bluuebunny/crossref_metadata_2025_split huggingface dataset:
Link between COVID-19 Vaccination Attitudes and Support for Mandatory Childhood Vaccinations
Authors: Chamova R , Pancheva R , Rohova M , Ivanova E , Hadjieva S , Mikhailov N , Kolarova M , Radeva N , Paunov T 
Published: October 2023

Abstract

Introduction
Despite vaccines being a proven intervention over time to limit the spread of infectious diseases, in recent decades there has been fluctuation among parents regarding the mandatory immunization calendar in Bulgaria.

Aim
This study aimed to investigate the impact of the COVID-19 pandemic on parents’ decisions regarding mandatory immunizations for children in Bulgaria.

Methods
A total of 1200 Bulgarian citizens participated in the cross-sectional study, which included questions related to socio-demographic indicators, COVID vaccination status, attitudes towards mandatory immunization, beliefs in personal doctors, rumors about vaccines, and the desire to vaccinate their own children against COVID-19. Data was analyzed using Jamovi software, and a chi-square test for association was used to investigate the relationship between COVID-19 vaccination status and attitudes towards mandatory childhood vaccinations.

Results
The study found that 93% of the 1133 participants who expressed an opinion on mandatory childhood vaccinations had a positive attitude. Respondents who were vaccinated against COVID-19 and had a positive attitude towards mandatory COVID vaccination were more likely to support mandatory childhood vaccinations – 98.8% vs 1.2% (χ2=27.6; p &lt; 0.001). Those who perceived moderate to high benefits of COVID vaccines were also more likely to support mandatory childhood vaccinations (χ2=43.4; p &lt; 0.001). Participants who had not heard of or did not believe in rumors about COVID vaccines and those who had trust in primary care physicians were more likely to support mandatory childhood vaccinations.

Conclusions
The study indicates that attitudes towards COVID vaccination could influence parents’ decisions on mandatory vaccines for children in Bulgaria. If parents distrust the safety and effectiveness of COVID vaccines, they may also be hesitant towards mandatory vaccinations for children.

Key messages
• Implementation of a proper vaccination policy is necessary to protect public health and limit infectious diseases.
• The COVID-19 pandemic has raised questions about the possibility of including mandatory vaccination against COVID-19 in Bulgaria's immunization calendar.
A&F effectiveness in reducing avoidable health differences: Equity issues & COVID 19
Authors: Tullio A , Valent F , Deroma L 
Published: October 2023

Abstract

Background
Healthcare equity aims to ensure that everyone can access affordable, culturally competent healthcare since everyone has a fair and just opportunity to attain their highest level of health. Italian National Health Service is characterized by the principles of universality and equality with the aim of the progressive overcoming of inequalities and social and territorial imbalances. The development of the principle of equality has made it possible to focus on three different areas in which the corollary of equity must find concrete implementation: access to health benefits and services, health outcomes for individual subjects, and the allocation of resources and services as needed. Key performance indicators (KPIs) are described as essential in studying and enhancing healthcare performance.

Methods
Within the network project EASY-NET (NET code 2016-02364191), we carried out an A&F study in Friuli Venezia Giulia region, Italy, over 4 years, evaluating the equity of emergency healthcare access. We calculated 6 KPIs investigating gender, education, residence, and nationality using administrative health databases. We calculated and compared 2019, 2020, and 2021 KPIs.

Results
We observed a reduction in emergency care access during the pandemic, greater among women than among men, as reported in the literature, and an increase in access among citizens with ‘not detected/no qualification’ scholarship level and citizens with non-EU or not detected country of birth.

Conclusions
Consistently with the literature, since the beginning of the pandemic, the population turned less to emergency health services, above all women. On the other hand, and contextually no-level-of-schooling citizens and non-EU-birth citizens turned more compared to the rest of the population. While healthcare systems were focused on COVID-19, a worrying reduction in access to care was observed, bringing attention to the issue of healthcare equity both during and post COVID.

Key messages
• We observed a reduction of healthcare access in the emergency context, above all for women, since the pandemic began.
• Non-EU-birth citizens and citizens with no level of schooling had more frequent access to emergency health services than the rest of the population in the pandemic context.
Bulgarian bioethicists on patients’ responsibility as a basis for prioritisation in healthcare
Authors: Yankulovska S , Anov A , Veskov L , Mihaylova A , Bakova D , Grigorova A , Mirchev M , Saleva M 
Published: October 2023

Abstract

Background
Patients’ responsibility as a criterion for setting priorities in healthcare has been widely discussed in the academic literature recently while the empirical knowledge is still limited.

