bluuebunny/crossref_metadata_2025_split huggingface dataset:
The global burden of neglected zoonotic diseases: current state of evidence
Authors: di Bari C , Venkateswaran N , Pigott D , Flastl C , Devleesschauwer B 
Published: October 2022

Abstract

The majority of emerging infectious diseases are zoonoses, most of which are classified as “neglected”. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives.

Key messages
• There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program.
• No complete list of zoonoses exist, and the definition used is vague. A stricter definition of zoonoses and what defines them will help provide a clear view of dealing with and controlling them.
Comparison between recommended and mandatory vaccine uptake during adolescence in Italy
Authors: Caracciolo MR , Angelillo S , Ficara F , Venturi D , Licata F , Bianco A 
Published: October 2022

Abstract

Background
Immunization programs are key preventive interventions and have largely contributed to reducing the burden of infectious diseases and decreasing related morbidity, mortality and healthcare costs. The study aimed to investigate coverage regarding diphtheria, tetanus, and acellular pertussis (dTap) - Inactivated Poliomyelitis Vaccine (IPV) and Human Papilloma Virus (HPV) vaccine and attitudes towards vaccinations among undergraduate university students in Southern Italy.

Methods
This cross-sectional study was conducted among 327 students through an anonymous online questionnaire and included socio-demographic characteristics, attitudes towards vaccinations overall and specifically on dTap-IPV and HPV, reasons for having received or not vaccinations and willingness to receive vaccinations.

Results
One third of the students were concerned about serious adverse effects of vaccines and 95% believed that vaccines for uncommon diseases are useless. During adolescence, 89% of the sample received the mandatory dTap-IPV vaccine booster. Among unvaccinated students, 45% were unwilling to get vaccinated against dTap-IPV because they believed not to be at risk of infection (59%) and had lack of recommendation (35.3%). Regarding vaccination against HPV, 67% had received the recommended schedule. Among those who did not receive it, 34% were unwilling to get vaccinated because they did not feel at risk of HPV infection (41%). Interestingly, 16% of the sample disclosed some barriers to access vaccination centers. Moreover, 30% declared that HPV vaccination was discouraged by healthcare professionals (HCPs).

Conclusions
Vaccination uptake is worryingly low and national objective coverage seems not still achieved. Likewise, risk perception of vaccine-preventable diseases was low and it seems negatively impact on the intention to get vaccinated. Improving vaccine confidence among HCPs is crucial as they have been shown to have the potential to influence patient vaccination uptake.

Key messages
Communication between cancer patients, caregivers and oncologists about out-of-pocket spending
Authors: Tur-Sinai A , Bentur N , Urban D 
Published: October 2022

Abstract

Background
Concern about the cost and affordability of cancer drugs is widespread and well known. Even in countries with universal healthcare systems or health insurance for all, additional patient out-of-pocket (OOP) expenses are prevalent. Studies showed that honest communication between oncologists and patients is an important component in alleviating financial burden of cancer care. The study explores patient-caregiver-oncologist communication regarding the affordability of OOP medication and the extent to which this communication is related to families’ financial burden after their loved ones’ death.

Methods
A cross-sectional survey is conducted in Israel among 491 primary caregivers of deceased cancer patients, Jewish and Arab, in three oncology centers.

Results
About 43% caregivers said that they and/or the patients had paid OOP for medications during the last half-year of the patient's life. Most (73%) oncologists who suggested an OOP medication hardly asked or did not ask about financial ability and took little or no interest in ability to afford it, 43% hardly explained or did not explain the advantages of an OOP medication, and 52% hardly explained or did not explain any treatment alternatives. A linear regression analysis reveals that older age and female gender are related to less communication about an OOP medication and that better education, greater affluence, and having private health insurance are related to more communication. About 56% of caregivers say that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. A regression analysis revealed that physicians’ interest in their financial ability and in the explanation they gave decreased their burden.

Conclusions
Discussing and explaining the meaning of OOP payment alleviates the financial burden that families experience. It is crucial to develop and invest in improving oncologists’ education and skills to communicate costs more openly.

Key messages
Temporal dynamics of socioeconomic inequalities in COVID-19 – a scoping review
Authors: Beese F , Wollgast L , Waldhauer J , Hoebel J , Wachtler B 
Published: October 2022

Abstract

Background
International evidence shows a socially unequal burden of SARS-CoV-2 infections and COVID-19 outcomes across different socioeconomic groups. However, less is known about the temporal dynamics of socioeconomic inequalities in COVID-19 throughout the pandemic. We conducted a scoping review to systematically map and synthesize the available evidence.

