bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Health Coordination: An evaluation of the first pilot training program in Lower Austria
Authors: Griebler U , Klingenstein P , Grillich L , Moick S 
Published: October 2023

Abstract

Background
Starting from 2018, the University of Krems and ‘Tut gut!’ Gesundheitsvorsorge GmbH have jointly implemented the two-year academic program ‘Regional Health Coordination’, which trains students to become a Regional Health Coordinator (RHC). It is funded by the Lower Austrian Health and Social Fund. We evaluated the pilot-program and the work of the RHC in the first two years after graduation. The objectives of the evaluation were to provide 1) a basis for further development of the academic program and 2) an assessment of the achievement of the program objectives.

Methods
The evaluation ran from 2018 to 2022 and followed a mixed-methods approach. Qualitative interviews and focus groups with stakeholders, document analyses of annual RHC activity reports and repeated written community surveys in 13 municipalities were conducted.

Results
The evaluation showed that RHCs already bundled health promotion (HP) activities and worked on their HP network within the municipalities during the practical training period. HP was given a higher priority in some municipal administrations. The pilot program was consistently rated positively, and the curriculum was optimized. In the first two years after graduation, the RHCs developed and implemented HP measures and endeavoured to engage citizens. However, genuine involvement was rare. The results showed that future HP interventions should especially target older people, less educated and male citizens. RHCs were seldomly involved in health policy decisions, although they often worked with mayors. Personal characteristics, an existing network in the community and support from the local government were success factors for the work of the RHCs.

Conclusions
RHCs play an important role in the coordination of community HP but should be stronger included in local policy decision-making. Citizens should be more involved in planning and implementing HP measures.

Key messages
• An academic training program for regional health coordination helped to improve community health promotion.
• An existing network and the involvement in the local government facilitated the work of graduated regional health coordinators.
Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood
Authors: Grigorian K , Östberg V , Raninen J , Låftman S B 
Published: October 2023

Abstract

Loneliness and a sense of belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. The dual continuum model has been suggested (Lim et al., 2021) where these two constructs are regarded as independent but related. Four groups of individuals are defined in the model depending on the level of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially searching (high loneliness, high belonging), socially distressed (high loneliness, low belonging), and socially indifferent (low loneliness, low belonging). Swedish cohort data collected among late adolescents (age 17-18 at baseline in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the association between these distinct groups of individuals and psychosomatic complaints. Three psychosomatic complaints were measured: stomach aches, headaches, and sleeping difficulties, and a summary index (range 3-15) was calculated. Linear regression analyses showed that loneliness and a sense of belonging were cross-sectionally associated with psychosomatic complaints (additional adjustment for sociodemographic characteristics barely affected the estimates). The socially fulfilled group reported fewer psychosomatic complaints compared with the other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Furthermore, the socially indifferent group reported fewer psychosomatic complaints than the socially searching group. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, only the socially distressed group showed a significant positive association with subsequent psychosomatic complaints. These findings confirm that the dual continuum model reflects the complexity of social needs and their association with health complaints.

Key messages
• The categorisation of the conjoint relationship of loneliness and belonging helps to reveal more nuanced links between these two constructs and psychosomatic complaints in young people.
• Knowledge of the more nuanced links between loneliness, belonging, and health complaints can be beneficial for developing specific, targeted public health recommendations and interventions for youth.
Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature
Authors: Hintermeier M , Pernitez-Agan S , Lopez J , Wickramage K , Gottlieb N , Baroudi M , Rohleder S , Flores S , Mohsenpour A , Bozorgmehr K 
Published: October 2023

Abstract
National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.
Artificial light at night and breast cancer risk: The findings from CECILE study (France)
Authors: Prajapati N , Cordina E , Boileau A , Faure E , Guénel P 
Published: October 2023

Abstract

Background
Environmental exposure to artificial light at night (LAN) has become ubiquitous in modern societies. Experimental and epidemiological studies suggested that LAN exposure disrupts circadian rhythm, inhibits melatonin production, and increases the risk of breast cancer.

