bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of long-term sickness absence trajectories among 19–39-year-old employees with pain
Authors: Fagerlund P , Shiri R , Rahkonen O , Lallukka T 
Published: October 2023

Abstract

Background
Previous studies have shown higher long-term sickness absence (LTSA) rates among employees with pain as compared to those not reporting pain. We examined distinct developmental patterns in LTSA (≥10 consecutive working days) among young and early midlife employees with pain at baseline, and factors associated with LTSA trajectories.

Methods
The study population consisted of 19-39-year-old employees (n = 1685) of the City of Helsinki who reported current pain at baseline in 2017. Data on all-cause LTSA days through March 2020 were collected from the Social Insurance Institution of Finland. Group-based trajectory modelling was used to identify distinct all-cause LTSA trajectories. Multinomial logistic regression was used to examine associations of pain characteristics, lifestyle- and occupational factors with trajectory group membership.

Results
Three distinct LTSA-trajectory groups were identified; No LTSA (74%), Decreasing (18%), and Increasing (8%). Compared to the No LTSA trajectory, employees in the Decreasing trajectory were more likely to have chronic (OR 1.34, 95% CI 1.04-1.73) or multisite (OR 1.81, 95% CI 1.36-2.41) pain, smoke (OR 1.55, 95% CI 1.18-2.03), have obesity (OR 1.70, 95% CI 1.21-2.38), manual or routine non-manual occupation (OR 1.87, 95% CI 1.31-2.67) and high physical workload (OR 1.47, 95% CI 1.14-1.90), after adjusting for age and gender. Predictors of the Increasing trajectory were not identified.

Conclusions
Distinct LTSA-trajectories were identified among young and early midlife employees with pain, of whom a majority had no LTSA during follow-up. Chronic and multisite pain, unhealthy lifestyle, lower occupational class, and higher physical workload are related to a pattern with more LTSA. Future intervention studies could examine opportunities to prevent LTSA through supporting younger employees who work with pain and have these risk factors.

Key messages
• Distinct trajectories of LTSA were identified among younger employees with pain, of whom most had no LTSA. Pain characteristics, lifestyle and occupational factors predicted trajectory membership.
• Future intervention studies could examine opportunities to prevent LTSA through support to employees who work with pain and have pain-, lifestyle- and occupation related risk factors of LTSA.
Stroke care pathways according to rural-urban residency
Authors: Grimaud O , Kerbrat S , Menant L , Olié V , Timsit S , Le Meur N 
Published: October 2023

Abstract

Context
There is concern in France about geographical access to health care, particularly in remote areas with scarce medical services. The objective of our study was to compare the care pathway of stroke patients according to their residence context (rural/urban) and their affiliation to the “agricultural social security” scheme (“MSA”).

Methods
The study population included ischaemic strokes occurring between 2010 and 2013 in the 79 communes covered by the Brest stroke register (BSR). State sequence analysis using BSR data linked to medico-administrative records led to the construction of a typology of care pathways encompassing a period of 12 months before and after stroke occurrence. The associations between the typology, communal density (3 levels: dense, intermediate, and sparse), and affiliation to MSA were analysed by multinomial logistic regression.

Results
The study involved 2499 strokes (men 47%, mean age 71 years) distributed equally between the three levels of density. The pathway typology identifies a 1st group of severe strokes (n = 539). Pre-stroke care consumption distinguishes the 2nd (high consumption, n = 844) and 3rd (low, n = 1117) groups. Communal density was not associated with the pathway type, although the use of post-hospitalisation care was lower in the intermediate density (e.g. use of GP services in the year: 85% versus 92%, p &lt; 10-3). Affiliation to MSA (n = 389, 16%) was positively associated with the low care consumption group. MSA patients had a lower prevalence of diabetes (10.5 versus 14.4%, p = 0.05) but a higher prevalence of cardiac arrhythmia (29% versus 22%, p &lt; 0.01). Stroke occurred significantly later in these patients (e.g. mean age in men: 76 versus 70, p &lt; 10-3).

