bluuebunny/crossref_metadata_2025_split huggingface dataset:
Structural stigma and 7-year improvement in life satisfaction: A repeated cross-sectional study of sexual minority individuals across 28 countries
Authors: Bränström R , Pachankis J 
Published: October 2022

Abstract

Background
Structural stigma toward sexual minority individuals varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in country-level structural stigma over time, as has recently characterized many European countries, with such outcomes is largely unknown. The current study examined the association between change in structural stigma from 2012 to 2019 across European Union countries and change in life satisfaction among sexual minority individuals during the same period. Secondary analyses examined whether changes in structural stigma differentially benefitted some subgroups of sexual minority individuals more than others.

Methods
The current study analyzed data from sexual minority respondents (2012: n = 82,668; 2019: n = 96,576) living in 28 European countries.

Results
Adjusted multilevel models showed that life satisfaction had improved among sexual minority individuals in all countries between 2012 and 2019 (β = 0.32, 95% CI: 0.29, 0.35), but the improvement was stronger among those living in higher stigma countries compared to those living in lower stigma countries. Changes also varied by relationship status; the strongest improvement in life satisfaction as a function of improvement in structural stigma was found among sexual minority individuals in a relationship.

Conclusions
Although life satisfaction has increased during the past decade among sexual minority individuals living in Europe, significant variation in this change exists across countries as a function of country-level structural stigma and individual sociodemographic characteristics. The findings support the relevance of structural stigma for sexual minority individuals’ life satisfaction and call for further research to understand the differential impact of structural stigma across sexual minority subgroups.
Tobacco Use Prevention and Cessation Programme For Pregnant Women Accessing Antenatal Care In Urban Public Health Facilities In Southern India
Authors: Thomas S , Lee H 
Published: October 2022

Abstract

Backgrounds and problem
By 2030, tobacco use is estimated to kill more than 8 million people worldwide annually, with LMICs accounting for over 80% of those deaths. In India, about 4.6% of women continue to use tobacco mainly (&gt; 80%) in smokeless (SLT) form during pregnancy. This may lead to: higher risk of anemia (∼ 70%), hypertension, and postpartum hemorrhage; poor fetal development; and 2-3 times higher rate of low-birth and stillbirth babies.

Importance
Anti-tobacco initiatives often focus on smoking over SLT, which is commonly consumed by women. Drivers of SLT use among women include: cultural appropriateness, medicinal benefits, and poor social determinants of health. These factors must be taken into account while formulating effective anti-tobacco interventions for pregnant women, ensuring safe motherhood and neonatal health.

Solution
We propose integrating oral health interventions in mitigating tobacco use within the existing antenatal care (ANC) model. Women enrolled in public health facilities in an urban poor neighborhood in South India receive oral health education (OHE) integrated into ANC. The intervention promotes oral hygiene habits, dietary advices, improving dental healthcare utilization, and sensitization on the ill-effects of tobacco-use. Training for ANC providers focuses on delivering antenatal tobacco screening, cessation, and referral services. This includes expanding the medical history to record tobacco use, conduct oral examination and referrals to dentists and/or tobacco cessation centres. Final outcomes of OHE will be measured using pre and post KAP surveys informed by WHO Oral Health Surveys; and training programme using in-depth interviews among providers. Desired policy change is the inclusion of tobacco prevention and cessation programme in the Indian ANC guidelines.
Determinants of excess mortality during the COVID-19 pandemic in 18 countries of the CMOR consortium
Authors: Kneebone-Hopkins C , Artemiou A , Demetriou CA 
Published: October 2022

