bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning from COVID-19: The inclusion of vulnerable groups in COVID-19 responses across Europe
Authors: Molenaar J , Van Praag L 
Published: October 2022

Abstract

Background
More than two years into the pandemic, many European countries have begun to evaluate their COVID-19 public health responses and draw lessons for future preparedness. As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is pertinent to evaluate the extent to which COVID-19 responses have successfully responded to the diverse needs of various vulnerable groups. We present a comparative analysis of how evaluations of European COVID-19 responses have assessed efforts to adapt or tailor COVID-19 responses to vulnerable groups, focusing on public testing and tracing strategies and vaccination campaigns.

Methods
We draw on data collected in the H2020 project COVINFORM. We combine insights from qualitative interviews conducted with public health policy- and decision makers in COVINFORM partner countries with a document review of available evaluations of COVID-19 responses published by both government and academic actors between March 2020 and June 2022.

Results
Across countries, evaluations of COVID-19 responses show that efforts to adapt or target public health responses to specific vulnerable groups became more common as the pandemic stretched on. Differences across countries were observed in relation to which groups were considered particularly vulnerable; the types of responses considered successful; as well as the organisational/governmental level at which responses were coordinated. Analyses reveal that the heavy emphasis on medical vulnerability distracted from efforts to address broader, structural inequalities, complicating the development of tailor-made policies.

Conclusions
The results inform ongoing policies that deal with the long-term consequences of the COVID-19 pandemic and aim to reduce disproportionate impacts faced by vulnerable groups. Our findings also add to a better understanding of how future preparedness structures should take into account how pandemic measures have unequal impacts.

Key messages
• As the COVID-19 crisis has exacerbated intersectional social and health inequalities, it is important to learn from efforts to adapt or tailor COVID-19 responses to vulnerable groups.
• The findings demonstrate how across Europe, the combination of particular sets of country-specific COVID-19 responses, tailor-made or not, yield specific consequences for vulnerable groups.
Readiness of Community Health Agents for COVID19
Authors: Vieira-Meyer A , Guimarães JMX , Morais APP , Dias MSA , Vieira NFC , Farias SF , Oliveira ALS , Meyer CHC , Vasconcelos MIO , Yousafzai A 
Published: October 2022

Abstract

Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic.

Key messages
• CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic.
• Addequate trainning and work environment are essencial for proper work development.
The burden of musculoskeletal disorders in Belgium: a national population-based study
Authors: Gorasso V , Van der Heyden J , De Pauw R , Pelgrims I , De Ridder K , Vandevijvere S , Vansteelandt S , Vaes B , De Smedt D , Devleesschauwer B 
Published: October 2022

Abstract

Background
According to WHO, approximately one in three people worldwide live with a chronic, painful musculoskeletal (MSK) disorder. Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the most disabling MSK disorders. According to the Global Burden of Disease (GBD) study, LBP was the leading global cause in terms of years lived with disability and OST showed an increase in prevalence and is predicted to be one of the leading future causes. Our study aimed to analyse the burden of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018.

Methods
Prevalence and disability-adjusted life years (DALY) were computed using data from the Belgian health interview surveys from 2013 and 2018, the INTEGO database (Belgian registration network for general practitioners) and GBD study 2019. Mortality data was retrieved from the Belgian statistical office for people dying from RHE. Following GBD methodology, LBP, NKP and OST were assumed to not generate any deaths.

Results
The prevalence of MSK disorders increased from 2013 to 2018 with OST being the disorder with the highest number of cases (1.7 million cases in 2018). The burden was higher in women and the gender disparities increased with age. Women died also more frequently due to RHE compared to men. In total MSK disorders contributed to 180,746 comorbidity-adjusted DALYs for female and 116,063 comorbidity-adjusted DALYs for men in 2018, with LBP being the largest contributor (140,031 DALY).

Conclusions
The burden of MSK disorders has increased over the years. In 2018, 2.5 million Belgians were affected by at least one MSK disorder that resulted in almost 300,000 DALY. Our study provides valuable information of a part of the health burden that is known to have a great impact on the total burden of disease but that is sometimes disregarded by public health institutions.

Key messages
• MSK disorders represent a major health problem in Belgium.
• Acting on risk factors associated to these disorders is crucial to mitigate their burden.
Social environment and cardiometabolic health outcomes: systematic review and meta-analysis
Authors: Abreu TC , Beulens JWJ , Schoonmade LJ , Mackenbach JD 
Published: October 2022

Abstract

A number of studies investigated the relationship between the social environment (SE) (i.e., the social relationships and social context in which groups of people live and interact) and lifestyle behaviours. However, to what extent this relation extends to cardiometabolic disease (CMD) outcomes is unknown. This systematic review and meta-analysis summarizes the available evidence. We systematically searched PubMed (Medline), Scopus, and Web of Science from inception to 16 February 2021. Outcomes of were type 2 diabetes mellitus and cardiovascular diseases and determinants were SE factors. We assessed the quality of the studies with Newcastle-Ottawa Scale (NOS). We meta-analysed exposure-outcome combinations when ≥3 associations from high quality papers were available. Results are expressed as OR, 95%CI. From 7,671 records screened, 208 were included. Of these, 92% were conducted in high income countries, 58% were cross-sectional studies, and 20% were of poor quality. Among the 208 studies, 746 relevant associations were investigated. The largest number of associations investigated was on the dimension Economic and Social Disadvantage (ESD; 59%), followed by Social Relationships and Norms (21%) and Discrimination and Segregation (9%). Less evidence was found for the remaining dimensions. Meta-analysis of 14 exposure-outcome combinations indicated that worse SE was associated with increased odds of CMD outcomes. Despite this tendency, only the association between ESD and heart failure was statistically significant (1.58, 1.11-2.27; n = 4; I2=92%). Generally, heterogeneity was high. In conclusion, higher levels of ESD seem to contribute to increased risk of heart failure. The existing literature is highly heterogeneous and varies notably in terminology. Moreover, the dimensions Social Cohesion and Social Capital, Crime and Safety, Civic Participation and Engagement and Disorder and Incivilities are underexplored in relation to CMD. (PROSPERO-ID: CRD42021223035).

Key messages
• Worse SE was associated with increased odds of CMD outcomes, with higher levels of Economic and Social Disadvantage being statistically significantly associated with increased risk of heart failure.
• The existing literature is highly heterogeneous and varies notably in study design and terminology.
To what degree are health insurance enrollees aware of the restrictive conditions of their policies?
Authors: Van der Hulst FJP , Holst L , Brabers AEM , De Jong JD 
Published: October 2022

Abstract

Background
Over recent decades, many Western countries have added market incentives to their health systems. In a system of managed competition, health insurers are supposed to be prudent purchasers of health care on behalf of their enrollees. They can contract healthcare providers selectively. Enrollees who choose a health insurance policy with restrictive conditions, will have to make a co-payment if they consult a non-contracted provider. If the co-payment is unexpected, it may cause a problem for the enrollee. This study aims to gain insight into enrollees’ awareness of the conditions of such health insurance policies in the Netherlands.

Methods
In August 2020, an online questionnaire was sent out via health insurers to enrollees with restrictive health plans. In total 13,588 enrollees responded. Descriptive statistics and logistic regression analyses were performed on various outcome measures relating to enrollees’ awareness of the restrictive conditions.

Results
One fifth (19%) of the respondents appeared to be totally unfamiliar with the policy conditions. Men, younger people, people with a low level of education, a lower income, a poorer health status, and non-care users were found to be less familiar with the conditions (p = 0.00 for all). 62% who wanted to visit a healthcare provider whose care was not fully reimbursed, still went to that provider. Of those who had to pay extra because hospital care was not fully reimbursed, 62% did not know this in advance and 30% indicated that paying extra was a serious problem.

Conclusions
Not all enrollees who choose a policy with restrictive conditions are aware of the consequences of receiving care from a non-contracted provider. There seems room for improving the information provision, in particular for people with a low income and people with a poorer health status, as these groups more often reported unawareness about having to pay extra and more often faced financial problems.

Key messages
• Not all enrollees are well informed about their policy with restrictive conditions.
• Selective contracting does not always affect enrollees’ choice of a healthcare provider.
Socioeconomic position and self-rated health among adolescents: the mediating role of the family
Authors: Rattay P , Blume M , Spallek J , Hoffmann S , Sander L , Herr R , Herke M , Reuter M , Novelli A , Hövener C 
Published: October 2022

Abstract

Background
Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents’ health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants.

Methods
Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11- to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents’ education, occupation, income, socioeconomic position index, and adolescents’ subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity).

Results
A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained.

Conclusions
The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.
The role of regional health policy for socioeconomic inequality in health services utilization
Authors: Iashchenko I , Schüttig W , Bammert P , Spallek J , Rattay P , Schneider S , Moor I , Pischke CR , Sundmacher L 
Published: October 2022

Abstract

Background
“J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1.

Methods
We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES.

Results
The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1.

Discussion
Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.
Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic
Authors: Scardina G , Ceccarelli L , Casigliani V , Mazzilli S , Padovan M , Petillo A , Tavoschi L , Foddis R , Privitera G , Baggiani A 
Published: October 2022

Abstract

Background
Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination.

Methods
Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed.

Results
Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (&lt;30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others; in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID.

Conclusions
A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake.

Key messages
• This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs.
• A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.
Resilience in Syrian refugee youth
Authors: Dangmann C , Solberg Ø , Myhrene Steffenak AK , Høye S , Andersen PN 
Published: October 2022

Abstract

Background
The importance of resilience factors in the positive adaptation of refugee youth is widely recognised. However, their actual mechanism of impact remains under-researched. The aim of this study was therefore to explore protective and promotive resilience mechanisms on both negative and positive mental health outcomes. Promotive resilience is seen as a direct main effect and protective resilience as a moderating effect.

Methods
Cross-sectional study with 160 Syrian youth aged 13-24 years, who recently resettled in Norway. A multi-dimensional measure for resilience was used to explore the potential impact of resilience factors on pathways between potentially traumatic events from war and flight (PTE), post-migration stress, mental distress and health-related quality of life (HRQoL). Analyses included regression, moderation and moderated mediation using the PROCESS macro for SPSS.

Results
A direct main effect of resilience factors (promotive resilience mechanism) was found for HRQoL and general mental distress, but not for post-traumatic stress disorder (PTSD). No moderating effects of resilience factors (protective resilience mechanism) were found. Post-migration stressors mediated the effects of PTE, and this indirect effect was present at all levels of resilience. Relational and environmental level resilience factors and combined amounts had more impact than individual level factors.

Conclusions
Despite high risk exposure and mental distress, resilience was also high. The direct main effect of resilience factors and less impact on PTSD, suggests universal resilience building interventions may be beneficial, compared to exclusively targeting groups with high symptom levels. These interventions should target relational and environmental resilience factors as well as individual coping techniques. Additionally, reducing current stress and symptoms could increase the efficacy of resilience factors already present.

Key messages
• Refugee youth may have both high levels of risk and high resilience.
• Universal resilience interventions should focus on relational and environmental support, as well as individual resilience.
Redistribution down under—dealing with ill-defined deaths in the Australian Burden of Disease Study
Authors: Dunford M , Ho W , Bishop K , Gourley M , Juckes R 
Published: October 2022

Abstract
Burden of disease analyses measure the healthy years of life lost due to living with and dying prematurely from disease and injury. It is now the global standard for comparable policy-relevant evidence on the impact of disease, injuries, and risks on a population. The Australian Burden of Disease Study (ABDS), undertaken by the Australian Institute of Health and Welfare, uses Australian-specific data and methods (based on the Global Burden of Disease Study, adjusted to suit the Australian context) to quantify disease burden for Australia. Despite the high quality of deaths registration data in Australia, in burden of disease analyses not all coded causes of death are considered appropriate or valid to estimate years of life lost (YLL). Therefore, these ‘ill-defined deaths’ are redistributed to one or more diseases on the ABDS disease list according to a more probable underlying cause of death. In the latest ABDS, almost 1 in 10 deaths in 2018 was an ill-defined death. Most of these were redistributed to other diseases using one of three methods developed for the Study:
1) direct evidence on more plausible causes of death from data linkage studies or other sources
2) redistribution algorithms based on the distribution of underlying causes of death where the ill-defined cause was recorded as an associated cause of death
3) reassignment of deaths across a specified range of target diseases according to patterns of causes of death observed in the mortality data for the ABDS disease list.
Expert advice was also received on the redistribution of deaths from septicaemia and deaths coded to ICD-10 code X59 Exposure to unspecified factor. Overall, 8.5% of the years of life lost for Australia in 2018 came from ill-defined deaths. These deaths generally followed age-specific all-cause mortality patterns. It is important to consider methods and target diseases when redistributing ill-defined deaths to appropriately quantify their contribution to disease-specific burden.