bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operationalization, characterization and validation of a healthy lifestyle index in 35 LMICs
Authors: Schindlmayr R , Theilmann M , Davies J , Danquah I 
Published: October 2023

Abstract

Background
For low- and middle-income countries (LMICs), there is no comprehensive and valid index reflecting overall lifestyle. This study aimed to operationalize, characterize, and validate a healthy lifestyle index (HLI), based on the World Health Organization (WHO) recommendations.

Methods
We used cross-sectional, complete-case data from individual-level, nationally representative surveys among non-pregnant adults in 35 LMICs, applying the WHO STEPwise approach to NCD risk factor surveillance (2009-2019; N = 125,607). The HLI was constructed based on WHO recommendations for fruit and vegetable intake, physical activity, smoking, and alcohol intake (unhealthiest = 0 points; healthiest = 16 points). We calculated the distributions of the HLI and its subcomponents across socio-demographic and geographic strata, accounting for the survey design and each country's World Bank population estimate. Partial Spearman correlations were calculated for the HLI with its subcomponents and cardio-metabolic risk markers.

Results
In this study (females: 51%, median age: 35.4 years), median HLI-score was 10.3 (interquartile range: 8.2-12.3), being highest in females (versus males) and low-income countries (versus middle-income countries). Twenty-two percent had at least five servings of fruits and vegetables per day (males: 20%, females: 24%); 82% exercised at least 600 MET-min/week (males: 87%, females: 78%); 69% never smoked (males: 40%, females: 97%); 64% were alcohol abstainers (males: 50%, females: 78%). Correlations of the HLI with its subcomponents were moderate and positive, ranging between r = 0.35 and r = 0.64; correlations with cardio-metabolic risk markers were weak, ranging between r = |0.02| and r =|0.12|.

Conclusions
The majority of adults in LMICs appear to live a healthy lifestyle, particularly women and individuals in low-income countries. Low fruit and vegetable intakes are a major concern. The HLI shows good content but poor construct validity.

Key messages
• There is an urgent need for interventions to promote fruit and vegetable consumption in LMICs.
• The HLI is suitable to monitor lifestyles in LMICs on individual-, country- and WHO region-level.
A descriptive study assessing the infodemic medical students faced during COVID-19 pandemic
Authors: Ataoğlu B , Hıdıroğlu S , Çetin H , Gümüş E G , Kılınç M , Köksal C , Karavuş M 
Published: October 2023

Abstract

With COVID-19, a new pandemic on worldwide basis emerged. An infodemic is a rapid and far-reaching spread of both accurate and inaccurate information about certain issues. Misinformation and disinformation can spread like a virus from person to person and affect people like a disease. The aim of this descriptive study was to assess the infodemic the medical students faced during COVID-19 pandemic. Second (n = 266) and third (n = 242) graders from a medical school in Istanbul, Türkiye were the study population. The study was completed with a total of 181 participants, 98 students from second grade and 83 from third grade who accepted to be included in the study in February 2022 while the COVID-19 pandemic was still continuing. A 5 point scale lickert type questionnaire was prepared and applied by the researchers to measure how much and particularly on which aspects the participants faced infodemic. Nearly half of the participants (47.5%) believed that they ‘almost always thought there was a COVID-19 infodemic'. As the most important causes of this infodemic the participants stated were ‘It is a new virus ‘ (31.5%) and ‘It affects daily routine life’ (31.5%). Around 40.9 % of the participants believed that the COVID-19 infodemic ‘adversely affected their health,’ 23.2% reporting low-mood and 15.5% anxiety. Around 52.5% of the participants stated that the COVID-19 infodemic had a negative impact on their general learning process at school. Additionally, 69.9% of the participants declared that they may not have shared anything that might have been the cause of any infodemic during the pandemic. Health authorities and educators should be aware that infodemic exists freely, adversely affecting health and education.

Key messages
• Majority of the medical students believed that there was a COVID-19 infodemic.
• The COVID-19 infodemic adversely affected their health and education.
Prehabilitation prior to elective surgery for frail elderly – protocol for a scale-up analysis
Authors: Felgner S , Eckhardt H , Quentin W , Rombey T 
Published: October 2023

Abstract

Background
Elderly patients frequently develop a frailty syndrome. Frailty is characterized by reduced physical reserves which increases the risk of perioperative complications and, thus, of patients needing long-term care. Prehabilitation before elective surgery can reduce risk factors and is currently evaluated as a new and sustainable care pathway for frail elderly in a randomized trial (NCT04418271). If found to be effective (the primary outcome being the level of care dependency 12 months after surgery), the pathway will be recommended for national scale-up. This protocol outlines the analyses intended to prepare for scale-up.

