bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk exposures in early life and incidence of early-onset colorectal cancer across countries
Authors: Wang Z Y , Yao W Y , Wu W M , Huang J J , Ma Y L , Yang C , Shi J F , Fu J X , Wong MCS , Xu W H 
Published: October 2023

Abstract

Introduction
Globally, the incidence of early-onset colorectal cancer (EoCRC) is increasing, indicating substantial changes in risk exposures. However, little is known about the environmental risk factors for EoCRC in young populations.

Methods
CRC incidence and risk factors data (1990-2019) were extracted from the GBD 2019. Age-standardised incidence of EoCRC and summary exposure value (SEV) of risk factors were estimated with the GBD world population standard using direct method. Early-life exposures were estimated as the gross domestic product (GDP) per capita, the socio-demographic Index (SDI) and the SEV of risk factors in previous decades and at age of 0-4, 5-9, 10-14 and 15-19 years. Average annual percent changes (AAPC) and their 95% confidence interval (CI) were calculated by Joinpoint regression. Associations between risk exposures and incidence were examined at national level by weighted linear or non-linearity regression.

Results
The global age-standardized incidence of EoCRC increased from 3.05 (95%CI, 3.03-3.07) per 100 000 in 1990 to 3.85 (95%CI, 3.83-3.86) per 100 000 in 2019. The incidence was higher in countries with high socioeconomic level, but increased drastically in countries in East Asia and Caribbean, particularly in Jamaica [AAPC: 5.1% (95%CI: 3.2, 7.0)]. The GDP per capita, SDI, and SEV of iron deficiency, alcohol use, high body mass index and child growth failure in earlier years were more likely to be associated with the incidence in 2019. Exposures in four age windows in early-life were significantly associated with the incidence, particularly for the exposures at age of 15-19 years. Similar association patterns were found in both gender.

Conclusions
The global, rapidly rising incidence of EoCRC highlights the importance to screen and control the cancer in young populations. The associated risk factors at country level in early life suggest the contribution of the early-life exposures.

Key messages
• Incidence of EoCRC is increasing globally, which was most notable in countries or regions that are undergoing rapid demographic and epidemiological transitions.
• This study demonstrates significant associations of economical and life-style factors in early-life with the incidence of EoCRC at country level.
Recurrence of wheeze in preschool aged children: a retrospective cohort study in primary care
Authors: Creese H , Hargreaves D , Foley K , Saxena S 
Published: October 2023

Abstract

Background
Approximately 1 in 7 children with wheeze will be admitted to hospital for treatment, often leading to repeat visits to emergency departments and hospital admissions. The UK lags other wealthy countries in the management of preschool wheeze and has amongst the highest rates of asthma deaths in Europe. There were reports that wheeze and asthma admissions to hospitals fell during the Covid-19 pandemic lockdowns, but the changing community incidence is unknown. We aimed to report the changing incidence of recurrent wheeze across the Covid-19 pandemic.

Methods
Using data from the UK Clinical Practice Datalink, a nationally representative sample of the UK population, we followed a cohort of 57,603 children aged 1-5 years who consulted their general practitioner with their first wheeze attack between January 2009 and July 2020. We calculated the incidence of wheezing recurrence by calendar year. We will calculate the incidence rate ratios for recurrent wheeze by level of area-based deprivation whilst accounting for potential confounders including child age, sex, birth weight, gestation age, ethnicity, comorbidities, bronchiolitis, maternal smoking, maternal asthma, and maternal age at birth.

Results
The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic (e.g., 2019: 27% vs 2020: 23%) even though total wheeze events in general practice fell from 3,135 in 2019 to 1,280 in 2020.

Conclusions
Around a quarter of children with wheeze have repeat visits to the GP. Our next steps are to identify preventive actions to reduce the risks of recurrent wheeze for children presenting with their first wheeze attack in primary care.

Key messages
• Around a quarter of children will have a repeat visit to the GP for wheeze within the first year after their initial wheeze attack.
• The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic.
Age trajectories of disability in middle and older age: a machine learning approach
Authors: Chang Y-H , Chung R-H , Lu X-H , Chiou H-Y 
Published: October 2023

Abstract

Background
The study employed machine learning methods to explore age trajectories of Instrumental Activities of Daily Living (IADL) disability in a representative cohort of middle- and older-aged individuals. This is crucial for understanding the impact of disability onset on healthy life expectancy (HLE) across sub-populations.

