bluuebunny/crossref_metadata_2025_split huggingface dataset:
Redistributing ill-defined deaths in the German Burden of Disease study BURDEN 2020
Authors: Wengler A , von der Lippe E 
Published: October 2022

Abstract
Having valid information on mortality within a country is of great importance for public health planning. This includes knowing the causes of death (CoD) within a population. However, these data are not always suitable for Burden of Disease calculations from the start and hence, need some realignment in advance. The CoD statistics in Germany include a relatively high share (26% in 2017) of ill-defined deaths (IDD) - using the definition of the Global Burden of Disease Study. Additionally, only the underlying CoD is included in the national statistics and no multicausal data are available yet. As part of the German Burden of Disease project BURDEN 2020 we redistributed IDD to valid CoD using a process of proportional redistribution. To do so, we made use of the distribution of the valid ICD-codes in the data. In the proposed presentation, we use examples of stroke, diabetes, and heart failure to illustrate how IDD were reallocated. After redistribution, the largest increases for both women and men were seen for lower respiratory infections, diabetes mellitus, and stroke. The numbers of deaths for these causes more than doubled after redistribution. Within this project, we carried out the first comprehensive redistribution of IDD for German CoD statistics.
10.D. Workshop: Injury Severity Classification and burden of disability measurement
Authors:   Organised by: EUPHA-INJ, EUPHA-EPI, EUPHA-PHMR, EUPHA-ECO,   Chair persons: Maria Papadakaki (EUPHA-INJ), João Vasco Santos (EUPHA-ECO)
Published: October 2022

Abstract

Globally, injuries cause over 4.3 million deaths per year with incalculable costs for the health, legal, and social systems. Burden of disease analyses are being conducted across the world in order to map the health status of injured population, run comparisons and enable prioritization of preventive and interventional measures. Metrics of injury burden are therefore important indicators of population health that are increasingly being incorporated into national and international health information systems. To prevent injuries and their disabling health consequences, and to effectively reduce injury burden, it is essential to provide policy makers and health system planners with detailed measurements and assessments that allow them to focus resources where they are most needed and areas where more targeted policy attention might be required. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient, specifically for certain injury populations and health outcome domains. A wide variety of measures are available to track outcomes after injury in various health domains. Reaching consensus is an important step in benchmarking of outcomes across institutions and injury types to improve quality and advance the field of injury care. Modern, validated measures that are feasible and usable in both research and clinical contexts are needed to facilitate the improvement of quality and comparability of research. The workshop aims to discuss trends and variation of injury burden, which is critical to health system planning. The high human and societal costs as well as inequalities of injury mortality and burden will be highlighted based on comparisons with long-term trends. The workshop will discuss the latest developments in injury severity classification and disability measurement. The most efficient measures to calculate the valid burden of injuries will be presented and comparative measurements across EU countries will be promoted. Limitations of injury classifications and factors introducing uncertainty and potential bias in estimation of disability, will be identified. The workshop will contribute to the identification of evidence-informed tools and measurements of injury burden.

Key messages
• Some injury outcomes are responsible for huge individual and societal burden but are still difficult to measure.
• Multiple measures are developed to assess severity and outcomes: e.g. AIS/ ISS/New ISS/ ICD-10. Efficient prevention and quality care requires validated and easy to use measures.
Quantification the cost of injuries
Authors: Haagsma J 
Published: October 2022

Abstract
The population health impact of injuries can be measured with a range of metrics. ranging from incidence and mortality to disability adjusted life years and cost-of-illness. Cost of illness gives insight into the societal burden of injury, and factors and characteristics that are associated with higher costs. Assessment of the economic burden of health care is important, because this information allows us to understand main cost drivers of health care and to monitor the impact of injury prevention and interventions. However, comparability of cost-of-illness is hampered by differences in included and excluded health care resources, the perspective and time horizon that is applied in the cost-of-illness studies and inclusion or exclusion of productivity costs. Productivity costs refer to that are caused by work absence. In our injury cost of injuries studies, we found that, among working age injury patients, productivity costs are a significant contributor to the total costs related to injury. We also found that there is a lot of variety in the health care and productivity costs in injury patients, and these costs are not solely dependent on injury severity. In this presentation, we will discuss data sources that can be used to assess the cost of illness of injuries, methodological choices that can be made and risk factors for high health care and high productivity costs.
A novel stream of collaborative National portals to enhance preparedness and informed choices
Authors: Carinci F , Vicario C , Zamperini N , La Valle F , Rocchi L , Veltro G , Siccardi G , Mantoan D 
Published: October 2022

Abstract

Issue/problem
AGENAS supports the implementation of health policies in direct collaboration with Italian Regions and Autonomous Provinces. To improve public reporting, we aimed to complement the production of technical reports with new forms of timely communication, using National Portals.