Methods
We will perform a scale-up analysis to assess whether and how prehabilitation can be implemented into routine care in Germany, including: (i) a Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis of facilitating factors and barriers from the perspective of health care providers and patients (via semi-structured interviews, and a realist review); (ii) a scalability analysis using the Intervention Scalability Assessment Tool (ISAT) in an expert advisory board; (iii) a subgroup analysis to identify patients in the PRAEP-GO trial for whom prehabilitation was particularly effective; and (iv) a budget impact analysis based on routine data to estimate the total cost of implementing prehabilitation from a payer's perspective. The scale-up analysis will identify challenges and opportunities for the implementation of prehabilitation. It will contribute to the development of an implementation strategy, including specific proposals on how to finance the intervention. The budget impact analysis will provide an estimate of the financial impact of routine implementation of prehabilitation on the health budget.

Conclusions
If prehabilitation for the frail elderly is evaluated positively, its implementation should be prepared based on our study results, which includes establishing required infrastructures and defining financing concepts.

Key messages
• The proposed scale-up analysis will examine scalability of the implementation of prehabilitation for frail elderly into routine care in Germany.
• The implementation of a new care pathway having a positive effect on patients’ level of care dependency can be considered sustainable.
HTA challenges for personalized medicine: the case of liquid biopsy for lung cancer
Authors: Aguilera-Cobos L , García-Sanz P , Rosario-Lozano M P , Blasco-Amaro J A 
Published: October 2023

Abstract

Background
Personalized medicine and related health technologies are growing rapidly. In this context, health technology assessment methodologies must be prepared and adapted. Evaluating liquid biopsy (LB) for the diagnosis, treatment indication and prognosis of lung cancer is an example of the challenges in the personalized medicine assessment.

Methods
A systematic review and metanalysis based on EUnetHTA CoreModel. Review question: What is the effectiveness of LB for the diagnosis, therapeutic adequacy and prognosis of lung cancer versus tissue biopsy? The Covidence software was used for the systematic review and MetaDiSC software for the meta-analysis. The quality of the included systematic reviews was assessed with AMSTAR-2 and the quality of the clinical studies with QUADAS-II.

Results
69 systematic reviews corresponding to different therapeutic purposes: 12 for treatment adequacy, 47 for diagnosis and 13 for prognosis. Also 24 clinical trials were included. The omics alterations analysed were: punctual mutations in EGFR, BRAF, KRAS and ALK, methylation patterns, lncRNA expression, detection of circulating tumour cells, quantification of circulating DNA, NGS analysis of point mutations, miRNA expression and analysis of exosome content.

Conclusions
Use of LB tests at different disease stages and need of individual validation for the biomolecules and mutations analysed, are the main challenges. An evaluation framework that includes the specificities of these technologies is necessary for their proper assessment.

Key messages
• Liquid biopsy may be an alternative to tissue biopsy. The evaluation of the biomolecules analysed should be disaggregated.
• The particularities of personalised medicine technologies require assessment methodologies adapted to them.
Mathematical model for the prediction of high blood pressure through digital dermatoglyphics
Authors: Castro-Jimenez L , Rodriguez-Florian R , Rocha-Gonzalez J 
Published: October 2023

Abstract

Background
Hypertension is considered not only a disease belonging to the large group of cardiovascular conditions, but also a risk factor that impacts at an economic, social, environmental, and cultural level, among others. Worldwide, it is recognized that arterial hypertension is increasing, with projections that estimate a 30% increase in prevalence by the year 2025. Objective. To develop a mathematical model for the prediction of high blood pressure in young people through digital dermatoglyphics.

Methods
This study was carried out in a sequence of three activities, which included in the first instance the collection and analysis of all the fingerprints of the upper limbs of each study participant with an image recognition device, to later carry out a characterization. in terms of number and type of footprint on each of the participants’ fingers. Subsequently, a multiple linear regression model was carried out for the right and left hand, which includes information on the type of footprint, number of relevant characteristics and other physical characteristics of everyone with which it is possible to determine an expected value of the pressure. diastolic and systolic arterial pressure, a model that was validated through the estimation of different types of error, the correlation coefficient, and the tracking signal, in a contrast between predicted and observed blood pressure in a second control sample with different participants. those used in the formulation of the mathematical model.

Results
The model had a significant R-square, allowing to establish a relationship of similarity and explanation of the blood pressure values, from the quantification of the characteristics of the fingerprints of the right and left hand with a significance level of 95%.

Conclusions
An important advance is presented for the prediction of high blood pressure through genetic markers with a non-invasive and low-cost method.

