bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender bias in cardiovascular practice guidelines: the example of ischemic heart diseases
Authors: Bastian K , Rohmann JL , Piccininni M , Kelly Irving M , Bajos N 
Published: October 2022

Abstract

Background
Despite declines in cardiovascular disease mortality, evidence suggests women have a higher mortality and worse prognosis after ischemic events compared with men. This work investigates to what extent clinical recommendations made by cardiovascular guidelines might include sex and gender biases.

Methods
We reviewed the primary literature base underlying the 2019 European Society of Cardiology guidelines’ recommendations on chronic coronary syndromes focusing on sex and gender sensitivity aspects pertaining to ischemic heart diseases. We applied an adapted Cochrane Collaboration appraisal checklist and only included recommendations with direct citation to literature evidence. We used beta regression to model the association between the proportion of female participants within the study population and the year of publication (modeled as cubic polynomial), impact factor, and sex of the first/last author.

Results
In the 20 recommendations that quoted the literature, gender-sensitive propositions were fully absent, while 4 included sex-sensitive statements. Sex- or gender- specific study design or a priori statistical considerations were largely absent in the included publications. The term “gender” was used exclusively to denote biological sex. The included studies published between 1991 and 2019 comprised of more than 2.1 million individuals (29% female). Representation of women as study participants undulated over time. Female sex of first (OR = 1.84, 95%CI= 1.30-2.60) or last (OR = 2.27, 95%CI=1.31-3.92) author were statistically significantly associated with the probability of having more female study participants.

Conclusions
Methodological sex- and gender-sensitive considerations are largely missing in the evidence base used to guide cardiovascular care decision-making in Europe. Women remain underrepresented in the studies from which the guidelines are derived. Studies with female first or last authors were more likely to have better representation of women.

Key messages
• Though differences in morbidity are well-described, current European cardiovascular recommendations lack sex and gender sensitivity, and women remain underrepresented in the underlying evidence base.
• To what extent the clinical cardiovascular recommendations may or may not be valid for groups not well-represented in the underlying evidence base remains unknown.
Characterizing population-based health care needs at the departement level in France
Authors: Rodts U , Ngo T , Ros E , Millet L , Malâtre-Lansac A 
Published: October 2022

Abstract
Aligning health care spending with population needs is a goal shared by many public health and health care systems. However, most modelling approaches have proven deceptive and ineffective. We propose a novel data-driven, population-based approach to help policymakers explore the discrepancies between spending and needs in France. We leveraged several national open data sources covering demographics, social deprivation, epidemiology, environment, health-related behaviors, and all-payer health care spending (hospital inpatient, prescription medicines, ambulatory events, and dental care). We classified the French “departements” (hereafter counties) into clusters that are homogeneous in terms of health care needs, based on a multidimensional framework. Then, we calculated all-payer per capita health care spending to analyze its within- and between-cluster variation. Based on these findings, we designed a web-based, interactive mapping tool dedicated to French policymakers and payers. The analysis shows 7 clusters of French counties differing in terms of health care needs and spending. The higher-needs/lower-spending and lower-needs/higher spending clusters suggest considerable room for improvement through a regional distribution of spending at least partially based on needs. Most interestingly, the data we used is publicly available, but policymakers lack expertise and time to undergo such analyses themselves. We plan to develop a dynamic and more granular version of the tool to allow policymakers to accurately design and evaluate health care policies.
An update on national recommendations for the use of the adjuvanted recombinant zoster vaccine
Authors: Parikh R , Widenmaier R , Weller R , Lecrenier N 
Published: October 2022

Abstract

Background
The adjuvanted recombinant zoster vaccine (RZV), first approved in 2017, has high, long-lasting efficacy against herpes zoster (HZ) and a clinically acceptable safety profile. In addition to the prevention of HZ in adults aged ≥50 years, the non-live RZV can be used from age 18 years in individuals with immunocompromised (IC) conditions. We reviewed the evolving landscape of national recommendations for RZV use.

Methods
National health authority and vaccination committee websites of countries where RZV is approved were searched in March 2022.

Results
Of 41 countries where RZV is licensed, 14 (Australia, Austria, Canada, Czech Republic, Germany, Ireland, Italy, Netherlands, New Zealand, Saudi Arabia, Spain, Switzerland, UK, US) provide national recommendations related to RZV; the majority are preferential to RZV or only recommend RZV. Overall, seven and seven countries recommend immunisation from age 50 years or 60/65 years, respectively. Of the seven countries that recommend immunisation from age 60/65 years, five recommend immunisation in individuals from age 50 years with comorbidities/IC conditions. Five countries recommend immunisation from age 18/19 years in individuals at increased risk of HZ due to immunosuppressive disease/treatment. In addition, six national recommendations refer to RZV safety and nine address prior HZ vaccination and/or infection. All recommendations outlined the RZV administration schedule.

