bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-admission after early discharge from involuntary hospitalization of psychiatric patients
Authors: Mor Z , Shachar C , Shai U , Sheffer R 
Published: October 2022

Abstract

Background
State psychiatrics in Public Health Departments in Israel can involuntary hospitalize patients (IHP) in psychotic status. IHP who are unsatisfied with the involuntary hospitalization can appeal to a Psychiatric Committee (PC) in the institution to ask to shorten their hospitalization. The PC can decide to discharge the patient to ambulatory treatment. This cohort study aimed to assess re-admission of IHP among patients who shortened their involuntary hospitalization in Tel-Aviv.

Methods
IHP whose involuntary hospitalization was shortened by PC (research arm) were compared to IHP patients who completed the entire hospitalization length, as was initially recommended by the psychiatrist (control arm). Re-admission was defined as hospitalization within one year after release by the PC/end of hospitalization.

Results
From 3,160 IHR between 2010 and 2015, 1,338 were re-hospitalized during a year after release, 317 (41.7%) from the research arm and 1,012 (42.6%) from the control arm, p &lt; 0.7. Discharge of IHP by PC during first month of the involuntary hospitalization resulted in a higher re-admission rates than IHR from the control group (58.4% vs. 46.4%, respectively, p &lt; 0.001). Yet, discharge of IHR by the PC after one month of hospitalization (or end of the hospitalization) resulted in lower re-admission rates (14.8% vs. 53.6%, respectively, p &lt; 0.001). Risks factors for re-admission included male gender, Israeli born, single and diagnosis of schizophrenia.

Conclusions
Re-admission rates were higher in IHR who were released by the PC during the first month of hospitalization. The first month is important for mental and therapeutic stabilization of IHP. After 30 days, release of IHP can be re-assessed according to the patients’ situation. Early discharge of males who were diagnosed with schizophrenia should be carefully assessed.

Key messages
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
Educational inequalities in major depressive disorder over the adult life course: a microsimulation
Authors: Lepe A , Hoveling LA , Boissonneault M , de Beer JAA , Reijneveld SA , de Kroon MLA , Liefbroer AC 
Published: October 2022

Abstract

Background
Educational inequalities in major depressive disorder (MDD) pose a major challenge. Tackling this issue requires evidence on the long-term impact of intervening on modifiable factors, e.g. behavioural and psychosocial factors. Therefore, we aim to simulate the development of educational inequalities in MDD across the life course, and to assess the impact of intervening on the modifiable factors that contribute to these inequalities.

Methods
We used data from the prospective Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation allowed us to estimate the development of educational inequalities in MDD with a synthetic cohort of 500,000 individuals followed from ages 18 to 65, and to assess the potential benefit of intervening on quality of social contacts, health literacy, and smoking.

Results
On average, an additional 19.1% of individuals with low education will ever experience MDD between ages 18 and 65 compared to those with high education (32.0% vs 12.9%, respectively). Additionally, individuals with low education generally will develop MDD 0.9 years earlier (35.6 years vs 36.5 years, respectively) and spend 1.2 years more with MDD (6.2 years vs 5 years, respectively), than individuals with high education. Improving the quality of social contacts in individuals with low education would have the largest impact; it would reduce the inequalities in the prevalence, onset, and duration of MDD by an average of 18.4%, 18.3%, and 28.6%, respectively.

Conclusions
Intervening on modifiable factors, especially quality of social contacts, in individuals with low education could help reduce the large estimated educational inequalities in MDD over the life course.

Key messages
• There are large educational inequalities in major depressive disorder (MDD) over the life course, especially with regard to the life course prevalence of MDD.
• Improving quality of social contacts, and to a lesser extent health literacy and smoking behaviours, amongst individuals with low education may help reduce the inequalities in MDD.
Methods of policy monitoring in physical activity promotion: a systematic review across different levels of government
Authors: Messing S , Tcymbal A , Abu-Omar K , Richardson D , Gelius P 
Published: October 2022

Abstract

Background
Even though the importance of policy monitoring in public health has increased in the last decades, there is still a lack of understanding what different approaches of policy monitoring exist and which methodology they employ. In order to address this research gap, this review attempts to provide a comprehensive overview about the methods of policy monitoring in the field of physical activity promotion.

Methods
A systematic search was conducted in five scientific databases, using the terms “physical activity”, “policy” and “monitoring” and their variations. In total, 12.963 studies were identified and, after the elimination of duplicates, screened independently by two reviewers. During full text analysis, information on the methods applied for policy monitoring was extracted and studies were categorized based on their key characteristics (monitoring tool, policy level, and setting).