Description of the problem
Between October-December 2020, we designed and implemented the Covid-19 National Portal, including a suite of targeted indicators, fully automated via ad hoc scripts written in php and R on top of a relational database using internal and external data sources. Targeted information was widely communicated and continuously updated. Dedicated sections on forecasting and resilience were delivered in collaboration with specialised academic institutions. In 2021, we deployed the Portal for the Transparency of Health Services, broadly oriented towards health issues, the location of services and performance indicators.

Results
Pre-post comparisons of web analytics for Jan-Apr 2020-2022 showed clear advantages of Covid-19 Portal. By Apr 2020, Italy had introduced national lockdown, while AGENAS covered the topic traditionally, recording 48,122 users overall, with daily peaks below 5,000 sessions. In 2021-2022, the number of users skyrocketed at 436,280, with daily peaks of 100,000 sessions, and 421,123 respectively, with daily peaks of 150,000 sessions. Visits to the Transparency Portal were considerably more limited.

Lessons
To be widely used, public health information needs to be relevant (responding to personal need close to home), understandable, accurate and timely. National Portals can gain efficiency through the mediation of search engines, enhanced by: targeted naming (url), coherent semantic perimeter (third level domain in a highly referenced institutional website), continuous updating, and impact factor (linked by authoritative websites). The Transparency Portal will take stock of these lessons to succeed in a new funded program of NextGenerationEU.

Key messages
• Relevant, understandable, accurate and timely dissemination for different types of audience may be effectively organised through National Portals.
• Productive collaboration between health specialists and communication experts can enhance usability and actionability of National Portals for public health.
Mortality among internal and international migrants in the 100 Million Brazilian Cohort
Authors: Pescarini JM , Goes E , Scaff P , Schindler B , Rodrigues LC , Brickley EB , Smeeth L , Barreto ML 
Published: October 2022

Abstract

Background
There is limited evidence on the health of migrant populations in low and middle-income countries (LMICs). Here, we investigated the patterns of mortality risk in migrants and non-migrants in women and men over the life course.

Methods
We linked socioeconomic and mortality data from 1st Jan 2011 to 31st Dec 2018 in the 100 Million Brazilian Cohort. We calculated all-cause and cause-specific age-standardised mortality rates according to individuals’ migration status. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., people born in Brazil but living in a different Brazilian state to their state of birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals.

Results
We followed 45,051,476 individuals, of whom 6,057,814 were internal migrants and 277,230 were international migrants. Internal migrants had a similar overall risk of all-cause mortality compared to Brazilian non-migrants (aHR=0.99, 95%CI=0.98-0.99), with lower mortality from some causes but higher mortality for some non-communicable diseases (NCDs). Compared to Brazilian-born individuals, international migrants had a lower risk of all-cause mortality (aHR=0.82, 95%CI=0.80-0.84), with up to 50% lower risk of death attributed to interpersonal violence among international migrant men (aHR=0.50, 95%CI=0.40-0.64), but a markedly higher risk of death by avoidable causes related to maternal health among young migrant women (aHR=2.17, 95%CI=1.17-4.05).

Conclusions
Overall, internal migration was not associated with excess all-cause mortality, while international migration into Brazil was associated with lower all-cause mortality. Mortality patterns among migrant populations in Brazil show marked variation for specific causes of death, and risks varied by age and sex.

Key messages
• Non-communicable diseases and maternal mortality are disproportionally higher among internal and international migrants, respectively.
• Further investigation of the underlying factors associated with higher maternal mortality among international migrant women is key to informing the targeting of social and health interventions.
Inequalities in adverse birth outcomes and survival in early childhood: birth cohort in South Korea
Authors: Jo M , Chung H 
Published: October 2022

Abstract

Background
Adverse birth outcomes (ABOs) are considered the most common factor of deaths in early childhood. Inequalities in child mortality occur due to interactions between intrinsic and socio-environmental factors related to socioeconomic disadvantage. There are, however, few studies investigating the impact of ABOs on mortality in terms of parental SEP.

Methods
Using the Under-5 Infant Birth-Death Cohort Data in Korea, a pooled retrospective birth cohort of all children born in 2012-2014 was built (N = 1,356,584). We analyzed neonatal, post-neonatal, and childhood mortality by ABOs and with the interaction of parental SEP using the Cox proportional hazard regression model for survival analyses. We further stratified the analysis both by parental SEP and child age. Multiple logistic regression was performed to confirm the social inequalities in ABO itself.

