bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of unnecessary antibiotic use in European hospitals – a systematic review
Authors: Tyllack L , Renz A , Runge Ranzinger S , Louis VR , Deckert A , Dambach P , Horstick O , Lowery Wilson M 
Published: October 2022

Abstract

Background
Antibiotics (AB) are essential to modern day medicine as prophylaxis and therapy. Yet, unnecessary use has various negative effects on individual and global health, such as antimicrobial resistance (AMR) and contribution to high greenhouse gas (GHG) emissions of the healthcare sector. This systematic review provides an overview of unnecessary AB use in European hospitals in order to present possible ways forward.

Methods
The systematic review followed PRISMA guidelines, included as databases were: Embase, ProQuest Environmental Science Collection, PubMed, ScienceDirect, Scopus and Web of Science. Studies conducted among adult in-patients in EU/EEA countries were included if they provided assessment methodology, included a clear standard of measurement and chart reviews were used as evaluation basis.

Results
Fifty-six included studies were categorised into the following three groups: (1) Studies using an established evaluation method; 20 studies belong to this group, 18 used the same, established approach. Eleven of these studies performed an observational audit, while the interventions in the remaining studies were of educational or advisory nature. Unnecessary AB use ranged from 1.5% to 51% of all observed prescriptions. Outcomes of interventions showed great variation of effects on unnecessary use (-34.7% - +11.6). (2) Studies using a newly developed, clearly stated evaluation method (4 studies); (3) Studies which conform with established evaluation methods but the processes were not specified (32 studies). Results are subject to further analysis.

Conclusions
The studies included reported a great range of unnecessary AB use in adult in-patients, for both prophylactic and therapeutic indications. Evaluation methods of unnecessary AB use vary greatly between studies. In future research, comprehensive application of established approaches is essential for better overview and identification of key areas for AMR and GHG emission reduction activities.

Key messages
• Unnecessary antibiotic use varies greatly among studies conducted in European adult in-patients.
• In future research, wider application of established evaluation methods will improve comparability and targeting of interventions.
Information technology systems to support antimicrobial stewardship programs
Authors: Gallinoro V , Grazzini M , Paolini D , Dannaoui B , Farese A , Mantengoli E , Ipponi A , Pieralli F , Bonaccorsi G , Niccolini F 
Published: October 2022

Abstract

Problem
Inappropriate antibiotic use contributes to the emergence and spread of multidrug-resistant organisms that are responsible for life-threatening infections. Furthermore, overprescription of antibiotics is associated with an increased risk of adverse effects and higher costs.

Description of the problem
Careggi is a tertiary care teaching hospital in Italy, with nearly 1,200-bed units, involved since 2015 in antimicrobial stewardship (AMS) programs. Despite implementation programs, carbapenems (CAR) consumption rates remained higher than the national average; for this reason, the AMS hospital team started a project aimed at improving the appropriateness of this type of drug.

Results
The project started in October 2021 and involved 10 hospital Units selected as the major prescribers of CAR. The strategies were planned by a multi-professional and multi-disciplinary team of experts in AMS and were set in place by a multimodal approach focused on information technology (IT) functions implemented in the electronic medical record such as:
• time-out alerts at 72 hours inviting physicians to evaluate if the prescribed antimicrobial is still warranted or effective against the identified organism(s);
• interactive and customizable prescribing algorithms to support physicians in empirical and targeted therapies;
• electronic dashboards viewable by physicians and the AMS team to daily monitor and review CAR prescriptions.
These functions were complemented by a series of training sessions for prescribing physicians aimed to promote a more rational and appropriate antimicrobials use. Six months after the project began, an overall reduction in the prescription of CAR was observed: from 6.2 DDD/100 patient-days to 4.9 DDD/100 patient-days.

Lessons
AMS programs use different interventions to influence the behavior of prescribers toward more appropriate use of antimicrobials. IT functions represent complementary and useful tools to promote antimicrobial stewardship programs.