Results
The search yielded in a total of 112 studies that were structured into seven categories: Report Cards on Physical Activity for Children and Youth, HEPA Monitoring Framework, HEPA Policy Audit Tool, national policies, subnational policies, school setting, and childcare setting. Across all categories, policy monitoring focused mainly on national level policies in a single country. Differences were identified with regards to the level of government involvement which allowed to differentiate between research-driven approaches (little or no government involvement), government-driven approaches (led by governments), and co-production approaches (strong collaboration between researchers and governments).

Conclusions
Research-driven, government-driven and co-production approaches have different strengths and weaknesses with regards to the monitoring of policies. Awareness needs to be raised regarding the implications of these approaches, and more research is needed to analyse the impact of policy monitoring on policy-making in public health.
Monitoring COVID-19 related changes in population mental health
Authors: Rodríguez-Blázquez C , Aldridge S , Bernal-Delgado E , Dolanski-Aghamanoukjan L , Estupiñán-Romero F , Garriga C , Gissler M , Lyons RA , Sagerschnig S , Tolonen H 
Published: October 2022

Abstract

Background
The COVID-19 pandemic, and its consequences in terms of control measures and restrictions to normal life, has affected the population mental health. One of the four case studies from the Population Health Information Research Infrastructure (PHIRI) for COVID-19 is focused on mental health with the objective to measure changes in incidence of mental health problems associated with the COVID-19 pandemic in several European countries.

Methods
Using electronic health records (EHR), data on new episodes of depression or anxiety, prescription of antidepressants and anxiolytics, and visits to primary care, specialized care or emergency units with an episode of depression/anxiety, were collected by participant data hubs at national/regional level for the period 2017-2021. A common data model to collect the data was defined for all participating data hubs and analysis of status prior and during the COVID-19 pandemic was performed using R.

Results
Data hubs from Austria, Finland, Spain (Aragon), and United Kingdom (Wales) were able to provide aggregated results from raw individual-level data. Preliminary analysis of trends suggests a decrease in new cases of depression and anxiety in the pandemic period (2020-2021) in comparison with previous years. Different trends were observed between data hubs regarding prescription of drugs and the number of primary/specialized care visits due to depression or anxiety. Issues in the access to data in some of the participating data hubs were observed, related to ethical and legal matters, and the lack of centralized registers and of private consultations statistics.

Conclusions
The results of this use case show that EHR for the secondary use can be retrieved in a common way across Europe to analyse and compare the impact of COVID-19 in population mental health in European countries. However, the process is more complicated and time consuming than expected.
Spread of SARS-CoV-2 at school through the pandemic waves: a population-based cohort study in Italy
Authors: Fonzo M , Pistellato I , Calzavara A , Sorrentino P , Selle V , Sbrogiò LG , Bertoncello C 
Published: October 2022

Abstract

Background
To limit SARS-CoV-2 transmission, proactive closure of schools is often believed by policy-makers and public an effective strategy. While evidence on the role of students in the spread is ongoing, effects of closure on children's well-being are well known. The number of secondary cases per class has been considered one of main driving criteria to mandate for distance learning. We aimed to calculate the rate of secondary infections per classroom and to identify factors associated with the development of school clusters.

Methods
We conducted a population-based cohort study between October 2020 and November 2021 in the province of Venice, Italy, a catchment area of 600,000 inhabitants. Primary, middle and high-schools were included.

Results
We identified 1,623 primary cases of SARS-CoV-2 infection in students. Of these, 72.5% did not lead to any secondary case in the school setting, 15.6% to 1, and 11.9% to 2+ contagions. The so-called second wave (Oct-Dec 2020) was associated with a lower occurrence of 2+ contagions (AOR=0.37; 95%CI: 0.24-0.56) than the fourth (Sep-Nov 2021). Both primary (AOR=1.74; 95%CI: 1.16-2.63) and middle schools (AOR=1.76 95%CI: 1,14-2,72) showed higher odds than high schools for cluster generation of 2+ cases. The involvement of 2+ secondary cases was lesser associated with the index case being a student rather than school staff (AOR=0.42; 95%CI: 0.29-0.60). The number of 2+ cases clusters per week followed a time trend in line with the general population incidence.

Conclusions
The school environment does not facilitate viral spread, but rather reflects transmission in the community. Appropriate measures (use of airway protection devices, interpersonal distancing, frequent hand and respiratory hygiene) and timely case tracking make school a safe place. Given the documented negative effects of school closures on children's learning and well-being, maintaining school attendance is as essential as it is desirable.

