bluuebunny/crossref_metadata_2025_split huggingface dataset:
The LoCo (Lockdown Cohort)-effect: Socioeconomic differences in fertility during the pandemic
Authors: Oberndorfer M , Tilstra AM , Dundas R , Leyland AH , Pearce A 
Published: October 2022

Abstract

Background
The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health - the LoCo-effect - are likely.

Methods
We analysed data from maternal inpatient discharge records containing births between January 2018 and November 2021 by Scottish Index of Multiple Deprivation (SIMD) quintile. We used monthly number of births before November 2020 to estimate expected monthly births after November 2020 and compared against observed births in each SIMD quintile. Further, we estimated associations between monthly average stringency of national mitigation measures (Stringency Index (0-100)) and births 9 to 13 months later using distributed lag models.

Results
Between November 2020 and November 2021, there were 1301 (10.3%) fewer births than expected for the most deprived quintile (Q1; 953 (8.7%) and 375 (4.1%) less in Q2 and Q3). In the two least deprived quintiles, however, fertility remained mostly unchanged. A 10-point increase in monthly average Stringency Index in Q1 was associated with an average cumulative decrease of 8.5 births (95%CI: -14.1; -2.8, p = 0.006) 9 to 13 months later. Conversely, this estimate was a 4.4 increase (95%CI: 1.3; 7.5, p = 0.008) in Q5 and a 5.9 increase (95%CI: 1.4; 10.4, p = 0.013) in Q4.

Conclusions
Apart from their exposure to pandemic and lockdowns, it is likely that, due to compositional changes in births, the observed LoCo started life, on average, more socially advantaged than previous birth cohorts in Scotland. We show a substantial decrease in fertility in the most deprived areas, while fertility remained little changed in the least deprived areas. Increases in the stringency of lockdown measures were associated with a decrease in births in the most deprived but an increase in the least deprived areas 9 to 13 months later.

Key messages
• Between November 2020 and November 2021, there were substantial decreases in births among deprived areas in Scotland while fertility in the least deprived areas remained mostly unchanged.
• For these births, the observed compositional shift in maternal socioeconomic characteristics may lead to changes in current and future health and health needs – the LoCo (Lockdown Cohort)-effect.
Managing Innovation for Sustainable Health:rethinking training of health officials in fragile states
Authors: Båge K , Batte C , Tomasdotter L , Mala Ali M , Alasow M , Ndejjo R , Hellden D , Ndeezi G , Alfven T , Wanyenze R 
Published: October 2022

Abstract

There is great urgency for action to achieve the Sustainable Development Goals, especially in fragile settings, which face acute and complex challenges. Yet, the public sector may be limited in its capacity to address these appropriately, with devastating effects on the health of people and environment now and in the future. The challenges to sustainable health require professionals who are trained relevant competences. In 2020, Karolinska Institutet, Sweden, and Makerere University, Uganda, developed the Centre of Excellence for Sustainable Health under which a new partnership was established with Benadir University, Somalia, Kinshasa School of Public Health, the Democratic Republic of Congo, and Tinkr, Norway to develop training on innovation for sustainable health. The aim of “Managing Innovation for Sustainable Health” (MISH) is to strengthen the capacity to contribute to achieving sustainable health through innovation in the public sector. It targets managers in Somalia, DRC and Uganda from the public and private sector, academia, and civil society. It is one year long, part-time and delivered online with one study trip. It features three modules covering Agenda 2030 and Sustainable Health; Multisectoral Collaboration and Implementation Science; and Innovation and Innovation Management. Integration of participants’ learnings into their professional role, mutual learning between participants, and an emphasis on applicability, all underpin the learning strategies of the program. Quality is monitored through expectation surveys, baseline mid and final impact assessments, module and final program evaluations. MISH has trained about 50 managers, 85% of which say that the training was useful. All partners are represented in both operational and strategic organizational bodies of the program. Our model shows what is possible through collaborative online international learning delivered by partnerships defined by teamwork, trust, and a dedication to true impact.