Key messages
• Antimicrobial stewardship programs aim at optimizing antibiotic use and reducing inappropriate antibiotic prescriptions.
• Information technology systems represent useful tools within AMS programs.
Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study
Authors: Scholaske L , Entringer S , Razum O , Spallek J 
Published: October 2022

Abstract

Background
Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy.

Methods
140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements.

Results
Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38–0.03, p&lt;.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p&lt;.05), and higher PSS (b = 0.46, SE = 0.13, p&lt; .001) and CESD scores (b = 0.29, SE = 0.08, p&lt;.001) during pregnancy after adjusting for socioeconomic factors.

Conclusions
The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin.

Key messages
• Women of Turkish origin in Germany have elevated psychological and biological stress levels during pregnancy compared to non-migrant women.
• This finding underscores the need for targeted interventions to reduce stress in this high-risk group.
Training peer researchers for CBPR on racism in health care in Germany
Authors: Gangarova T 
Published: October 2022

Abstract

For many affected by ongoing coloniality, research is not neutral or objective, but is part of the colonial violence inflicted through disciplines as diverse as medicine and ethnography. Against this background, choosing Community-based Participatory Research (CBPR) as research strategy for researching racism in health care can be seen as a way of challenging existing epistemologies of ignorance by embracing diversity of knowledge production. ‘Community Perspectives on Racism in Health Care’ is a participatory research project carried out in the frame of the National Discrimination and Racism Monitor which aims to improve the involvement of people affected by racial injustice in the research process, collect data on and generate theory about healthcare-related racism. It is conducted by DeZIM-Institut in collaboration with different racialized communities. Community members were trained as peer researchers and supported to conduct CBPR-projects. Two CBPR-projects were conducted: 1) digital focus groups with people marked as Muslims 2) digital focus groups with Black people. ‘Racial’ health disparities were identified on three levels: differential access to health care, differential care within the system and differences in exposures. The theory was built inductively, while drawing on existing theoretical concepts from the disciplines of public health, postcolonial and decolonial studies. Racialized people used the opportunity to be trained as peer researchers. They conducted CBPR projects tailored to the needs of their communities and conceptualized racism in the broader context of health care. Suggestions were made for improving health care services. Including those most impacted by racial injustice as peer researchers enables us to widen the “we” who constitute the researchers and to harvest the wisdom of situated knowledges. However ongoing challenges have been faced raising the question of the (im)possibilities of democratic knowledge production in German academia.

Key messages
• Including those most impacted by racial injustice as peer researchers enables us to harvest the wisdom of situated knowledges.
• Ongoing challenges have been faced by trying to establish democratic knowledge production in German academia.
Years of life lost for 137 causes of death in Belgium by age, sex, and region, 2004-2018
Authors: Scohy A , De Pauw R , Gorasso V , Van den Borre L , Devleesschauwer B 
Published: October 2022

Abstract
Information on years of life lost (YLLs) due to premature mortality is necessary to assess the fatal impact of disease, crucial for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to redistribute cause of death data. Belgian cause of death data are obtained from Statistics Belgium (Statbel). After mapping the ICD-10 codes defining the underlying cause of death to the GBD cause list, we redistributed ill-defined deaths (IDDs) to specific causes using a four-step probabilistic redistribution process developed to fit the Belgian context: internal redistribution, redistribution using predefined ICD codes, redistribution using multiple causes of death data, and redistribution to all causes. Finally, we used the GBD 2019 standard life expectancy table to calculate the years of life lost at age of death. In Belgium, between 2004 and 2018, IDDs increased from 31% to 34% of all deaths, reflecting increases in the average age at death. The majority was redistributed using predefined ICD codes (13%), followed by the redistribution using multiple causes of death data (10-11%). The total number of YLLs decreased from 1.83 to 1.77 million. In 2018, the top causes of YLLs were ischemic heart disease and lung cancer with a share of 8.4% each, followed by dementia and cerebrovascular disease with a share of 5.5% each. All results are stratified by age, sex, region, and year, and can be explored via an online tool: https://burden.sciensano.be/shiny/mortality.
Report from public health decision-maker interviews
Authors: Landsman Keren 
Published: October 2022

Abstract
Report from NGO interviews on impact on vulnerable communities
Sylvia Agbih
Ethik der Medizin, University of Augsburg, Augsburg, Germany
Contact: sylvia.agbih@med.uni-augsburg.de
Report from school interviews
Quintus Sleumer
Ethik der Medizin, University of Augsburg, Augsburg, Germany
Contact: quintus.sleumer@uni-a.de
Report on selected key ethical issues arising from analysis
Verina Wild
Ethik der Medizin, University of Augsburg, Augsburg, Germany
Contact: verina.wild@uni-a.de
Building for the future: some thoughts on a comprehensive ethics assessment
Angus Dawson
Sydney Health Ethics, University of Sydney, Sydney, Australia
Contact: angus.dawson@sydney.edu.au
Life-work balance of school-principals during the COVID-19 pandemic in Poland
Authors: Leksy K , Borzucka-Sitkiewicz K , Muster R 
Published: October 2022

Abstract

Background
The health crisis caused by the COVID-19 pandemic has severely affected the education sector and its whole community. Due to their responsibility for organizing schoolwork, school managers were in an extremely challenging position. The main objective of the present study is to reveal the extent to which school principals in Poland put aside their own needs in favor of fulfilling their professional duties during the COVID-19 pandemic.

Methods
The results come from an online survey among school principals in Poland, which is part of the international COVID-19 Health Literacy School Principals Survey. The survey was conducted in 8 out of 16 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire.

Results
The study revealed that 68,3% of school principals often and very often worked longer than contractually agreed and 71,3% reported to be available for their colleagues, pupils, and parents in their free time. Most of them also had to give up leisure activities in favor of work (67,9%), work extra hours in their spare time (60%), waive breaks during working hours (57,3%), and did not get sufficient sleep in favor of work (50,5%). Devoting more time to work and high stress levels during the pandemic were associated with somatic complaints among respondents (e.g. muscle pain (neck, shoulder, or back) and headache).

Conclusions
The results suggest that Polish school principals worked at the expense of their free time and health during the COVID-19 pandemic. As such, findings emphasized a lack of life-work balance and the need to raise their awareness of the consequences of self-exploitation in work in challenging times. The ability to set healthy boundaries between work and private life among managers is one of the health promotion tasks in demanding times.
Future in Pediatrics: prevention in maternal child chronic diseases in the first 1000 days
Authors: Hugonin-Rao B 
Published: October 2022

Abstract

Introduction
The screening and management of obesity, metabolic chronic conditions conditions and genetic predisposition, before and during pregnancy, improve the effects of therapies and reduce the rate congenital diseases, metabolic fetal disorders and early chronic diseases during first 1000days. The maternal child health promotion program ‘Future in Pediatrics’ is dedicated to women in preconception and in early pregnancy, with three steps: 1) a specific survey, 2) a personalisated plan 3) the management of chronic conditions (diabetes, hypertension, overweight, metabolic disorders) and surveillance during the first maternal child 1000 days. Encouraged results

Methods
In 2019-2021, FUTURA project involved 460 women (before,during and after pregnancy) into 2 groups: group 1 of 280 women, with overweight/ obesity, metabolic conditions, malnutrition, and hypovitaminosis, group 2 of 180 women without chronic conditions, but physical inactivity, high level of homocysteine (60 to 100 μmol/L) and with predisposition for cardiovascular diseases. We have involved the patients in a survey of 100 questions about health, lifestyle, habits, sleep and in a daily diary. In the second time we have realized a personalised and educational program for diet, supplementations sleep, physical activities, health routine.

Results
The 2 groups of women improved the quality of their health and the management of weight, chronic and metabolic conditions, with impact on reproductive and perinatal health, reduction of inflammatory status and metabolic parameters.We have observed a great influence on cardiovascular health in both groups and decreased of homocysteine levels in the 2nd group. During first 1000 days 393 women, involved into the program, continued with the healthy and preventive routine with zero cases of weight and metabolic chronic disorder in their children.

