bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiological Profile of Tuberculosis in Tunisia
Authors: Mansouri A , Bouguerra H , Belkahla M , Gzara A 
Published: October 2023

Abstract

Introduction
Tuberculosis (TB) is still a public health problem causing significant morbidity in several countries. In 2020, TB was the second global leading cause of death from an infectious disease, behind COVID-19. Despite the continuous efforts of the national tuberculosis control program, Tunisia remains a country with intermediate tuberculosis endemicity. The objective of this study was to describe the incidence of tuberculosis from 2018 to 2021 and its epidemiological profile in Tunisia.

Methods
This is a descriptive study of the national tuberculosis surveillance data within the framework of the national tuberculosis control programme. All new confirmed cases notified and registered for treatment were included. Data was entered through a registration and notification platform (WEB TBS), which is available in all governorates. Data collected included age, gender, governorate, clinical form. Data analysis was using SPSS-21.

Results
The incidence rate decreased from 28/100,000 inhabitants in 2018 to 22.46/100,000 inhabitants in 2021. In 2021, 2647 new cases were recorded. The majority were aged between 15 and 64 years old (80.4%). More than half were females (52.4%). There was an increasing trend of extra-pulmonary tuberculosis. It affected 64.6% of cases in 2021, mainly lymph node forms (68.5%). The incidence varied considerably by region; from 59.3/ 100,000 inhabitants in Ariana to 7.3/ 100,000 inhabitants in Monastir (2021). The number of reported cases of co-infection (TB-HIV) increased from 0.09 to 0.14/100,000 inhabitants.

Conclusions
Despite the overall decline, there is still a long way to go to reach the target of ending TB by 2030. More adherence to control activities is needed in the most affected regions, including early case detection, patient monitoring and epidemiological investigations. There is also an urgent need to develop an effective strategy to control lymph node tuberculosis, which becomes an increasing burden on the national program.

Key messages
• From 2018 to 2021, there was a national decline in TB incidence, but some regions remain highly endemic.
• With the increase of extra-pulmonary tuberculosis, appropriate preventive and control measures should be taken.
Challenges and opportunities for continued access to effective antibiotics - what role for the EU?
Authors: Anderson M , Panteli D , Mossialos E 
Published: October 2023

Abstract

Large pharmaceutical companies have withdrawn from antibiotic R&D because of the high risk of failure and because antibiotics are less profitable than other areas; small and medium-sized enterprises (SMEs), which now drive antibiotic R&D, face difficulty securing funding for preclinical and early clinical trials, and risk significant economic losses when launching new antibiotics. To reinvigorate the antibiotic pipeline, a holistic package of aligned incentives is required, which takes into account public health factors, improves return of investment while supporting SMEs, and considers operational feasibility including potential political, regulatory, legislative, industry and financial hurdles. This presentation will highlight the main options in this area. Improving access to effective antibiotics requires both short- and longer-term measures. Reducing regulatory administrative hurdles, engaging in good procurement practice, increasing joint purchasing efforts, and considering payment models that de-link revenue from sales can keep older (but effective) antibiotics on the market by ensuring their economic viability. Strengthening the mapping of production capacities and product availability can improve transparency and identify options for action, while stockpiling and strengthening manufacturing capacities within and outside of the EU can boost the supply chain itself. Concrete measures and their feasibility will be briefly presented. The EU has a major role to play by supporting antibiotic R&D and engaging with other international efforts to promote optimal deployment of incentives, by ensuring that the lack of access to appropriate and effective antibiotics is recognized as a threat to global health security, and by building on its relationships with international institutions to act as a facilitator in the global space towards ensuring synergies among existing structures, communicating the cost of inaction, and supporting national and regional initiatives.

Speakers/Panelists
Danilo Lo Fo Wong
Division of Country Health Programmes, WHO/Europe, Copenhagen, Denmark
Malin Grape
Ministry of Health and Social Affairs, Stockholm, Sweden
Lieven De Raedt
Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
Pharmacist care in hypertension management: systematic review of randomized controlled trials
Authors: Gastens V , Tancredi S , Kiszio B , Del Giovane C , Tsuyuki R , Paradis G , Chiolero A , Santschi V 
Published: October 2023

Abstract

Background
Hypertension management remains a major public health challenge in primary care. Recent hypertension guidelines recommend the involvement of pharmacists for team-based care management. Our objective was to systematically review the evidence of the impact of pharmacist care alone, or in collaboration, on blood pressure (BP) amongst hypertensive outpatients compared with usual care. One major focus was to assess the heterogeneity in the effects of these interventions to identify which ones work best in a given healthcare setting.