Conclusions
In the BSR territory, stroke patients’ pathway did not vary according to communal density suggesting equitable access to care. The unexpected result of higher age at stroke occurrence among MSA patients (reflecting lower incidence) requests further investigation.

Key messages
• Access to stroke care was comparable in rural and urban areas of Brittany, France.
• Affiliation to the agricultural social security scheme was associated with lower risk of stroke.
Health economic analysis of inpatient prostate cancer treatment in Austrian hospitals
Authors: Heilig D , Wienand D , Zuba M , Mitterhauser M , Simon J 
Published: October 2023

Abstract

Background
Prostate cancer (PrC) is the fourth most prevalent type of cancer worldwide. Its high incidence and 5-year survival rates contributing to high inpatient care costs make it an important public health issue. In Austria, surgery has been the most common inpatient procedure for PrC, despite clinical recommendations not clearly indicating its benefits over alternatives. No health economic comparison of these procedures has considered the period after treatment yet. We bridge this gap by analysing the health economic impact of treatment pathways.

Methods
We use a large administrative dataset of all inpatient PrC patients in Austria who received either only surgery or only radiation therapy from 2005-2014 (n = 34,286). To assess the health economic impact, we used diagnosis-related-group (DRG) points and length of stay (LOS). Monthly DRG points and LOS for each patient ±12-months around the index procedure were analysed using the difference in difference (DID) method. We controlled for age, and physical comorbidity burden using Charlson Comorbidity Index (CCI) scores.

Results
Looking at unadjusted averages, patients in the surgery group were significantly younger and had a lower CCI compared to the radiation group. Consequently, the surgery group had lower nominal average DRG points and LOS. However, when controlling for age and CCI, we found that radiation treatment was less resource intensive. A DID estimation found a shorter average LOS and lower DRG points for the radiation group compared to surgery for the 12 months post index.

Conclusions
We found significant additional costs and LOS times for surgical pathways following risk adjustment in Austria. This implies a potential excess burden of ∼4,400 hospitalisation days and ∼4 million DRG points (€4.8m) a year for the healthcare system during the observed period. Considering international evidence on higher patient burden in surgical pathways, these findings may call for clinical reconsiderations of PrC care.

Key messages
• Patient characteristics of different inpatient treatment pathways for PrC in Austria were very heterogenous.
• Health economic outcomes in the post treatment period for PrC inpatient treatment were significantly better for radiation treatment compared to surgery.
Has cross-level clinical coordination changed in the Catalan health system after the pandemic?
Authors: Campaz D , Vargas I , Cots F , Escosa A , Perez-Castejón J M , Plaja P , Sánchez E , Banqué M , Sánchez A , Vázquez M L 
Published: October 2023

Abstract

Background
The COVID-19 pandemic triggered several changes in the organization of health services, such as the acceleration of the introduction of digital tools to improve cross-level clinical coordination and, therefore, the quality of care. The aim is to analyse changes in the experience, perception of cross-level clinical coordination and related factors of primary care (PC) and secondary care (SC) doctors in the Catalan health system between 2017 and 2022.

Methods
Comparison of two cross-sectional studies based on the online surveys COORDENA-CAT (2017) and COORDENA-TICs (2022) to PC and SC doctors. Sample 2017 n = 3308 (participation: 20.9%); 2022 n = 2277 (participation: 17.5%). Outcome variables: experience and perception of cross-level clinical coordination, and related factors, knowledge, and use of digital coordination mechanisms. Descriptive and multivariate analyses were performed to detect changes between years.

Results
Compared to 2017, there was a worse experience of clinical management coordination, particularly in cross-level care consistency and accessibility, and of the perception. Regarding related factors there was a worsening in some organizational factors (time available for coordination, institutional support), attitudinal factors (satisfaction with the job) and interactional factors (knowledge between doctors). The use of some coordination mechanisms such as electronic medical records and virtual consultations between PC and SC increased, while the use of virtual joint clinical sessions was limited.

