bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long COVID and NCDs: the Elephant in the Room
Authors: Nagyova I 
Published: October 2022

Abstract

Issue/problem
COVID-19 has now emerged as a public health concern that not only disrupted healthcare services of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs.

Description of the problem
Before the pandemic, SDG target 3.4, which calls for a reduction in premature mortality from NCDs by one third by 2030, was expected to be achieved by 17.5% of countries, and a further of 23% could achieve the target with a slight acceleration in decline. Currently, most countries are off track due to disruption of healthcare services for people with NCDs, overstretched health systems, and fewer resources than before the pandemic. In addition, only around one in four people who had COVID-19 reported feeling fully recovered within a year of being discharged from hospital. The adverse health effects from long COVID range from ‘invisible symptoms’ such as fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease.

Results
The COVID-19 pandemic has shown that siloed programmes are increasingly unfit, and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Cost-effective, feasible, and relevant interventions that target both physical and mental health impairments are urgently required.

Lessons
By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Protecting current investments and scaling up cost-effective public health interventions is especially crucial in the context of long haul COVID and NCDs. Policy makers and planners will need concrete guidance for making progress on SDG target 3.4, often with overburdened health systems and scarcer resources.
Making the case for the governance of (digital public) health futures
Authors: Wong B 
Published: October 2022

Abstract
Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet & Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 - the largest youth population in history - 90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and well-being. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.
Association between socio-economic deprivation and AHRQ composite indicator during pandemic
Authors: Cedrone F , Di Giovanni P , Di Martino G , Romano F , Staniscia T 
Published: October 2022

Abstract

Background
The Agency for Healthcare Research and Quality (AHRQ) identifies preventable hospitalizations as proxy of potentially low-quality of care. Previous studies showed as socio-economic status was associated to poor diseases outcomes and to the performance of health services. Recently a particular attention was focused on the effect of the pandemic on this context. The aim of this research is to analyze the association between poor quality of primary care and socio-economic status before and during the pandemic.

Methods
A retrospective observational study was conducted in Abruzzo Region, Italy. Hospital discharge records (HDR) of two different periods were selected: from April to December for 2019 and 2020. The aggregate Prevention Quality Indicator 90 (PQI-90) has been coded according to the indications of the AHRQ. The Italian socioeconomic deprivation index (DI), divided in quintiles (from 1st less deprived to the 5th most deprived) was attributed to all patient, based on the municipality of residence. A multivariate logistic regression model was performed to evaluate the association between PQI-90 and DI.

Results
Totally were analyzed 253,063 HDR, of which 14,845 attributable to the PQI-90. By correcting for gender, age and number of comorbidities, the DI was not associated with the PQI-90 during 2019. During 2020 the PQI-90 was associated to 4th DI quintile (aOR 1.19;95%CI 1.09-1.30) and 5th DI quintile (aOR 1.13; 95%CI 1.03-1.23), compared to the 1st quintile.

Conclusions
The impact of the pandemic on primary care has been substantial. Compared to the pre-pandemic era, during the pandemic, an association between potentially poor quality of care and the most disadvantaged socio-economic areas has been shown in Abruzzo. This evidence must be an interesting starting point for health planning in order to fight against inequalities in health services access.

Key messages
• The reduction in the primary care quality during pandemic caused potentially preventable hospitalizations and it was associated to socioeconomic deprivation.
• The analysis of hospital admission linked to context indicators such as the deprivation index, can be a useful tool for the policy maker in order to reduce healthcare inequalities.
Socio-economic inequalities in mental health: a new framework and analysis across 113 countries
Authors: Henking C 
Published: October 2022

Abstract

Background
Socio-economic inequalities in common mental health disorders (CMDs) cut across each step in the cascade of care: (1) Less affluent individuals have a higher prevalence of CMDs, (2) are less likely to utilise treatment and (3) might benefit less from treatment when they do receive it. Here, we propose a new framework for distinguishing between these three types of inequalities in CMDs and test if such ‘triple inequalities’ exist globally and how they vary across countries.

Methods
We use the Wellcome Global Monitor 2020 (N = 119,088 in 113 countries) to test if socio-economic factors, psychological factors (stigma and trust) and country-level factors (GDP, GINI and health expenditure) predict CMD lifetime prevalence, utilisation and perceived helpfulness of talking therapy and medication. Multi-level logistic regression models were used.