Methods
We investigated perceptions of bioethicists within the Bulgarian Association of Bioethics and Clinical ethics (BABCE) on the relevance of patient's responsibility for priority setting in Bulgarian healthcare context through focus group interview. Discussions were recorded and transcribed verbatim. Conceptually driven thematic analysis was used.

Results
The findings suggest that members of BABCE supported the concept of patients’ responsibility but were reluctant to the application of the life style contract as a basis for prioritization in health care. The life style contract was seen as not corresponding to Bulgarian cultural particularities. The existing similar mechanisms in the field of social assistance in our country had proved to be ineffective. The main precondition for introduction of patients’ responsibility was the building of supportive environment on the side of the society and the government. The concept of prospective responsibility was seen as more acceptable than the retrospective responsibility. The participants distinguished other dimensions of personal responsibility such as intentional damages of healthcare facilities, misuse of resources, violence towards health professionals that were considered as deleterious to the healthcare system as the life style induced diseases.

Conclusions
The acceptance of patients’ responsibility as a criterion for prioritization in health care in Bulgaria needs to be studied further among wider professional community and the general public. A field study in the real national conditions would contribute to the development of specific tools to deal with resource allocation issues in our context.

Key messages
• Prioritisation in healthcare is inevitable and patients’ responsibility could be an acceptable criterion under certain conditions.
• National particularities should be studied to find the most appropriate tools to deal with resource allocation issues.
Application of personalized medicine implementation framework: a multi-country analysis
Authors: García Sanz P , Aguilera-Cobos L , Rosario-Lozano M P , Blasco-Amaro J A 
Published: October 2023

Abstract

Background
Personalized medicine (PM) is a rapidly evolving field, and its implementation varies widely across different countries. Some countries have invested significantly in PM research and development, while others still need to adopt these approaches.

Methods
To create a visual map of the PM implementation current state between countries. A framework was applied to determine the PM implementation level. The necessary information was identified and gathered from various sources, including policy documents, national guidelines, websites of major governmental agencies, research organizations, and health technology assessment agencies such as NICE, CADTH, AHRQ, and RedETS.

Results
Our search retrieved 184 full-text documents to fulfill the framework, generating a PM implementation country map. The map reflects the variability between countries based on different factors, particularly social-economic development.

Conclusions
Our PM framework was applied in a multi-country context, ranking countries based on their implementation levels. Our findings can reflect the adoption of best practices to improve implementation efforts. Policymakers, healthcare professionals, and researchers can use our framework to assess PM implementation in their respective regions. Further research is needed to evaluate the framework's challenges, limitations, and performance in different contexts.

Key messages
• Our PM framework was applied in a multi-country context, ranking countries based on their implementation levels.
• Policymakers, healthcare professionals, and researchers can use our framework to assess PM implementation in their respective regions.
The impact of covid-19 pandemic on Albanian health emergency operation centre
Authors: Giusti M , Vannini I E , Caldes M J , De Luca M , Persiani N 
Published: October 2023

Abstract

During the COVID-19 pandemic, each State adopted different health emergency strategies to face this new challenge. After the first hospital centred answer, these strategies promoted the strengthening of the territorial health assistance as better response to population health needs at worldwide level. This approach was especially important in the countries in transition, where the hospital systems are weaker. This research aims to assess the impact of these new health policy strategies on health emergency operation centre (HEOC) in a country in transition. Country case study was found to be the most effective methodology. Albania was a significant case study due to its ongoing efforts to align its national healthcare system with European health standards being in pre-adhesion to the European Union. Moreover, this country has recently implemented a modern national HEOC (2018). The data shows that at the beginning to COVID-19 pandemic, the response by HEOC was limited and mainly hospital-centred. In 2020 only 8% of the calls for COVID-19 to the HEOC had an intervention, that was in the 49% a transport in hospital. Medical consultations and treatments on site were only the 4%. In 2021, the issue of guidelines aimed at giving priority to the territorial health assistance brought to a relevant reduction of calls (-64%). It allowed the HEOC to enlarge its response until to give a response to the 34% of calls. The 15% of calls were managed by medical consultations and 18% by treatments on site. The cases transported in hospital were always the 50% but they decreased off -63% in absolute value. In Albania the implementation of national health policy strategies that have enhanced the territorial response to COVID-19 pandemic, relieved the pressure on HEOC by calls’ reduction. In this way, HEOC focused its efforts on the applications of territorial responses instead of hospitalization, according to national health policy strategies, increasing its responsiveness.

