bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast Cancer Screening: Navigating the Complexities of Informed Consent
Authors: Newport H , Donnelly P 
Published: October 2023

Abstract

Background
Breast cancer ranks as a leading cause of death worldwide, however screening has become controversial in recent years due to new evidence suggesting the risks may outweigh the benefits. Whilst being the target of organised screening programmes, the average women overestimates both their own risk of breast cancer and the benefit gained from screening attendance. It is unclear whether a woman would make the same decision to participate if she was fully informed. This review aims to examine current evidence for the relationship between informed consent and screening participation rates.

Methods
A literature search was performed over 3 databases to find studies relating breast cancer screening, informed consent, and participation. 11 original studies and 4 systematic reviews were identified as relevant. Outcomes for knowledge/informed choice and resultant intention/attendance were extracted then evaluated.

Results
Results were diverse in regards to relationship. 4 of 8 original studies with an increase in knowledge/informed choice found a decrease in attendance/intention. The remaining 4 found no significant difference. Similarly, the systematic reviews found a decrease in 2 of 4, while the remaining found no change. On evaluation, follow up time was found to be a potential confounding factor. Studies measuring outcomes over multiple time periods found more significant differences at earlier recordings. This may indicate a relationship between increased knowledge/informed choice and decreased delay to attendance.

Conclusions
This review highlights the need for healthcare providers to ensure that women are fully informed about the risks and benefits of screening. While some women may still choose to participate, others may opt out, raising questions on the balance of patient autonomy and provision of healthcare. Ultimately, it is the duty of healthcare providers to empower women with the knowledge they need to make informed decisions about their health.

Key messages
• Women may opt-out of breast cancer screening if fully informed about risks/benefits. Providers must empower patients to make informed decisions, while balancing effective healthcare and autonomy.
• The ethical principle of patient autonomy requires informed consent for medical interventions. Empowering women with knowledge about may make them opt out, however this right is crucial to respect.
10.K. Workshop: Evaluating the effectiveness of health promotion and prevention
Authors:   Organised by: BZgA - Federal Centre for Health Education (Germany), RIVM (Netherlands), Finnish Institute for Health and Welfare (Finalnd),   Chair persons: Ursula von Rueden (Germany), Djoeke Van Dale (Netherlands)
Published: October 2023

Abstract

The discussion about evidence and the ‘right’ form of evaluation for assessing effectiveness in the field of health promotion and prevention continues to be controversial in the relevant literature. Randomised controlled trials analogous to evidence-based medicine as the ‘gold standard’ of effectiveness research are often rejected as inappropriate for the evaluation of health promotion and prevention interventions because they would not do justice to the complexity of the interventions. In the search for alternatives, system-theoretical approaches for dealing with complexity are reflected. The evaluation of effects moves in the field of tension between simplicity and complexity, which is difficult to map. In the application of impact models, the use of a generic framework model, which roughly represents the intervention logic (‘theory of change’) is recommended. An important implication of evaluating interventions in the field of health promotion and prevention is that effects can not only be measured in numerical ways. To address this, approaches are needed to evaluate interventions also with qualitative research and mixed methods. In order to disseminate evidence-based practices which have been evaluated, evaluation criteria are needed to determine the degree of effectiveness, evidence, and practical applicability. The organisers will share their experiences and perspectives of different methods for evaluating the effectiveness of health promotion and prevention, and discuss the advantages and challenges of approaches with the workshop participants. Three countries (the Netherlands, Finland and Germany) will present different approaches resp. aspects of evaluating health promotion and prevention measures. The different contributions will be discussed and the participants will be invited to share their experiences and successes.
With the objective to:
• Illustrate the role of health literacy in the evaluation of health promotion and prevention interventions (Germany)
• Present a checklist for qualitative research and mixed methods, criteria for an assessment system of interventions as well as first results of the pilot study (Netherlands)
• Present the evaluation criteria of evidence-based practices to be selected for the national best practice portal (Finland)
• Reflect and discuss the different aspects of evaluation to contribute to a better understanding and implementation of methods to ensure effectiveness in the complex contexts.