Results
After adjusting for covariates, children born with ABOs presented higher risk of mortality for all periods. For post-neonatal period, lower maternal education showed significant interaction effect with LBW (HR = 0.57; 95% CI = [0.39-0.85]), PTB (HR = 0.53; 95% CI = [0.33-0.86]), LBW & PTB ([HR = 0.67; 95% CI = [0.54-0.83]) while lower paternal education (HR = 0.67; 95% CI = [0.54-0.82]) and maternal unemployment (HR = 0.80; 95% CI = [0.63-0.99]) showed significance for babies with LBW & PTB. However, stratification analyses suggested that the impact of ABOs on mortality was greater for children born to lower parental SEP in neonatal period. Meanwhile apparent social inequalities in ABOs were suggested from regression analyses.

Conclusions
We confirmed social inequalities in the incidence of ABOs as well as mortalities from ABOs. However, the difference in mortality between babies with and without ABOs was greater for advantaged children. Policies to reduce the mortality of children with ABOs as well as those of healthy children among socioeconomically disadvantaged families are required.

Key messages
• Social inequalities in mortality from ABOs were apparent especially in the neonatal period while the incidence of ABOs itself was greater among children from disadvantaged families.
• Disadvantaged children are more likely to die not only from ABOs but also from other socio-environmental determinants, especially in the post-neonatal period than their counterparts.
The COVID-19 pandemic as an disruptive event in school health promotion. Survey results from Germany
Authors: Dadaczynski K , Messer M , Okan O 
Published: October 2022

Abstract

Background
This study examines the extent to which schools implement activities on health promotion and prevention during the COVID-19 pandemic. Moreover, potential differences with regard to demographic variables, school type, state, and participation in state public health and health promotion initiatives are determined.

Methods
As part of the international COVID-Health Literacy Research Network, an online-based cross-sectional study was conducted from March to April 2021 with 2,186 school principals from three German federal states. The implementation status of COVID-19 related school health promotion was assessed using a self-developed instrument. After examining the factorial structure of the instrument, univariate and bivariate data analyses were performed.

Results
Three dimensions of implementing school health promotion can be identified (1. COVID-19- related support for pupils, 2. Health promoting design of teaching, learning and working conditions, 3. Principles of Health Promoting School). A low level of implementation can be observed for aspects of teaching, learning and working conditions (31%) as well as for participation (52%) and cooperation with community stakeholders (42%). Significant differences can be determined with female, older and primary school principals reporting a higher implementation status while for federal state mixed results are found. Stratified by participation in state health promotion initiatives, only schools with a certificate in health promotion show a higher level of implementation.

Conclusions
The results indicate that the COVID-19 pandemic is a disruptive event for schools, impeding the implementation of holistic activities on health promotion and prevention. In addition to systematic support for school principals in the area of health promotion and prevention, it should be ensured that existing initiatives are provided with sufficient resources, especially in times of crisis.
School health promotion during the COVID-19 pandemic: Associations with school leaders’ health literacy
Authors: Betschart S , Sandmeier A , Skedsmo G 
Published: October 2022

Abstract

Background
School leaders are credited with an important role when it comes to school health promotion. During the COVID-19 pandemic, much health-related information was available and had to be interpreted and acted upon by school leaders. Therefore, it is crucial that they have sufficient health literacy as the ability to gain access to, understand and use health-related information. A study in Germany showed that limited health literacy among school principals was associated with low levels of health promotion activities. This paper explores the association between school leaders’ health literacy and school health promotion in Switzerland, addressing the following questions: 1. What is the relationship between health literacy of school leaders and the implementation of school health promotion? 2. Does health literacy explain variance above and beyond other antecedents, such as principals individual mental health and attitudes?

Methods
The quantitative analysis is based on an online survey conducted among school leaders in the German- and French speaking parts of Switzerland in June 2021 as part of the project “COVID-19 health literacy school principals survey”. The final sample comprised N = 339 school leaders. The data were analyzed using stepwise regression with health literacy, stress, wellbeing and attitudes toward school health promotion as antecedents and COVID-19 related school health promotion as the outcome.

Results
The results show that health literacy of school principals has played an important role in the implementation of school health promotion during the COVID-19 pandemic. It explains additional variance beyond other antecedents.

Conclusions
One way to promote implementation of school health promotion is to strengthen the health literacy of school leaders.
Impact of booster vaccination on COVID-19 outcomes in Portuguese population aged 80 or more years old
Authors: Kislaya I , Rodrigues AP , Silva S , Santos AJ , Matias Dias C , Nunes B , Machado A 
Published: October 2022

Abstract

Background
Vaccination is essential to control SARS-CoV-2 transmission and complications. The study aimed to estimate the number of SARS-CoV-2 infections, COVID-19 hospitalizations and deaths averted by booster vaccination in Portuguese population aged 80 or more years old.

