bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Gender gap in the Tuscany Regional Health System
Authors: Marconi D , Serafini A , Golinelli D , Nante N , Marinari D , Faraoni N 
Published: October 2023

Abstract

Background
According to the Italian Ministry of Health, the presence of women in the National Health System has increased. While women now represent the majority (69%) of healthcare workers (HCW) in Italy, and females make up 50% of medical doctors, only 18% of health unit directors are women. In Tuscany, there are 56.207 HCW, 72% of which are women. The objective of this study was to investigate the role of gender in the healthcare workforce, taking into account the issues of sharing caring responsibilities.

Methods
Between January and February 2022, the Tuscany Regional Institute for Economic Planning conducted a cross-sectional study among its HCW. An internally validated questionnaire was sent to the HCW to investigate working life, in particular schedule shift (fulltime or parttime) and night shifts; data were collected online anonymously and then analyzed with STATA. We performed logistic regression adjusting for age, gender, having children (&lt;14 yo) and caring for a family member.

Results
15.631 HCW answered the questionnaire: 76% were female, 23% were male and 1% preferred to not specify their sex. 73% of women and 65% of men have at least one child. 18% of women and 13% of men have at least one child and care for a family member. Those who have at least one child (adjOR=1.52 95%CI 1.26-1.83) or care for a family member (aOR 1.49 1.27-1.75) are more likely to work part-time, especially women (aOR 2.33 1.87-2.91). Moreover, those who have at least one child (aOR=0.90 0.83-0.97) or care for a family member (aOR 0.89 0.82-0.96) are less likely to work the night shifts, especially women (aOR 0.90 0.83-0.98).

Conclusions
Our analysis shows that under the same conditions, women end up sacrificing their work more than their male colleagues. It is necessary to implement policies that encourage equitable sharing of caring responsibilities, fostering fairer work opportunities for women in the health system, including in positions of leadership, to overcome the gender gap.

Key messages
• The gender gap persists in the health personnel system.
• It is necessary to encourage equitable sharing of caring responsibilities, ensuring women hold leadership positions.
Learning health systems in rehabilitation care - findings and recommendations from a scoping review
Authors: Torok Z , Christophers L , Hudson C , Carroll A 
Published: October 2023

Abstract

To meet the challenges posed by an aging population and changing health needs, healthcare systems require transformative action at a systemic level. One solution is to create “learning” health systems (LHS) that generate and apply evidence, innovation and quality to improve the provision of care. Given the lack of research focusing on operationalizing LHSs and the predominance of acute care studies, this scoping review aimed to fill this gap by exploring how LHS frameworks have been conceptualized and operationalized in rehabilitation organizations. The review was conducted according to the JBI guidelines and Arksey & O’Malley methodological framework. Comprehensive search was performed across 5 databases to capture the extent of the literature on this topic specific to rehabilitation. Following screening and data extraction, qualitative content analysis and thematic mapping was employed to explore the selected studies (n = 26). Results were reported in accordance with PRISMA guidelines. Studies conceptualised LHS as organizational infrastructure that supports continuous learning by integrating clinical care and research. It aims generate new knowledge by capturing data from every clinical encounter and applying it to practice through iterative learning cycles, characterized by three phases: Data to Knowledge, Knowledge to Performance, and Performance to Data. Four themes emerged regarding the operationalization of LHS in rehabilitation: creating a functioning data infrastructure; facilitating research; promoting an organizational culture of learning; and person-centredness. This study is the first scoping review on LHSs in the context of rehabilitation, employing a systematic and rigorous process to capture the relevant literature. The review identified key transformational steps to become a LHS e.g., generation, dissemination and implementation of new institutional knowledge and early stakeholder engagement. Findings can be applied across non-acute health settings.

Key messages
• This is the first scoping review on LHSs in the context of rehabilitation.
• The findings will aid organisations in non-acute health settings with the transformational process of becoming LHSs.
Very high intensity of the bronchiolitis epidemic during the 2022-2023 season in France
Authors: Forgeot C , Verrat B , Vaux S , Viriot D , Casério-Schönemann C 
Published: October 2023

Abstract

Background
During epidemic seasons, bronchiolitis affects young children with a large burden in emergency departments (EDs). Following the beginning of the COVID-19 pandemic and 2 perturbed seasons, the aim of this study was to assess the burden of bronchiolitis in EDs in terms of visits and post-discharge hospitalisations in 2022-23 compared with the pre-COVID seasons.

