bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of restrictive asylum-seeker healthcare policies: systematic review of evidence from Germany
Authors: Gottlieb N , Gold A W , Nutsch N , Duwendag S , Bozorgmehr K 
Published: October 2023

Abstract

Background
Asylum-seekers’ entitlements to healthcare vary within and across European countries, over time, and between different nationalities. Within Germany, healthcare policies for asylum-seekers range from restrictions of both scope and access to healthcare to full health entitlements, depending on a person's legal status, duration of stay, country of origin, and place of residence. We seized these variations to study the effects of restrictive vs. inclusive healthcare policies on health status, health system outcomes (incl. health equity), healthcare provision, healthcare utilization, and efficiency.

Methods
We conducted a systematic review in five databases (PubMed, Web of Science, SCOPUS, LIVIVO, Google Scholar) to identify and analyse empirical studies on the effects of healthcare policies for asylum-seekers in Germany. Out of 1159 initial hits, 66 records were assessed for quality and included in the narrative synthesis.

Results
The synthesised evidence shows that more inclusive policies facilitate needs-based health care utilization, incl. broader utilization of ambulatory services and lower use of emergency services. They reduce complexity, fragmentation and bureaucracy for healthcare users and providers by simplifying authorisation and reimbursement. Evidence suggests that inclusive policies contribute to better subjective and mental health among asylum-seekers. We found no evidence for access restrictions being associated with cost savings or other health system benefits.

Conclusions
Restrictive healthcare policies are often justified with the need to protect fiscal resources and health systems. Yet, evidence from Germany shows that more inclusive healthcare policies for asylum-seekers hold benefits in terms of health system outcomes, while not entailing higher costs. Inclusive policies are thus not only normatively preferable to restrictive policy options; they also yield better performance from a health systems perspective.

Key messages
• Germany is a pertinent test-case for analyzing the effects of restrictive vs. inclusive healthcare policies for asylum-seekers.
• Inclusive healthcare policies hold benefits in terms of health outcomes and health system performance, while restrictions fail to show advantages in fiscal or other domains of performance.
Increasing incidence of ovarian cancer in young women in England, 1985-2019
Authors: Ikram H , Taylor-Gallardo E , Salari Y , Memon A 
Published: October 2023

Abstract

Background
Ovarian cancer is the 6th most common cancer in women in the UK, accounting for about 7,500 new cases and 4,100 deaths each year. Genetic predisposition and obesity are the two most important risk factors. We conducted a retrospective population-based cohort study to ascertain trends in incidence of ovarian cancer in England from 1985-2019.

Methods
Individual level data for women diagnosed with ovarian cancer, and the corresponding national population (denominator) data were obtained from ONS/PHE. Average annual incidence rates (AAIR) were calculated for 2 age categories (0-49 and 50+ years) and for the 7 five-year time periods (1985-89 to 2015-19).

Results
During the 35-year study period, a total of 192,791 women with ovarian cancer were registered in England. The large majority of the cases (83%) were diagnosed in women aged 50+ years. In women aged 0-49 years, there was a steady increase in the AAIRs from 4.9/100,000 in 1985-89 to 6.3/100,000 in 2015-19 (+28.6%). Whereas in older women (aged 50+ years), the AAIRs initially increased from 47.9/100,000 (1985-89) to 54.4/100,000 (2000-04), and then steadily declined to 44.6/100,000 in 2015-19. As for the stage at diagnosis, the majority of younger women (72%) were diagnosed at Stage 1 or 2, whereas the majority of older women (65%) were diagnosed at Stage 3 or 4. There was also a dichotomy with regards to socioeconomic status - in younger women the disease was relatively more commonly diagnosed in the most deprived groups, whereas in older women the disease was more commonly diagnosed in the most affluent groups.

Conclusions
This study shows that from 2000 onwards, there has been a steady decline in the incidence of ovarian cancer among women aged 50+ years in England. On the other hand, the incidence rates have been steadily increasing in women aged 0-49 years during the past 35 years. The reasons for this increasing trend in the incidence of ovarian cancer in young women needs further investigation.