Conclusions
Although national recommendations can inform decision making in clinical practice, RZV recommendations are not available in all licensed countries. The recommendations highlight a trend in favour of the use of RZV for the prevention of HZ in older individuals and those with IC conditions.
Main messages: An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals and those with IC conditions.

Key messages
• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals.
• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in IC conditions.
HPV self-sampling as an additional option in cervical cancer screening: a pilot study in Estonia
Authors: Hallik R , Innos K , Jänes J , Veerus P 
Published: October 2022

Abstract

Background
Cervical cancer incidence and mortality rates remain high in Estonia and participation in organized cervical cancer screening program is low. The aim of this pilot study was to estimate the impact of offering an HPV self-sampling option on screening uptake.

Methods
A randomized intervention study was conducted within Estonian organized cervical cancer screening program in 2021. Among target group women who had not participated in screening by August 2021, 26,000 women were randomly selected and allocated to two equally sized intervention arms offering a choice between attending a clinic or taking a self-sample. The opt-out group received a Qvintip sampler by regular mail to home address, the opt-in group received by e-mail a link to order the sampler from a web-site. A control group of 32,000 women received the usual reminder to attend screening at a clinic. Participation rates were calculated and data on user experience were collected with a questionnaire.

Results
Significant difference in participation rates was observed between opt-out (41%) (among them 20% chose self-sampling, 21% chose clinic attendance), opt-in (34%) (8% self-sampling, 26% clinic) and control group (28%). Intervention arms showed higher screening uptake in all age-groups and regions, but the largest effect was seen at ages 60 and 65 years and in regions showing the lowest screening participation rates. Among self-sampling users, 99% agreed that self-sampling was easy and only 3% prefer testing at a clinic.

Conclusions
Offering women a choice between HPV self-sampling or attending a clinic significantly increased cervical cancer screening uptake. Sending an HPV self-sampling kit to home address was the most effective approach. Majority of women who chose HPV self-sampling want to use this option in the future. HPV self-sampling should be integrated in the cervical cancer screening program in Estonia.

Key messages
Older German adults’ health-related quality of life and associated social factors
Authors: Geigl C , Spagert L , Loss J , Leitzmann M , Janssen C 
Published: October 2022

Abstract

Background
A differentiated analysis of the structural relationships between social factors and health-related quality of life (HRQOL) in older German adults has not yet been conducted. In this analysis, we aimed to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental HRQOL in older German adults.

Methods
A community-based postal survey was used to collect cross-sectional data from German adults aged 65 and older (n = 1687, 33% response proportion, 52% female). Physical and mental dimensions of HRQOL were assessed using Short Form 36, version 2. Multiple linear regression models were used to analyse the associations between social factors and both physical and mental HRQOL.

Results
Health locus of control, physical activity, and income were positively associated with both physical HRQOL (Adj. R2 = 0.34, p &lt; 0.001) and mental HRQOL (Adj. R2 = 0.22, p &lt; 0.001), whereas age was negatively associated with both. Alcohol use was positively associated with physical HRQOL, and social support was positively associated with mental HRQOL.

Conclusions
A differentiated understanding of the relationships between social factors and HRQOL assists in group-specific targeting of health interventions. Demand-oriented interventions should consider underlying social factors to reduce socially determined inequities in HRQOL among older German adults. Depending on the focus of the intervention, it may be helpful to take specific social conditions into account. The results may be transferable to municipalities in high-income European countries.

Key messages
Regulation and financing of prenatal screening and diagnostic tests for fetal anomalies in Europe
Authors: Reinsperger I , Zechmeister-Koss I 
Published: October 2022

Abstract

Background
Pregnant women frequently use prenatal screening and diagnostic tests to detect fetal structural and chromosomal anomalies; however, the regulation and financing of these examinations differ substantially across countries. In this paper we focus on the provision, financing and setting of the following tests in selected European countries: First Trimester Screening (FTS)/Combined Test (CT), Non-invasive Prenatal Test (NIPT), second-trimester ultrasound screening for fetal anomalies, amniocentesis/chorionic villus sampling.

Methods
We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy. We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.

Results
The results are based on 11 completed expert questionnaires and 22 published sources. The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists). There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.