Methods
Santé publique France, collects ED data through OSCOUR® (95% of French ED visits). ED visits with a medical diagnosis of bronchiolitis (based on ICD-10 codes) in children under 2 years of age (yo) were included. The burden of the 2022-23 epidemic season (from 2022-W36 to 2023-W16) was compared with that of the pre-COVID seasons (2015-16 to 2019-20), by age group, in terms of visits and hospitalisations after discharge, in particular in intensive care units (ICUs) (annual data and means).

Results
In 2022-23, 99,864 ED visits for bronchiolitis and 31,505 post-discharge hospitalisations were registered for children under 2 yo (vs. respectively +49% and +44% compared to the pre-COVID seasons). It represented 15% of all ED visits and 33% of all hospitalisations after discharge of this age group (vs. 10% and 23% pre-COVID). Among children under 1 year, distribution of bronchiolitis ED visits by age group remained relatively stable in comparison with pre-COVID seasons. For children under 6 months, bronchiolitis accounted for 27% of all ED visits (19% pre-COVID), 45% of all hospitalisations (35% pre-COVID) and more than 70% of hospitalisations referred in ICU during 7 weeks (2 weeks pre-COVID).

Conclusions
The 2022-2023 bronchiolitis epidemic was of extreme intensity in France with a highest impact than for pre-covid seasons and leading to saturation of EDs. These findings were consistent with an increase in respiratory illness in children during the 2022-23 winter season, and raised questions about the impact of the COVID-19 pandemic on their epidemiology and a potential decrease of immunity.

Key messages
• Beside a very high intensity for the 2022-23 bronchiolitis epidemic, distribution of ED visits by age group remained relatively stable among children under 1 year.
• In 2022-2023, among children under 6 months, during nearly two months (7 weeks), more than 70% of hospitalizations after discharged referred in ICU were due to bronchiolitis.
The burden of cardiovascular disease associated with PM2.5 exposure in the Portuguese population
Authors: Martins C , Corda M , Lima L , Assunção R 
Published: October 2023

Abstract

Background
Exposure to air pollution has been associated with increased mortality, premature mortality, and morbidity. A causal relationship between fine particulate matter (PM2.5) exposure and cardiovascular morbidity and mortality was demonstrated by the American Heart Association. In 2020, exposure to PM2.5 concentrations above limits defined by World Health Organization was responsible for 238,000 and 2,600 premature deaths in the European Union and in Portugal, respectively.

Aim
To estimate the impact on cardiovascular diseases (CVD) attributable to exposure to PM2.5 between 2010 and 2020, expressed as years of life lost (YLL), in Portugal.

Methods
National Statistics databases were used to collect the number of cardiovascular mortality cases between 2010 and 2020. The atmospheric levels of PM2.5 were obtained from Online Database on Air Quality of the Portuguese Environment Agency. When PM2.5 data were absent, PM10 data were used to estimate the PM2.5 concentration through the ratio: PM2.5/PM10=0,65. The burden of disease was estimated as YLL. The YLLs due to PM2.5-associated stroke and IHD in the Portuguese adult population, older than 30 years, were determined using the population-attributable fraction (PAF).

Results
YLLs per year for stroke and IHD were estimated as 41,489.60 (95% CI: 34,610.68 - 48,368.52) YLL and 27,573.44 (95% CI: 24,939.94 - 30,206.93) YLL respectively. Between 2010 and 2020, the crude number of YLL in mainland Portugal due to PM2.5 exposure-associated stroke and IHD decreased. The YLLs for IHD and for stroke are higher for men than for women. However, for stroke, the YLLs do not demonstrate as significant a difference as for IHD.

Conclusions
These findings provide evidence of the impact of air pollution on human health, which are crucial for decision-making.

Acknowledgments
This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021).