Key messages
• The increasing incidence of ovarian cancer in young women (aged 0-49 years) is consistent with the increasing prevalence of obesity in England.
• The declining trend in incidence of ovarian cancer in women aged 50+ years needs to be examined in light of the increasing trend in incidence of HRT prescriptions for menopausal women.
Joint associations of leisure time physical activity and sitting time with sickness absence
Authors: Sarttila K , Pohjola V , Kuusela M , Hautala A , Lahti J , Lundqvist A 
Published: October 2023

Abstract

Background
Physical inactivity and prolonged sitting are risk factors for non-communicable diseases and threaten public health. The aim of this study was to examine the joint associations of leisure time physical activity and sitting time with sickness absence among Finnish adult population.

Methods
Randomly selected adults (N = 10 300, response rate 70,5 %) were asked to fill in questionnaire of the FinHealth 2017 population survey. The survey data were linked to the Finnish Social Insurance Institution's register data on sickness benefit periods (over 10 working days), including diagnoses (follow-up 2,9 years). Self-reported leisure time physical activity was classified into three groups: inactive, moderately active, and active and screen sitting time into two groups: ≤3hrs hours or less and over three hours a day, yielding a six-category variable for the joint analyses. The analytical sample were restricted to working age (18-63 years), which included 5183 participants. Associations were examined by using logistic regression analysis adjusting for key covariates with SPSS 29.

Results
Those who were inactive and spend a lot of time sitting in front of a screen (&lt; 3h) during leisure had a higher risk for sickness absence due to mental disorders (OR = 2,07 95% CI 1,03-4,18) than physically active low sedentary group. Also, the inactive and low sedentary group (OR = 1,69 95% CI 1,12-2,55) and the moderately active and high sedentary group (OR = 2.06, 95% CI 1.15-3.67) had a higher risk. No significant differences were found for associations due to all-cause and musculoskeletal disorders sickness absence.

Conclusions
Alongside increasing leisure-time physical activity, reducing sedentary behavior can have a positive impact on the risk of sickness absence for mental health reasons. A reduction in sedentary behavior and an increase physical activity should be encouraged.

Key messages
• Sedentary behavior in leisure was associated to a higher occurrence of mental health sickness absence.
• Attention should be paid to reducing sitting time and increasing physical activity.
Conceptualisation of co-creation and co-production
Authors: Egilstrød B , Wegener C , Henriksen L S , Petersen K S 
Published: October 2023

Abstract

Background
Creating and producing welfare with citizens has been trendy governmental rhetoric for the last decades, involving partnerships between municipalities, civil societies, and the citizens, aimed to mobilize citizens’ and civil societies’ resources. Co-creation and co-production are topical approaches to involve citizens in improving municipal health services or contributing to service production to balance scarce municipal resources and better target services to citizens’ needs. However, challenging in applicating the concept in practice has resulted in several new definitions being applied within Health and Social Care research. This has led to studies failing to define the concept or to involve citizens in the process. Thus, we aim to clarify the co-creation and co-production concepts to underpin their applicability when involving older people in community health services.

Methods
We draw on theoretical knowledge of co-creation and co-production based on Brandt and Honnigh (2018) conceptualization, combined with results from a scoping review, which explored co-production within health services among older people. We searched six databases across health and social science, 22 studies met the inclusion criteria.

Results
A theoretical agreement exists on how to conceptualize co-creation and co-production. However, the scoping review found that co-production is randomly applied across different theoretical concepts, such as public involvement, co-creation, and co-production. Co-production was applied in 1) intervention and service development, 2) service provision, and 3) the design and process of research.

Conclusions
Contributing to disseminating the concepts may help qualify the applicability within community health services among older people. There remains an unexplored potential in activating resources and involving citizens through co-creation and co-production. However, concept clarity is needed to underpin co-creation and co-production processes.
A first intervention to support the mental health of transgender individuals in Eastern Europe
Authors: Lelutiu-Weinberger C , Pachankis J E , Filimon M , Dogaru B , Braila P , Ichim S , Pana E , Pruneau C 
Published: October 2023

Abstract

Background
Transgender and gender-diverse (TGD) people in Romania experience high discrimination and related dysphoria, while gender-affirmation resources are scant. TGD Romanians report significant emotional distress and no access to competent mental health care. This pilot tested the feasibility, acceptability, and early efficacy of the first evidence-based mental health intervention implemented in Eastern Europe, using cognitive behavioral therapy within an identity-affirming framework.