Methods
We utilized data from the Taiwan Longitudinal Study on Aging, which included 5,334 individuals aged 50 and over from 1996 to 2011. To investigate the change in physical functions, we focused on the 6 IADL items assessed over five waves of surveys. Each IADL item was dichotomised and summed to calculate a disability score ranging from 0 to 6 based on its difficulty level. We used K-means clustering to identify IADL disability trajectories and applied 10-fold cross-validation, repeated ten times, to select the optimal classification. We transformed the identified groups into age trajectories based on the mean IADL score at each age within each group. The age trajectories were then smoothed using locally estimated scatterplot smoothing and generalized additive models.

Results
We identified four trajectory groups based on changes in IADL scores over 15 years: (1) individuals who remained consistently able, (2) individuals with persistent and slower decline, (3) individuals with persistent and faster decline, and (4) individuals with persistent disability. The proportions of the four groups were 56.1%, 20.0%, 16.1% and 7.8%, respectively. The average posterior probabilities for all groups were above 83.3%. The results of this study were comparable to those of traditional regression-based models. We also analyzed the associations between trajectory group membership and participants’ characteristics at baseline.

Conclusions
This machine learning approach based on K-means clustering is valuable for investigating diverse disability trajectories within the population and can inform future research to explore factors that may enhance HLE.

Key messages
• Machine learning enables investigating disability trajectories across sub-populations.
• The study identified four distinct disability trajectory groups using K-means clustering, providing insights into factors for enhancing healthy life expectancy.
Night shift work and sickness absence – many for the few or few for the many?
Authors: Larsen A D , Nielsen H B , Nabe-Nielsen K , Kolstad H A , Hansen ÅM , Hansen J , Garde A H 
Published: October 2023

Abstract

Background
Night shift work is related to adverse health outcomes. Yet, some choose working permanent night and it is speculated that they tolerate night work better. However, research on permanent night work is sparse. The aim was to study the association between organisation of night work and sickness absence. Should we allow many night shifts for the few or should we enforce few night shifts for the many?

Methods
Information on working hours, age (19-70 years), gender (women, men) and sickness absence (annual number of days) was obtained from 94 815 nurses and nurse assistants (88% women) from the Danish Working Hour Database (DAD). DAD contains daily information on working hours based on payroll data for all employees in Danish public hospitals (2017-2020). For each year with &gt;50% work participation, individual schedules were classified into “no night shifts”, “1-50 night shifts”, “51-100 night shifts”, “101-150 night shifts” and “more than 150 night shifts”. We applied linear regression (with individual as random intercept) for risk of sickness absence the following year adjusted for age, gender and calendar year.

Results
Preliminary results showed night shift workers with more than 150 night shifts per year had 5.0 more sick days (95% CI: 3.5-6.4, p = &lt;0.001) than employees with no night shifts. No statistically significant differences were observed between the four night shift groups.

Conclusions
Employees had more sickness absence the year after working during the night compared to employees without night shift work. However, no differences were seen when yearly comparing employees with many night shifts to those with few night shifts.
The study adds to scientific support to guidelines on scheduling of shift work in governmental policies with the aim of securing healthy and safe workplaces.

Key messages
• Night shift workers have higher number of sick days compared to daytime workers; however, number of night shifts during a year did not affect the results.
• The study adds value for the use of the scientific recommendations for minimizing health risk for night shift workers in governmental policies with the aim of securing healthy and safe workplaces.
Novel ways to drive catch-up vaccination of adult migrants in UK primary care: a pilot study
Authors: Crawshaw A F , Goldsmith L P , Deal A , Carter J , Knights F , Seedat F , Iwami M , Wurie F , Majeed A , Hargreaves S 
Published: October 2023

Abstract

Adult and adolescent migrants to Europe may have missed routine vaccinations and must be aligned with European schedules, but awareness and implementation of catch-up guidelines in UK primary care is poor. We conducted a pilot study of novel primary care mechanisms (May ‘21-Sept ‘22) to explore under-immunisation and increase catch-up vaccination of migrants ( &gt; =16 years, born outside W. Europe, N. America, Australia, or New Zealand) in 2 London boroughs. We recorded vaccination history, past vaccine-preventable diseases (VPD), and prompted staff to offer MMR, Td/IPV, HPV, MenACWY vaccines according to UK guidelines on uncertain or incomplete immunisation status. Data were analysed in STATA12. We included 57 participants (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) from 18 countries. Demographic distributions were not significantly different between boroughs (sites) for age, sex, or years in UK, but differed by birth region (p &lt; 0.0001). Nearly all participants required vaccination for MMR (86%) and Td/IPV (88%), suggesting migrants would benefit from catch-up vaccination on arrival.12/22 participants reported a past VPD (15 cases including measles, rubella, pertussis, active TB, HPV, hepatitis A, HPV, meningitis). 93% of participants were referred for catch-up vaccination and 81% had at least one dose (at study end). Start of vaccination was higher in Site 2 (100%) than Site 1 (44%). Half (30, 59%) of those referred for MMR completed the course (2 doses) by study end. Less than half (17, 41%) referred for Td/IPV had received at least 1 dose at study end. Direct and indirect barriers exist to delivering catch-up vaccines to migrants, including staff knowledge/training; incomplete vaccination records; lack of incentives, time and care pathways. Designated staff champions, financial incentives and awareness are needed to drive catch-up vaccination in primary care, alongside novel ways to deliver vaccinations at scale and in the community.

