bluuebunny/crossref_metadata_2025_split huggingface dataset:
Where you live matters: how degree of urbanization influences healthcare utilization in Portugal
Authors: Martinho J , Leite A 
Published: October 2023

Abstract

Background
The degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal's proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence's degree of urbanization and healthcare utilization in the country.

Methods
A cross-sectional study was conducted, using data from the Portuguese 2019 National Health Survey, a multi-stage clustered stratified sample. All participants, aged over 15, were included. Outcomes assessed included: going to general practitioner (n = 14 360) and specialist consultations (n = 14 334), taking a flu vaccine (n = 5 270), undergoing a colonoscopy (n = 9 075), too-long waiting times (n = 12 009) and waiting for healthcare due to distance/transportation (n = 12 117). Crude and adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated using Poisson regression models.

Results
Compared to urban areas, living in less populated areas was significantly associated with waiting for healthcare due to distance/transportation (aPR=1.54, CI95% 1.06-2.24) and lower colonoscopy utilization (aPR=0.86, CI95% 0.78-0.95). Flu vaccination prevalence ratios were significantly higher for rural (aPR=1.15, CI95% 1.03-1.29) and suburban areas (aPR=1.16, CI95% 1.04-1.30) than urban areas. There was no significant association between degree of urbanization and attending general or specialist consultations nor too-long waiting times.

Conclusions
Healthcare needs are not being met in less populated areas likely due to geographic constraints. Against expectation, flu vaccination might not be optimized in urban areas, which could bring concerns for immunization rates in risk groups. Policies to improve universality and equity in population's access to healthcare are needed.

Key messages
• Differences in healthcare utilization related to place of residence's degree of urbanization show that universal health coverage is yet to be reached.
• Less populated areas are more likely to wait too long to receive healthcare due to distance and mobility hindrances, representing a challenge for health systems which policies should help mitigate.
Psychosocial determinants of adherence to COVID-19 preventive behaviors
Authors: Gali K , Hermanns B , Sabat I , Neumann-Böhme S , Schreyögg J 
Published: October 2023

Abstract

Background
Non-adherence to medical guidelines is associated with suboptimal health outcomes and increased healthcare costs, and yet adherence to preventive therapies is often difficult to achieve. Understanding which factors can improve adherence is a public health priority. In this study, we examined the association of psychosocial factors and adherence of preventive behaviors within the context of the COVID-19 pandemic.

Methods
Panel data from the European COvid Survey (ECOS), a representative sample of residents aged 18+ from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy collected from April 2020 (wave 1) to May 2022 (wave 10) was used to examine trends and determinants of COVID-19 preventive behaviors (i.e., mask wearing, hand washing).

Results
With a total of 27,095 participants, 53.5% were female, and 15.9% were aged 18-24, 67.9% 25-64, and 16.3% 65+. The trends in adherence decreased over time except in wave 5 where a spike in adherence levels matched wave 1 levels and a surge in reported COVID-19 infections. In multivariable logistic regression models, worry about overloading the health system (OR = 1.26, 95%CI: 1.22-1.31), perceived risk to one's own health (OR = 1.13, 95%CI: 1.08-1.18) and others (OR = 1.16, 95%CI: 1.10-1.22), and trust in institutions (OR = 1.20, 95%CI: 1.12-1.26), traditional news media (OR = 1.05, 95%CI: 1.01-1.10), and health providers (OR = 1.31, 95%CI: 1.26-1.37) increased the likelihood of engaging in COVID-19 preventive behaviors. However, those with high trust in social media were less likely to follow prevention guidelines (OR = 0.78, 95%CI: 0.75-0.80).

Conclusions
Psychosocial factors (risk perceptions, worry, and trust variables) were associated with adhering to COVID-19 prevention guidelines. Findings that high trust in social media was related to low adherence suggests more research is needed to understand how public health can improve health communications via social media, a popular information resource.

Key messages
• Health risk perceptions and worry about overloading the health system were associated with adhering to COVID-19 prevention guidelines.
• Trust in social media was related to low adherence to COVID-19 prevention guidelines.
Examination of the Effectiveness of a Public Health Nurses’ National Call Center for Young Families
Authors: Bord S , Satran C , Odesky G , Ali-Saleh O , Wagman S , Madjar B 
Published: October 2023

Abstract

Background
The Public Health Nurses Call Center (PHNCC) is an innovative, free-of-charge Israeli national pilot aimed at parents of 0-6 years old children. The Center provides information, counseling, and guidance re- issues of health and preventative medicine and is active when the daily Infant-Parent Centers are closed.

Aims
Examining the PHNCC's suitability for the target population's needs and evaluating its effectiveness in locating situations needing intervention, improving patient experience, and promoting the children's and their parent's health.

