bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in active commuting and changes in health
Authors: Gluschkoff K , Haukka E , Kalliolahti E , Lanki T , Jussila J J , Halonen J I , Salo P , Oksanen T , Ervasti J 
Published: October 2023

Abstract

Background
Previous studies have shown that regular physical activity through active commuting, such as walking or cycling, is positively associated with physical and mental health. However, because longitudinal within-individual studies on the association between active commuting and health are scarce, the results may have been biased due to unmeasured confounding. Additionally, information about commute length has rarely been included in studies on within-individual change in active commuting. A better understanding of the association between active commuting and health could inform public health policies and interventions to promote active transportation.

Methods
Using two waves (2020, T1 and 2022, T2) of self-report data from of the Finnish Public Sector study (N = 16881), we examined the association between within-individual changes in active commuting and health. Active commuting was measured by kilometers/week (i.e., by multiplying the number of walking or cycling days/week with the daily commute distance). The primary outcome, self-rated health, was measured with a single item (scale from 1=poor to 5=good) at T1 and T2. The secondary outcomes, psychological distress and sleep problems were measured only at T2 and were therefore analyzed with a between-individual model.

Results
After adjustment for potential time-varying confounders such as socioeconomic factors, BMI, and health behaviors, an increase of 10 additional active commuting kilometers per week was associated with a slight improvement in self-rated health (unstandardized B = 0.01, p = 0.001). No associations were observed between changes in active commuting and psychological distress or sleep problems.

Conclusions
This study provides evidence supporting a modest causal association between active commuting and improved health. Promoting walking or cycling to work may have potential benefits for public health, but further intervention research is needed to better understand the extent of these benefits.

Key messages
• The study provides evidence supporting a modest causal association between active commuting and improved self-rated health.
• Promoting walking or cycling to work may have potential benefits for public health.
A mixed method study to explore knowledge, attitudes, behaviour and experience of introducing solids
Authors: Kolokotroni O , Koutrouba A , Economou M , Kouis P , Rubinsohn C , Enayati Zadeh P , Derlagen A , Philippou E , Quattrocchi A , Mosquera M 
Published: October 2023

Abstract

Background
Infancy is a critical time for establishing dietary habits. EARLY START aims to build an intervention for reducing early life obesogenic behaviours. Using participatory action research, the exploratory phase investigates mothers’ knowledge, attitudes, behavioural intent and experience of introducing to solids

Methods
A mixed methods approach was used. Knowledge, attitudes and behavioural intent about infant feeding were investigated amongst mothers using the Infant Feeding Education Questionnaire (IFEQ). A subgroup participated in a focus group discussion of their experience of introducing solids. Data were analyzed using Descriptive and Thematic Content methods.

Results
One hundred and three mothers participated (mean age 33 y.o., tertiary education 94.3%, in employment 98.9%). Advice from health care professionals (HCP) was the most influential factors for when to start solids. Despite a relatively high total IFEQ score (39, min -56, max 56), learning needs were identified in areas, such as putting baby to sleep with bottle and recommended size of food pieces and breastfeeding duration. Maternal characteristics did not influence the IFEQ score. Mother's confidence on when to wean was associated with higher IFEQ score (β coeff.: -2.9, CI -5.4, -0.4, per change to a lower confidence category). Qualitative analysis showed that mother consider introduction to solids a ritual process that is challenging, emotional and requires guidance. It is compared to a “dance” between mother and baby with HCPs positively influencing coordination. Mothers express the need for timely and continuous information beyond the weaning phase that takes into consideration baby's behavioural development and self-contained needs.

Conclusions
Mother's confidence on weaning is influenced by knowledge, attitudes and behavioural intent. New interventions should build confidence by focusing on challenges and addressing mother's emotional and baby's developmental and specific needs.

Key messages
• Knowledge, attitudes and behavioural intent of introducing solids affects a mother's confidence whilst infant feeding is considered a complex and emotional process requiring guidance on evolving needs.
• Future interventions should focus on building confidence by addressing mother's challenges and emotions whilst taking into consideration the baby's developmental and self-contained needs.
Using single case design and mixed methodology to evaluate a community-based befriending intervention for older Irish adults
Authors: McHugh-Power J 
Published: October 2023