Key messages
• Exposure to PM2.5 has a significant health impact concerning cardiovascular mortality.
• Estimating burden of disease contributes for the decision making and environmental policies.
Correlates of psychotic experiences in gender-diverse youth in Ireland: A population-based survey
Authors: Hoey J , Fleury R , Dooley N , Power E , Cannon M 
Published: October 2023

Abstract

Epidemiological studies have shown that psychotic disorders are more prevalent in transgender and non-binary (TR/NB) individuals compared to their cisgender (i.e., male & female) counterparts (CIS). Despite this, little research exists that examines the association between gender diversity and psychotic episodes (PEs), with implications for public health policy. This study examines the prevalence of, and the factors associated with, PEs in both CIS and TR/NB adolescents in Ireland. The study is a cross-sectional analysis of the 2021 Planet Youth survey completed by secondary school students in Cavan, Monaghan and North Dublin. The outcome of interest was self-reported episodes experienced by students at least once over their lifespan, using the 7-item Adolescent Psychotic-like Symptom Screener. Of 4406 students who completed the questionnaire, 3877 identified as CIS and 169 identified as TR/NB. TR/NB cohorts reported higher levels of PEs (M = 4.6, SE = .206, CI = 4.2, 5.0) than CIS (M = 2.6, SE = .027, CI = 2.5, 2.6), z = -6.393, p &lt; .0001). In both cohorts, PEs positively correlated with the incidence of serious arguments with parents (CIS: rs = .210, p &lt; .0001; TR/NB: rs = .202, p = .0374), being bullied (CIS: rs = .227, p &lt; .0001; TR/NB: rs = .360, p = .0002) and the occurrence (CIS: rs = .288, p &lt; .0001; TR/NB: rs = .303, p = .0016) and disclosure (CIS: rs = .208, p &lt; .0001; TR/NB: rs = .305, p = .0015) of suicidal thoughts. Additionally, PEs were negatively correlated with feelings of safety at home, school and in the neighbourhood (CIS: rs = -.283, p &lt; 0001; TR/NB: rs = -.279, p = .0037). These findings indicate that further research is needed to examine how psychosocial stressors may operate as trauma and contribute to clinical symptoms in TR/NB youth. Results from the Planet Youth survey suggest that more attention needs to be paid to the mental health needs of gender diverse youth and policy makers must be cognisant of this.

Key messages
• Gender diverse youth in Ireland report a higher prevalence of psychotic symptoms compared to cisgender youth.
• Gender diverse youth reported feeling less safe at home, at school and in the neighbourhood compared to their cisgender counterparts.
Health literacy in migrants: the SPRINT2 project
Authors: Zanobini P , Lorini C , Tizzi G , Caldès M J , Bonaccorsi G 
Published: October 2023

Abstract

Introduction
Migrants generally reported lower levels of health literacy (HL) thus increasing their difficulties in accessing and interacting with the healthcare system. This study, carried out within the SPRINT2 project, aims to assess the HL level of 2 samples of asylum seekers and refugees residing in Tuscany, and to examine the relationship among HL, educational interventions, COVID-19 risk perception and preventive behaviours

Materials and Methods
Questionnaires were administered to a sample of refugees and asylum seekers (group A) between June and September 2021 and to another sample between April and September 2022 (group B) which participated at least in one health-related educational intervention. The Italian version of HLS-EU-Q16 was used to measure HL

Results
Among 171 subjects belonging to group A 25% had an inadequate HL level. Group B consisted of 102 respondents of which 37% had an inadequate HL level. Group B compared with group A had higher percentages of respondents who considered COVID-19 a serious health problem (58.8% vs 41.1%), very likely to be infected by SARS-COV-2 (58.2% vs 29.6%) and who thought quarantine compliance (89.7% vs 75.9%), the use nasopharyngeal swabs (78.4% vs 61.2%), and to get COVID-19 vaccination (89.4% vs 66.1%) were very important preventive measures. HL was found to be significantly associated (p &lt; 0.05) with COVID-19 risk perception and propensity for handwashing, face mask use, and social distancing. At multivariate logistic analysis, low educational level and residing in Italy for less than 2 years were found to be predictors of inadequate HL level (OR 2,7 CI 95% 1,22-6,13; OR 3,9 CI 95% 1,93-7.79, respectively).