Key messages
• To give insight into new attempts of evaluating effectiveness of health promotion and prevention in Europe.
• To reflect and discuss advantages and disadvantages of the different evaluation approaches.
Work-stress, coping, and emotional exhaustion of school principals in Germany and Switzerland
Authors: Sandmeier A , Dadaczynski K , Okan O , Skedsmo G 
Published: October 2023

Abstract

Background
While student and teacher health enjoy a high level of interest in health research, research on the health of school leaders has hardly been studied so far, especially in the German-speaking countries. How school leaders cope with work-related stress and the extent to which work-related coping behaviors are associated with mental health has not been studied to date. This paper focuses on the relationship between work-related stress and exhaustion of school leaders in Germany and Switzerland during the COVID-19 pandemic, using the job demands-resources model.

Methods
Data from the COVID-HL school leadership study are used, which was conducted in 2021 with N = 2186 school leaders from Germany and N = 293 school leaders from Switzerland. Structural equation modeling in R (R Team, 2020) is used to model the relation of stress, coping strategies, and exhaustion. Coping behavior, measured as different strategies for dealing with stress, is examined as potential explanation for the relationship between stress and exhaustion.

Results
The study shows systematic country differences to the disadvantage of German school leaders for all factors: German school leaders report to be more stressed, and they engage more in self-endangering coping strategies such as intensification of work, extensification of worktime or quality reduction in their work. In addition, German school leaders are more exhausted than Swiss school leaders. Stress is associated with exhaustion and is partly mediated through the strategy of intensifying work (working in a pace that is burdensome). Stress also causes school leaders to work longer hours and reduce the quality of work, but this has no further influence on exhaustion.

Conclusions
School leaders should become a target of school health promotion. There is a need for a holistic stress prevention, which promotes not only healthy work conditions but also adaptive coping strategies.
Years of life lost associated with COVID-19 deaths in Portugal: two years of pandemic
Authors: Martins C , Santos J , Assunção R 
Published: October 2023

Abstract

Background
The impact of the COVID-19 pandemic on the Portuguese population is still underexplored. Therefore, the characterization of years of life lost (YLL) due to this epidemic may provide relevant data for establishing effective strategies in future epidemics. The aim of this study was to calculate YLL associated with COVID-19 deaths in Portugal between 2020 and 2022.

Methods
This was an observational, cross-sectional study. Data on the average resident population and life expectancy at birth by age group and sex were obtained from Statistics Portugal (INE) and GBD 2019 standard life-table, respectively. Data on COVID-19 deaths were extracted from the Directorate-General of Health's (DGS) reports. YLL was calculated as the number of COVID-19 deaths multiplied by standard life expectancy at the age of death, globally, by sex and age group. YLL was calculated by 100,000 population and age-standardized.

Results
Between 2020 and 2022, 3413013 cases of COVID-19 were reported in Portugal, of which 21342 (0.6%) eventually died of the disease. The number of deaths by sex was similar globally or by age group. Globally, the YLLs estimated for COVID-19 in Portugal were 309383,8. YLLs were higher for males than for females for most age groups except of age groups 10-19 yrs (76.56 vs 153.11) and &gt; 80 yrs (58710.88 vs 68491.44). YLLs age-standardized also showed a steady increase as we progressed in the age group [from 3.25 (0-9 yrs) to 885.54 (&gt;80 yrs)], in which from the 50-59 yrs age group onwards we observed a steeper slope of increase in YLLs.

Conclusions
COVID-19 has had a major impact on mortality rates in Portugal, with this impact being greater in the older population, especially in people aged over 70 years. Also, males presented higher YLLs than females, with this difference increasing substantially as age increases. These insights can be useful in terms of public health as the disease progresses to an endemic phase.