Methods
Eligible TGD individuals (e.g., ≥ 18 years old, symptoms of past-90-day depression and/or anxiety) were recruited through community outreach. Participants completed a baseline (BL) assessment, were assigned to one of two trained psychologists, attended up to 16 1-hr virtual counseling sessions, and completed a 5-month follow-up assessment. Participants reported demographics, mental health (e.g., anxiety, depression), and identity-related psychosocial experiences (e.g., gender identity congruence). Analyses were conducted using paired sample t-tests and Wilcoxon rank sum tests to compare pre-post intervention scores.

Results
Of 24 participants enrolled (40% transgender female, 43% transgender male, 17% non-binary; M age=25.1, SD = 6.53), 22 were retained at follow-up. Significant reductions occurred from BL to follow-up in depression, anxiety, and psychological distress (p &lt; 0.001), alcohol-related problems, gender identify rumination and difficulties with emotion regulation (p = 0.05). Satisfaction with the intervention was high. There were no changes in suicidal ideation, assertiveness, transgender congruence, gender identity acceptance, and emotion regulation.

Conclusions
This first intervention to support TGD Romanian's mental health shows promise and can be further studied in a randomized controlled trial. Its implementation across similar high-stigma, low-resource countries can provide critical mental health support in settings lacking such resources.
Mothers' decisions regarding treating their children with attention deficit hyperactivity disorder
Authors: Shehadeh Sheeny A , Goldblatt H , Baron Epel O 
Published: October 2023

Abstract

Background
The use of medication for attention deficit hyperactivity disorder (ADHD) differs globally, depending on ethnic group. Stimulant prescriptions for ADHD among Israeli Jewish children are four times higher than among Arab children. Ethnical differences may affect parents' perceptions and attitudes towards diagnosing and treating ADHD. This qualitative study aimed to identify mothers and teachers' attitudes regarding ADHD and what affects mothers' decisions on whether to medicate their child diagnosed with ADHD.

Methods
In-depth interviews were conducted with 23 Arab and Jewish mothers of children diagnosed with ADHD and 12 elementary school teachers. Data were analyzed using thematic analysis.

Results
Four themes were revealed, describing different perceptions of ADHD in the two ethnic groups: (1) medicalization of ADHD; (2) between guilt and sympathy: Mothers' feelings towards ADHD; (3) social pressure and social norms; (4) stigmatization. Jewish mothers and teachers tended to perceive ADHD as a medical problem, whereas Arab mothers and teachers perceived it more as a childhood social behavior. Arab mothers reported guilt feelings relating to ADHD, whereas Jewish mothers felt sympathy towards their child. The social environment influenced Arab mothers more than Jewish mothers. Stigmatization was reported only by Arab mothers.

Conclusions
Ethnic differences in ADHD perception may explain the differences in diagnosis and treatment. Educators and school psychologists should consider cultural factors when advising parents and planning educational programs for children with ADHD.

Key messages
• Social and cultural factors are vital for understanding trends in ADHD diagnosis and treatment because cultural beliefs play a key role in determining parents’ perceptions and attitudes.
• School managers, school psychologists, counseling staff and teachers should be aware of cultural factors when advising parents and planning educational programs for children with ADHD.
Health behaviour and cardiovascular risk in women living in a disadvantaged region in Hungary
Authors: Rucska A , Kiss-Tóth E , Lakatos C , Gyulai A 
Published: October 2023

Abstract

Background
The risk factors for non-communicable diseases more prevalent among socioeconomically disadvantaged (SED) adults. The aim of our study was to investigate monitored health status and health behaviour, including risk factors for cardiovascular disease, among women living in disadvantaged regions of Hungary.