Abstract

Many countries suffered excess all-cause mortality during the COVID-19 pandemic. This study aims to identify factors associated with excess mortality rates (EMR) in partaking countries during 2020. Weekly all-cause death counts for 2015-2020 were extracted from national databases for Australia, Austria, Brazil, Cyprus, Denmark, Estonia, France, Georgia, Israel, Italy, Mauritius, Norway, Peru, Slovenia, Sweden, USA, Ukraine and UK. EMR per 100,000 population were gauged using a 5-year mean baseline. Separate OLS multiple linear regressions explored pre-pandemic country profiles including healthcare system, geographic, socio-economic and population factors. Feature selection methods detected the main factors contributing to 2020 EMR. The health system model showed that an extra nurse per 1,000 and a 1% increase in Healthcare Access and Quality Index reduces EMR by 41.7% (p = 0.019) and 0.48% (p = 0.034). The model was statistically significant (R^2=0.415,p=0.018). Although the geographical model suggested that a 1% increase in neighbouring countries increased EMR by 0.42% (p = 0.078), population density and the model itself were statistically insignificant (p &gt; 0.05). The socio-economic and population model indicated a 1% increase in service employed (% of employed) and investment (% GDP) was linked with a 43.4% (p = 0.01) and 43.7% (p = 0.01) fall in EMR. The model was significant (R^2=0.488, p = 0.007). Death registration quality and population share over 70 years, improved model performance (R^2=0.632), but neither approached nominal significance. EMR during the COVID-19 pandemic benefited from higher ratios of nurses to population and able and prompt healthcare. The geographic traits were trivial in explaining EMR variation. Higher ratios of service employed, and investment (% of GDP) were linked to lower EMR. These results help to inform policies now and in future pandemics to strengthen resilience against EMR.

Key messages
• This study identified which pre-pandemic factors affected EMR in partaking countries, adding to a growing body of work on the COVID-19 pandemic.
• Higher ratios of nurses to population, able and prompt healthcare, higher % employed, and investment (% of GDP) were linked to lower EMR.
Prevalence of cardio-metabolic multi-morbidity and associated risk factors in a population-based sample of South Africans
Authors: Kandala N-B , Sewpaul R , Mbewu AD , Fagbamigbe AF , Reddy SP 
Published: October 2022

Abstract

Objectives
Cardio-metabolic multi-morbidity (CM), the co-existence of two or more cardio-metabolic disorders in the same person, is rapidly increasing. We examined the prevalence and risk factors associated with CM in a population-based sample of South African adults.

Study design
Data were analyzed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES), a cross sectional population-based survey conducted in 2011-2012.

Methods
CM was defined as having ≥2 of hypertension, diabetes, stroke and angina. Multivariable logistic regression was used to investigate the sociodemographic and modifiable risk factors associated with CM.

Results
Of the 3832 individuals analyzed, the mean age was 40.8 years (S.D. 18.3), 64.5% were female and 18% were ≥60 years. The prevalence of CM was 10.5%. The most prevalent CM cluster was hypertension and diabetes (7.3%), followed by hypertension and angina (2.6%) and hypertension and stroke (1.9%). Of the individuals with diabetes, nearly three quarters had multi-morbidity from co-occurring hypertension, angina and/or stroke and of those with hypertension, 30% had co-occurring diabetes, angina and/or stroke. Age (30-44 years Adjusted Odds Ratio (AOR) = 2.68, 95% CI: 1.15-6.26), 45-59 years AOR = 16.32 (7.38-36.06), 60-74 years AOR = 40.14 (17.86-90.19), and ≥75 years AOR = 49.54 (19.25-127.50) compared with 15-29 years); Indian ethnicity (AOR = 2.58 (1.1-6.04) compared with black African ethnicity), overweight (AOR = 2.73 (1.84-4.07)) and obesity (AOR = 4.20 (2.75-6.40)) compared with normal or underweight) were associated with increased odds of CM.