Key messages
• COVID-19 has had a major impact on mortality rates in Portugal.
• Calculating YLLs associated with COVID-19 in Portugal provides relevant data for establishing effective strategies in future epidemics.
Quality of life among people with different chronic diseases – A Finnish population-based study
Authors: Jääskeläinen T , Pietilä A , Härkänen T , Koskinen S , Koponen P 
Published: October 2023

Abstract

Background
In Finland, the associations between different chronic diseases and quality of life have not been comprehensively studied since the early 2000s. Updated information is needed. The aim of this study was to assess how much different common chronic diseases impair quality of life in the adult population.

Methods
This cross-sectional study was based on the FinHealth 2017 Study (sample n = 10 000) representing the Finnish adult population. The study population comprised 5208 individuals (PR 52%; aged 25+) whose quality of life (QOL) was measured using the EUROHIS-QOL 8-item index (EUROHIS-8). The overall EUROHIS-8 score was calculated by summing the scores on the eight items, with higher scores indicating better QOL. The mean value (ranging 1 to 5) of EUROHIS-8 was used. A total of 14 common chronic diseases including both psychiatric and somatic diseases were determined from the national health registers. Weighted mean values based on predictive margins were analyzed using linear regression models adjusted for age, sex, education, marital status, and other chronic diseases, taking into account the sampling design and non-response.

Results
Most of the chronic diseases studied impaired the quality of life. The lowest EUROHIS-8 mean scores were observed in individuals with depression (3.35; 95% CI 3.24, 3.46) compared to those without (4.01; 95% CI 3.99, 4.03) followed by Parkinson's disease (3.64; 3.45, 3.82 vs. 3.98; 3.96, 4.00), severe psychological disorders (3.75; 3.60, 3.89 vs. 3.98; 3.96, 4.00), rheumatoid arthritis (3.79; 3.69, 3.89 vs. 3.98; 3.96, 4.00), stroke (3.82; 3.66, 3.97 vs. 3.98; 3.96, 4.00), heart failure (3.84; 3.74, 3.94 vs. 3.98; 3.96, 4.00) and diabetes (3.84; 3.78, 3.91 vs. 3.99; 3.97, 4.01).

Conclusions
In the Finnish adult population, quality of life is impaired especially in those with mental disorders and in those having chronic diseases which limit physical functioning. Promoting the prevention of common chronic diseases is essential.

Key messages
• In social and health care, it is important to identify those people who are at the greatest risk to impaired quality of life and support their mental and physical functioning.
• Health promotion actions to improve the prevention of chronic diseases are essential to promote quality of life and reduce human suffering at the population level.
A cost-utility analysis on a multicomponent intervention for fibromyalgia syndrome in Spain
Authors: Arfuch V , Aguilar Martín C , Berenguera A , Caballol Angelats R , Queiroga Gonçalves A , Carrasco-Querol N , Friberg E , Pettersson E , Casajuana M 
Published: October 2023

Abstract

Background
Fibromyalgia is a chronic musculoskeletal condition associated with widespread pain, fatigue, and other somatic symptoms that reduce functionality and quality of life. Its significant economic burden for society urges improving the usual clinical practice.

Methods
This study presents a trial-based cost-utility analysis on a multicomponent intervention programme (MCI) for patients with fibromyalgia compared to the usual clinical care in Catalonia's primary care centres. This economic evaluation was conducted from a societal perspective, a human capital approach, and a one-year time horizon. The study outcomes included direct medical costs, productivity losses, and quality of life. Quality-adjusted life years (QALYs) were calculated using the SF-6Dv2 metric algorithm. Subsequently, crude and adjusted incremental cost-utility ratios (ICUR) were estimated to compare the treatment strategies and one- and two-way deterministic sensitivity analyses were performed.

Results
The complete case analysis comprised 297 individuals (161 in the intervention group / 136 controls). The obtained crude ICUR of €1,780.75 per QALY gained, and the adjusted ICUR of €851.67 suggested that the increase in participants’ quality of life outweighed the cost increase as they fell below the cost-effectiveness threshold. Furthermore, the sensitivity analyses supported the robustness of the results when variating large cost components and increasing therapeutic adherence, which endorsed the implementation scheme.