Methods
Three sub-studies were conducted: (1) a descriptive study using an initial analysis of 6,000 calls received at the Center, as well as a profound analysis of randomly selected 1,500 calls; (2) a comparative study among 201 parents who had called the Center and 232 parents who had not; and (3) a qualitative study which included interviews with 20 parents who had called the Center and six of the PHNCC nurses.

Findings
The PHNCC provides a fast, professional, and accessible response. Caller satisfaction is high, as is that of the Center's nurses. The population of people calling the Center is mainly made up of young parents to first-born children, as well as parents characterized by high levels of parental efficacy perception, social support, and health literacy, as opposed to the population of parents who did not call. There is a direct association between callers’ satisfaction with the PHNCC and their level of trust in the Center nurses.

Conclusions
Both parents and nurses describe an accessible, professional Center and high satisfaction levels. However, the study's findings highlight the need to minimize health-related gaps and make the Center accessible to additional populations, such as parents with lower health literacy.

Key messages
• Both parents and nurses describe an accessible, professional Center suitable for the target population's needs.
• The PHNCC is a service with excellent implementation potential for promoting public health. It should be budgeted accordingly and made accessible to the various populations of Israeli society.
Out-of-pocket expenditure and mortality in the elderly in Europe: a longitudinal analysis, 2006-20
Authors: Palladino R , Mercogliano M , Sorrentino M , Fiorilla C , Esposito F , Triassi M , Hone T 
Published: October 2023

Abstract

Background
European Health Systems are increasingly considering the implementation of cost-sharing policies to compensate cuts in public health spending. However, out-of-pocket expenditure (OOPE) has been associated with delay in seeking care, especially in the elderly population, with negative effects on health. This is the first study to assess the relationship between OOPE and mortality in European Health Systems.

Methods
Longitudinal analysis of 11 European Health Systems between 2006 and 2020 using data from the Survey of Health, Ageing, and Retirement in Europe. Total OOPE, OOPE on medicine, outpatient, and inpatient were the main variables of interest. Covariates included multimorbidity, age, sex, marital status, residential country, educational attainment, and household income. To model the association between OOPE and mortality we employed mixed-effect parametric survival models with Gompertz distribution. Analyses were stratified by income quintiles and sensitivity analyses were conducted with time-varying independent variables.

Results
Study population included 70367 respondents, average age was 65 year (±14.1), 53.7% were female, and average number of chronic disease was 1.6 (±2.6). 60.1% of the sample paid OOPE, 41.2% more than 100 euros in a year. For each 100 euro increase in OOPE we found a 1% increase in mortality over the study period (HR 1.01, 95%CI 1.01-1.01), with little difference when stratifying analyses by income quintiles. The largest effect was found for OOPE on medicine (HR 1.04, 95%CI 1.02-1.06), while the smallest for OOPE on inpatient (HR 1.02, 95%CI 1.01-1.03), although it was much larger when restricting analyses to only those in the lowest income quintile (HR 1.08, 95% 1.92-1.12). Time-varying analyses confirmed main findings.

Conclusions
Cost-sharing policies, especially on medicine, increase the risk of mortality in elderly people in Europe. For certain health services the association might affect especially the most disadvantaged groups.

Key messages
• For each 100 euro increase in OOPE we found a 1% increase in mortality for elderly people in Europe over the study period, with little difference when stratifying analyses by income quintiles.
• The largest effect was found for OOPE on medicine, while the smallest for OOPE on inpatient, although it was much larger when restricting analyses to only those in the lowest income quintile.
Perinatal common mental health disorders among migrant women: a systematic review and meta-analysis
Authors: Stevenson K , Fellmeth G , Edwards S , Calvert C , Bennett P , Campbell OMR , Fuhr D C 
Published: October 2023

Abstract

Background
Pregnant migrants are particularly vulnerable to mental illness because they are exposed to stressors including conflict, poverty, and discrimination. We aimed to assess the global prevalence of perinatal mental health disorders or substance use among migrant women.

Methods
We searched MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in the perinatal period or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal mental health disorders amongst migrant women globally. A random-effects meta-analysis was used to calculate pooled prevalence estimates. PROSPERO: CRD42021226291.

Results
18,650 studies were retrieved, of which 135 studies (comprising data from 621,995 participants) met the inclusion criteria. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all migrant women, 32·5% (1·5-81·6; 98·7%; τ2 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; τ2 0·01) among economic migrants (p &lt; 0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32).

Conclusions
One in four migrant women who are pregnant or postpartum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher amongst forced migrant women compared to economic migrants. These findings highlight the need for community-based perinatal mental health screening and access to interventions that are culturally sensitive.