Conclusions
Results show that after the pandemic there was a worsening in some items of the experience and in the perception of cross-level clinical coordination, despite the increased use of some digital coordination mechanisms. There is a need to explore in depth the factors associated with this worsening to identify and promote more effective strategies to improve cross-level clinical coordination in Catalonia.

Key messages
• Cross-level clinical coordination in Catalonia has worsened despite the increase in implementation and use of some digital coordination mechanisms.
• It is necessary to explore in depth the factors related to this worsening to develop more effective strategies to improve cross-level clinical coordination.
Chronic disease management: Preventive care framework for migrant workers in Singapore
Authors: Karthikeyan N , Yong E , Ang P , Talib H , Lee H Y , Lam M C 
Published: October 2023

Abstract

Chronic diseases, if unmanaged, can contribute to significant premature mortality and morbidity. Before the COVID-19 pandemic, there was limited data on chronic disease prevalence amongst migrant workers (MWs) in Singapore. The antecedent episodic and fragmented primary care for migrant workers also affected care continuity for common chronic diseases. In April 2022, a Primary Care Plan (PCP) was developed for migrant workers to improve access and affordability which included chronic disease detection and management and risk factor reduction. In addition, chronic disease screening was also enhanced in migrant workers’ pre-employment medical screening for those with risk factors or above 40 years old. Beyond disease management, interventions to address health gaps and strengthen the healthcare resilience of MWs are incorporated into a population-health based “Management of Oral and Chronic Conditions and Ailments - MOCCA” framework, anchored on three thrusts:
1. Address knowledge gaps and inculcate healthier habits - Improve health literacy via outreach programmes and culturally nuanced health materials
2. Mitigate risk factors - Build primary care providers’ capabilities to deliver alcohol/tobacco interventions
3. Treat and control disease progression - Set up referral pathways between primary and tertiary healthcare institutions including for post-discharge case management
MOCCA was implemented in December 2022 through the collective efforts from the government, community, social service agencies and their employers.

Key messages
• Migrant workers have been receptive to interactive health programmes, regular health screening, follow up on chronic disease under the PCP and 324 workers attended basic dental screening.
• The MOCCA framework is integral to the provision of care for MWs, through risk factor identification, empowerment of health ownership, and periodic assessment of health and behavioural outcomes.
Improving prevention in primary care: results of a review of reviews and a case study
Authors: Clet E , Leblanc P , Cohidon C , Alla F 
Published: October 2023

Abstract

Background
For many reasons, such as the ageing of the population and the increase in chronic diseases, the organization of primary care (PC) systems is undergoing a major transformation in many European countries. Prevention policies are becoming more and more important but are still struggling to be implemented in the field. This study therefore aims to identify and analyse the obstacles and levers to the integration of prevention into PC.

Methods
This study mobilized: i) A systematic review of reviews of the literature who was conducted on PubMed, Web of Science, Embase and the Cochrane Database, ii) a case study who focused on three different cases of coordinated PC practice structures in France called communauté professionnelle territoriale de santé (CPTS). A qualitative method was used: 18 semi-structured interviews were conducted with health professionals, institutions and partners.

Results
In the review, among the 420 records identified, 35 reviews were included. This review identified many barriers (e.g. time and training) and levers (e.g. guidelines and motivation of the professionals) to the integration of prevention into PC. They were classified into 8 thematic categories according to their potential field of action. The case study complements the findings of the literature in the light of the French context. Specific obstacles and levers in the French context and in CPTS organizations were identified. For example, the construction of a network of professionals, the integration of PC into the health care system, its context and links with other policies (education, housing, transport, employment, etc.) were identified as major levers.

Conclusions
This study highlights: 1) the need to consider all the factors that can influence the integration of prevention in PC in order to meet the challenge of the preventive shift faced by our health systems 2) the specific conditions linked to the coordinated practice by PC professionals, using the French example.