Key messages
• This type of research allows progress in the establishment of relationships between the subject's genetic conditions and the potential risk for the development of diseases.
• Biotechnology is currently presented as a tool that contributes to the challenges that are generated in different areas such as the health sector.
The employment consequences of hearing loss among teachers: a 7-year follow-up study
Authors: Schriemer A G , Bültmann U , Roelen CAM 
Published: October 2023

Abstract

Background
Hearing loss is the third leading cause of years lived with disability. As the retirement age is rising, age-related hearing loss (HL) is an increasing occupational health (OH) problem. This study aimed to examine long-term changes in employment and work outcomes in teachers with HL and to identify barriers to and facilitators for their work participation.

Methods
In this prospective cohort study with 7-year follow-up, teachers completed an internet survey and an online hearing test. Teachers were classified as normal hearing (NH) and teachers with HL. For those who had stopped working during follow-up, we compared retirement age and proportions receiving disability pension in both groups. For those still working, differences between NH and teachers with HL in work outcome changes, i.e. work ability (Work Ability Scale), work performance (Health & Work Performance Questionnaire), and sustainable employability (Capability Set for Work Questionnaire) were investigated with ANOVA. Furthermore, teachers with HL answered questions on work participation barriers and facilitators for a thematic analysis.

Results
Of the invited N = 325 teachers, n = 211 (65%) responded and n = 89 were teachers with HL. Among those who had stopped working (n = 89), the mean retirement age was 64.6 years for both NH and teachers with HL. At follow-up, n = 10 received disability pension of which n = 9 had HL (p &lt; 0.01). No differences were found over time for changes in work outcomes. Barriers for work participation were attending meetings, teaching, and poor classroom acoustics. Facilitators were job satisfaction, cooperation of the work environment, task adjustment, good acoustics, and technical equipment.

Conclusions
Teachers with HL retired at the same age as NH teachers, but more often received disability pension. No differences were found in work outcomes over time. Our study identified barriers and facilitators relevant for OH professionals when advising teachers with HL about work participation.

Key messages
• Although work outcomes over time were not different for teachers with and without hearing loss, teachers with hearing loss more often stopped working because of disability pensioning.
• The identified barriers to and facilitators can be used to advise teachers with hearing loss and their employers about workplace accommodations.
Work-related stress, reason for consultation and sick leave diagnosis in primary health care patients
Authors: Hultén A-M , Holmgren K , Bjerkeli P 
Published: October 2023

Abstract

Background
Work-related stress is common and stress-related ill health is often managed in primary health care. The reason for consultation is important for diagnosis and treatment. This study aimed to improve the understanding of the association between reason for consultation, work-related stress and sick leave diagnosis in primary health care patients.

Methods
In all, 232 patients who sought care for mental and physical health complaints at primary health care centres in Sweden participated. At inclusion, the patients were employed and non-sick listed. Pearson chi-squared test and relative risk were used to assess the associations.

Results
Patients reporting high work-related stress, compared with low work-related stress, were more prone to seek care for mental symptoms (59% versus 18%), sleep disturbance (36% versus 17%) and fatigue (40% versus 26%). Among the high-stress patients, the risk for sick leave with a mental diagnosis was three times as high as in low-stress patients within a year of baseline (RR 2.97, 95% CI 1.59;5.55). However, no risk increase was seen in sick leave with a musculoskeletal diagnosis (RR 0.55, 95% CI 0.22;1.37). Stating mental symptoms, sleep disturbance or fatigue as reason for consultation were associated with future mental sick leave diagnosis (p-values &lt; 0.001). Stating musculoskeletal symptoms as reason for consultation was also associated with future musculoskeletal sick leave diagnosis (p-value 0.009), but not in patients reporting high work-related stress.

Conclusions
High-stress patients, compared with low-stress patients, more often sought care for mental symptoms, sleep disturbance and fatigue leading to a mental sick leave diagnosis. No such associations were found between stress, care seeking due to musculoskeletal symptoms and future musculoskeletal sick leave diagnosis. It can therefore be assumed that patients as well as general practitioners saw work-related stress as a mental issue.

Key messages
• Incorporating the reason for consultation increased the understanding of the association between work-related stress and sick leave.
• Work-related stress was characterized as a mental issue, which could affect care seeking behaviors and measures taken.
Organisational aspects and determinants on intention to seek psychotherapeutic consultation at work
Authors: Kohl F , Angerer P , Weber J 
Published: October 2023

Abstract

Background
Worldwide, a minority of people suffering from mental illness receives adequate treatment. Psychotherapeutic consultation at work (PT-A) offers low-threshold and short-term access to psychotherapeutic care for employees with mental burden. However, utilisation has been low so far. Therefore, this study aimed to identify employees’ preferences on organisational aspects and determinants on intention to seek PT-A.