Methods
We developed an ecological study for the period of the Omicron variant of concern predominance (week 2 to week 16, 2022). Data on vaccine coverage and effectiveness, and number of events of different severity reported to the national COVID-19 surveillance system were used to estimate the number of averted events, prevented fraction and number needed to vaccinate. Uncertainty intervals (UI) were obtained using Monte Carlo simulations.

Results
By week 2 2022, vaccination coverage in the target population reached 91.2%. Booster vaccine effectiveness was 4.1% (CI95%: -0.1 to 9.0), 87.5% (CI95%: 84.9 to 89.7) and 83.2 (CI95%: 80.3 to 85.7) against infection, hospitalization and death, respectively. During the study period, 70862 SARS-CoV-2 infections, 2697 COVID-19 hospitalizations and 2106 deaths were reported. Booster vaccination averted 2731 (UI95%: -298 to 5838) infections, 10629 (UI95%: 9173 to 12127) hospitalizations and 6608 (UI95%: 5725 to 7546) COVID-19 related deaths among individuals aged 80 years or more resident in Portugal. Prevented fractions were 3.7% (UI95%: 0 to 7.6%), 79.7% (UI95%: 77.3 to 81.7%) and 75.8% (UI95%: 73.2 to 78.1%), respectively. It would require to vaccinate 59 individuals (UI95%: 52 to 69) to prevent one hospitalization and 94 individuals (UI95%: 82 to 109) to prevent one death in the target population.

Conclusions
The booster vaccination strategy had considerable impact on preventing severe outcomes in the Portuguese population aged 80 and more years old.

Key messages
• High vaccine coverage combined with high vaccine effectiveness resulted in considerable reduction of severe COVID-19 outcomes.
• Information on number of outcomes of different severity levels averted by COVID-19 booster vaccination allows to strength public health communication.
Suicide attempts in LGBTQ+ youth in Switzerland: Qualitative insights in school-based risk factors
Authors: Bomolo NJ , Koschmieder N , Gavin A , Kupferschmid S , Bourquin C , Michaud L , Pfister A 
Published: October 2022

Abstract

Background
Studies show that the LGBTQ+ population is particularly vulnerable to suicidal thoughts and behavior. This vulnerability is even more pronounced in the younger population. However, in Switzerland, qualitative studies on this topic are missing. Our study investigates the processual dynamics and background of suicide attempts of LGBTQ+ youths while looking into their subjective meaning. Here, behaviors of help-seeking are also from interest. In addition, the burdens and resources associated with being LGBTQ+ are explored. By better understanding the process of suicide attempts, we can identify relevant contexts of the respondents’ experiences and illustrate how to enhance suicide prevention strategies. We are referring here to the school context.

Methods
From 2021 until 2024, we interview LGBTQ+ youths in the German- and French-speaking parts of Switzerland who have tried to end their lives between the ages of 14 to 25 (max. three attempts). Applying a multi-perspective approach, we interview persons from their social environment if agreed. Recruitment is based on ‘theoretical sampling’. Data collection and analysis follow the grounded theory methodology. As of July 2022, the sample consists of 18 persons: 3 bisexual women, 1 lesbian woman, 2 gay men, 7 transgender persons, and 5 persons with fluid identities.

Results
Through preliminary analysis, the school context could be identified as one relevant burdening context in the respondents’ experience and suicide attempt process. In this respect, respondents experienced complicated social relationships: e.g., bullying, social exclusion, and pressure to conform. Moreover, the school environment was experienced by some as LGBTQ+ hostile.

Conclusions
Our current findings support the necessity to integrate schools as important stakeholders in suicide prevention but highlight a need for LGBTQ-specific and LGBTQ-sensitive orientations to suicide prevention strategies.
Meso-level ambulatory care and ambulatory care sensitive hospitalizations in Germany
Authors: Schüttig W , Sundmacher L 
Published: October 2022

Abstract
Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and continuity of care in the ambulatory care sector on ambulatory care sensitive hospitalizations in patients with type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional regional data sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the ambulatory care sector, we used an instrumental variable approach. In doing so, we adjust for a number of known risk factors for hospitalizations among this patient group. We undertook a Shorrocks-Shapley decomposition to investigate the relative contribution of groups of regressors to the pseudo R2. The results of our analysis suggest that spending in the ambulatory care sector has weak negative effects on ambulatory care sensitive hospitalizations. We also found that continuity of care was negatively associated with hospital admissions. Patients with type 2 diabetes are at increased risk of hospitalization resulting from ambulatory care sensitive conditions. The results of the decomposition analysis for groups of variables indicate that ambulatory care characteristics account for 9.8% of the pseudo R2, morbidity of patients (including gender and age groups) for about 85.5%, and system-related factors of health provision for 4.7%. Our study provides some evidence that meso-level factors such as increased spending and improved continuity of care while controlling for process quality in the ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes.