially run practices in the Netherlands is somewhere between 45 and 230 practices (out of the 4,874 practices registered in 2022). No research has so far been undertaken in the Netherlands on the consequences of the emergence of practice chains for service provision, but both positive and negative consequences are possible. The risks of decreased accessibility and continuity of care have resulted in ongoing investigations by the Inspectorate for Health Care and Youth and the Dutch Health Care Authority.

Conclusions
Several general practice chains have emerged in the Netherlands and some of these are commercial, but precise data on numbers are not available. Concerns have been raised on the impact of this development on service provision.
Large investors’ involvement in Ireland's primary care centres
Authors: Mercille J 
Published: October 2023

Abstract

Background
In 2001, Ireland announced a Primary Care Strategy that has led to the implementation of primary care centres (PCCs) throughout the country. This presentation examines the nature and extent of private sector involvement in establishing the PCC network since 2001, focusing on large global investors.

Methods
A dataset on all primary care centres in Ireland was constructed, comprising information on geographical location, the year that it became operational, and its delivery mode (public procurement, lease, or public-private partnership). A survey of large investment patterns was also conducted through the grey literature and news reports.

Results
By 2023, 172 PCCs are planned to be operational, developed through public, leased or public-private partnerships arrangements. Before 2009, PCCs were delivered by traditional public procurement, but since 2009, private delivery methods have been prioritized. Leased primary care centres have been attractive for large institutional investors attracted by stable rental income. This paper surveys the patterns and trends involved.

Conclusions
Trends in large multinational and domestic investments in the primary care market should be documented systematically because they have the potential to transform the existing PCC network and primary care system.
Hepatitis C virus screening in Piemonte: an effective strategy to eliminate HCV chronic infections
Authors: Thomas R , Castella A , Audisio L , Fasano P , Maina P , Massobrio G , Simoncini M , Zanella D , Minniti D , Dall’Occo F 
Published: October 2023

Abstract

In 2016, WHO set the goal of elimination of Hepatitis C Virus (HCV) by 2030. Globally, about 58 million people have chronic HCV, which causes cirrhosis, hepatocellular carcinoma and death (around 300000 in 2019), representing a heavy burden for public health. In Italy, the incidence of HCV acute infection is around 0.11 per 100000, and the estimated number of non-diagnosed chronic infections is 280000. In order to reach WHO's goal, the Istituto Superiore di Sanità (ISS) and the Ministry of Health implemented a strategy based on the detection of silent chronic infections and their treatment with direct-acting antivirals (DAAs), which cure around 95% of HCV infections. Therefore, in 2022, Regione Piemonte started a screening program contacting all residents born between 1969 and 1989. The screening was performed with rapid blood tests (antibodies detection, sensibility and specificity ca. 99%), and in case of a positive result, a HCV-RNA test was offered to confirm chronic infection and the need for treatment with DAAs. The Local Health Authority TO3, invited 36120 out of 158017 eligible residents (temporary and permanent), in the period March 2022 - April 2023 with invitation letters or catch-up strategies on other occasions; 6000 rapid blood tests were used (16.6% of invited population), and 11 (0.19%) tested positive. The RNA test confirmed 5 (0.08%) results. All the positive subjects were referred to 2 hospitals for DAAs treatment. As demonstrated by ISS, HCV screening could represent an effective mean to meet WHO's goal of HCV elimination by 2030 and also allow us to reduce HCV's burden on public health; although, with the current low adhesion rate, these results may not be reachable. Therefore, it is necessary to implement health promotion campaigns, to involve more stakeholders, including social and healthcare associations, General Practitioners and policy-makers, as the entire population's health would benefit from a successful HCV elimination program.

Key messages
• HCV and viral hepatitis represent a heavy burden for public health, high costs for Health Systems and severely affect the quality of life of subjects with un-diagnosed chronic infections.
• The availability of reliable, non-invasive, tests and of extremely effective treatments should move policy-makers to allocate more resources in the implementation of HCV eradication strategies.
Comparison of predictors for long-term survival and healthcare costs of cancer patients in Scotland
Authors: Haining K , Lone N , Lemmon E , Hall P 
Published: October 2023

Abstract

Background
New cancer treatments can improve prognosis, but may impact on the sustainability of health systems due to additional healthcare use by survivors of cancer. This study compared predictors of long-term healthcare costs with predictors of survival in a national cohort of people with cancer, with an aim of identifying factors associated with both improved survival and reduced costs.

Methods
This was a retrospective cohort study using linked administrative healthcare data from NHS Scotland. Participants were people diagnosed with a first malignant cancer (1st Jan 2009 to 31st Dec 2010). The outcomes were incident healthcare costs derived from inpatient episodes, outpatient visits and prescription costs. Univariable and multivariable Cox and GLM regressions were used to evaluate the predictors (age, sex, area deprivation, method of detection, pre-diagnosis costs, rurality, region, stage of detection, comorbidities).

Results
55,807 individuals with cancer were followed over eight years after diagnosis and found to incur substantial healthcare costs (mean £29,460 at 2017 GBP, 95% CI £29,199 to £29,720). Variables negatively associated with costs tended to be positively associated with hazard of death, e.g., age &gt; =80 (adjusted cost ratio 0.55, p &lt; 0.001; adjusted hazard ratio 5.94, p &lt; 0.001), stage IV (adjusted CR 0.69, p &lt; 0.001; adjusted HR 3.14, p &lt; 0.001), history of dementia (adjusted CR 0.51, p &lt; 0.001; adjusted HR 1.69, p &lt; 0.001). Only screening as a method of first detection was significantly associated with both lower costs (adjusted CR 0.85, p &lt; 0.001) and lower hazard of death (adjusted HR 0.30, p &lt; 0.001).