Conclusions
A tenth of South Africans have two or more cardio-metabolic conditions. The findings call for immediate prioritization of prevention, screening and management of cardio-metabolic conditions and their risk factors to avert large scale health care costs and adverse health outcomes associated with multi-morbidity.
Metabolic syndrome as predictor of work exit type: A longitudinal study among 55,817 Dutch workers
Authors: Runge K , van Zon SKR , Henkens K , Bültmann U 
Published: October 2022

Abstract

Background
Chronic diseases like cardiovascular disease or type two diabetes mellitus are related to work exit types such as unemployment and work disability. It is unknown whether metabolic syndrome as a risk factor preceding these chronic diseases is related to work exit type. Metabolic syndrome is present when people have at least three out of the following five risk factors: hypertension, abdominal obesity, raised triglycerides, raised blood glucose, and reduced HDL-cholesterol. We examined the association of metabolic syndrome with work exit type while controlling for socio-demographic and occupational factors.

Methods
The sample included 55,817 Dutch workers aged 40-65 years from the Lifelines Cohort Study and Biobank. We used data from five measurement waves with a mean follow-up time of 4.1 years. Metabolic syndrome was measured at baseline and based on physical examinations, blood markers, and medication use. Follow-up work exit types were self-reported and included unemployment, work disability, early and regular retirement. Competing risk regression analysis was used.
Preliminary

Results
Metabolic syndrome increased the risk of work disability (adjusted SHR: 1.69, 95% CI: 1.42, 2.02) and unemployment (adjusted SHR: 1.11, 95% CI: 1.01, 1.22), and was not associated with early and regular retirement.

Conclusions
Metabolic syndrome increases the risk of work disability and unemployment. More awareness about and prevention of metabolic syndrome is needed among general practitioners and occupational physicians. Early detection of metabolic syndrome as a risk factor preceding chronic diseases might prevent premature work exit in middle- and late-career.

Key messages
• Metabolic syndrome increases the risk of work disability and unemployment among middle-aged and older workers.
• More metabolic syndrome awareness and prevention might help to extend healthy working years.
HL-Kids-NRW – Study of fourth-graders’ health literacy
Authors: Bollweg T , Okan O 
Published: October 2022

Abstract

Background
Although children are identified as a key target group for interventions targeting the development of health literacy, little data is available on children's health literacy and how it is related to health outcomes at a young age. This study addresses this research gap by providing data on fourth-graders’ health literacy and associated health outcomes.

Methods
A cross-sectional study was conducted among fourth-grade students in the state of North-Rhine Westphalia, Germany. The study was designed as a representative survey starting in 12/2020, which could, however, not be realized due to pandemic-related constraints. Data collected between 07/20 and 11/20 is included in the analyses presented here. Among others, we assessed self-reported health literacy with the HLS-Child-Q15 questionnaire, while also assessing various self-reported health outcomes.

Results
n = 364 students are included in the analysis, 49,5% of which are female. The mean age is 9.5 years (SD=.7). The HLS-Child-Q15 demonstrated high internal consistency (Cronbach's α=.812). Self-reported health literacy is high, with a HLS-Child-Q15 mean score of 3.13, indicating that it is rather easy for participants to deal with health-related information. Health literacy is significantly associated with a number of outcomes related to health status (KINDL-R subscales physical wellbeing and mental wellbeing, Spearman's ρ = .280 and ρ = .271, respectively; p &lt; .001) and health behaviour (freq. of brushing teeth: ρ = .173; p &lt; .01; freq. of eating fruit and vegetable: ρ = .217 and ρ = .299; p &lt; .001; freq. of physical activity: ρ = .279; p &lt; .001).

Conclusions
While the overall level of health literacy in our sample is high, higher health literacy is associated with better health behaviours, as well as improved mental and physical wellbeing. Further analyses are necessary to explore the causal pathways between the investigated variables, and representative survey are needed to verify these findings.
5.M. Workshop: The need to account for vaccine-specificities in the implementation of the EU Regulation on HTA
Authors:   Organised by: EUPHA-HTA, Vaccines Europe, HTAi,   Chair persons: Chiara de Waure (EUPHA-HTA), Elena Petelos (EUPHA-HTA)
Published: October 2022