Methods
We conducted a systematic literature search in Embase and Scopus with pre-defined eligibility criteria, including empirical research from 1 January 2020 to 24 August 2021. Additionally, several journals and the reference lists of all included articles were hand-searched to identify relevant studies. We used a standardized charting approach to extract relevant content and narratively synthesized the included evidence. The study follows the PRISMA guidelines for scoping reviews.

Results
From 8,011 identified records, we finally included 46 articles in the analysis. 50.0% of all included studies were conducted in the United States. The majority of all studies analyzed surveillance data (n = 44) and used area-based socioeconomic indicators on an ecological level (92.5%). The study results show temporal dynamics in COVID-19 inequalities, frequently initiated through higher outcome rates in more affluent populations and subsequent crossover dynamics to higher rates in more deprived populations (41.9%). Furthermore, 91.4% of the analyses show maintaining or worsening social inequalities in health with ongoing pandemic progression, which hit the most deprived populations the hardest.

Conclusions
The results show worsening social inequalities in COVID-19 over the course of the pandemic, with the most disadvantaged populations most affected during its progression. Targeted prevention and interventions, such as low-threshold testing and vaccination programs, infection protection for precarious jobs or living conditions, and targeted information are crucial to face socioeconomic inequalities throughout pandemics.

Key messages
Psychosocial wellbeing of Berlin school children during the COVID-19 pandemic, June 2020-March 2021
Authors: Theuring S , van Loon W , Hommes F , Bethke N , Mall MA , Kurth T , Seybold J , Mockenhaupt FP 
Published: October 2022

Abstract

Background
The COVID-19 pandemic and related restrictions have affected the wellbeing of school children worldwide. Specific problems evolving during the pandemic, their extent and duration haveńt been sufficiently explored yet. We aimed at describing school childreńs psychosocial and behavioral parameters and associated factors during the COVID-19 pandemic in Berlin, Germany.

Methods
Our longitudinal study included students from 24 randomly selected Berlin primary and secondary schools, assessing psychosocial wellbeing and behaviors at four time points between June 2020 and March 2021. We analyzed temporal changes in the proportions of anxiety, fear of infection, reduced health-related quality of life (HRQoL), physical activity and social contacts, as well as sociodemographic and economic factors associated with anxiety, fear of infection and HRQoL.

Results
Of initially 384 recruited students, 324 still participated in the fourth study round after nine months. During the observation period, presence of anxiety symptoms increased from 26.2% (96/367) to 34.6% (62/179), and fear of infection from 28.6% (108/377) to 40.6% (73/180). The proportion of children with limited social contacts (&lt;1/week) increased from 16.4% (61/373) to 23.5% (42/179). Low physical activity (&lt;3 times sports/week) was consistent over time. Low HRQoL was observed among 44% (77/174). Factors associated with anxiety were female sex, increasing age, secondary school attendance, lower household income, and presence of adults with anxiety symptoms in the student's household. Fear of infection and low HRQoL were associated with anxiety.

Conclusions
A substantial proportion of school children experienced unfavorable psychosocial conditions during the COVID-19 pandemic in 2020/2021. In particular, students from households with limited social and financial resilience require special attention.

Key messages
Research ethics with real-world data (RWD) on COVID-19 infections: the unCoVer study
Authors: Riva S , Kabir Z , Biscoe N , O'Sullivan G , Soriano G , Penalvo J 
Published: October 2022

Abstract

Issue
The aim of the Horizon 2020 unCoVer project (Unravelling Data for Rapid Evidence-Based Response to COVID-19) is to coordinate research expertise in utilising Real World Data (RWD) to investigate the underlying risk factors for COVID-19 infection and severity, the effectiveness of treatments and the impact on health systems. RWD is particularly useful in a dynamic health context as it is relevant, timely, and more ecologically valid. Pooling clinical databases and integrating epidemiological principles and powerful biostatistical tools optimises resources and fully exploits routinely-collected data.

Description of the problem
RWD sharing poses new practical and ethical challenges to research. The unCoVer network has developed a federated data platform to access diverse databases for advanced analytics. This data access process entails GDPR, and regulatory and ethical nuances. The use of large-scale data from heterogeneous sources across multiple jurisdictions for research purposes presents a complex systems challenge.

Effects & Lessons
A dedicated team of unCoVer network members is responsible for addressing these challenges. Here, we describe the ethical and regulatory aspects of RWD sources, the role of the Data Protection Authorities and the Data Protection External Authority Board (DP-EAB) of the Uncover project, and the documentation involved, including a data processing agreement and a data transfer agreement. We provide an overview of the main principles for sharing RWD whilst maintaining integrity and security and how this translates into procedures to protect the rights, security, and well-being of human research participants. This represents a practical framework for researchers.

Key messages
Applicability of European legislation for the protection of data while using tracing applications
Authors: Mullerova P 
Published: October 2022

Abstract

Background
Since the beginning of the COVID pandemic, Member States have started using tracing applications. The European Commission immediately confirmed the possibility of collecting personal data without the obligation to obtain the citizens’ consent. Aware of the threat of data breach, the Commission has tried to remedy the situation and has given up the recommendation followed by a guide on how to use the tracing applications.

Methods
In order to achieve the determination of the applicable European legislation, we used the doctrinal method in combination with the quantitative empirical research in the area of comparison of individual tracing applications.

Results
The geolocal applications are regulated by GDPR. Based on Article 6 (1) GDPR, Commission confirmed the possibility to restrict the citizens’ privacy. The Commission drew the attention to the collection of personal data based on the exception of “public interest” without necessity of the citizens’ consent. In combination with Article 23, the Member states may restrict the lawful processing of data by legislative measure for protection of “public health”. The applications using Bluetooth exposure notification system (ENS) do not operate with personal data. Thus, these are in general out of scope GDPR and regulated by the Directive on privacy and electronic communications. Article 15 of the Directive allows processing of communication without citizens’ consent for the reasons listed in paragraph 1, which did not include “public health”, therefore the applications cannot be use without citizen's consent.

Conclusions
The use of applications with geolocation allows Member states to process personal data without guarantees in order to protect public health. This approach is unacceptable in relation to the right to privacy. If a situation like the covid pandemic occurs again, exclusively applications with ENS should be used. The use of these applications, even in times of pandemic, is conditioned by the citizens’ consent.

Key messages
Digital Health Literacy and Infodemic: the impact on Italian medical students between 2019-2020
Authors: Moretti V , Arnoldo L , Valdi G , Conte A , Masoni M , Guelfi MR , Anelli F , Brunelli L 
Published: October 2022

Abstract

Background
The COVID-19 infodemic is putting pressure on public health systems to control the pandemic. With the internet and social media playing a key role in emergency communication, digital health literacy (DHL) can be considered a determinant of health. This study aims to assess the impact of infodemic on the skills of medical students, for whom low levels of DHL may affect the ability to identify the best available medical evidence.

Methods
A cross-sectional web-based survey was conducted at the University of Florence (Italy) in Apr-May 2019 (pre-pandemic period) and in Nov-Dec 2020 (pandemic period) to investigate DHL skills. Two different cohorts of students, both in their first year of medical school, participated in the survey. The 8-item self-assessment tool (IT-eHEALS) with a 5-point Likert scale was used to examine DHL. The change in perception of ability between the two cohorts was examined using the Wilcoxon test.

Results
A total of 329 students participated in the survey in 2019 (F: 58.1%; mean age 20.6±2.1) and 341 in 2020 (F:61.9%; mean age 19.8±2.0). In 2019, participants’ DHL level was moderate with a IT-eHEALS overall mean score (MS) of 28.4±5.8. Students had a good idea of how to find helpful health information (MS 3.9±0.8) and how to use the web for this purpose (MS 3.8±0.9), but they were less confident about the usefulness of the information they received (MS 2.9±1.1). In 2020, the medical students’ DHL level deteriorated as the overall MS of IT-eHEALS decreased to 23.4±7.2 (p &lt; 0.01). The scores of the IT-eHEALS items were significantly lower and students indicated that they found it difficult to assess the information they found (MS 2.4±1.1; p &lt; 0.01).

Conclusions
DHL can contrast infodemic, but the latter in turn may have a negative impact on perceived DHL skills if personal knowledge base is not well structured. Training programmes for medical students as future health care providers should be reinforces to guide their practise.

Key messages
Burned area mapping using satellite data – a tool for monitoring effects on environment
Authors: Cara ML , Becheru A , Nicola L , Cara C , Prejbeanu IM 
Published: October 2022

Abstract

Background
Significant crop residue burning not only negatively affects local communities but is becoming an important public health issue for global climate change mitigation efforts. This practice is linked with air quality impairment, water contamination, soil degradation, fauna destruction. Chronic exposure to a high level of air pollution may cause permanent health injuries such as the development of lung diseases. The intentional burning of crop residues is a well-known practice across Romania even it is restricted by law.

Methods
We propose a generic software model capable of detecting burned areas based on a time series of multi-spectral optical images together with a multi-step algorithm that uses a pre-trained Gaussian Naive-Bayes classifier to map burned crop fields, named BCMA (Burned Crop Mapping Algorithm), using Copernicus Sentinel-2 acquisitions. BCMA can be trained and extended to recognize other user-defined burned areas and it can be used to produce burned crop fields maps at a global scale in near-real-time at high resolution. We focused on two restrained geographical areas where burned areas were signalized in local press as massive burning vegetation events.