Conclusions
The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies. Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary. Decision-makers should pay particular attention to high-quality and non-directive counselling.

Key messages
Evaluation of Telemedicine awareness, knowledge, attitude, skill levels of physicians and students
Authors: Mutlu A , Kilinc A , Ozcan L , Tepetas M , Metintas S , Onsuz MF 
Published: October 2022

Abstract

Background
The increase in the use of information and communication technologies around the world brings about developments and changes in the provision of health services. It is accepted that telemedicine applications will facilitate health services for patients and health personnel. This study aimed to evaluate the telemedicine awareness, knowledge, attitude and skill levels of physicians and medical school students.

Methods
This cross-sectional study was conducted between July and August 2021. A questionnaire form was prepared using the relevant literature then filled online by the participants. Telemedicine Awareness, Knowledge, Attitudes and Skills Questionnaire was used in the research. The universe of the research consisted of medical faculty students and physicians across Turkey. In the study, 933 people were reached by using the purposeful snowball sampling method, one of the non-probability sampling methods. Mann Whitney-U test, Kruskal Wallis test, Spearman correlation analysis and Multiple Linear Regression analysis were used.

Results
Of the participants, 442 (47.4%) were female, 497 (53.3%) were medical students, and 436 (46.7%) were physicians. Their ages ranged from 18 to 59, with a mean of 28.0±8.8 years. The median (min-max) scores obtained from the Telemedicine Awareness (TA) sub-section were 18(0-24), 51.3% of them had scores above the median score. TA sub-section had a moderate positive correlation (r = 0.559, p &lt; 0.001) with knowledge sub-section and a weak positive correlation (r = 0.208, p &lt; 0.001) with skill level sub-section. TA scores were higher among men, physicians and those who want to participate in a telemedicine training program. TA increased as the level of computer and internet knowledge increased (F = 29.171, R2=0.197, p &lt; 0.001).

Conclusions
It can be said that TA is at a moderate level among medical students and physicians in Turkey. TA increased as the level of computer and internet knowledge, telemedicine knowledge and skills increased.

Key messages
Remote patient monitoring at home using ambient sensors: a systematic review
Authors: Alboksmaty A , Solomons N , Gul S , Neves AL , Aylin P 
Published: October 2022

Abstract

Background
The world population is ageing, and their health needs imply substantial demands on health systems. Remote Patient Monitoring (RPM) may help elderly patients live independently in their homes for longer. The essence of RPM is the continuity of use, which is challenging for wearable devices and patient-led technologies. Unobtrusive (ambient) sensors could be an innovative solution, such as motion detectors and similar technologies. This study aims to review the evidence on the effect of ambient sensors on healthcare use by the elderly.

Methods
This is a systematic review for narrative synthesis, searching five databases, Medline, Embase, CINHAL, Scopus and Web of Science, on 21 Feb 2022 without setting a lower time limit. No restrictions on the design of studies were applied. A meta-analysis was not feasible due to the heterogenicity of the studies.

Results
Out of 5,653 search results, 180 studies were subjected to full-text review, of which 6 studies were included in the final synthesis. All the included studies were conducted in the USA. Four studies assessed the technology's cost-efficiency, while only one reported significant cost savings. One study reported a significant reduction in hospital days and visits to a physician among the users. Using ambient sensors was associated with an increased length of stay in facilities where the elderly can live independently, including at home. The impact on the number of hospitalisations or emergency room visits was unclear.

Conclusions
Our review identified limited evidence on the effect of ambient sensors on healthcare use by the elderly. The potential has been demonstrated for ambient sensor technologies to result in cost savings; however, further research is needed to assess the impact on health outcomes.

Key messages
Scientific clues on global food (in)security and climate change relationship as drivers of health
Authors: Aslan D 
Published: October 2022

Abstract

Issue
Food insecurity is in close relationship with the determinants of health. Global crisis including climate change (CC), natural disasters, poverty can deepen the burden, and all are linked with the economic, social, commercial, structural determinants of health. Defining such connections may help in proposing practical solutions.

Description of the problem
COVID-19 pandemic made the food security (FS) problem more visible. Food security considers basically the affordability, availability, and the quality of food. Food insecurity (FiS), violation of the right to healthy food, influences disease patterns and causes communicable and non-communicable diseases (NCDs). Globally, 71% of deaths are attributed to NCDs. Analyzing the relationship between FiS and other determinants of health like CC may be helpful for sustainable solutions in such a world where we are talking on “our planet, our health” motto. Example given in this study is the relationship between the country values/rankings of the “Global Food Security Index (GFSI)” and the “Climate Change Performance Index (CCPI)”. GFSI defines the FS situation and CCPI defines countries’ response to CC.