Conclusions
Our findings suggest that HL and educational interventions are important factor to improve healthy behaviours. Structured educational interventions to increase HL levels will be an important contribution in the process of inclusion and integration of migrants thus reducing health related inequalities.

Key messages
• The level of health literacy among migrants is most influenced by their educational level and length of stay in Italy.
• Health literacy and educational interventions are important factor to improve healthy behaviours.
Engaging Czech-Slovak Roma women in the co-creation of an antenatal care information resource
Authors: Lie M , Claisse C , Karchnakova Z 
Published: October 2023

Abstract

Background
Czech-Slovak Roma women in the UK suffer barriers to antenatal care such as stigma contributing to reduced engagement with health services. There is a scarcity of research and intervention studies with this population. This study aims to co-create an antenatal care community information resource with a group of these women through participatory research. Women's stories of their pregnancy journeys would be able to provide an understanding of their maternity needs, to inform design considerations for a prototype of an antenatal care information resource.

Objectives
1. To understand Roma women's needs in pregnancy, childbirth, and maternity services through storytelling
2. To share with women publicly available antenatal information resources such as pregnancy apps
3. To co-create a low-resolution paper prototype of an antenatal care information resource that meets their needs

Research activities
1. Six two-hour workshops with 6-8 women supported by a peer researcher and an interpreter.
2. Two workshops focused on the co-creation of an antenatal information resource.
3. Design-based participatory methods and thematic analysis, culminating in a community event and webinar for public and professional stakeholders.

Findings
The women's pregnancy journeys covered several topics such as unplanned pregnancies, nausea and vomiting, pregnancy loss and birth trauma. Through all these, the main message they wished to convey was the need for women in the community to overcome the stigma of seeking help for their mental health. Our information resource developed using a co-creative participatory approach, signposts Roma women to reliable information and healthcare provision potentially reducing poor maternal and perinatal health outcomes. This study could be replicated in other marginalized newly arrived groups of migrant women to facilitate timely uptake of antenatal and mental health support services.

Key messages
• Czech-Slovak Roma women face stigma in seeking help for their mental health during pregnancy.
• Roma women can be supported to overcome stigma through design-based participatory research.
Cost comparison of vitamin D from egg biofortification: the case of Slovenia study
Authors: Kukec A , Vičič V , Pandel Mikuš R 
Published: October 2023

Abstract

Introduction
Various food fortification possibilities have been suggested to prevent vitamin D deficiency. The aim of this article is to compare cost of direct vitamin D fortification, hen egg biofortification and individual supplementation.

Methods
The cost comparison was done for the Slovenian population over &gt;1 of age (n = 2,050,916). The demographic data was sourced from Statistical office of Slovenia. The economic evaluation was done using the cheapest prescription drug and cheapest food supplement. Unfortified hen egg has total vitamin D efficacy (combined efficacy of cholecalciferol and dietary 25(OH)D3) of 2.4 μg/1 egg. For the production of one vitamin D fortified egg with total vitamin D efficacy of 11.98 μg/egg, Browning and Cowieson used feed containing 36.2 μg cholecalciferol and 9.99 μg of 25(OH)D3. The milk and yoghurt can be fortified by direct addition during manufacture. For the economic analysis, the prices of vitamin D3 and feed grade 25(OH)D3 were provided by DSM Nutritional Products.

Results
The economic comparison of the annual cost of 10 μg vitamin D/d/person was EUR 6.17 for prescription drugs, EUR 6.37 for food supplements, EUR 0.09 for direct milk fortification and EUR 0.12 for egg biofortification with vitamin D. The annual cost of 10 μg vitamin D/d/person for Slovenia (n = 2,050,916) would be EUR 12.66 million for prescription drugs, EUR 13.06 million for food supplements, EUR 0.18 million for direct milk fortification and EUR 0.26 for egg biofortification with vitamin D.

Conclusions
In Slovenia, vitamin D drug prescriptions amounted to EUR 6.03 million in 2020. Considering the low cost of fortification, even a slight decrease in drug dosage due to the effect of fortified food could bring substantial savings. Regulatory challenges in EU and projected intake of vitamin D using egg fortification alone and in combination with milk fortification was described in article Vičič et. al..