Conclusions
Screening was associated with both improved survival and reduced healthcare costs. These results support the current priorities of national public health agencies and research funders to focus investment on improving early diagnosis.

Key messages
• Factors associated with reduced post-diagnosis healthcare costs tended to be associated with poorer survival.
• Screening was associated with reduced healthcare costs and better survival.
Snapshot of CSE landscape in Eastern European and Central Asian countries and introduction to SERAT tool
Authors: Yepoyan T 
Published: October 2023

Abstract
Comprehensive sexuality education when delivered in schools by well-trained teachers consistently over several years following an evidence-based informed curriculum can empower learners to realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and understand and ensure the protection of their rights throughout their lives. However, too many young people globally including in Eastern Europe and Central Asia are deprived of the right to such education. Some countries like Ukraine, Republic of Moldova, Armenia and Kyrgyzstan have made elements of sexuality education part of the school curriculum. Other countries have integrated into the curriculum topics related to physical, mental and reproductive health but find it challenging to discuss in the classroom gender, sexuality and relationships because of resistance coming from political and religious circles as well as from parents. To support countries to collect data and analyze the strengths and gaps in their health education programmes, UNESCO has devised an excel-based tool called SERAT (Sexuality Education Review and Assessment Tool). Once data is entered into SERAT, results are presented in bar charts, which are automatically created, to enable immediate analysis of the strengths and weaknesses of a programme. The tool also helps to assess the relevance of a sexuality education programme in relation to the national context and SRH priorities. SERAT is based on the International Technical Guidance on Sexuality Education (UNESCO, 2018).
Translation of SERAT findings into concrete steps to advance CSE in Georgia
Authors: Bandzeladze M 
Published: October 2023

Abstract
The 2018 revision of the National Educational Curriculum in Georgia made the first attempts to integrate selected CSE topics into two school subject standards - biology and civic education. The Ministry of Education and Science recognizes that the changes introduced in the National Curriculum and school subject standards in 2018 are not sufficient and is therefore committed to gradually expanding the coverage of topics in the formal education system and strengthening the process through informal education. To support this initiative and assess the current quality of school-based sexuality education in the country, an analysis was conducted using SERAT. Overall, the legal and policy context in relation to many CSE components is quite well developed in Georgia. The curriculum development process is very participatory, with the involvement of teachers, parents, students and experts. While the general curriculum for CSE focuses on equity and equal rights for all, gender-specific topics, especially on sexuality, are not covered. Using SERAT, the Ministry of Education and Science of Georgia clearly identified the gaps within the National Curriculum and started the process of revising the two subject standards (Biology and Civic Education) to ensure the coverage of more topics within the framework of the formal education system per UNESCO standards. The Ministry initiated a project School Doctor's Hours with the technical assistance of UNFPA CO Georgia. The project envisages conducting informational sessions with the children enrolled in the elementary education. Finally, Civil Society representatives started actively using the findings of SERAT either in their advocacy efforts or while designing projects on CSE. SERAT findings greatly informed the process of designing the comprehensive communication campaign entailing work on the policy, community and individual levels, while simultaneously working with the traditional and new media for changing public discourse on CSE.
How should we monitor marketing foods to children for their better eating habits?
Authors: Gregorio M J 
Published: October 2023

Abstract
There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS). Furthermore, there is convincing evidence that HFSS marketing in traditional media has detrimental effects on children's eating and eating-related behaviour, and HFSS marketing in digital media has similar effects with stronger effect in vulnerable groups. According to the WHO Commission on ending childhood obesity, efforts must be made to ensure that children everywhere are protected against the impact of marketing and given the opportunity to grow and develop in an enabling food environment - one that fosters and encourages healthy dietary choices and promotes the maintenance of healthy weight. Children are being continuously exposed to powerful food marketing, increasingly in the digital environment. Best-ReMaP partners were exploring how to better monitor food marketing and advertising activities, in particular of promotional activities targeted to and/or impacting children at one hand, and how could marketing activities could be better regulated. Main actions of Best-ReMaP consortium in this field were as following, among others: (1) to identify, develop and share best policy practices to reduce exposure of children to the (digital) marketing of unhealthy foods, (2) develop coordinated and comprehensive protocols and tools to monitor the extent and nature of (digital) marketing exposure of children, including the upgraded WHO nutrient profile model, and to (3) support Member States with the implementation of the new EU rules on audiovisual media services.
Using Causal Loop Diagrams (CLDs) to inform the development of Directed Acyclic Graphs (DAGs)
Authors: Avila-Palencia I 
Published: October 2023

Abstract
Complex systems-based approaches, like causal loop diagrams (CLDs), are increasingly being used in population health studies. Traditionally, directed acyclic graphs (DAGs) have been frequently used in causal inference methods in population health studies to define analysis plans and identify potential biases. The use of those two methodologies has been suggested to be incompatible due to DAGs being apparently unsuitable for modelling systems containing feedback loops, a common feature of complex systems. In this presentation we will detail the steps and decisions that a research team could follow to translate a CLD into a series of DAGs.