Key messages
• Designated staff champions, incentives and other mechanisms to raise staff awareness and willingness to engage with guidelines are needed to drive catch-up vaccination in primary care.
• Novel ways to deliver vaccinations at scale and use of community-based or community-led interventions are needed to advance vaccine equity and ensure inclusion of marginalised migrant groups.
Integrated maternity care in Finland: mothers’ experiences and professionalś perceptions
Authors: Paavilainen M , Kalliolehto J , Vuorenmaa M , Gissler M , Heino A , Hujala A , Jouhki M R , Kaarakainen M , Raussi-Lehto E , Klemetti R 
Published: October 2023

Abstract

Background
Divided responsibility to organise primary and specialised maternity care is common. In Finland, this has caused increasing number of visits and poor information flow between the care sectors. Some counties have had vertically integrated care sectors for a few years. Thus, we aim to study mothers’ experiences on care in counties with integrated care (IC) and non-integrated care (NIC), as well as perceptions of maternity care managers about the integration.

Methods
FinChildren Survey data 2020 on mothers with small babies (N = 8,923) and qualitative thematic interviews for maternity care managers (N = 8) were used. IC-counties were compared to NIC-counties adjusting for confounders in logistic regression. Over 30 indicators on motherś experience were used as outcome measures. The qualitative data were analysed with content analysis.

Results
Mothers were often more satisfied with care in IC- than in NIC-counties. 72% of first-time mothers in IC-counties compared to 66% in NIC-counties considered visits in antenatal clinics customer-oriented (adjusted OR 1.30 (1.05-1.63)). 87% of mothers in IC- and 81% in NIC-counties received adequate professional support for personal coping during pregnancy (OR 1.57 (1.08-2.27)). 64% of mothers in IC- and 56% in NIC-counties found prenatal classes beneficial for fear of childbirth (OR 1.44 (1.04-1.98)). However, part of the indicators did not show difference in motherś experience on care between IC- and NIC-counties. Maternity care managers felt that the fragmented structures within maternity care together with organisational boundaries pose a challenge to integrated care. Shared structure, management and information systems were seen as promotors for integration.

Conclusions
Integration of maternity care is to some extent associated with positive experience. However, maternity care should be better integrated in terms of structures, resources and management, to guarantee continued care and support for mothers and families.

Key messages
• Integrated maternity services are essential from the perspective of pregnant mothers.
• Shared organisational systems are needed to ensure sustainable care for mothers and families.
Monitoring the outpatient process: the Teaching Hospital of Siena experience
Authors: Guarducci G , Vannini P , Cuccaro C , Messina G , Golinelli D , Nante N , De Marco M , Barretta A D 
Published: October 2023

Abstract

Background
Nowadays, the outpatient process is assuming an increasingly central role health authorities’ strategic planning, which is why it is necessary to develop new approaches and specific skills to ensure its more effective organizational management. The aim of this paper is to illustrate how the Teaching Hospital of Siena (THS) has responded to the demand for outpatient services and its fluctuation after the COVID-19 pandemic.

Methods
A retrospective study was conducted on outpatient services’ prescriptions and provisions of the catchment area of THS during years 2021 and 2022. The prescription data was extracted from the regional computer system “Business Object”, while the provisions data from information flow of outpatient service. Monthly data were divided into two fortnightly periods; the prescription fortnight was associated with the dispensing fortnight of the following period. The statistical analysis (T-test and linear regression) was carried out with STATA. Significance level was set at 95%.

Results
During studied period, the demands increased from 2.728±407 twice-weekly prescriptions in 2021 to 3.054±502 twice-weekly prescriptions in 2022 (p &lt; 0.05). At the same time, the provisions increased from 1.152±162 in 2021 to 1.470±196 in 2022 (p &lt; 0.05). The relationship between fortnight of prescription and subsequent provision shows a R2 of 0.6921 with an angular coefficient of 0.4025[95%CI: 0.3755-0.4295] (p &lt; 0.05) in 2021 and an R2 of 0.7396 with an angular coefficient of 0.4729[95%CI: 0.4463-0.5011] (p &lt; 0.05) in 2022.