Key messages
• Vitamin D fortification is a cost-effective way of increasing vitamin D intake in the population.
Investigating the risk benefit balance of dairy consumption in the Danish population
Authors: Jakobsen L S , Davydova A , Pires S M , Pilegaard K , Devleesschauwer B 
Published: October 2023

Abstract

Background
Sustainability and health concerns are driving dietary shifts globally, including changes in consumption of dairy products. Dairy provides essential micronutrients e.g., calcium, iodine, and B12 vitamin, and are a source of high-quality protein. They have also been associated with increased risk of diseases. We estimated the health risk-benefit balance of changes in dairy consumption in the Danish population, formulated as three possible consumption scenarios.

Methods
We applied a risk-benefit assessment approach to compare the health impact of current consumption with the impact of three alternative scenarios (AS) of dairy consumption. We accounted for beneficial and adverse health impacts associated with dairy and micronutrients and estimated disability adjusted life years (DALY) caused or prevented by the theoretical changes in consumption. Data were collected from the Danish food consumption survey, literature and the Global Burden of Disease Study.

Results
Results showed that a decrease in consumption of dairy in the overall population from current intake to 270 g/day (AS1) would lead to a loss of 4,865 healthy years annually (3,434; 6,344). The health outcomes contributing more were intellectual disability (men) and type 2 diabetes (women). Negative impacts were larger in men than women. Decreasing consumption would also lead to a higher proportion of women below recommended intake of iodine and of children of calcium. In contrast, increasing consumption to 500g/day (AS2) or to estimated optimal consumption for each health outcome (AS3) would lead to a health benefit (3,853 and 11,354 DALYs averted, respectively). We will present results of scenario analyses and discuss impact of assumptions.

Conclusions
Our estimates emphasize the need to quantify impacts of dietary changes, including health risks and benefits. They will be useful to inform public health policies that consider both sustainability and health impacts of dietary transitions.

Key messages
• We estimate that the Danish population will loose approximately 5000 healthy life years annually if dairy intake is decreased from the current level.
• We argue that our assessment provide quantitative evidence of the trade-offs of shifts in dairy product intake.
Regional and temporal patterns of Italian COVID-19 mortality
Authors: Sanmarchi F , Golinelli D , De Girolamo G , Rucci P , Stoto M A 
Published: October 2023

Abstract

Background
Italy responded to COVID-19 with stringent lockdowns and a mass vaccination campaign. We describe the temporal and regional impact of these measures on mortality, along with social-behavioral correlates.

Methods
The analysis uses National Ministry of Health data on COVID-19 mortality (CM), excess mortality (EM), and vaccine uptake, along with survey data. We calculate avoidable mortality (AM) as observed mortality minus the lowest regional EM rate in each period.

Results
In 2020-21 EM was 180,169, of which 76% were counted as COVID-19. This fraction varied from 13% in the South in Jun-Oct 2020 to 140% in the Northeast in Mar-Jul 2021. Impact varied across Italy, with EM and AM highest in the North during the first and second waves (Feb-Jun 2020 & Nov 2020-Feb 2021) and in the South afterwards (Mar-Dec 2021). After the first wave, there were 33,587 avoidable deaths, 41% of which were in the South. Higher rates in the North in Nov 2020-Feb 2021 were possibly due to less social distancing (e.g. avoiding social events and staying home from work/school), perhaps because residents of the North are more likely to be employed in private industry, which were more likely than public agencies to remain open. Higher rates in the South after Mar 2021 were possibly due to lower trust in hospitals and reduced vaccine uptake, particularly among those aged 80+.

Conclusions
Official CM was differentially under-reported, so EM estimates provide a more robust picture of regional and temporal patterns of COVID-19 deaths. Mortality was high in the North in the second as well as first wave. It was high in the South afterwards (Mar-Dec 2021), accounting for 41% of avoidable mortality.

Key messages
• Excess mortality estimates provide a more robust understanding of regional and temporal patterns of COVID-19 deaths than reported COVID-19 deaths.
• Heterogeneous impact of COVID-19 was associated with differences in preventive habits, trust levels, and vaccine uptake.