Key messages
• The practice of prevention in PC is very complex, depending on many factors.
• It must be organized and integrated into the health system and local policies.
Factors associated with hospital service access during COVID-19: A longitudinal study in Uganda
Authors: Komasawa M , Aung M N , Ssekitoleko R , Saito K , Shirayama Y , Makimoto S , Yuasa M 
Published: October 2023

Abstract

Background
A global review summarized that the failure of healthcare systems and the capability of pandemic responses affected adverse health outcomes more than restricted movement policies. Studies on sub-Saharan Africa reported that lockdowns directly impeded access to necessary health services. We examined the factors associated with the accessibility of hospital services in Uganda.

Methods
We performed a multiple linear regression analysis. The outcome variable is the number of monthly outpatients (NMPs) at eight services (obstetrics, maternal care, family planning, malaria testing, HIV testing, antiretroviral therapy, diabetes, and child immunization) in four regional referral hospitals (Kabale, Lira, Soroti, and Naguru), comprising 32 services. Explanatory variables included the stringency index (SI) and vaccination policy (VP) from the Oxford COVID-19 government response tracker, and COVID-19 confirmed cases (CC). The data covered the period from January 2019 to December 2021. Statistical significance was set at 0.05.

Results
The SI showed a significantly negative association with NMPs (16/32 services, 50.0%) in four hospitals. The CC also showed similar trends (8/32 services) in three hospitals. In contrast, VP was positively associated with NMPs (8/32 services). Of the eight services, both malaria and HIV testing were negatively associated with SI in all hospitals. Naguru hospital in the capital city, where health facilities were sufficient, was the least affected by SI (2/8 services) while Kabale and Lira hospitals in local cities were negatively impacted regarding SI (5/8 services).

Conclusions
This study showed that the restrictive measures to control COVID-19 transmission had the greatest impact on the disruption of hospital service access, more than the COVID-19 infection itself. Innovative service delivery systems for all necessary populations should be developed during mobility restrictions in health-resource-limited settings for future health crises.

Key messages
• Stringency, public health and social measures, showed the strongest association with the disruption of hospital service access in Uganda, particular in areas with insufficient health facilities.
• Innovative service delivery systems for all necessary populations should be developed in health-resource-limited settings for future health crises.
Electronic file data analysis to improve health services and impact health policies. A pilot study
Authors: Tsilakis D , Parissis I , Polyzogopoulou E , Barbouni A , Lagiou A 
Published: October 2023

Abstract

Background
An important issue faced by Emergency Departments (ED) worldwide is “overcrowding”, whereby demand for health services exceeds available resources and may lead to increased morbidity and mortality. One cause of overcrowding is patients’ visits characterized as “avoidable” or “inappropriate”. Our study aims to estimate their prevalence in a Cardiology ED of a tertiary hospital.

Methods
This is a cross-sectional study, utilizing electronic files of patients attending a Cardiology ED during 2021. Using predefined criteria including tests, treatments, referral to/by other specialties/healthcare facilities and final admission, visits are categorized as either “inappropriate” or not. Our pilot results include all patients attending Cardiology ED on two separate days, one weekday and one weekend, in two different seasons, to account for respective variations.

Results
55 patients (28 females) were studied with a mean age of 53.3 years, of whom 16 (29.1%) were transported by ambulance and 9 (16.4%) were finally admitted. Main analysis showed that 4/55 (7.3%) visits were “inappropriate”, however, in 13/51 (25.5%) of the “appropriate” visits, the sole criterion was D-dimers testing. A prespecified sensitivity analysis including them in the “inappropriate” group, increased the prevalence of “inappropriate” visits to 30.9% (17/55).

Conclusions
Our results show that a considerable proportion of visits in a Cardiology ED may be “inappropriate”, and thus could be more suitable for primary care management. If confirmed by our full study results, this could trigger a health policy reform, aiming to increase the role of primary care thus reducing ED “overcrowding”.