Results
We provide burned area maps generated with an implementation of BCMA over two sites in Romania: Ostroveni - Dolj county and Domogled - Mehedinti county, based on acquisitions from July 2020.

Conclusions
This model provides a fast and reliable tool for detection of burned areas regardless of the landscape and vegetation that could help stakeholders to react and make a proper intervention. Our study highlights the meaningful implications of using this tool to track crop fields burning and to organize large scale awareness campaigns around sustainable crop residues management with positive impact on environment, human health, and agriculture. Further government agencies’ positions regarding using satellite monitoring of burning vegetables might be crucial.

Key messages
Trends of socioeconomic inequalities in overweight and obesity in children and adolescents in Germany
Authors: Hoebel J , Waldhauer J , Blume M , Schienkiewitz A 
Published: October 2022

Abstract

Background
Overweight and obesity in early life are risk factors for chronic health conditions in the later life course. Children and adolescents from socioeconomically disadvantaged families are more likely to be overweight or obese than their better-off peers. This study examined post-millennial trends of socioeconomic inequalities in the prevalence of overweight and obesity among young people in Germany.

Methods
Repeated cross-sectional data were used from the German health interview and examination survey for children and adolescents (KiGGS). Overweight and obesity were assessed by body mass index, based on measured height and weight of 3- to 17-year-old participants in KiGGS baseline (2003-06) and KiGGS wave 2 (2014-17). Socioeconomic position (SEP) was measured using a composite index of parental education, occupation and income. The regression-based slope index of inequality (SII) and relative index of inequality (RII) were calculated to estimate the extent of absolute and relative inequalities in the prevalence of overweight and obesity.

Results
The overall prevalence of overweight and obesity among 3- to 17-year-olds in Germany did not change over time and was recently 15.4% and 5.9%, respectively. In both survey waves, overweight and obesity were more prevalent in lower SEP-groups. From 2003-06 to 2014-17, overweight increased in the low-SES group, whereas it tended to decrease in those with higher SES. This trend was concomitant with increasing socioeconomic inequalities in overweight over the observation period (SII from 0.11 to 0.19, p = 0.054; RII from 2.1 to 3.7, p = 0.021). No such trend was found for obesity.

Conclusions
Socioeconomic inequalities in overweight have widened among the young in Germany since the early 2000s. Structural interventions that are effective in preventing and reducing overweight in young people from socially disadvantaged backgrounds are still needed.

Key messages
Area-level socioeconomic deprivation, non-national residency, and Covid-19 incidence
Authors: Rohleder S , Costa D , Bozorgmehr K 
Published: October 2022

Abstract

Introduction
Socioeconomic conditions affect the dynamics of the COVID-19 pandemic. We analysed the association between area-level socioeconomic deprivation, proportion of non-nationals, and Covid-19 incidence in Germany.

Methods
Using nationally representative data at the level of 401 German districts from three waves of infection (January-2020 to May-2021), we fitted Bayesian spatiotemporal models to assess the association between socioeconomic deprivation, proportion of non-nationals, and Covid-19 incidence, controlling for age, sex, vaccination coverage, settlement structure, spatial and temporal effects. We estimated risk ratios (RR) and corresponding 95% credible intervals (95%-CrI) for deprivation quintiles. We further examined the deprivation domains (education, income, occupation), interactions between deprivation, sex and the proportion of non-nationals, and explored potential pathways from deprivation to Covid-19 incidence.

Results
Covid-19 incidence risk was 15% higher (RR = 1.15, 95%-CrI=1.06-1.24) in areas with the highest deprivation quintile (Q5) compared to the least deprived areas (Q1). Medium-low (Q2), medium (Q3), and medium-high (Q4) deprived districts showed 5% (1.05, 0.98-1.13), 8% (1.08, 1.01-1.15), and 6% (1.00, 1.00-1.12) higher risk, respectively, compared to the least deprived. Districts with higher proportion of non-nationals showed higher risk compared to districts with lowest proportion, but the association weakened across the three waves. During the first wave, an inverse association was observed with highest risk in least deprived areas (Q1). Deprivation interacted with sex, but not credibly with the proportion of non-nationals.

Conclusions
Socioeconomic deprivation and proportion of non-nationals are independently associated with Covid-19 incidence. Regional planning of non-pharmaceutical interventions and vaccination strategies would benefit from consideration of area-level deprivation and non-national residency.

Key messages