Results
As predicted, people with higher household income are less likely to experience anxiety or depression (OR = 0.90 for each income quintile, p &lt; 0.01), more likely to talk to a mental health professional (OR = 1.05; OR = 1.34 for higher education, p &lt; 0.01) and more likely rate this treatment as very helpful (OR = 1.06, p = 0.02) across countries. In contrast, income is not linked with utilisation (OR = 0.99, p = 0.18) and helpfulness of ‘taking medication’ for CMDs (OR = 1.02, p = 0.26). In LMICs, the highly educated take less medication (OR = 0.74, p &lt; 0.01). Local stigma reduces utilisation (OR = 0.95) and helpfulness of talking therapy (OR = 0.77), while trust in health practitioners increases both (OR = 1.07 util. and OR = 1.31 helpf., p &lt; 0.01 in all cases).

Conclusions
Three types of socio-economic inequalities for CMDs (in prevalence, talking therapy utilisation and helpfulness) deepen disadvantages for the less affluent across 113 countries. For pharmacological treatment, inequalities in utilisation and helpfulness are weaker and have a different social gradient in LMICs. Here, less educated people are more likely to take medication.

Key messages
• Three types of socio-economic inequalities in common mental health disorders (in prevalence, talking therapy utilisation and helpfulness) exacerbate disadvantages for less affluent individuals.
• These Inequalities in CMD treatment utilisation and helpfulness are stronger for talking therapies than for medication, and depend on country contexts, stigma and trust in health practitioners.
Diabetes Prevention Programme and socioeconomic inequalities in Type 2 Diabetes in England
Authors: Chatzi G , Whittaker W , Chandola T , Mason T , Soiland-Reyes C , Sutton M , Bower P 
Published: October 2022

Abstract

The National Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type 2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH, HbA1c 42-47 mmol/mol or 6.0-6.4%). How this programme affects inequalities by age, gender, disability, ethnicity, or deprivation is not known. We used multinomial logistic regression models to compare population characteristics at three stages along the prevention programme pathway: prevalence of NDH [using survey data from UK Household Longitudinal Study (N = 794) and Health Survey for England (N = 1,383)]; identification in primary care and offer of the programme [using administrative data from the National Diabetes Audit (N = 1,267,350)]; and programme participation [using programme provider records (N = 98,024)]). Younger adults (aged under 40) [4% of the NDH population (95% CIs 2%-6%)] and older adults (aged 80 and above) [12% (95%CIs 10%-14%] were both underrepresented amongst DPP participants [2% of DPP participants (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.7%-8.3%) respectively]. People with disabilities were underrepresented in the DPP [15% (95%CIs 14.9%-15.1%) vs 60% (95%CIs 58%-62%)] compared to the general population. People living in more deprived areas were under-represented [14% (95% CIs 13.7%-14.3%) vs 20% (95%CIs 16%-24%) in the general population]. Ethnic minorities were overrepresented [36% (95%CIs 35.8%-36.2%) vs 13% (95%CIs 9%-17%) in the general population] among DPP referrals, though the proportion dropped at programme completion stage [19% (95%CI 18.5%-19.5%)]. The DPP has the potential to reduce ethnic inequalities but may widen socioeconomic, age, and disability-related inequalities in T2DM. Whilst ethnic minority groups are overrepresented at identification and offer stage, efforts are required to support the completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM.

Key messages
• The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability.
• The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.
Hospital admissions in Austria during the COVID-19 Pandemic – a rapid analysis for 2020 and 2021
Authors: Ostermann H , Eglau K 
Published: October 2022

Abstract

Background
The COVID-19 pandemic posed a substantial shock to health service provision, in particular regarding hospital services. The reasons and also rationales for reduced health service provision were manifold ranging from limited supply due to resource restrictions, limited demand in order to avoid infections or due to reduced incidence of various diseases, and postponement of elective services. Nevertheless, the provision of services for acute care at an adequate level is paramount to avoid patient harm.

Methods
Hospital admissions were analysed via administrative DRG data reported by Austrian hospitals. We compared health service provision on a monthly basis between 01/2018 and 12/2021. Services were classified according to ICD-10 and encompassed admissions due to acute heart failure, stroke, accidents, knee and hip surgery and breast cancer surgery.

Results
Our findings show that hospital admissions for acute heart failure decreased by up to 25% between 03/2020 and 05/2020. In contrast, no significant difference to the initial pre-pandemic levels could be observed in the later stages of the pandemic. Stroke admissions remained at the initial levels throughout the whole period of analysis, while a substantial decrease (up to 50%) in admissions because of accidents was observed whenever severe NPIs were in place. Knee and hip surgery levels dropped in line with increasing ICU occupancy rates caused by COVID-19 patients. Decreases in breast cancer surgery could only be observed (up to 20%) during the four months of the pandemic (03-06/2020).

Conclusions
Our analysis provides an aggregated insight into service provision management in Austrian hospitals throughout the pandemic. While acute care was continuously provided for most areas of diseases and elective surgeries were widely postponed in line with pressure on ICU capacities, the decline in breast cancer surgery demands attention and further clarification of whether this decline was supply- or demand-driven.

Key messages
• During the pandemic inpatient acute care services were continuously provided for most diseases in Austrian hospitals while elective surgeries were postponed in line with pressure on ICU capacities.
• The pandemic posed a substantial challenge to service provision management in hospitals and unwarranted levels of service provision so far indicate areas of action for future (pandemic) preparedness.
Ultra-processed food consumption and survival in older Italians from the Moli-sani Study
Authors: Bonaccio M , Di Castelnuovo A , Costanzo S , Ruggiero E , Esposito S , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L 
Published: October 2022

Abstract

Background
Ultra-processed food (UPF) is a major public health concern being reportedly associated with increased risk of non-communicable diseases and lower survival. However, most of the epidemiological evidence has been almost exclusively provided by research conducted in populations of youths or middle-aged adults. We tested the hypothesis that a large dietary share of UPF could be a risk factor also for vulnerable groups, as older adults (≥65 years).

Methods
Longitudinal analysis on 5,215 men and women (mean age 72±5 y) from the Moli-sani Study (2005-2010, Italy) followed up for 10.9 y (median). Food intake was assessed by a 188-item FFQ. UPF was defined using the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food consumed (g/d; weight ratio). The overall nutritional quality of the diet was measured by the Food Standard Agency nutrient profiling system dietary index (FSAm-NPS DI).

Results
UPF contributed to 8% (min-max 0.0-58.4%) of the total food eaten daily and represented 14.4% (0.0-70.0%) of daily energy intake. In multivariable-adjusted analyses controlled for known risk factors, higher intake of UPF (Q4, ≥10.2% of total food), as opposed to the lowest (Q1, UPF&lt;4.3%), was associated with increased all-cause mortality (Hazard ratio [HR]=1.19; 95%CI 1.03-1.39); these results remained unchanged after adjustment for the FSAm-NPS DI (HR = 1.21; 95%CI, 1.04-1.41). A linear dose-response relationship of 1% increment in UPF intake with all-cause mortality was also observed (p = 0.017; p for non-linearity=0.85).

Conclusions
A large dietary share of UPF was associated with lower survival in older Italians consuming relatively low amounts of these foods. Expanding on previous studies on different age groups, these findings provide further justification to advise people to limit consumption of UPF even at older age.

Key messages
• A large dietary share of ultra-processed food was associated with lower survival in older Italians consuming relatively low amounts of these foods.
• These findings provide further justification to advise people to limit consumption of ultra-processed food even at older age.
Nurses’ coping with patients’ relatives: Attachment style, burnout, and intentions to leave nursing
Authors: Gur A , Gur-Yaish N , Sher-Censor E , Zisberg A 
Published: October 2022

Abstract

Background
Conflictual interactions with patients’ relatives are prevalent in the work of hospital nurses. These situations may increase burnout and result in intentions to leave the nursing profession and high rates of turnover. It is important to understand the coping mechanisms and behaviours that nurses employ in such conflicts, to help them develop more adequate strategies that could prevent these outcomes. This study aimed at revealing how nurses’ attachment styles colour their behavioural coping mechanisms when dealing with such interactions with patients’ relatives, and how they are related to burnout and intentions to leave the profession.

Methods
An online survey was completed by 140 hospital nurses that included three scenarios of typical conflicts with patients’ relatives. Each scenario was followed by questions that assess stress and inadequacy when handling such situations, and behaviours: problem-solving responses, emotional support seeking, avoidance, and escalating responses. The survey also included self-reports of attachment styles, burnout, and intentions to leave nursing. Data were analysed using SEM (Amos 23).

Results
The model shows an acceptable fit (χ2(24) = 39.33, p = .025; CFI = .963; RMSEA = .068). Higher anxious attachment was associated with higher stress and feelings of inadequacy in handling the situation, which in turn were associated with more emotional support seeking, avoidance, and escalating responses. Escalating responses were indirectly associated with intentions to leave the nursing profession via higher burnout. Higher avoidant attachment was associated with fewer problem-solving responses.