Conclusions
The results show the resilient response of THS to the increase in services’ demand after the COVID-19 pandemic, avoiding system distress and recovering the backload of patients in the waiting lists. This result is due to a refinement of the outpatient process, through the creation of an Operational Management Team, the implementation of process monitoring, the reorganization of slots and the extension of outpatient activity hours.

Key messages
• It is essential to consolidate more appropriate and organizationally efficient forms of healthcare services.
• Monitoring hospital processes is important to respond to the increasing population health needs.
Is violence a gender issue among community health agents in Northeast Brazil?
Authors: Vieira-Meyer A , Ferreira RGLA , Albuquerque G A , Aguiar A S , Guimarães JMX , Morais APP , Meyer CHC , Castro M C , Yousafzai A K , Guedes F 
Published: October 2023

Abstract

A biopsychosocial phenomenon, violence may be defined as the hurtful outcome of conflicting social forces. Violence affects individual and collective health, creating a demand for targeted public policies and the implementation of services for the prevention and treatment of injury. Community Health Agents (CHAs) are the link between the Brazilian primary health care system and the community. As they live and work in the same neighborhoods, they are involved in what happens in the community, including observants and or potential targets of violence. We aimed to investigate the violence to which CHAs are exposed and if female CHAs experience and or perceive violence the same way as male CHAs. A structured questionnaire applied to CHAs was used to collect information. Two periods (2019 [n = 1402] and 2021 [n = 364]) were compared. The sampled CHAs were found to be highly exposed to violence (&gt;80%), whether as victims in the workplace and at home or as witnesses within the community served. In general, while the occurrence of violence towards CHAs decreased, their perception of community violence increased. Moreover, between 2019 (before the Covid-19 pandemic) and 2021 (a year into the pandemic) the prevalence of perceived urban/community violence (physical aggression, assault, stabbing, lethal and non-lethal gunshots, and gang violence) increased among female CHAs, but remained practically unchanged (with the exception of ‘assault') among male CHAs, indicating a gender-related difference for this variable. In addition to impacting the health and work routines of CHAs, violence is also injurious to the health of the community (directly or indirectly - inability of CHA to deliver care). Given the complexity of violence and its repercussions on the daily routines of CHAs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

Key messages
• CHA are highly exposed to violence (&gt; 80%), whether as victims in the workplace and at home or as witnesses within the community served.
• There is a gender-related difference for the perception of violence among CHA, which may be due to social inequalities or women's vulnerability to violence.
Care pathways for older multimorbid patients: lessons learned from 16 clinical sites in 3 Countries
Authors: Ferrara L , Ardito V , Tozzi V , O'Sullivan B , Staines A , Davies P , Tarricone R 
Published: October 2023

Abstract

Background
The fact that multimorbid and vulnerable patients need improved care coordination is well known. However, current healthcare system is still mainly single-disease oriented and as a result, coexisting morbidities are often under-evaluated and under managed leading to inappropriate care, inefficiencies, duplication and poor quality of care. We also know that different strategies have been developed to manage older multimorbid patients and varies from one country to the other. We therefore aimed to describe the care pathway for older, multimorbid cancer patients to understand current practices and shed light on the care pathways currently followed by the 16 clinical sites in 3 Countries that are participating to a EU funded research project.

Methods
Semi-structured interviews were conducted in each site with key, relevant stakeholders (e.g., oncologists, geriatrician, nurses). An interview outline was drafted and followed systematically, to collect coherent responses across centres. Overall, 39 interviews were conducted. Evidence of the interviews were processed under several dimensions, including but not limited to organizational context, health care professionals involved, multidisciplinarity, spaces and organization of the activities.

Results
The analyses highlighted high variability in the process of care of older multimorbid patients across countries and centres. In particular, the organizational context in which each site is embedded affects its operating conditions and there are at least three dimensions that affect the delivery of patient care: a) the scope of the services offered by each clinical site within the care pathway; b) the relationships between health care professionals, including access to specialist knowledge; c) the tools available to ensure integration between the different professionals in the different stages of the care pathway.
GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218.

Key messages
• Multimorbid patients need improved care coordination but current healthcare system is still mainly single-disese oriented.
• Delivery of patient care is affected by the scope of the services offered by each hospital, the relationship between professionals and the operational tools available.