Abstract
This presentation will describe the design and results of a mix method study of a community-embedded befriending intervention in Dublin, Ireland. There is mixed evidence regarding the impact of befriending interventions on loneliness. However, befriending interventions may instead yield an impact on health-related quality of life of older adults. We explored this hypothesis and additionally whether such an intervention might buffer the negative impact of loneliness on health-related quality of life of older adults. A single-case experimental design approach was used with new users (n = 86) between 2018 and 2021. Generalised additive modelling was used to analyse the intensive longitudinal data. Furthermore, dyadic qualitative interviews were used with befriending service users and volunteer partners to explore potential mechanisms through which befriending might impact the health of older adults. The befriending intervention yielded a therapeutic effect on health-related quality of life of older adults, and buffered the negative effect of loneliness on health-related quality of life. Dyadic interviews revealed five key mechanisms through which befriending services might impact health, including via health behaviour support and cognitive stimulation. In conclusion, the results suggest that befriending services are beneficial for maintaining the health of older adults, and that they ought to be advised in this respect, rather than as solutions to loneliness. In this presentation, results will be discussed in the context of policy and service recommendations we developed during this research.
Internalized social stigma and its determinants among drug-sensitive tuberculosis patients in Armenia
Authors: Demirchyan A , Petrosyan V 
Published: October 2023

Abstract

Background
Internalized social stigma (ISS) is still an issue among tuberculosis (TB) patients, exacerbating their suffering and affecting their treatment compliance. Quantitative studies of TB-related ISS are scarce. This study sought to measure ISS and identify its predictors among primary drug-sensitive TB patients in Armenia.

Methods
All patients throughout Armenia diagnosed with drug-sensitive TB from Apr, 2019 through Feb, 2021 were targeted for baseline and follow-up interviews at the start of their TB treatment and shortly after completing it, respectively. The instrument included domains on patient's social support, TB knowledge, health, and stigma. ISS was measured via a 10-item scale previously used in Armenia, with the total score ranging from 10 to 50. Fitted linear regression models identified predictors of ISS at each assessment.

Results
Overall, 401 patients were interviewed at the baseline and 285 at the follow-up. Between the assessments, patient's ISS score decreased from 27.4 to 23.8 (p &lt; 0.01). Factors related to higher stigma at the baseline included age (B = 0.13, p &lt; 0.01), rural residence (B = 1.56, p &lt; 0.05), depression (B = 2.46, p &lt; 0.01), frequent alcohol use (B = 2.67, p &lt; 0.01), and higher stigma in the family (B = 0.55, p &lt; 0.01), while socioeconomic status score was protective against ISS (B = (-0.74), p &lt; 0.01). The fitted model explained 33.4% of the ISS score variance. Age and depression were related to higher ISS score at the follow-up as well, while quality of life score (B = (-5.27), p &lt; 0.01), family support score (B = (-0.53), p &lt; 0.01), and receiving psychological counseling/education (B = (-2.04), p &lt; 0.05) were protective against ISS.

Conclusions
This study found rather high levels of ISS both at the time of TB diagnosis and after the treatment course. It also pointed out several factors that could be targeted to reduce ISS, including educating TB patients and their family members, providing them timely psychological counseling and financial support.

Key messages
• During TB treatment, ISS decreased significantly. Modifiable factors protective against ISS included more support in the family and family's satisfactory financial status.
• After the treatment, ISS score was significantly lower among those patients who received psychological counseling and education on TB at the treatment start compared to those who did not receive it.
Healing Obesity with health-promoting environments – can interventions in Urban Policies bring health benefits?
Authors: Jevtic M , Matković V , Savin M , Bouland C 
Published: October 2023

Abstract
Obesity is a complex chronic disease associated with numerous health and social consequences. In 90% of cases, obesity is multifactorial, with a basis in a discrepancy between energy intake and consumption, but also caused by endocrine, psychological factors, environment, improper diet, physical inactivity, and lifestyle. The environment where people live and work must provide opportunity for enough physical activity to prevent obesity. The availability of fitness parks, bike paths, and publicly accessible swimming pools are the many possibilities that a positive and encouraging environment could provide. Urban areas demand publicly accessible places for physical activity. At the same time, it is important to motivate citizens in urban areas to increase their physical activity, because of a predominantly sedentary lifestyle. If the city's urban and health policies promote a healthy lifestyle, for example encouraging cycling and walking by providing infrastructure that will allow for a greater percentage of people to engage daily in physical activity. A healthy-behaviors-promoting environment is important to combat obesity (walkable neighborhood, green space, safe cycling, healthy food availability). A variety of policy strategies are available to create an active and safe environment: 1) increasing green and blue areas in urban settings: to promote recreation and relaxation; 2) promoting cycling and walking as a form of active mobility; 3) reducing or banning of public advertising of unhealthy food, while promoting healthy nutrition and increase of markets with healthy food; 4) encouraging socialization through sport, etc. Providing a healthy and safe environment is necessary to curb the obesity epidemic. Numerous interventions aimed at implementing a plan to change the environment and create a safe and stimulating environment for children and adults are needed.
The English health inequalities strategy: A time-trend study of mortality rate disparities at 65
Authors: Bennett N , Kingston A , Norman P , Bambra C 
Published: October 2023