Key messages
• There is great urgency for action to achieve sustainable health especially in fragile settings.
• There is momentum for higher education to leverage the opportunities of the covid-19 to rethink learning for the global challenges.
Racism in German medical education – Perspectives of racialized physicians and medical students
Authors: Vogt H 
Published: October 2022

Abstract

Background
The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research. The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a ‘medical habitus’ and exclusionary discrimination, have hardly been examined to date. The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning.

Methods
Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism. The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees.

Results
The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context. This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials.

Conclusions
There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany. Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups.

Key messages
• Hegemonic normativity in German medical education is an important and challenging issue. There are several institutional levels of medical knowledge reproducing racism in the health care sector.
• Both racialized physicians and racialized patients are affected by symbolic and material forms of racism in the German health care system, which are interweaving and crucial on diverse levels.
Epidemiological factors affecting health service utilization in diabetic patients in Ethiopia
Authors: Benoni R , Sartorello A , Paiola E , Andreani G , Moretti F , Tsegaye A , Tardivo S , Manenti F 
Published: October 2022

Abstract

Diabetes-related deaths reached 2 million in 2019. The highest percentage of undiagnosed diabetes (59.7%) was observed in Africa, where accessibility to health services is pivotal to improving the outcome of diabetic patients. The study aims to assess the association between diabetic patients’ epidemiological factors and accessibility to healthcare services in a low-income country. The retrospective cohort study included diabetes-related outpatient department (OPD) visits and hospitalizations from 01/01/2018 to 31/08/2021 at St Luke Hospital (Ethiopia). Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature, and precipitations. The ARIMA method was applied to OPD visits and hospitalizations time series. OPD visits increased over time (p &lt; 0.001) while hospitalizations were stable. The time series model was ARIMA(0,1,1) for OPD visits and ARIMA(0,0,0) for hospitalizations. Diabetes OPD patients were 1,685 (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (p = 0.002). Patients missing follow-up were 801 (48%). The time between follow-ups was longer as age increased (p &lt; 0.001). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. OPD visits decreased differently by geographic area as COVID-19 cases increased (p &lt; 0.001). Hospitalized patients for diabetes were 408, 85 (20.8%) newly diagnosed. The odds ratio (OR) of diagnosis at admission was lower as age increased (OR 0.98, p = 0.009). Compared to type 1 diabetes, hospitalized females with type 2 (117-39.7%) were fewer than males (p = 0.019). Readmissions were 52, 10 (19.2%) within 30 days, without OR difference by sex, age, or diabetes type. Despite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Gender and age influenced service utilization. Females’ access to care is still problematic (concept of “missing women”).

Key messages
• Primary health care should be implemented to improve access to health services and diabetes management.
• Ensuring equity in healthcare accessibility should be a priority in low-income countries.
Health System Performance Assessment: Does Germany provide good access to healthcare?
Authors: Blümel M , Hengel P , Achstetter M , Schwarzbach M , Busse R 
Published: October 2022

Abstract

Background
Providing equal access to health care is a major goal of health systems and a criterion for health system performance assessment (HSPA). The first systematic HSPA for Germany has been piloted in 2021. Access is one dimension of the conceptual framework (others are, e.g., population health, quality, and efficiency), which will be analysed in the following.

Methods
Nine indicators to measure access were selected based on a systematic search of established instruments in (inter)national HSPA initiatives. Included indicators are availability and accessibility of services (e.g., waiting times) and financial risk protection, among others. Other criteria for the inclusion of indicators were data availability and international comparability. Indicators were evaluated in terms of their trend over time (2000-2020), in international comparison (e.g., Austria, Denmark, France), and according to various equity categories (e.g., age, gender, region).

Results
The indicator access to palliative care could not be evaluated due to lack of data. Overall, access is good in Germany. Internationally, Germany performs better than average on most of the indicators, and its performance has improved over time. Physician density in the inpatient and outpatient sectors has increased since 2000 and is above the average of comparator countries. For some specialties, physician density in rural areas is lower than in urban areas, but the gap has decreased in recent years and does not apply to primary care. Furthermore, only 0.3% of the total population report having foregone care, although they had considered it necessary.