Methods
In the monitored study, nutritional status was measured by a medical body composition analyser and vascular status by the arterial stiffness parameter (PWVao) measured by arteriograph (ARG), supplemented by a health questionnaire. Descriptive statistical analyses were performed to analyse the database, within a 95% confidence interval (CI). Pearson's χ2 test and analysis of variance (ANOVA) were used to test assumptions. The source population of the study was women living in the Abaúj region, the most disadvantaged regions of Hungary. A total of 150 SED adult women constituted the target population.

Results
The average age of the study participants was 52.8 (SD:15.9) years. More than half of the participants had at completed 8 years of primary education or less (52.3%; 95% CI: 44-61). They were overweight in terms of Body Mass Index (mean BMI=28.7 SD:6.6), and mean systolic blood pressure was 139 mmHg (SD:21.43). The mean PWVao measured in the population was 10.51m/s (SD:6.9). Elevated BMI was significantly (ANOVA p &lt; 0.011) associated with higher PWVao. 36.2% (95% CI: 48-64) of the target group smoked daily. More than half of smokers (55%; 95%CI:38-76) smoked 11-20 cigarettes per day. Smokers scored an average of 4.82 (SD = 2.3) on the Fagerström Test for Nicotine Dependence (FTND) scale of moderate dependence. Lower educational attainment status (χ2 p &lt; 0.001) significantly increase the proportion of smokers in the sample.

Conclusions
Obesity, smoking and elevated PWVao, are associated with higher circulatory and vascular risk and higher atherosclerotic organ damage, which may contribute to higher premature mortality among disadvantaged women.

Key messages
• Examining the association between heath behaviour and cardivascular risk of socioeconomically disadvantaged individuals can enhance the development of interventions to decrease health inequalities.
• Targeted community health promotion for disadvantaged women is a priority, because their health behaviour determines the health of their children and families.
Cervical cancer screening attendance related factors among women in Latvia
Authors: Springe L , Kivite-Urtane A , Kursite M , Curkste A , Zodzika J , Parna K , Uuskula A 
Published: October 2023

Abstract

Cervical cancer is the second leading cause of death in Latvia among women aged 15-44. Since 2009 organized cancer screening has been available, but responsiveness from the target population was still not optimal - only half of the invited persons participated in screening in 2022. Our study aimed to analyse sociodemographic factors and knowledge about screening concerning participation in the screening procedure. Data from a cross-sectional population survey conducted in 2021-2022 were analysed (n = 1313). The survey was part of the project “Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening” (EMP416). A multivariate model was adjusted for independent variables found to be statistically significantly associated with the outcome in univariate analysis. The dependent variable was participation in cervical cancer screening. Independent variables - knowledge about screening, age, education, marital status, and employment
81 % (n = 1063) of respondents participated in cervical cancer screening. The odds of screening attendance were higher among women aged 30-39 (aOR=3.6, p &lt; 0.001), 40-49 (aOR=2.8, p = 0.005), 50-59 (aOR=12.3, p = 0.001) in comparison to women aged 25-29 years. Secondary (aOR=5.9, p &lt; 0.001) and university (OR = 13.1, p &lt; 0.001) education in comparison to primary education and being married (OR = 3.7, p &lt; 0.001) to being single, as well as being employed (OR = 2.0, p = 0.085) and economically inactive (OR = 3.1, p &lt; 0.05) in comparison to unemployment was associated with cervical cancer screening attendance. Knowledge about screening was associated with higher odds of participation (OR = 4.1, p = 0.001). Knowledge about screening is positively related to attendance. Differences were observed across various sociodemographic groups emphasizing the importance of providing targeted information for vulnerable social groups such as the elderly, single and unemployed women, and women with lower education to promote cervical cancer screening.

Key messages
• Cervical cancer screening is important, but target group responsiveness to it is still not optimal. Targeted public health activities are needed to improve cervical cancer screening attendance.
• Equity in cervical cancer screening attendance could be ensured by targeting vulnerable social groups, specifically, the elderly, single and unemployed women, and women with lower education.
Health Impact Assessment (HIA) of a daily physical education lesson in Austrian schools
Authors: Fuchs-Neuhold B , Movia M , Macher S , Simi H , Antony G , Zeuschner V , Wamprechtsamer G , delle Grazie J 
Published: October 2023

Abstract

Background
Encouraging physical activity among school children is vital for their overall health and well-being. This study aims to evaluate the potential impact of implementing a daily physical activity unit in Austrian schools and to identify areas for optimization of the implementation plan to ensure maximum health benefits.