Key messages
• Women who are forced migrants have a higher prevalence of perinatal depressive disorders compared with women who are economic migrants; forced migrants also experience a high burden of PTSD.
• The findings highlight the need for culturally sensitive mental health screening and care for migrant women who are pregnant or postpartum, particularly for forced migrants.
Temperature around conception and metabolic health in adulthood: Evidence from the UK Biobank
Authors: Münz T , Pradella F , Gerking L , Gabrysch S , van Ewijk R 
Published: October 2023

Abstract

Background
Mice studies and correlational evidence among humans suggest that paternal cold exposure around conception is associated with improved metabolic outcomes among the offspring, which is caused by an increase in their amount of active brown fat. Especially the 2 weeks prior to conception are relevant as epigenetic programming during spermatogenesis takes place. Causal evidence on humans is thus far lacking. We overcome this challenge by exploiting quasi-random temperature variation around conception and studying metabolic health in a large sample.

Methods
We combine daily temperature data with individual-level data from UK Biobank (N = 430,000, birth years 1934 - 1971) and link quasi-random temperature variations around conception to later-life metabolic health outcomes. We do not use actual temperatures, since conceiving during cold months or living in cold areas may be associated with socioeconomic and other characteristics that may affect offspring later-life metabolic health. Instead, we utilize deviations from the temperature that is to be expected for a certain place at a certain time point in a natural experiment framework. Date of conception is estimated from date of birth and our main exposure is temperature variation in the 2 weeks before conception. Since pregnancy length varies, temperatures during several time windows around conception are considered.

Results
Individuals who were conceived when it was one degree Celsius colder than usually have a lower BMI (-0.018; 95% CI -0.033, -0.003), waist circumference (-0.038; 95% CI -0.071, -0.004), as well as lower levels of triglycerides (-0.004; 95% CI -0.007, -0.001) and cholesterol (-0.013; 95% CI -0.017, -0.010).

Conclusions
Comparatively subtle environmental shocks such as temperature variations around conception are causally associated with long-term metabolic health. This study points to the importance of future research on similar potential health externalities of rising global temperatures.

Key messages
• Colder temperatures around conception lead to improved metabolic health outcomes in adulthood, including lower BMI, waist circumference, and levels of triglycerides and cholesterol.
• Subtle environmental factors during the periconceptional period can have long-term health impacts, highlighting the need for further research on potential health externalities of climate change.
Mental health in Swedish adolescents prior to and three years after the Covid-19 outbreak
Authors: Uvhagen L , Söderqvist F 
Published: October 2023

Abstract
Viewing mental health from a two continua perspective, this presentation focuses on results of pooled data from a recurrent cross-sectional survey, carried out in ninth and eleventh grade in lower and upper secondary school of Västmanland county, Sweden, 2020 - weeks prior to the Covid-19 outbreak - and 2023. In total, 7908 students participated of which 50% were girls (2020 N = 3880; 2023 N = 4028; response rate≈72%). A compilation of the results according to the two continua model and the six mental health status groups described in the previous presentation shows that 39.0% are categorized as having Complete Mental Health (CMH), 1.6% as Symptomatic But Content (SBC), 36.7% as Vulnerable (V), and 2.9% as being the Most Vulnerable (MV). Further, 12.8% are categorized as being Troubled (T) and 6.9% as Most Troubled (MT). Statistically significant differences are seen between boys and girls in the categories CMH (boys=47.4%, girls=30.8%), SBC (boys 1.0%, girls 2.1%), T (boys 7.2%, girls 18.3%) and MT (boys 3.7%, girls 10.1%). Significant changes over time, between 2020 and 2023, are seen in SBC (0.9% statistically significant increase) and MV (1.9% statistically significant increase). When divided by sex, significant changes over time are only seen among girls: in CMH (5.3% statistically significant decrease), MV (1.9% statistically significant increase) and SBC (1.3% statistically significant increase). No statistically significant changes are seen over time for boys. The result indicates that only four out of ten adolescents have a CMH. The differences between boys and girls are substantial; almost five out of ten boys and three out of ten girls has CMH. This emphasizes the importance of promoting mental well-being, especially among girls. The result also implies the importance of strengthening well-being in the large group without flourishing mental health since the latter can also provide a buffer against mental illness.
Barriers and facilitators for food systems policy development and implementation in African countries and cities
Authors: Van Dam I , Burgaz C , Vandevijvere S 
Published: October 2023

Abstract

Background
The sustainable food systems policy index (SFS index) was created to evaluate government actions towards healthy diets from sustainable food systems at national and city level. A mapping of policies was conducted across East (Kenya, Tanzania, Uganda) and West (Burkina Faso, Benin, Ivory Coast, Senegal, Togo) African countries and cities. Only few recommended policies were in place. Therefore, this study set out to identify the barriers and facilitators for food systems policy development and implementation within food supply chains and environments at national and city level.