Results
Countries’ CCPI and GFSI values do not show a linear relationship. For example, Norway, as a country at the top of the Human Development Index (HDI) ranking list has both high CCPI and GFSI values. On the other hand, although USA and Canada have low CCPI, both have good GFSI values. Sub dimensions of the indicators may also vary across countries. Crisis like COVID-19, conflicts, poverty emphasize the need on improving the indicators in a transdisciplinary approach.

Lessons
Investigating indicators taking the determinants of health into account is helpful. However, different characteristics of the countries make it difficult to propose a standard approach to overcome the problems. Developing “new” indicators with transdisciplinary work might be useful in this sense.

Key messages
Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort
Authors: Bellicha A , Wendeu-Foyet G , Coumoul X , Koual M , Pierre F , Debras C , Srour B , Kesse-Guyot E , Deschasaux-Tanguy M , Touvier M 
Published: October 2022

Abstract

Background
Acrylamide is classified as a probable human carcinogen by the IARC but epidemiological evidence on the carcinogenicity of acrylamide from dietary sources is limited. This study aimed to investigate the associations between dietary acrylamide and breast cancer risk in the NutriNet-Santé cohort.

Methods
This prospective cohort study included 80,597 French women (mean [SD] age at baseline: 40.8 [14] years) during a mean (SD) follow-up of 8.8 (2.3) years. Acrylamide intake was evaluated using repeated 24h dietary records (n = 5.5 [SD 3.0]), linked to a comprehensive food composition database. Associations between acrylamide intake and breast cancer risk (overall, premenopausal and post-menopausal) were assessed by Cox hazard models adjusted for known risk factors.

Results
The mean (SD) dietary acrylamide intake was 30.1 (21.9) µg/d (main contributors: coffee, potato fries and chips, pastries and cakes, and bread). During follow-up, 1016 first incident breast cancer cases were diagnosed (431 premenopausal, 585 postmenopausal). A borderline significant positive association was observed between acrylamide intake and breast cancer risk overall (HRQ4 vs Q1= 1.21 [95% CI: 1.00-1.47]) and a positive association was observed with premenopausal cancer (HRQ4 vs Q1= 1.40 [95% CI: 1.04-1.88]). Restricted cubic spline analyses suggested evidence for non-linearity of these associations, with higher HR for intermediate (Q2) and high (Q4) exposures. Receptor-specific analyses revealed a positive association with estrogen receptor-positive breast cancer, which represented 86% of total cancer cases. Acrylamide intake was not associated with post-menopausal breast cancer.

Conclusions
Results from this large prospective cohort study suggest the potential deleterious role of dietary acrylamide in breast cancer etiology, especially in premenopausal women, and provide new insights that should encourage further mitigation strategies to reduce the content of acrylamide in food.

Key messages
The economic value of informal long-term care
Authors: Huis in ‘t Veld T , Korver D , Orhan R , Berenschot L 
Published: October 2022

Abstract

Informal care makes up a significant share of long-term care (LTC) and is likely to become even more important in the near future because of the ageing population, rising numbers of chronic patients and shortages of formal carers. At the same time, informal care is under pressure because of societal developments (shrinking family sizes, increased participation of women on the labour market, rising retirement age and geographical dispersion of families). These developments may further enhance the effect of informal care in terms of individuals’ quality of life and opportunity costs caused by work absence and productivity losses. Against this background, Ecorys has performed studies, to empirically estimate the social value of informal LTC and increase the awareness on its importance. The results of the study, commissioned by the European Commission, demonstrate that informal caregivers represent about 80% of all caregivers (measured in FTE). If paid for, these hours would cost between 2.4 and 2.7% of EU GDP. Currently, these costs are not paid and the actual costs of informal care are estimated at 1.05% of EU GDP, mostly in lost tax revenues. European countries vary greatly in the extent to which informal carers are supported by public policies. Only some countries have cash benefit schemes to compensate for the loss of income from employment. Specific benefits and leave entitlements to support informal caregivers are often insufficient or lacking. In several studies in the Netherlands, Ecorys found that total social costs of informal care are estimated at 2.54% of NL GDP (€22 billion/year) and informal caregivers perceive increasing economic and psychological burden and are at higher risk of depression and burn out. Government policies are developed to better support informal caregivers.

Key messages