Abstract

Background
Rapid population ageing is common in many Global North countries, with the UK being a prime example (with 18.6% aged 65 and over in 2021). Despite this, life expectancy in the UK began to stall around 2011, and the gap between the least and most deprived has been widening. To address these inequalities, a ‘levelling up’ programme was announced by the current Conservative government. Previously, a national health inequalities strategy was implemented (2000 to 2010) by the then Labour government, with many of the interventions targeting older age groups. To provide evidence on the effects of national health inequalities strategies on life expectancy later in life, we assessed the impact of the English health inequalities strategy on inequalities in mortality rate at age 65 by area deprivation.

Methods
Using ecological mortality and population data for Middle Super Output and Local Authority areas, we calculated life expectancy for individuals aged 65 and over in England from 1991 to 2016. We applied time-trend analyses methods with marginal spline terms to evaluate how mortality rate trends at age 65 changed before, during and after the strategy period. We also conducted a series of robustness analyses to considering varying cut points, deprivation levels and geographical scales.

Results
Prior to the programme (1991-1998), there was no change in the absolute difference in mortality rate between the 20% most deprived areas and the rest. During the programme, inequalities decreased at a rate of -0.0000936 (95% CI -0.0001281to -0.0000592) each year. However, after the strategy period (2011-2016) inequalities widened at an annual rate of 0.000078 (95% CI 0.0000166 to 0.0001395).

Conclusions
This study provides evidence of an association between the national health inequalities strategy and a narrowing of inequalities in mortality rate at age 65. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach.

Key messages
• The national health inequalities strategy (2000 to 2010) was associated with a narrowing of inequalities in mortality rate at age 65.
• Future national strategies which aim to reduce inequalities in life expectancy in older age groups may benefit from adopting a similar approach.
Decreasing trust in health institutions in EU during COVID-19: A Spatio-temporal analysis
Authors: Yaddanapudi L , Hahn J , Ladikas M 
Published: October 2023

Abstract

Background
Public trust is essential for easier acceptance of scientific, technological and policy interventions during crises. COVID-19 pandemic witnessed varied public responses to safety measures, highlighting the need for detailed public trust studies, especially in the health sector. Research shows considerable variation in trust in neighbouring regions to countries which is useful to understand in order to respond better to future pandemics.

Objectives
To analyze public trust in health institutions within the EU, to identify spatial clusters of the same at the beginning of the COVID-19 pandemic to the present, and understand factors contributing to decreasing trust.

Methods
Data from the Standard Eurobarometer surveys between 2020 to 2022 was used to perform spatio-temporal analysis of trust in health institutions & medical staff.

Results
Data shows that trust in health institutions and medical staff decreased in most EU countries from 2020 to 2022. Mapping these values showed clear geographical clusters of varying trust. At the beginning of the COVID-19 pandemic, Eastern Europe (52-66%) trusted less in health institutions and medical staff compared to Central (66-85%) or Western Europe (85-97%). By 2022, although Eastern Europe maintained their tendency to not trust, the percentage of people who trusted health institutions reduced in Western and Central Europe. Interestingly, socio-demographic factors such as age, gender, education and income were found to not be associated with trust. However, several factors of perception such as life going in the right direction and difficulty in paying bills were identified to be significantly associated with trust.

Conclusions
It is essential to understand the reasons for this decrease in trust, whether pandemic responses of health institutions or by policy is what contributed to this pattern. Understanding these changes can enable better policy responses towards supporting trust in health institutions.

Key messages
• There is clear geographical clustering of public trust in the EU - Eastern European countries tended to not trust health institutions during the pandemic.
• Socio-demographics showed no significant association with public trust. Interestingly, factors of perception were significantly associated.
WhySchool mental health training programs: effective for students, teachers, and school health staff
Authors: Conceição V , Gusmão R 
Published: October 2023

Abstract

Introduction
Adolescent mental health is an increasing concern due to the high prevalence of mental disorders and low levels of mental health literacy (MHL). Enhancing MHL and promoting access to services during this critical developmental phase is essential. Teachers and other educational professionals are vital in addressing mental health issues, encouraging positive mental health, reducing the stigma associated with mental illness, and promoting help-seeking behaviors.