Key messages
• A SARS-CoV-2 positive student at school does not generate secondary infections in 3 out of 4 cases. The risk of cluster generation is lower when the index case is a student rather than school staff.
• The school environment does not facilitate viral spread, but rather reflects transmission in the community. School attendance is essential considering the effects on children’s learning and wellbeing.
5.D. Workshop: Challenges and opportunities for health systems in the era of multi-morbidity
Authors:   Organised by: Western University (Canada),   Chair persons: Saverio Stranges (EUPHA-CHR), Arnaud Chiolero (Switzerland)
Published: October 2022

Abstract

Multimorbidity, defined as the co-existence of two or more chronic conditions in the same individual, is affecting increasing segments of the population across both high-income and low-resource settings. The workshop will provide a comprehensive and global perspective on the clinical and public health burden of multimorbidity from a health system perspective, including presentations and speakers from Europe, Africa and North America. Current research and policy initiatives are still primarily focused on the clinical management of multimorbidity after it occurs as well as on the prevention of adverse events in those individuals who are already living with multimorbidity. There is still a significant need to develop and establish effective and equitable primary prevention strategies in order to avoid the occurrence of multimorbidity across populations. Also, health systems around the world will need to implement context-specific initiatives and changes to tackle the growing burden of multimorbidity in ageing populations, which will be constrained by available resources, societal and political priorities and values. Any potential health system transformations will need to reconcile the concomitant burden imposed by multimorbidity and other major public health priorities, including the current pandemic, the health impact of climate change and widening health disparities across marginalized populations.

Key messages
• There is a significant need to develop effective and equitable primary prevention strategies in order to avoid the occurrence of multimorbidity.
• Health systems around the world will need to implement context-specific initiatives and changes, which will be constrained by available resources, societal and political priorities and values.
Association between functional limitation and quality of life among older adults with multimorbidity in Luxembourg
Authors: Wilk P , Ruiz-Castell M , Bohn T , Fagherazzi G , Nicholson K , Moran V , Makovski TT , Pi Alperin MN , Stranges S , Samouda H 
Published: October 2022

Abstract

Introduction
Multimorbidity, defined as the co-existence of two or more chronic conditions, is affecting an increasing number of Europeans, leading to poorer quality of life (QoL). This study assessed how functional limitation affects the QoL trajectories in a cohort of older individuals having multimorbidity, and whether there are any gender differences in these effects.

Methods
We used a longitudinal cohort of 906 multimorbid respondents 50 years of age or older from Luxembourg who participated in four waves of the Survey of Health, Ageing, and Retirement in Europe (2013-2020). We used the Control, Autonomy, Self-Realization, and Pleasure scale (CASP-12) to assess QoL and the Global Activity Limitation Indicator (GALI) to measure functional limitation. Multigroup latent growth curve (LGC) modeling techniques were employed to assess how the measures of functional limitation over time are related to QoL trajectories and whether or not these effects are different by sex.

Results
In 2013, over 60% of older residents of Luxembourg were affected by multimorbidity. The results from the LGC models suggest that both men and women with multimorbidity experienced a statistically significant decline in QoL between 2013 and 2020 at a constant rate; there were no significant differences in the rate of this change between men and women. The level of QoL at baseline and over time was significantly lower for individuals reporting functional limitation. However, functional limitation had no significant impact on the rate of decline in QoL for both men and women.

Discussion and conclusions
As an increasing number of individuals in Europe are becoming vulnerable to more years lived with multiple chronic conditions, there is a growing need to identify factors that may lead to improvements in QoL among people affected by multimorbidity. Gaining more knowledge on the role of functional limitation may be particularly important for planning comprehensive care for patients with multimorbidity.
Factors associated with the perception that eHealth facilitates access to healthcare
Authors: Kainiemi E , Virtanen L , Saukkonen P , Vehko T , Aalto AM , Kaihlanen AM 
Published: October 2022

Abstract

Background
The provision of eHealth has increased in the COVID-19 era with the aim of improving access to care without the risk of infection. Perceiving eHealth beneficial may affect the use. This study examined which patient-related factors are associated with the perception that eHealth facilitates access to care.

Methods
A nationwide survey was sent to 61,600 Finnish residents during the COVID-19 pandemic (September 2020-February 2021). Binary logistic regression analysis was used to examine whether the service needs (self-rated health, met service needs, challenges accessing traditional care) and eHealth experience (e-visits, need for guidance, data security concerns) were associated with perceiving that eHealth facilitates access to care. The model was adjusted for age, gender and education.