Key messages
• To our knowledge, this is the first study evaluating “inappropriate” Emergency Department visits, focused solely on a Cardiology ED.
• The considerable proportion of patients who could be managed in primary care, paves the way for novel healthcare policies to reform ED services in Greece.
Evaluation of lifestyle change in patients with cardiovascular event in an Italian regional hospital
Authors: Parente F , Panatto D , Dattoli V , Formoso M , Polo A , Milazzo M , Guida P , Icardi G 
Published: October 2023

Abstract

Background
Lifestyle change is one of the tertiary measures undertaken to prevent a new Cardiovascular Event (CVE). In order to evaluate critical issues and undertake actions aimed at improving preventive strategies, we carried out a cross-sectional survey to assess post-CVE lifestyle in patients aged 18-79 years affected by CVE in the 5 years prior to their current admission to Miulli Hospital (Acquaviva delle Fonti, Italy) (702 beds, 64 wards).

Methods
Consecutive patients were enrolled (10/20/22-4/4/23). Data were collected by means of an anonymous questionnaire based on literature.
Patients were matched, according to gender, age and level of education, with two control groups: one constituted by healthy controls (ratio 1:10) and the other by CVE patients (ratio 1:2) involved in the European Health Interview Survey (EHIS).

Results
Forty-two subjects (a number suitable for statistical analysis) were enrolled (73.8% male). They ate fruit and vegetables at least once/day, with an increase from the pre-CVE period (fruit: 61.9% vs 69%; vegetables: 59.5% vs 66.7%) to levels similar to healthy subjects (fruit: 71.7%; vegetables: 66%). Comparison with the CVE EHIS group revealed lower fruit consumption (69% vs 78.6%) but higher vegetable consumption (66.7% vs 52.4%). The proportion of those who did not use alcohol increased after CVE (64.3% vs 69%) to higher levels than in the control groups (healthy subjects: 56.9%; CVE EHIS group: 61.9%). Fish consumption increased from 1-3 times/week (45.2% vs 38.1%) to 4-6 times/week (23.8% vs 33.3%). Red meat consumption decreased from 4-6 times/week (33.3% vs 14.3%) to 1-3 times/week (50% vs 64.3%). A reduction in smoking followed CVE similarly to the EHIS population (90.5% VS 84.5%). No improvement in physical activity was recorded.

Conclusions
The activities of tertiary prevention undertaken yielded a lifestyle improvement in post-CVE patients, who adopted similar habits to those of healthy subjects.

Key messages
• In post-CVE patients, preventive measures can be enhanced through medical counseling at the time of discharge.
• Lifestyle surveillance in post-CVE patients should be strengthened.
Improving healthcare professionals’ interactions with patients to tackle antimicrobial resistance
Authors: Ayorinde A , Ghosh I , Shaikh J , Adetunji V , Brown A , Jordan M , Gilham E , Todkill D , Ashiru-Oredope D 
Published: October 2023

Abstract

Background
Antimicrobial resistance (AMR) is one of the most important public health threats. It is important for healthcare professionals (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to mitigate inappropriate antimicrobial use. This review identified existing interventions which aim to improve HCPs’ interaction with patients and examined factors that enables or hinders appropriate behaviours.

Methods
We searched MEDLINE, EMBASE, Science Citation Index, Social Sciences Citation Index, Google Scholar, internet and conducted forward and backward citation searching from eligible studies. We included studies of any design, published in English language from year 2010 to 2023. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation - Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels.

Results
We included 59 studies of diverse designs examining a range of interventions from 16 countries. Many interventions involved multiple components beyond HCPs’ interaction with patients, e.g., Treat Antibiotics Responsibly, Guidance, Education and Tools (TARGET). Patient interaction components mostly involved use of posters, leaflets, videos, interactive decision support tools and C reactive protein point-of-care testing. The interventions were often found to be useful. Barriers and facilitators identified related to capability (e.g., knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions, forgetfulness); opportunity (e.g., time constraint, intervention accessibility) and motivation (e.g., patient's desire for antibiotics, fear of litigation).

Conclusions
There are many useful interventions to improve HCPs and patients’ interactions for appropriate behaviours in antibiotic use. The barriers and facilitators identified in this review should be considered by intervention designers/adopters and policy makers to improve implementation and effectiveness.

Key messages
• Factors hindering appropriate antimicrobial use are complex.
• This review can inform the development and implementation of strategies to improve healthcare professional’ interaction with the users.