Objectives
We aimed to assess the association of exposure to outdoor LAN with breast cancer risk, along with possible effect modifications of this association.

Methods
We used data from a population-based case-control study, including 1185 incident breast cancer cases and 1282 healthy controls enrolled in 2005-2007 from two French departments- Côte d’Or and Ille-et-Vilaine. Data for outdoor LAN exposure was obtained using radiance-calibrated images from Defense Meteorological Satellite Program (DMSP) for 1995-2006. Exposure was assessed for 10 years before inclusion in the study by cross-referencing the DMSP images and the geocoded locations of residences in ArcGIS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the association, adjusting for sociodemographic factors, urbanization, reproductive factors, lifestyle-related factors, night shift work, and air pollution.

Results
The overall OR for breast cancer per 1 interquartile range (IQR) increase in LAN exposure (159.9 nW/cm2/sr) was 0.98 (95% CI: 0.81-1.17). Subgroup analyses showed slightly higher ORs in post-menopausal women (OR: 1.15; 95% CI: 0.97-1.37) and a stronger association for HER2-positive breast tumors (OR: 1.55; 95% CI: 1.03-2.31).

Conclusions
We did not find any overall association between outdoor LAN and breast cancer; however, possible associations in certain subgroups were indicated. The strength of this study was the use of calibrated satellite images for exposure assessment and the consideration of a large set of potential confounders. Further large-scale studies using improved exposure assessment methods, including blue light and indoor exposure measurement, are required.

Key messages
• Light pollution is growing as the newest form of environmental pollution in modern society, potentially affecting health.
• More studies are required to explore and ascertain its public health impact.
The development of a social prescribing glossary of terms to facilitate engagement & communication
Authors: Newstead S , Wallace C 
Published: October 2023

Abstract

Background
Social prescribing (SP) offers an alternative and adjunctive form of holistic support for many issues, through engagement in community-based activities. SP has undergone a period of growth and development, accompanied by a diverse and confusing terminology that creates barriers to engagement and communication.

Methods
We used a mixed methods approach to collate the terminology associated with SP: Consultation with the SP workforce, a group concept mapping study (GCM), and a scoping review of UK peer-reviewed literature and Welsh grey literature.

Results
We identified a total of 426 terms, many of which described the same specific elements of SP. Scoping review data was charted from 205 documents: 60% of terms occurred solely in peer-reviewed literature, 20% occurred solely in Welsh grey literature, with an overlap of 10% across both sources. Grey literature contained a higher number of terms per article. Data from the scoping review and GCM study indicated a bias for articles and terminology from England and the healthcare sector that does not necessarily reflect the terminology commonly used by the SP workforce. Preferences for some terms were sector-specific, although many of the terms identified were seemingly used interchangeably with little standardisation across and within specific services.

Conclusions
This research highlights the breadth and diversity of the terminology associated with SP. Results were used to produce an innovative and interactive glossary of terms, in the form of a PDF and a website. Unlike traditional glossaries, it incorporates a description of the terms, shows the connectedness of terms, and identifies alternative terms and preferences for certain terms across sectors. The glossary of terms for SP provides an informative reference tool for the general public, SP workforce and commissioners. It will improve understanding across sectors and professions, and facilitate the standardisation of the language associated with SP.

Key messages
• The language associated with social prescribing is diverse and confusing, creating barriers to engagement and impairing communication with the public, and across sectors and professions.
• The glossary of terms for social prescribing, that resulted from this research, provides an informative reference tool for the general public, social prescribing workforce and commissioners.
Tingbjerg Changing Diabetes: Experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighborhood in Copenhagen, Denmark
Authors: Termansen T , Bloch P , Tørslev M K , Vardinghus-Nielsen H 
Published: October 2023

Abstract

Background
As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study thus contributes with important insights on the role of context and how it contributes complexity in community-based health promotion.