Conclusions
This research that the prevention in perinatal health influences the children's health.

Key messages
• The origins of chronic and metabolic conditions are in uterine life before the conception. The unhealthy lifestyle influenced fertility, cardiovascular health and child health.
• The cardiovascular health and metabolic chronic conditions are influenced by first 1000 days health and habits.
Structural and school factors, affirmation and well-being among gender minority youth across Europe
Authors: Sevic S , Klasnic K , Doyle DM 
Published: October 2022

Abstract

Background
Previous research has shown that structural-level factors (discriminatory laws and policies) result in impaired health and well-being for transgender and gender diverse (TGD) adults. This study aims to assess if structural stigma is associated with school bullying/victimization and well-being among TGD youth and if more LGBTI supportive school environments, as well as social, physical, and legal gender identity affirmation ameliorate the effects of both structural stigma and experiencing violence.

Methods
The study was conducted online in 2019 in 27 EU Member States and in the UK. We analyzed data from TGD students, aged 15 to 24 years, who at most had completed lower secondary education (n = 2,714). Well-being indicators used in the analyses included one-item measures of life satisfaction, depression, and considering leaving or changing school.

Results
School environment, but not structural-level stigma, was associated with school bullying/victimization. Similarly, the effects of structural-level stigma, along with physical and legal gender identity affirmation were inconsistently related to students’ well-being across the multilevel models, whereas a more positive school environment and especially experiences of social identity affirmation were related to greater life satisfaction, better mental health, and lower odds of considering leaving or changing school; even though the negative effects of school bullying/victimization remained statistically significant across all models.

Conclusions
This study's results suggest that compared with distal factors, more proximal factors - better school environment and social identity affirmation - have a greater impact on TGD students’ well-being. Given the inconsistency of our findings, more research is needed to understand the role of structural stigma and legal and physical gender identity affirmation in TGD students’ well-being.
Psychotherapy and change in mental health-related work disability - A prospective population level register-based study in Finland
Authors: Kausto J , Gluschkoff K , Selinheimo S , Turunen J , Väänänen A 
Published: October 2022

Abstract

Introduction
Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up.

Objectives
We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis.

Methods
All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days.

Results
The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group

Conclusions
Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.
Preschool children’s temperament and its associations with energy intake
Authors: Pajulahti R , Ray C , Salmela-Aro K , Korkalo L , Lehto R , Vepsäläinen H , Nissinen K , Roos E , Erkkola M 
Published: October 2022

Abstract

Background and objectives
Child's temperament dimensions have been linked with different weight outcomes as well as dietary factors such as consumption of fruit and vegetables, sugar-rich foods and drinks and an overall dietary quality. Links between temperament dimensions and energy intake, however, remain under-examined. This study expands the literature by investigating associations between child's temperament dimensions and energy intake.

Methods
Altogether 505 Finnish children aged 3-6 years provided data for the analyses. The data is a part of the DAGIS (Increased Health and Wellbeing in Preschools) study conducted in 2015-2016. Child's energy intake was measured with 3-day food records. To be included, children had to 1) have food record for two preschool days and one weekend day and 2) to have consumed both lunch and an afternoon snack in the preschool on the two preschool days. The very short form of Children's Behavior Questionnaire was used to measure child's temperament dimensions. Concurrent associations between three temperament dimensions (surgency, negative affectivity, and effortful control) and energy intake were examined using linear regression models adjusted for child's age, sex, mother's highest education, and moderate-to-vigorous physical activity.

Results
Surgency, temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake. Effortful control or negative affectivity were not associated with energy intake.

Conclusions
The findings imply that temperamental surgency may be one relevant determinant of energy intake among preschool children. The result is in line with previous studies linking child's surgency as well as its specific facets, such as impulsivity, with weight outcomes and food approach behaviors. Considering child's individual temperament dimensions when counselling families in eating issues could be beneficial.

Key messages
• Surgency, a temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake.
• When promoting children’s balanced eating, tailored support for parents acknowledging child’s temperament could be beneficial.