Abstract

In January 2022, the EU Regulation on Health Technology Assessment (HTAR) entered into force. The HTAR provides for the centralized conduct of EU-wide joint clinical assessment (JCA) for oncology treatments (2025 onwards), and for other medicinal products incl. vaccines (2030 onwards). HTA is a multidisciplinary process aiming to disentangle the value of a health technology in comparison to other. It has been used, to different extent across EU countries, to inform vaccine price and reimbursement decisions. Nevertheless, existing assessment frameworks utilized by HTA bodies, incl. National Immunization Technical Advisory Groups (NITAGs), as well as the relative effectiveness assessment (REA) framework developed by the European Network for Health Technology Assessment (EUnetHTA), do not fully account for the specificities of vaccines. In fact, to account for the broad value of vaccines several aspects ought to be considered, including societal benefits. Attention has been paid to these topics for years by the public health community, and in particular EUPHA-HTA, and also Vaccines Europe, a specialized vaccines group within the European Federation of Pharmaceutical Industries and Associations (EFPIA), has recently released a position statement on the need to tackle vaccine specificities in future JCA. Furthermore, as the COVID-19 pandemic has highlighted, such aspects are critical for joint procurement efforts to combat the current and future pandemics. The objective of this workshop is to address the current and future role of HTA in vaccine regulation across EU countries, inform on key specificities of vaccines in respect to JCA and HTA as a whole and discuss opportunities to develop vaccine-specific methodological guidelines within the HTAR. Following an introduction, the following topics will be addressed:
• Competent bodies and HTA impact on vaccine decision-making process, incl. a discussion of implementation challenges and potential impacts of the HTAR.
• JCA specificities in respect to vaccines and the importance of addressing the whole value of vaccines and vaccinations.
• The proposal of Vaccines Europe for guiding principles to account for vaccines specificities in JCA built on the outcomes of an ‘across-the-industry’ project incl. also non-industry experts.
The presentations will be followed by a panel discussion to further explore the themes, consider next steps and address questions from the audience.

Key messages
• The new EU HTAR is paving the way for JCAs of several medicinal products, incl. vaccines necessitating expert guidance in terms of determining their whole value.
• Vaccines specificities should be duly considered in JCAs to inform national and EU-wide decision-making for vaccination programmes, reimbursement, and pricing.
Do EU countries comply with the right to healthcare under the UN Convention on the Rights of the Child?
Authors: Hernandez Quevedo C , Scarpetti G , van Ginneken E 
Published: October 2022

Abstract
Children's health status varies within and between European countries. To what extent this is associated with access barriers to timely and effective care children may face is not yet fully understood. Article 24 of the UN Convention on the Rights of the Child (UNCRC) guarantees a fundamental right to healthcare for all children, regardless of their legal status in terms of citizenship, residence, or insurance. Using information contained in the Health Systems in Transition reports produced by the European Observatory on Health Systems and Policies, additional relevant literature, and responses to a structured questionnaire filled out by key informants from all 27 EU MS and the United Kingdom, we evaluated whether European countries comply with the specific obligations that can be drawn from the UNCRC. While all countries considered have ratified the UNCRC, only four countries have included a specific disposition in their legislation that establishes an unconditional, universal right to health services for all children living in their territory. In other countries, the fragmented way of defining children's access rights can create gaps in legislation which can leave certain groups of children without coverage. Children with irregular residence are the most vulnerable group when it comes to eligibility problems, but other groups of children may also fall between the cracks or be only entitled to restrict-ed or conditional access to health care. These insights show that international treaties, such as the UNCRC, can help monitor health coverage and ensure that basic human rights to health services are guaranteed in times of crisis, such as the Covid-19 pandemic and the Ukraine Displacement, but may be insufficient without concrete transposition into national legislative frameworks.
What can we learn from the effects of the COVID-19 pandemic on hospital care for children in Germany?
Authors: Mauer N , Tille F , Nimptsch U , Panteli D 
Published: October 2022