Results
The study included 21,409 respondents who had used healthcare services in the past 12 months (55.0% female, mean age 52.88, SE .18). The majority (63.8%) agreed with the benefit that eHealth facilitates access to care. Patients in good health (OR 1.24, 95% CI 1.13-1.37), whose service needs were met (OR 1.34, 95% CI 1.19-1.52) and who had no challenges in accessing traditional care (OR 1.18, 95% CI 1.02-1.36) had greater odds of perceiving the benefit compared to their counterparts. Patients with experience of e-visits (OR 2.60, 95% CI 2.28-2.96) and without need for guidance (OR 1.71, 95% CI 1.52-1.91) had greater odds of perceiving the benefit compared to their counterparts.

Conclusions
Patients in good health, with met service needs and with easy access to traditional care appear to perceive eHealth more beneficial than their counterparts, which might exacerbate the already existing inequalities in healthcare access and health outcomes. Promotion of eHealth skills might increase equitable opportunities to benefit from eHealth for those patients whose service needs could be met without traditional face-to-face encounter.

Key messages
• Patients in good health, with met service needs and without difficulties accessing traditional healthcare appear to find eHealth more beneficial than their underprivileged counterparts.
• Promotion of eHealth skills might increase equitable opportunities to benefit from eHealth for those patients whose service needs could be met without traditional face-to-face encounter.
Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19
Authors: Alboksmaty A , Beaney T , Elkin S , Clarke J , Darzi A , Aylin P , Neves AL 
Published: October 2022

Abstract

Context
A surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration.

Description of the problem
We need an indicator to enable remote monitoring of COVID patients at home that can be measured by a handy tool; pulse oximetry which measures peripheral blood oxygen saturation (SpO2). Evidence shows that SpO2 is a reliable indicator of deterioration among COVID patients. The UK initiated a national programme (COVID Oximetry @ Home (CO@H)) to assess the theory. The concept can be potentially applied in other countries in various settings. As part of CO@H, we conducted a systematic review of the evidence on the safety and effectiveness of pulse oximetry in remote monitoring of COVID patients.

Results
Our review confirms the safety and potential effectiveness of pulse oximetry in remote home monitoring among COVID patients. We identified 13 research projects involving 2,908 participants that assessed the proposed strategy. Evidence shows the need to monitor at-rest and post-exertional SpO2. At-rest SpO2 of ≤ 92% or a decrease of 5% or more in post-exertional SpO2 should indicate care escalation. The recommended method for measuring at-rest SpO2 is after 5-10 min of rest, and assessing post-exertional SpO2 is after conducting a 1-min sit-to-stand test. We could not find explicit evidence on the impact on health service use compared with other models of care.

Lessons
Remote monitoring of COVID patients could alleviate the pressure on health systems and save hospital resources. Monitoring SpO2 by pulse oximetry can be widely applied, including in resource-limited settings, as the tool is affordable, reliable, and easy to use.

Key messages
• Adopting relevant health technologies in remote patient monitoring is critical to combat the pandemic.
• Pulse oximetry is an affordable, easy to use and widely available tool to monitor patients with COVID-19 at home.
The characteristics of women not-attending screening and their barriers to attendance in Czechia
Authors: Altová A , Lustigová M , Kulhánová I 
Published: October 2022

Abstract

Background
Cervical screening is one of the most important tools to reduce the incidence and mortality of cervical cancer, but uptake is still insufficient in many European countries with implemented population screening programs. In this study, we analyze the sociodemographic characteristics of women who do not attend cervical screening and describe the barriers that these women may have to attend cervical screening using Czechia as an example.

Methods
In the representative sample of 902 Czech women, we first employed binary logistic regression to identify groups of women that have higher chances of being non-attendees. Second, we described the reasons non-attendees declared as barriers to attendance. Third, we analyzed whether there were differences in women's characteristics according to the declared barriers.

Results
In the study sample, 36.7% of the women were considered non-attendees. Women with lower education (primary compared to university education, OR = 2.2, 95%CI 1.2-3.9) single women (compared to married/partnered, OR = 3.6, 95%CI 2.0-5.1), or older women, had a higher chance of not attending the screening. The most frequently declared reasons for not attending were ‘not experiencing any symptoms’ (36.3%), ‘fear of cancer diagnosis’ (23.0%), and ‘fear of the examination procedure’ (20.2%). In most of these barriers, women declaring these reasons did not differ from the other non-attendees.

Conclusions
Identifying sociodemographic determinants of cervical screening non-attendance and the barriers women have to attend are crucial for improving cervical cancer prevention. Based on this knowledge, public health policies should minimize screening hesitancy by targeting psychological factors and improving screening literacy among women. Although this research is a case study for Czechia, we believe that the results may be applicable in other countries.

Key messages
• Cervical screening promotion should be targeted on women at higher risk of non-attendance.Those are women with lover education, single women or older women.
• Understanding the specific barriers to cervical screenin attendance could help develop strategies to improve the communication of prevention.