Methods
The study is based on 18 months of ethnographic action research in the local community where the first author participated in the development and implementation of one of TCD's activities, a community restaurant, alongside partner representatives and residents, including participant observations and 9 in-depth interviews with key partner representatives.

Findings
Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners’ navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness.

Conclusions
The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.
Bridging social work and health care: The example of Integrated Diabetes Intervention in Tingbjerg
Authors: Tetens A , Boye M C , Bloch P , Tørslev M K 
Published: October 2023

Abstract

Background
In Denmark, type 2 diabetes (T2D) is on the rise particularly among people in vulnerable positions and of low socioeconomic status. People with T2D often have a complex course of treatment that includes continuous contact with different parts of the healthcare system. For the most vulnerable groups however, navigating diabetes related health services can be challenging and may be a decisive obstacle. Low socioeconomic status is associated with a low degree of participation in screening programmes and low compliance with treatment and rehabilitation. Tackling this problem requires collaborative action across the social and the health sector, a challenge that remains unsolved within the field of diabetes. Thus, coordinated diabetes initiatives are required to ensure that people in vulnerable positions achieve optimal benefits from diabetes treatment and rehabilitation.

Methods
This presentation will introduce Integrated Diabetes Intervention in Tingbjerg (IDIT), a holistic diabetes intervention with the dual aim of a) strengthening the motivation and capacity of residents in vulnerable positions to participate in diabetes-related treatment initiatives and b) strengthening collaboration and partnerships in the field of diabetes between key stakeholders in the municipality, the region, and the civil society. IDIT works across the social and the health sector to bridge the gap between the two and offer coherent and integrated treatment and rehabilitation based on the need of the individual.

Findings
Based on findings from one year's intervention period (still ongoing), this presentation will discuss the potentials and challenges associated with integrating social work and health care for populations in vulnerable positions. Thus, it showcases how a Supersetting approach to diabetes care may provide sustainable solutions to tackle low compliance with treatment and rehabilitation among people in vulnerable positions
Effect of a health service integration on health care use of patients with alcohol disorders
Authors: Laatikainen T , Lamidi M-L , Wikström K 
Published: October 2023

Abstract

Background
In North Karelia, Finland an integration of all levels of health and social services was carried out in 2017. One of the usual targets in the service integration is to increase the performance of the service system especially in the care of patients with high use of services. The aim of this study was to assess the impact of the performed integration on the use of health services among patients with alcohol use disorders (AUD).

Methods
Data on all health care contacts of patients with AUD (n = 4344) covering both primary and specialized care was obtained from the electronic patient records for years 2016 to 2020. Patients having AUD were identified using AUD related ICD-10 diagnosis codes that were either set permanent for the patients or recorded at health care contacts. Information on the type of the contact (appointments and remote contacts), reason of contacts (ICD-10 code) and the professional providing the service (physician, nurse or other health professional) was collected.

Results
The proportion of patients with any yearly contact to health services was about 90% and did not change after the integration. The proportion of those having alcohol related contacts declined in the whole patient population, but not among the cohort having AUD related diagnosis already in 2016. Appointments decreased and remote contacts increased, but this was not associated with the year of the integration. Especially remote contacts to nurses in outpatient services increased remarkably during the two last years of the study.

Conclusions
Integration had very little effect on service use of AUD patients. It seemed that the overall trend with increasing remote contacts and decreasing appointments in the health services explain the observed changes. The decline of alcohol related contacts in the whole patient cohort can be explained by the identification of patients with less complicated and advanced diseases as the recording of diagnosis codes has improved.