Conclusions
Given its cost-utility for society, the study's results support including the proposed MCI as part of the standard regional practice for patients with fibromyalgia. These findings provide decision-makers with evidence to enhance the healthcare approach to fibromyalgia syndrome, reduce its social burden and improve patients’ quality of life in a context of medical uncertainty.

Key messages
• The usual clinical practice for fibromyalgia syndrome urges improving its therapeutic approach in a scenario of medical uncertainty.
• Patients with fibromyalgia syndrome can benefit from multicomponent intervention programmes that cover physical, psychological and health education needs reducing the economic burden for society.
Involving Older People in Co-creation of Social Health Promoting Activities in a Senior Village
Authors: Terkelsen A , Jespersen J , Gulis G , Andersen P T 
Published: October 2023

Abstract

Background
Since 2018 the municipality of Esbjerg has been engaged in the WHO global network for age-friendly cities in which they are obligated to have age-friendly visons and strategies. With an establishment of a senior village with shared facilities, the municipality offers its older citizens an environment with opportunities to co-create social activities. Experiences of co-creation initiatives with older people are sparse and it is thus important to explore the benefits and drawbacks of this initiative.

Objectives
To co-create social activities with older people in senior village with shared facilities to develop a sustainable solution to the welfare challenge of a rising number of older people and a lack of staff to keep up the level of service for securing health and well-being in old age.

Methods
The co-creation initiative consisted of an initial information meeting inviting older people interested to participate in social activities followed by a series of workshops framing activity groups with concrete ideas for activities. Employees from the municipality facilitated the workshops and attended all activity groups during implementation.

Results
150 older people attended the information meeting and the following workshops generating 12 activity groups, each managed by one or two older people. However, interviews with older people involved in the co-creation process suggested barriers for co-creation at both individual and organizational level: Personal resources for organizing and managing social activities among older people were less than expected due to high average age of participants, while the level of information from the municipality on the intention, aim and anticipations on active involvement of citizens was scanty.

Conclusions
Informing older people about the intentions and aim of a co-creation process and aligning expectations between stakeholder is essential early in the process to guide the optimal utilization of personal and organizational resources.
Promoting students’ digital health literacy: does learning in school make a difference?
Authors: Renninger D , Stauch L , Fischer L , Hartmann A , Ranow P , Dadacznyski K , Okan O 
Published: October 2023

Abstract

Background
Given the increasing use of digital media among schoolchildren and the resulting opportunities concerning health information seeking and use, it appears important to equip them with the necessary skills to access, understand, appraise, and apply online-based information. The school setting is key to strengthen digital health literacy (DHL). This study examined differences in students’ DHL between those who learned the respective skills at school and those who did not.

Methods
Face-to-face interviews using a standardized questionnaire were conducted with N = 1,448 secondary schoolchildren (9-18 years) to assess their DHL. DHL was assessed using a translated and adapted version of the DHLI. Learning DHL skills in school was assessed using specifically developed items along the seven dimensions of the DHLI. Chi-squared test assessed associations of learning skills with sex, age and subjective family affluence. T-Tests indicated mean skill differences between students who learned the respective skill in school and those who did not.

Results
About 50% of students reported to have learned DHL skills in school. More girls than boys reported to learn skills to seek information (X2 (1) = 6.86, p = .009) and determine information relevance (X2 (1) = 6.92, p = .009). With increasing age and decreasing family affluence, more students reported to have learned DHL skills. On average, students who learned the respective skill in school also reported higher levels regarding operation skills t(1172.55) = 4.04, p &lt; .001, adding self-generated content t(224.51) = 4.68, p &lt; .001, information seeking t(1163.58) = 14.89, p &lt; .001, determining relevance t(1257.21) = 12.19, p &lt; .001, and evaluating reliability t(1200.06) = 14.38, p &lt; .001.