Methods
In total, 755 employees answered online questions on organisational aspects of PT-A (type, time, location, scope and purpose) and on determinants (sociodemographic variables, psychological well-being, stigma-related barriers and psychosocial safety climate) of intention to seek PT-A. To identify organisational preferences, various repeated measures analyses of variances were conducted. Multiple linear regressions were used to identify determinants of intention to seek PT-A.

Results
Results showed that employees prefer in-person consultations that take place outside of working hours and outside company premises, with treatment sessions included in addition to diagnostics. Intention to seek PT-A for occupational reasons was higher than for private reasons. The study also found that male gender, higher psychological well-being and higher perceived stigma-related barriers were associated with a lower intention to seek PT-A. However, these associations were found to depend on whether participants currently showed symptoms of depression.

Conclusions
These results provide practical indications under which conditions employees would make use of PT-A. Furthermore, recommendations that might increase utilisation can be derived from these results (e.g. anti-stigma campaigns). Nevertheless, longitudinal studies are necessary to confirm whether these factors determine actual utilisation.

Key messages
• Results suggest that employees prefer PT-A as in-person consultation during working hours and off company premises.
• Interventions like anti-stigma campaigns or target group specific advertising might address the determinants on intention to seek PT-A found in this study.
The use of employment and social services and rehabilitation after the onset of unemployment
Authors: Rinne H , Perhoniemi R 
Published: October 2023

Abstract

Background
Even though employment and social services and rehabilitation are available to the unemployed, there is little information about their service paths after the onset of unemployment. The aim was to follow different service spells using sequence analysis among those who became unemployed.

Methods
The register-based data included all 18-59-year-old individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 8,935). For the 12 months after the onset of unemployment, eight states were constructed: rehabilitative work activities, mental health and substance abuse services, social work, rehabilitation, work trial, labour market training (LMT), several services, and no services. We used sequence analysis and clustering to identify groups with different service paths. Sociodemographic and health-related factors and later employment were examined using multinomial regression analysis.

Results
We identified eight clusters: 1) no services (57%), 2) short LMT (11%), 3) several and simultaneous services (6%), 4) mental health or substance abuse services (2%), 5) work trial (10%), 6) rapid LMT (6%), 7) intermediate LMT (5%), and 8) long LMT (4%). Persons in cluster 1 had a more advantaged background. Compared to them, clusters 3 and 5 were associated with being female and cluster 7 was associated with being male. All service clusters were associated with being under 50 years old. Clusters 3-8 were associated with primary education and clusters 3, 5, and 8 also with secondary education. All service clusters were associated with no employment days before the onset of unemployment. Clusters 3-5 were associated with chronic diseases. Later employment was highest among clusters 1, 6, and 8.

Conclusions
The unemployed can have very different service paths. Lower SES predicts the use of employment and social services and rehabilitation, but the paths also differ by sex and health. Duration and timing of LMT vary by sociodemographic characteristics.

Key messages
• Most of the unemployed do not use any employment or social services or rehabilitation. Those who do can have very different service paths.
• Lower education predicts more frequent use of services. Paths vary by sex, age, and health.
The unemployed on sickness allowance: segmenting 3-year labour market pathways with sequence analysis
Authors: Blomgren J , Laaksonen M 
Published: October 2023

Abstract

Background
Understanding how the combination of unemployment and work disability affects future labour market pathways is important. We followed labour market pathways among those who were unemployed at the start of a sickness allowance spell.

Methods
Register data covered disability pensions (DP), rehabilitation spells, sickness allowance spells, unemployment spells and employment spells, retrieved for unemployed Finnish 18-58 years old persons who had a new sickness allowance spell in 2016. Sequence analysis and clustering were used to identify latent homogenous subgroups. Using multinomial regressions, demographic, socioeconomic, and disability-related covariates were examined.

Results
Preliminary analyses revealed six clusters with unique pathways and identities. 1) Unemployment; 2) Employment; 3) Rehabilitation spells, recurring disability and unemployment; 4) Unknown sources of income; 5) Permanent disability pension; and 6) Temporary disability pensions. Compared to the cluster with emphasis on return-to-work, other clusters were associated with less pre-LTSA employment days, having a pre-LTSA chronic illness, and a mental disorder.

Conclusions
Unemployed persons starting an LTSA have very different labour market pathways. For many, there are low chances for employment or regained work ability in the following years. Persons with poor health, long history outside employment, older age, low educational level and a mental disorder could benefit from targeted support.

Key messages
• Despite heterogeneous pathways found, for most of the unemployed, sickness allowance spells are followed by recurring unemployment, recurring sickness allowance, or disability retirement.
• Since the unemployed with work disability rarely regain work ability in the following years, supporting their work ability is crucial in preventing permanent exclusion from working life.