Methods
A systematic literature search was conducted for any article published up to 05.12.2022 in MEDLINE, EMBASE, CENTRAL, CINAHL, Web of Science, and Trip databases. Randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients were included. Results were synthesized descriptively and, where appropriate, pooled across studies to perform meta-analysis. We have previously published the study protocol in BMJ Open and registered in PROSPERO (CRD42021279751).

Results
2048 study records were identified by electronic database searching. After removal of duplicates, 2006 were independently screened based on title and abstract by two authors (VG, ST), and 253 full texts were evaluated. A total of 90 studies with 33425 patients were included for data extraction. These studies were published between 1973 and 2022 and conducted in different regions (North America: n = 45, Europe: n = 17, other: n = 28). The preliminary random-effects summary estimate of the effect of pharmacist intervention is -6.6 mmHg (95% CI: -8.0 to -5.2) for systolic BP and -3.2 mmHG (95% CI: -4.1 to -2.2) for diastolic BP. Further results on the heterogeneity in the effects are in preparation.

Conclusions
This systematic review provides updated evidence on the effect of pharmacist intervention on hypertension management. Pharmacist-directed or -collaborative interventions improve hypertension management.

Key messages
• Pharmacist-directed or -collaborative interventions improve hypertension management.
• This systematic review provides updated evidence on the effect of pharmacist interventions on hypertension management.
Adherence behaviours in breast cancer patients at risk of cardiovascular disease
Authors: Artignan J , Goussault-Capmas P , Panjo H , Constantinou P , Pelletier-Fleury N 
Published: October 2023

Abstract

Background
High rates of discontinuation undermine the effectiveness of adjuvant endocrine therapy (AET) among hormone-receptive breast cancer patients. Patient prognosis also relies on the management of cardiovascular (CV) risk, which affects a high proportion of postmenopausal women. As with AET, adherence with CV drugs is suboptimal. We examined whether patient adherence with CV drugs was associated with AET discontinuation in a French nationwide claims database linked with hospitalisation data.

Methods
Women aged over 50 starting AET between 01/01/2016 and 31/12/2020 and taking at least two antihypertensive and/or lipid-lowering drugs were followed for 5 years or until AET discontinuation, 31/12/2021, death or cancer recurrence. Women were categorised as fully adherent, partially adherent or fully non-adherent with their CV drug regimen in the year before starting AET. The primary outcome was AET discontinuation, defined as a 90-day gap in treatment availability. Cumulative incidence curves were used to estimate time to discontinuation according to CV drug adherence and accounting for competing risks of death and cancer recurrence. Multivariate Cox and Fine-and-Gray regressions were used to assess the relative hazards of AET discontinuation while adjusting for potential confounders.

Results
32,072 women fit the inclusion criteria. Fully adherent women had the lowest cumulative incidence of AET discontinuation at any point over the follow-up period. Partial adherence and full non-adherence with CV drugs were predictors of AET discontinuation in both models (cause-specific hazard ratios 1.15 [95% CI: 1.15-1.25] and 1.49[95% CI: 1.42-1.63]; subdistribution hazard ratios 1.15[95% CI: 1.09-1.21] and 1.47[95% CI: 1.38-1.57]).

Conclusions
Patients who do not adhere with their CV drug regimen are more likely to discontinue AET. Appropriate support should be brought to these patients as they may be at heightened risk of both cardiovascular and cancer-related events.

Key messages
• Concurrent management of cardiovascular health and breast cancer is essential and clinicians should know that patients with low adherence to cardiovascular drugs are more likely to discontinue AET.
• Patients with suboptimal adherence across their drug regimen should be brought appropriate support as they may be at heightened risk of both cardiovascular and cancer-related events.
Disease burden in Belgium in 2040: Methodological considerations
Authors: De Pauw R , Gorasso V , Guariguata L , Devleesschauwer B 
Published: October 2023

Abstract
Non-communicable diseases (NCDs) are responsible for a significant proportion of global morbidity and mortality, placing a substantial burden on individuals, communities, and healthcare systems. To effectively plan and allocate resources for prevention and treatment, it is crucial to understand the future burden of NCDs. Projections of prevalence of NCDs can provide valuable insights into the future burden of disease and inform policy decisions and resource allocation. These projections can include various factors such as changes in demographics, health determinants, and healthcare access. By predicting future trends in disease prevalence, policymakers can better anticipate the demand for health services, identify areas where prevention efforts can be targeted, and allocate resources more effectively. For example, projections can help policymakers understand the potential impact of interventions such as increased physical activity, improved diet, or increased access to healthcare services. Several methods can be used to project future NCD prevalence, such as generalised linear models, age-period-cohort models, and microsimulation models. Each of these methods come with advantages and disadvantages. Based on our current projections using generalised linear models within a Bayesian framework, the burden of most NCDs will increase by 2040. In this presentation, the thought-process will be addressed to implement future projections in Belgium for NCDs. We will also present the initial results of the projections based on generalised linear models. These projections can help to reduce the burden of NCDs on individuals and society, and ultimately improve public health outcomes.
The role of health literacy in evaluation of health promotion and prevention interventions
Authors: von Rueden U 
Published: October 2023

Abstract
One specific contribution to the workshop is the consideration of the role of health literacy in the evaluation of health promotion and prevention interventions both as an outcome variable and as a determinant of health-related behaviour. Health literacy has a detectable impact on health status and quality of life and is a necessary prerequisite for health-promoting behaviour. Health promotion should therefore address the determinants of health literacy. The causal relationships reported in the literature between the determinants of health literacy and the dimensions of health literacy (finding health information, understanding, evaluating, implementing) and outcomes can be illustrated in impact models. By using them it becomes clear that health literacy programmes should aim to improve situational determinants as well as individual determinants. It also highlights the central importance of the availability of accessible, understandable and trustworthy health information. Health literacy outcomes are only relevant when they lead to health-related decisions and related actions of individuals. Therefore, measuring health literacy is essential, especially at the decision-making level.
Gender gap in life expectancy in Europe and the United Kingdom in 2019
Authors: Kabir Z , Curtin B 
Published: October 2023

Abstract

Background
Life expectancy (LE) is an important metric for overall population health and well-being. The gender gap in LE can be used as a population health metric to capture progress and monitor health inequality in a specific setting. Health inequality is an expression of universal health care coverage and unequal access to health care and the quality of health care - otherwise known as ‘amenable’ mortality.

Methods
The Global Burden of Disease (GBD) Study- a comprehensive global epidemiologic database has developed and validated two population health metrics across 200+ countries- the Universal Health Coverage (UHC) Index (0-100) and the Healthcare Access and Quality (HAQ) Index (0-100) to monitor progress in these two specific domains for each country. We set out to examine the association of gender gap in LE with UHC and HAQ indices across 27 EU countries and the UK combined for year 2019 employing correlation and linear regression analyses.

Results
Overall, LE ranged from 73.3 years in Bulgaria to 83.1 years in Italy; UHC index was worst in Bulgaria (62.6), while Luxembourg (91.5) was the best performing nation; HAQ index had the highest score in the Netherlands (91.1), while Bulgaria had the lowest score (64.9). Lithuania had the largest gender gap in LE (9.2 years; M:71.5; F: 80.7), while the Netherlands had the narrowest gender gap (3.4 years; M:80.0; F: 83.4). On multivariable linear regression, gender gaps in LE were significantly associated with both HAQ (beta: -0.17; R2=0.66), and UHC (beta: -0.14; R2=0.52) across 27 EU countries and the UK combined.

Conclusions
Gender gap in LE can be a proxy measure to monitor progress in health inequality in terms of universal health care coverage, as well as health care access and quality of health care for a specific population setting. The findings suggest that gender gap in LE can be significantly reduced through expansion of universal health care and improving both access and quality of health care in the EU.

Key messages
• Gender gap in life expectancy can be a good proxy to monitor progress in health inequality for EU countries and the UK combined, which has 5.5 years of gender gap in life expectancy on average in 2019.
• A 10% increase in both universal health care coverage and health care access and quality, can reduce gender gap in life expectancy by 1.4 and 1.7 years, respectively, across EU and the UK combined.
The state of community health practice in the Czech Republic: Saste Roma project
Authors: Volevach E 
Published: October 2023

Abstract
A central public health objectives of the Czech government is to reduce health inequalities for community members living in deprived areas of Czechia, where Roma are the most frequent inhabitants. This is achieved through Community Health Workers (CHWs) and subsidies for NGOs. However, they often lack the necessary training in health promotion. Developing more systematic intervention tools could help tackle this challenge, thus improving community health practices and decreasing the burden on the health system. The Saste Roma project responded to the lack of systematic community health practices. It aimed to improve secondary prevention in Roma by developing several interventional tools. Socio-culturally appropriate printed materials are to be used by CHW, as well as by doctors and community members; e-learning is intended for implementation as a part of the school curriculum. These tools have the potential to lower the burden on the health care system to improve community health as they act as communication channels between health professionals and the community. The development of the above tools was carried out with the help of governmental and non-governmental organizations, CHWs, and community members. During the development of the project, some shortcomings of Czech community health services were identified. They include the low competence of CHW, the unwillingness of different sectors to cooperate, refusal of schools to participate due to poor school attendance and workload from other projects. Thus, despite the large government investments in the policy of reducing health inequality, at the local level, it often does not work as it was officially stated. Moreover, despite a 20-year Roma-oriented policy, no evaluation has yet been carried out. Intervention tools from the Saste Roma project can be a first step to get community health practice more systematic in Czechia. The Randomized-control-trial to evaluate the efficacy of developed tools will follow.
Low-dose CT for lung cancer early-detection in China: Findings from a screening program in Shanghai
Authors: Teng J Y , Yao W Y , Li J , Xu H L , Xu W H 
Published: October 2023

Abstract

Background
Low-dose computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. This study is aimed to evaluate the effects of LDCT screening for lung cancer in Chinese populations.

Methods
A total of 26124 subjects aged over 40 years were enrolled from the Minhang District of Shanghai, China, 2013-2017. The detection of lung cancer and the survival status of cases up to Dec 31,2018 were obtained. Standardized incidence ratio (SIR) was calculated for the screened populations relative to the local general population. Three-year survival rates and proportion of early-stage (stage 0-I) cancer were estimated for all cases from general population and for screen-detected cases. For 12184 high-risk individuals in the screened population, a total of 12184 matched controls without LDCT were identified using propensity score matching (PSM), lung cancer mortality and all-cause mortality were calculated and compared between groups.

Results
The crude incidence of lung cancer in the screened population was 426.6 (95%CI: 387.4-470.2) per 100000 person-years, with an overall SIR of 2.3 (95%CI: 2.0-2.5). The SIR decreased with the highest level in the first year [3.8 (95%CI: 3.3-4.3)], and a lower level over 3 years [0.6 (95%:CI: 0.5-0.7)]. Early-stage lung cancer accounted for 26.3% of screen-detected cases, significantly higher than 15.3% in all cases during the same period. The 3-year survival rate was also higher in screen-detected cases (60.4%) than all cases (50.9%). Compared with the matched control group, the screened group had a 32.0% (95%CI: 0.47- 0.99) reduced lung cancer mortality and a 56% (95%CI: 0.37-0.52) decreased all-cause mortality. The proportion of early-stage lung cancer was also higher in cases screened-detected than in non-screened (28.9% vs 11.8%, p &lt; 0.05).

Conclusions
Our results prove the benefits of LDCT screening and its great potential in reducing the disease burden of lung cancer in Chinese populations.

Key messages
• LDCT screening improved the detection of lung cancer in Chinese populations, and increased the proportion of early-stage cancer and 3-year survival rate of detected lung cancer cases.
• LDCT screening decreased 32% of lung cancer mortality and 56% of all-cause mortality in Chinese populations.
Joint trajectories of physical activity, self-rated health and income in Finnish statutory retirees
Authors: Lallukka T , Kolmonen P , Rahkonen O , Lahelma E , Lahti J 
Published: October 2023

Abstract

Background
Health behaviours, health and socioeconomic position, particularly income, are known to change during ageing. However, no previous study has examined how they develop together over statutory retirement transition. We aimed to examine this joint development and to identify determinants of distinct groups.

Methods
We examined former employees of the City of Helsinki, Finland, who retired statutorily 2000-2022 (n = 4384, 79% women). We used five repeated questionnaire surveys to examine the joint developmental patterns in key indicators of healthy ageing and wellbeing: self-rated health, leisure-time physical activity and household income. We used joint group-based trajectory analysis to identify latent developmental groups and average marginal effects to examine determinants of the trajectory group membership.

Results
We found four distinct groups describing the joint developmental patterns. Group 1 (23%) had consistently poor health, little physical activity, and low, although slightly increasing income levels. Group 2 (34%) had first good but then declining health, average physical activity, and low but slightly increasing income. Group 3 (13%) had good health and very high level of physical activity, but average and fluctuating income. Group 4 (30%) had first good but then declining health, stable rather low physical activity and sharply increasing and high income. People with obesity had 23% (95% CI 22-26) higher likelihood of belonging to the Group 1 as compared to people with normal weight. They were also more likely with low education.

Conclusions
Over a follow-up of more than 20 years, we identified distinct groups among statutory retirees regarding their development of physical activity, self-rated health and income. Public health interventions to improve well-being and narrow health inequalities during ageing need to consider this heterogeneity and target policies considering people with different developmental patterns in their well-being.

Key messages
• Changes in income did not develop jointly with changes in health. Most statutory retirees had relatively good health, despite the development in leisure-time physical activity and household income.
• Decline in physical activity could reflect decreasing intensity. Social and health-related factors show associations with the trajectory memberships, reflecting the known inequalities in health.