Conclusions
Children and youth largely benefit from learning DHL in school. Nevertheless, there is a need to combine DHL interventions and measures with existing curricular requirements to ensure students’ skill acquisition from an early age.
Sociodemographic features of COVID-19 premature mortality: Serbian individual-level data evidence
Authors: Stevanović A , Šantrić-Milićević M , Todorović J , Mandić-Rajčević S , Rosić N , Bjelobrk G , von der Lippe E , Devleesschauwer B 
Published: October 2023

Abstract

Background
In Serbia, premature mortality due to COVID-19 usually has been assessed using aggregated mortality data, thus overlooking the impact of sociodemographic factors. Within the European Burden of Disease Network (COST Action CA18218), we examined the association between several sociodemographic factors and COVID-19 years of life lost (YLL) to reveal potential social inequalities.

Methods
The Statistical Office of the Republic of Serbia (SORS) has provided disaggregated, anonymized, and individual data on COVID-19 deaths in 2020 and 2021 from death certificates having U07.1 and U07.2 ICD codes as the main cause of death. Additionally, SORS remaining life expectancy and population size estimates were used along with sociodemographic data for each YLL case (sex, time and place of death, type of residential settlement, educational attainment, marital status, and economic activity).

Results
In the observed two-year period, 38,098 COVID-19 death cases were assessed, of which 72.8% were registered in 2021. The average YLL per death case was 12.51±7.62, and the median YLL was 11.50 (12.60±7.44 for men and 12.39±7.85 for women, p &lt; 0.006). The multivariate linear regression indicated a significant association between the number of YLL and sex (B = 1.02, p &lt; 0.01), residential area (B = 0.21, p &lt; 0.01), educational attainment (B = 0.84, p &lt; 0.01), marital status (B = 1.65, p &lt; 0.01), employment (B=-7.02, p &lt; 0.01) and place of death (B=-1.76, p &lt; 0.01).

Conclusions
This study demonstrates social inequalities in COVID-19 premature mortality associated with the highest YLL among men, single persons, retired persons, and those with higher education status. We identify significant differences in YLL when comparing different regions.

Key messages
• Individual-level data reveals differences in premature mortality aggravated by social disparities.
• Policymakers should consider sociodemographic factors when designing COVID-19 prevention measures.
Impact of the transition to retirement on smoking habit: longitudinal results from SHARE project
Authors: Bertuccio P , Vigezzi G P , Mosconi G , Gallus S , Odone A 
Published: October 2023

Abstract

Background
In an ageing society, the impact of retirement on behavioural risk factors and health status needs to be carefully assessed. There are few longitudinal studies on the short-term and long-term effects of retirement on smoking habits.

Methods
A longitudinal study was conducted based on data from the Survey on Health, Ageing and Retirement (SHARE) collected between 2004 and 2020 in 27 European countries and Israel. A repeated measure generalized estimating equation (GEE) model was fitted to estimate the relative risks (RR) and corresponding 95% confidence intervals (CI) of smoking status and its intensity at seven different time periods before and after retirement.

Results
We selected a cohort of 8,998 individuals who were employed at baseline and retired during follow-up (median follow-up: 9 years; maximum: 16 years). Compared to the year of retirement, the RR for smoking was 1.59 (95% CI 1.44-1.76) 10 years before retirement and 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking habits decreased steadily after retirement, with a RR of 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46 to 0.74) 10 years or more after retirement. For ever-smokers, the estimated daily number of cigarettes smoked decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p-trend &lt;0.001).

Conclusions
Longitudinal data suggest that positive lifestyle changes and adaptations may occur as people reach retirement age. Further research is needed to better guide strategies that promote healthy ageing.

Key messages
• Our findings indicate that retirement has a positive impact on smoking habits, regardless of geographical and individual sociodemographic factors.
• This study is the first to examine the short- and long-term effects of retirement transition on risky behavior among a large European retiree cohort using SHARE data.