Key messages
• The enhancement of the territorial response to COVID-19 pandemic has eased the pressure on the Albanian HEOC.
• The territorial response to COVID-19 pandemic by the Albanian HEOC especially focused on mainly the provision of medical consultations and treatments on site.
Lung cancer screening by low-dose CT among asbestos-exposed workers in Germany
Authors: Heidrich J , Greiner F , Keller H , Harth V 
Published: October 2023

Abstract

Introduction
The German Social Accident Insurance (DGUV) has introduced lung cancer screening (LCS) by means of annual low-dose CT. Eligibility criteria for the main cohort are age ≥55 years, smoking history of ≥ 30 pack years and occupational asbestos exposure (OAE) of ≥ 10 years with onset before 1985. Medical counselling prior to CT scan is mandatory and supports shared decision-making. After being launched in pilot regions, LCS has been rolled out nationwide since 2017. As guidelines recommend a systematic evaluation for LCS, the research project EVALUNG has been implemented since 2022.

Methods
EVALUNG was designed to evaluate process and outcome of LCS combining quantitative and qualitative elements. The quantitative part is based exclusively on routine administrative and medical data. So far, anonymised data with selected items were used to assess availability of data and potential quality indicators, and to perform initial descriptive analyses in terms of participation rates, suspicious findings and detected lung cancer in first round screening.

Results
By end of 2021, 22,794 eligible persons were offered participation in LCS at least once. Based on first round screening, 12,808 pre-screening medical consultations were carried out and resulted in 9,277 initial CT scans, corresponding to a participation rate of 40.7 % of invited persons, and 72.4 % after medical consultation, respectively. Overall, 931 CT findings (10.0%) required control scans within a shortened interval. A total of 103 persons (1.1 %) were diagnosed with lung cancer, of which almost half (n = 54) were legally recognised as occupational disease.

Conclusions
EVALUNG shows feasibility of a screening evaluation of an occupational cohort based on routine data. However, not all quality indicators for LCS can be covered yet and outcome parameters need to be investigated in more detail in this cohort. Linkage with cancer registry data is an option to enhance data and will be explored further in the project.

Key messages
• Routine administrative data can be used to assess basic outcomes from LCS in an occupational cohort from Germany. Linkage with registry data is desirable to investigate detailed LCS indicators.
• Detection rate in first round LCS in an occupational cohort from Germany was 1.1% and half of detected cases were legally recognised as occupational disease.
Sickness absence after work injuries and post-traumatic stress among white-collar workers
Authors: Farrants K , Alexanderson K 
Published: October 2023

Abstract

Background
There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden.

Methods
A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit.

Results
64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly.

Conclusions
About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD.

Key messages
• About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days.
• Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.
What hinders me returning to work? Sick listed employees own stories
Authors: Lervik L V , Frostestad E , Strømstad K , Gulliksen I G , Lillefjell M , Skogen J C , Aas R W 
Published: October 2023

Abstract

Background
Long-term sick leave can have extensive consequences ranging from the micro- to the macro-level and poses a challenge globally. Low educational level is negatively associated with return to work (RTW) across disorders. Still, there is limited research into which barriers for RTW this group experience. The aim of this study was to identify self-perceived barriers for RTW among employees on long-term sick leave with low educational level.

Methods
We used material from the NOW WHAT RTW Barrier study, a large-scale interview study with long-term sick listed employees from Norway. Employees on long-term sick leave with low educational level (defined here as primary and secondary school level) were included in the current study (N = 122). Using the World Health Organization's classification system of function, disability, and health (ICF), the data was investigated with a qualitative and quantitative content analytical approach.