Methods
This study evaluates the WhySchool project, a mental health training program for teachers, school health professionals, and students in Portugal, consisting of two interventions. The first intervention was a prospective pre-post study for teachers and school health professionals who underwent training during 2015-2016 and 2018-2020, with three evaluation phases. The second intervention was a quasi-experimental study in 2019-2020 for students who received the intervention program in a classroom setting administered by previously trained teachers.

Results
The first intervention significantly improved teachers’ and school health professionals’ mental health literacy, help-seeking attitudes, stigma reduction, and confidence in referring students in case of need. These effects remained stable at the M2 follow-up. In the second intervention, MHL scores increased significantly in the intervention group, while the control group showed no significant change. Stigma reduction and help-seeking attitudes also improved significantly in the intervention group, with no significant change in the control group.

Conclusions
The WhySchool program significantly and positively impacted teachers’ and students’ mental health literacy, help-seeking attitudes, and stigma reduction. The results underscore the importance of incorporating mental health programs into school curricula and providing teachers and school staff with the necessary tools and knowledge to deliver these programs effectively.
Pay-for-performance for appropriate prescribing using routine healthcare data from general practices
Authors: Arslan I G , Verheij R A , Ramerman L 
Published: October 2023

Abstract

Background
A national pay-for-performance (P4P) scheme was introduced in the Netherlands to incentivize appropriate prescribing among general practitioners (GPs) using routine care data of electronic health records (EHRs). The goal of this program was to encourage GPs to choose the most clinically appropriate and cost-effective medication for their patients to promote an affordable and sustainable health system. Nivel facilitated and evaluated this program. Facilitators and barriers of this P4P program were assessed as part of this endeavour.

Methods
Semi-structured interviews were conducted with all stakeholder representatives (n = 15) to evaluate their experiences with the program. The interviews were analysed thematically.

Results
Our research was structured around the three ‘flows’ necessary for an effective learning health system. The ‘data to knowledge’ flow was impacted by: 1) effect of different EHR information systems on data quality, and 2) advantages of using EHR data for measuring quality of care, minimising GPs’ administrative burden. The ‘knowledge to practice’ flow was impacted by: 1) meaningfulness and robustness of indicators, and 2) measure for appropriate prescribing. The ‘practice to data’ flow was impacted by: 1) feedback to GPs, with most stakeholders emphasizing the need for GPs to reflect on their results with other GPs to stimulate learning, 2) impact of the P4P model, such as improvement in quality of GP registration in EHRs and better stakeholder collaboration, and 3) methods, communication and GP perspectives on the performance payment.

Conclusions
The study showed the factors that can support or hinder P4P programs in promoting appropriate care with EHR data for a sustainable and affordable health system. Enhancing uniformity of EHR information systems is crucial for more consistent quality of care assessment. To encourage GPs to deliver better care, it is recommended to complement monetary incentives with other forms of incentives.

Key messages
• This study showed that routine healthcare data are feasible for the use in P4P schemes promoting a sustainable and affordable health system.
• P4P as a standalone approach may not be optimal for promoting a sustainable and affordable health system.
Direct costs of rheumatoid arthritis multidisciplinary care in Ireland
Authors: Priyadarshini A , Kenny C 
Published: October 2023

Abstract

Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining a chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary and secondary care within the Health Service Executive in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member of the primary (N = 21) and secondary care (N = 13) RA pathway. Overall cost of each patient type was calculated using time-driven activity-based costing along with medication and clinic running costs. Treating newly diagnosed RA patients costs second highest in primary (€337.39/year) and highest in secondary care (€922.32/year). While patients with advanced RA were most expensive to treat in primary (€469.18/year) and least costly in secondary care (€615.70/year). In primary care occupational therapists were the most expensive allied health care professionals (HCPs) at €1.19/min, followed by physiotherapists at €1.17/min. GP secretaries were the least costly at €0.30/min. In secondary care, consultant rheumatologists and phlebotomists were most and least costly respectively at €3.10 and €0.60/min/patient. Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more (€8718.98/year) than Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) (€120.87/year). In terms of personnel cost newly diagnosed patients and patients with advanced RA are expensive to treat as these require more time with the HCPs. Being referred to departments outside of rheumatology such as orthopaedics, advanced RA patients cost less in secondary care. The difference between whether a patient was on a csDMARD or bDMARD had the biggest influence on total, overall costs amongst the RA patient.

Key messages
• The study provides a breakdown of costs of RA multidisciplinary care in Ireland, facilitating understanding cost drivers and potential areas for cost-savings.
• The study advances the understanding of RA management in HSE Ireland.