Key messages
• Organizational integration of health and social services had very little impact on the service use of patients with alcohol use disorders.
• There is a need of better functional integration.
Complex vaccination strategies prevent the emergence of vaccine resistance
Authors: Rella S A , Kulikova Y A , Minnegalieva A R , Kondrashov F A 
Published: October 2023

Abstract

Background
Vaccination is among the most effective tools to control infectious diseases. However, the evolution of vaccine resistance, exemplified by vaccine-resistance in SARS-CoV-2, Influenza or Hepatitis B, remains a concern. As an attempt at containing antigenic evolution, multi-epitope vaccines were proposed, but displayed varying success. Rapidly evolving pathogens call for alternative vaccination procedures.

Methods
We model complex vaccination strategies against a pathogen with multiple epitopes, by diversification of available vaccine targets across the vaccinated population. Our analytical model incorporates within-host evolution in response to vaccination (in form of an evolutionary Wright Fisher model) as well as between-host pathogenic spread (in form of a stochastic transmission model). The model allows analyzing how the combined effects of different life history properties of a pathogen affect the evolution of novel resistant variants.

Results
Vaccine resistance in highly infectious pathogens was prevented by the full-vaccine, one targeting all available epitopes, but only when the rate of pathogen evolution was low. Strikingly, a bet-hedging strategy of random administration of vaccines targeting different epitopes was the most effective in preventing vaccine resistance in pathogens with low rate of infection and high rate of evolution.

Conclusions
Complex vaccination strategies utilizing a diversified vaccine portfolio may be preferable to the currently used single-vaccine approaches for long-term control of disease outbreaks. Depending on the rate of evolution and the transmissibility of a pathogen, an optimal vaccine portfolio may greatly reduce the risk of newly evolving variants. Given the biological feasibility and our knowledge about the life history of a pathogen, we recommend stronger consideration of diversification in vaccine design.

Key messages
• Diversification of vaccine targets reduces the pathogens propensity to evolve vaccine resistance.
• Fast evolving pathogens are best contained by random administration of diverse multi-epitope vaccines.
Prevalence of healthcare-associated infections and antibiotic use in Sicilian hospitals in 2022
Authors: Barchitta M , Maugeri A , Campisi E , La Mastra C , La Rosa M C , Manoli M , Favara G , Magnano San Lio R , Agodi A 
Published: October 2023

Abstract

Introduction
Point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of the fourth PPS conducted in Sicilian acute care hospitals (Italy) in 2022.

Methods
The PPS was conducted according to the 6.1 version of the European Centre for Disease Prevention and Control protocol. Each ward carried out a single-day surveillance, including all patients admitted to the ward before or at 8 a.m. and not discharged at the time of the survey. The definition of an active HAI relied on the presence of signs and symptoms, the day of onset of symptoms in relation to hospital admission, and the possible presence of an invasive device before infection.

Results
We used data from 4496 patients from 52 acute care hospitals in Sicily (Italy), with a mean age of 60.7 years (50.9% females). Patients exposed to medical devices were 13.1% for central venous catheter, 37.6% for indwelling urinary catheter, and 4.0% for mechanically assisted ventilation. Antibiotic treatment was given to 48.6% of patients. Overall, our survey found 8.3% patients with at least one active HAI on the survey day. Of a total of 369 HAIs for which information was available, the most commonly reported types were pneumonia (22.2%), urinary tract infections (20.1%), and surgical site infections (10.3%).

Conclusions
Approximately one in 12 patients has a HAI on a given day in Sicilian hospitals. This estimate is higher than that obtained through the previous Sicilian PPS conducted in 2018 (8.3% vs. 5.1%). By contrast, the proportion of patients who received at least one antimicrobial agent was lower than in 2018 (48.6% vs. 53.7%). Nevertheless, the high prevalence of HAIs observed underlines the need for maximising infection, prevention and control strategies and antibiotic stewardship programs against HAIs and antimicrobial resistance.

Key messages
• The prevalence of HAIs in Sicilian hospitals is higher than previous years.
• There is the need for actions against HAIs and antimicrobial use at regional, national, and global levels.