Results
We identified N = 1,942 meaning units describing barriers for RTW. The frequency of coded barriers was highest for the ICF domain Body Function n = 552(28%, min 0, max 15, mean=4,5), followed by Environmental factors n = 411(21%, min 0, max 17, mean=3,4), Activity limitations n = 352(18%, min 0, max 14, mean=2,9), Personal factors n = 323(17%, min 0, max 16, mean=2,6), and lowest for Participation restrictions n = 151(8%, min 0, max 5, mean=1,2) and Body structure n = 146(8%, min 0, max 9, mean=1,2). The most prevalent ICF sub-domains were Mental functions n = 229(42% of the Body Functions barriers, min 0, max 11, mean=1,9) and Services, systems, and policies n = 257(63% of the Environmental barriers, min 0, max 16, mean=2.1).

Conclusions
Employees on long-term sick leave with low educational level describe a wide range of barriers to RTW. In addition to functional barriers, identifying environmental barriers are important to increase insight and understanding of potential determinants of absence from work for this group.

Key messages
• Identifying RTW barriers related to functional and environmental factors can increase insight and understanding of absence from work for employees on long-term sick leave with low educational level.
• Insight into self-perceived RTW barriers for long-term sick listed with low educational level can contribute to more effective and sustainable RTW processes and further development of RTW services.
Work-related factors and interest in working while drawing an old-age pension
Authors: Polvinen A , Tenhunen S 
Published: October 2023

Abstract

Background
Working while drawing an old-age pension has become more common in recent years. Working is often occasional and part-time, but it has many benefits for individuals and society. Less is known about the importance of work-related factors to post-retirement employment. The aim of this study was to examine whether pre-retirement work-related factors are associated with working and interest in working alongside a pension.

Methods
The Finnish survey data (response rate=68%), supplemented with register data, included 3,212 old-age pensioners aged 55-68 who retired from work on an old-age pension between 2019-2021. The respondents were asked whether they had worked or would like to work while drawing an old-age pension. The survey also included questions about pre-retirement working conditions. Multinomial logistic regression analysis was used to estimate ORs and 95% CI for working while drawing a pension and the interest in working compared to those who had not worked or were not interested in working alongside the pension.

Results
32 percent of old-age pensioners were working or had worked while drawing an old-age pension and 16 percent had not worked but would like to work. 52 percent had not worked while drawing a pension and they were not interested in working. The experience of work being an important area of life was strongly associated both to working while drawing a pension and to interest in working. Those old-age pensioners who found that working competence requirements had increased too much were working less often alongside a pension. The experience of work being too physically demanding was associated with less interest in working alongside a pension.

Conclusions
Our results suggest that favourable pre-retirement work-related factors increase old-age pensioners’ possibilities of and interest in working alongside a pension.

Key messages
• Many work-related factors, such as physical workload or finding work as an important area of life, are associated with working and being interested in working while drawing an old-age pension.
• From a policy perspective, more attention should be placed on improving older workers’ working conditions to induce more people to continue working while drawing a pension.
The impact of overweight on employment outcomes: a review of the evidence
Authors: Kesaite V , Greve J 
Published: October 2023

Abstract

Background
Overweight has been recognised as a significant public health issue. Several hypotheses have been posed to explain the impact of overweight on employment outcomes, including the role of productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of overweight on labour market outcomes worldwide.

Methods
We searched Econ Lit, Medline, and Web of Science databases for relevant studies from 1st Jan 2010 to 20th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used Mendelian Randomisation methodology and have been published since 2010. Only those studies with measures of overweight and employment outcomes were included.

Results
The number of potentially relevant studies constituted 4,321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were carried out in the USA (N = 18), followed by the UK (N = 9), Germany (N = 6), Finland (N = 4), and non-EU countries (N = 22). Evidence from the included studies suggests that the overweight effect differs by gender, ethnicity, country, and time period. White women with obesity in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are more likely to experience overweight/obesity related labour market penalties such as reduced likelihood of employment, and when employed they also face lower wages compared to non-overweight counterparts. For men there is no evidence of an effect of overweight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases.

Conclusions
This review has shown that despite ample research on the impact of overweight on employment status and wages, robust causal evidence on the effects of weight status on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions.

Key messages
• The first study to evaluate the evidence base and the methodology of studies that assessed the economic consequences of overweight.
• There is a need for better identification approaches and more recent datasets, especially from low-income countries.