Methods
The HIA systematically followed several stages including screening and scoping, appraisal and formulation of recommendations. The study included a review of literature, an online survey (n = 712), four online focus group discussions, and two online appraisal workshops with stakeholders.

Results
The HIA identified several considerations for implementing the daily physical activity unit model, including promoting equity, ensuring high-quality implementation, and integrating five additional units of physical activity per week into the Austrian school curriculum. Results show that 62% of the respondents are in favor of integrating sports clubs more strongly into everyday school life in the future. Regarding additional personal effort of the pedagogical staff, 45% of the participants of the online survey indicated neutral or no effects, 30% (very) positive effects and 20% suspected (very) negative effects.

Conclusions
The results suggest that the daily physical activity unit model has overall positive effects on individual student health, social and community networks, living and working conditions in the school environment, and the system level. Promoting equal opportunities and supporting disadvantaged children and schools is important. Additionally, organizational, and structural differences of the respective school types and regions, availability of sufficient infrastructure, and appropriate selection of pilot regions must be considered. The binding nature/voluntariness of the physical activity units as well as high-quality implementation, training of teachers and coaches, and focusing on the elementary/kindergarten level are recommended.

Key messages
• Recommendations for implementation include ensuring equal opportunity and support for disadvantaged children and schools.
• The integration of five additional physical activity classes per week and a greater focus on the elementary/kindergarten level were identified as important.
National and subnational analysis of diabetes and health inequalities in European Union countries
Authors: Andrade C , Kovacs N , Mahrouseh N , Varga O 
Published: October 2023

Abstract

Background
Diabetes mellitus (DM) has been a major public health concern with increased epidemiologic and economic burden in the European Union (EU) member states. We aimed to estimate national and subnational DM prevalence in individuals aged 50 years or over in 13 EU member states between 2010 and 2019.

Methods
The present study extracted microdata from waves 4 - 2010/2011, 5 - 2013, 6 - 2015, and 8 - 2019 of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. The analysis was carried out at national and subnational levels from 13 EU member states. Socioeconomic risk factors such as urbanization, income, and educational level were involved in the analysis. Gini coefficient (GC) and concentration Index (CI) were used to evaluate health inequalities.

Results
Prevalence of DM in EU between waves 4 and 8 ranged from 12% to 13.9%, respectively. GC for DM prevalence in EU was 0.140±0.028 (p = 0.00) in wave 4 and 0.141±0.024 (p = 0.00) in wave 8. The highest prevalence was 21.4% in Czechia (wave 8) and the lowest was 6.7% in Switzerland (wave 4). The EU member state with highest GC was Denmark with 0.336±0.085 (p = 0.00) in wave 4 and the lowest was found in Slovenia with 0.001±0.001 (p = 0.04) in wave 5. Urbanization showed the highest CIs, ranging from -0.062±0.030 (p = 0.04) in Italy (wave 8) to 0.079±0.024 (p = 0.00) in France (wave 5). Income ranged from -0.275±0.033 (p = 0.00) in Denmark (wave 5) to -0.007±0.035 (p = 0.85) in Slovenia (wave 4) and educational level from -0.249±0.042 (p = 0.00) in Denmark (wave 4) to -0.028±0.036 (p = 0.43) in Switzerland (wave 5).

Conclusions
In the EU, there are inequalities in the increasing prevalence of DM at national and sub-national levels, with higher rates among those living in non-urban areas, with low educational levels and low income. To tackle such level of health inequalities, the EU and its member states should create prevention programs and policies that prioritize vulnerable groups.

Key messages
• Our research highlights inequalities in DM prevalence between and within member states of EU.
• The study underlines the need for tailored actions addressing specific regions and vulnerable population.