Conclusions
Evaluating nurses’ attachment style, cognitions, and behaviours in conflicts with patients’ relatives is imperative for understanding burnout and intentions to leave nursing. Nursing training should include simulations of conflictual interactions with patients’ relatives to help modify maladaptive coping.

Key messages
• Evaluating nurses’ attachment style, cognitions, and behaviours in conflicts with patients’ relatives is imperative for understanding burnout and intentions to leave nursing.
• Training for nursing staff should consider nurses’ awareness of their attachment style to modify maladaptive cognitions and behaviours in conflicts with patients’ relatives.
Individual and country-level variables associated with the medicalization of birth
Authors: Miani C , Wandschneider L , Batram-Zantvoort S , Covi B , Elden H , Hersoug Nedberg I , Drglin Z , Pumpere E , Costa R , Lazzerini M 
Published: October 2022

Abstract

Introduction
According to the World Health Organization, the medicalisation of birth tends “to undermine the woman's own capability to give birth and negatively impacts her childbirth experience”. The COVID-19 pandemic has disrupted maternity care, with potential increase in the medicalisation of birth and in occurrences of disrespectful maternity care. We aim to investigate potential associations between individual and country-level factors and medicalisation of birth in 15 European countries during the COVID-19 pandemic.

Methods
We collected data through an online, anonymous survey for women who gave birth in 2020-2021. We ran multivariable, multi-level logistic regression models estimating associations between indicators of medicalisation (caesarean section (CS), instrumental vaginal birth (IVB), episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country-level.

Results
Among 27173 women, 24.4% had a CS, and 8.8% an IVB. Among women with IVB, 41.9% reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalisation. For example, women who reported having CS, IVB and episiotomy reported not feeling treated with dignity more frequently than women who didn't have those interventions (respectively: OR: 1.37; OR: 1.61; OR: 1.51; all: p &lt; 0.001). Country-level variables contributed to explaining some of the variance between countries.

Conclusions
We recommend a greater emphasis in health policies on the promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor the medicalisation of reproductive care.

Speakers/Panellists
Emanuelle Pessa Valente
WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS, Trieste, Italy
3.O. Workshop: Structural stigma shapes LGBTQ+ mental health and well-being across countries
Authors:   Organised by: University of Exeter (UK),   Chair persons: David Doyle (UK)
Published: October 2022

Abstract

Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people around the world have been shown to suffer from disparities in mental health and well-being relative to cisgender heterosexual people. Past research aiming to explain these gaps has referenced the added stress experienced by LGBTQ+ people in the form of, for example, interpersonal discrimination, rejection, and harassment (i.e., minority stress). While these phenomena exist at the interpersonal level, emerging evidence suggests that discriminatory structural-level factors, such as policies, norms and rules (i.e., structural stigma), may be just as influential in shaping LGBTQ+ mental health and well-being. Given the passage of a slate of bills limiting sexual and gender minority rights and banning open speech around these issues across many different countries, this is an extremely timely issue for sexual and gender minority health. This workshop will give examples of cutting-edge research on the ways in which structural stigma affects mental health and well-being for LGBTQ+ people. Dr. Dinah Gutermuth (University of Exeter, UK) will discuss findings from a global study (conducted in partnership with the BBC) including older and younger LGB individuals from 113 different countries, showing that structural stigma impairs social capital and creates disparities in loneliness between younger and older LGB individuals. Berk Can Ünsal (Eötvös Loránd University, Hungary) will present data from Europe highlighting structural stigma as a risk factor, and community participation as a protective factor, for depression in sexual and gender minority people. Dr. John Pachankis (Yale University, USA) will present results on how migration from countries of varying levels of structural stigma shapes depression and suicidality in sexual minority men. Finally, Dr. Richard Bränström (Karolinska Instituet, Sweden), will discuss how average life satisfaction improved from 2012-2019 for sexual minority people across Europe, with greater increases in countries with higher levels of structural stigma. Together, these presentations will demonstrate the far-reaching effects of structural stigma on LGBTQ+ mental health and well-being around the world.

Key messages
• Lesbian, gay, bisexual, transgender and queer (LGBTQ+) people around the world have been shown to suffer from disparities in mental health and well-being relative to cisgender heterosexual people.
• Structural stigma is an important factor determining risk for poor mental health among LGBTQ+ individuals across countries.