Methods
A total of 64 semi-structured interviews are being conducted (April-July 2023) across aforementioned eight East and West African countries. Per country, four city level and four national stakeholders actively engaged in the design, implementation or evaluation of food systems policies were selected, 36 working on food supply chains, 27 on food environments and one involved in both.

Results
Results of the interviews are expected to highlight common barriers and facilitators to develop and implement policies to obtain healthy diets from sustainable food systems. Moreover, these will contribute to the finalisation of the SFS index.

Conclusions
Understanding barriers and facilitators influencing sustainable food systems policies is key to achieving the sustainable development goals. Moreover, the final SFS index will be useable in countries and cities across the world to map existing policies to obtain healthy diets from sustainable food systems and identify areas of improvement.
Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study
Authors: Sá R , Roquette R , Rebecchi A , Rocha J , Buffoli M , Capolongo S , Ribeiro A I , Nunes B , Dias C , Sousa Uva M 
Published: October 2023

Abstract
Diabetes is responsible for a high burden of disease, yet there is a great potential for prevention. Physical inactivity is one of the major risk factors for type 2 diabetes which can be tackled by increasing area-level walkability. That said, there are still few population-based studies exploring the association between area-level walkability and objective measures of diabetes. The aim of this study is therefore to estimate the association between area-level walkability and individual levels of glycated haemoglobin in the Portuguese adult population. Area-level data required to estimate walkability was obtained from the 2011 census and an updated street map. The walkability index was constructed using measure of residential density, land-use mix and street connectivity. Individual-level health data was obtained from The National Health Examination Survey (INSEF) 2015, a population-based survey representative of Portuguese adult population. We used gamma regression to estimate associations. The regression coefficients showed that living in medium walkable areas reduced the average glycated haemoglobin (Exp(β)=0.906; 95%CI: 0.821, 0.999) in a statistically significant way when compared with least walkable areas. The association was smaller, and not significant, for the third tercile of walkability (Exp(β)=0.919; 95%CI: 0.822, 1.028). Our findings suggest a non-linear protective association of walkability on glycated haemoglobin. These findings could have important policy implications for urban planning, with a goal of preventing diabetes and promoting health by increasing walkability.
Socioeconomic Disparities in Beliefs about Cancer: Irish National Cancer Awareness Survey
Authors: O'Hare C , McCarthy T , Mullen L , Bennett K 
Published: October 2023

Abstract

For most tumour types survival varies according to socioeconomic position (SEP) and stage at diagnosis. The aim of this study was to examine the association between SEP and beliefs about cancer, and the impact of beliefs on symptom awareness and help-seeking. This is important as negative beliefs about cancer may represent a modifiable target in cancer awareness campaigns aimed at adults aged 50+ years. A cross-sectional study of 1,327 adults aged 50+ years was conducted using data from the Irish National Cancer Awareness Survey, 2022. SEP was indexed using educational attainment. Beliefs about cancer were assessed using the Awareness and Beliefs about Cancer measure, symptom awareness using the Cancer Awareness Measure, and help-seeking using the French Cancer Barometer. Latent Clas Analysis (LCA) was used to identify unobserved ‘beliefs about cancer’ subgroups across belief items. Multivariable logistic regression, adjusted for age, sex, smoking status and cancer experience, was then used to identify associations between SEP and belief subgroups, and subsequently between belief subgroups and symptom awareness and anticipated help-seeking. LCA identified two subgroups: n = 1,033 (77.7%) broadly positive and n = 294 (22.3%) broadly negative. Those with primary education or less, and those with secondary education, were more likely to endorse negative beliefs relative to those with tertiary education (aOR 3.20 (95%CI 1.84, 5.53;p&lt;0.001) and aOR 1.88(95%CI 1.32, 2.70;p&lt;0.001) respectively). Compared to the positive beliefs subgroup, the negative subgroup were less aware of persistent cough as a potential cancer symptom (aOR 0.60(95%CI 0.40, 0.88);p=0.01) and less likely to anticipate seeing a doctor first with symptoms (aOR 1.52 (95%CI 1.11, 2.08;p=0.009) ‘other’ vs. ‘doctor’). Negative beliefs about cancer are associated with lower SEP. Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.

Key messages
• There is a need for interventions to increase symptom awareness and encourage timely help-seeking in those with symptoms suggestive of cancer particularly among socioeconomically disadvantaged groups.
• Negative beliefs about cancer should be targeted in health promotion campaigns seeking to increase awareness and help-seeking behaviour.