Abstract
The COVID-19 pandemic created substantial disruptions in the delivery of health services around the world. Reductions in hospital admissions have been reported for several conditions in the adult population; less evidence currently exists for children. To what extent such changes reflect a risk for patients due to unmet care needs, or a “correction” of previous overprovision of care has not been thoroughly examined yet. Based on complete national hospital discharge data, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020 and 2021 in Germany. We also analyse the development of monthly admissions between January 2019 and December 2021 for three tracers of variable urgency and severity. Total admissions were approximately 20% lower in 2020 and 2021 compared to 2019. The composition of the most frequent diagnoses did not change dramatically across years, although changes in rank were observed. The number of admissions for acute lymphoblastic leukaemia (tracer 1) showed a slight increasing trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions (tracer 2) decreased by about 9% in 2020 and a further 8% in 2021, while tonsillectomies/adenoidectomies (tracer 3) decreased by more than 40% in 2020 and a further 30% in 2021; for these tracers, monthly changes are in line with pandemic waves. Observed variations in child hospitalisations reflect the effects of pandemic mitigation measures and/or changes in demand. In Germany, inpatient care for critical conditions appears to have been largely upheld, potentially at the expense of elective treatments. Complementary data on ambulatory care and health outcomes would enable a better understanding of change in healthcare patterns and effects on children's health.
Obesity, body weight stigma and biomedical oversimplification: moving beyond BMI
Authors: Stranges S 
Published: October 2022

Abstract
Body Mass Index (BMI) is one of the most important factors considered to analyse health status. High BMI scores are usually associated with physical or mental disorders, such as cardiovascular disease, diabetes, inflammation, dyslipidemia and depression. However, obesity is usually characterised by the presence of various comorbidities that should be addressed as part of a unique, more complicated picture. Emerging evidence suggests that a deeper acknowledgment of the complexity of obesity as disease, including its comorbidities, should take place in the near future. Overweight, obesity and related disorders have been associated with direct healthcare-related costs and the indirect costs of productivity loss, mostly due to the presence of comorbidities rather than to body weight in general. The belief that weight loss is the best recommendation for people with high BMI as the only path to health could be questioned. In fact, it would seem that weight loss in some subjects does not necessarily coincide with any health improvement. Thus, the relationship between weight status and health expenditure is complex with particular reference to the fact that costs of disease are higher in high-comorbid profiles independently of weight status. Over the last years, researchers have also studied some conditions, such as metabolically healthy overweight and obesity. Recent studies deal with alternatives to conventional weight-loss approaches that could be more effective in health terms. Conventional methods of weight loss are based on calorie restriction and increased energy expenditure instead of unconventional methods, such as the weight-neutral program, which is based on the crucial concept of “mindfulness” to underline the importance of intuitive eating, self-care, pleasurable exercise and size-acceptance. The health benefits related to such types of approaches include physical, psychological and behavioural improvements.
EHDS2 pilot infrastructure for the secondary use of health data
Authors: Bacry E , Jendrossek M 
Published: October 2022

Abstract
The EHDS2 Pilot consortium brings together 16 European partners (national platforms, research infrastructures, EU agencies and associations in the area of health) to respond to the EC's call for projects to set up a test version of the future European Health Data Space (EHDS) for the secondary use of health data (EHDS2). It aims to build this pilot version of EHDS2 by interconnecting data platforms in a network of nodes, implementing and testing a first user journey for creating, deploying and running health data research projects at EU level. The network will investigate the technical tools and set up the standards allowing researchers to query the metadata of all nodes, to request selected data via a single application form and to analyze data across national nodes. To build this network, the EHDS2 Pilot will propose legal and technical frameworks based on use cases selected by the EC. These will also serve to illustrate the powerful impact of exploiting health data from several countries and address topics from population health to healthcare pathways, cancer, rare diseases and genomics. This presentation will give an overview of the planned activities by the coordinating team.