Conclusions
Nine indicators were identified and calculated to assess the performance of the German health system in terms of access to healthcare. Access can be assessed as predominantly positive, but inequities exist. Identified gaps and future extensions, e.g., additional data sources, can provide impetus for evidence-based policy management.

Key messages
• First systematic Health System Performance Assessment for Germany has been piloted.
• Access to health care is good in Germany, both over time and in international comparison, but inequities exist.
Maternal educational inequalities in child’s birth weight: ONS Longitudinal Study
Authors: Pikhartova J , Shelton N 
Published: October 2022

Abstract

Background
Studies found that maternal education is the most frequently assessed predictor of child’s birth weight. Lower level of education was consistently found as indicator of lower child’s birthweight. In turn, inequalities in child’s birthweight have been repeatedly shown to be closely related to inequalities in later adult health. The aim of this project is to evaluate the association between the highest achieved level of maternal education and birthweight of single born babies in large English and Welsh population sample, taking into account factors such as child’s gender, parity, maternal age, partnership status, ethnicity, and household socioeconomic characteristics.

Methods
Using Office for National Statistics Longitudinal Study (ONS LS) based on English and Welsh Census data, information from almost quarter of a million children born since 1981 to ONS LS sample mothers were used. Maternal education was categorised in 3 categories (below secondary, completed secondary education, degree and higher), and its association with child’s birth weight was analysed by logistic regression accounting for range of available covariates.

Results
Significant association between the level of education and birth weight was found in crude analysis (p &lt; 0.001). When adjusted, the magnitude of the association with education gradient declined but remained highly significant and was found to considerably increase over the years. The birth weight difference between those born to mothers with below secondary education and those born to mothers with degree increased by more than 60 grams (p for change &lt;0.001) between 1981 and 2016.

Conclusions
These findings support previous evidence based on different population samples. According to our results, children of mothers with below secondary education tend to have lower birth weight. Our results suggest that the inequalities in birth weight by the highest education level achieved by mother significantly increased since 1981.

Key messages
• Lower levels of maternal education predict low birth weight in children.
• The differences in birth weight by maternal educational demonstrate increase in inequalities over the years.
Epidemiology of Tuberculosis in Kazakhstan: Data from National Electronic Healthcare System 2014-2019
Authors: Sakko Y , Madikenova M , Kim A , Gaipov A 
Published: October 2022

Abstract

Background
Tuberculosis (TB) remains a global public health threat. WHO determined Kazakhstan as one of 18 high-priority countries for TB elimination in Europe, with reported TB incidence &gt;20 cases per 100,000 population. There is a lack of comprehensive reseach of TB epidemiology in the country. This study aims to estimate the prevalence, incidence, mortality rates and survival hazard ratios of TB in Kazakhstan, using large-scale administrative health data records in 2014-2019.

Methods
This is a population-wide retrospective study assessing 150 thousand TB (ICD10: A15-A19) patients’ incidence, prevalence and mortality. Demographic factors, diagnoses and comorbidities were analyzed. Univariate, bivariate and multivariate statistical analyses were performed. Cox regression and Kaplan-Meier survival analysis have been done.

Results
Out of 150 thousand all TB patients, 61 percent were male and 94 percent had respiratory TB. During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively. Age-specific TB incidence was lowest for 0-10 y.o., highest for 20 y.o. Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.

Conclusions
This was the largest TB study in Kazakhstan, presenting the country’s TB by demographic groups, incidence, prevalence, mortality trends, and risk factors against survival.

Key messages
• During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively.
• Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.
Case-mix and outcome variability in people with diabetic foot complications in England and Scotland
Authors: Meza B , Heiss C , Joy M , Feher M , Leese G , Cunningham S , DeLusignan S , Carinci F 
Published: October 2022

Abstract

Background
We assessed the difference in survival rates for people with diabetes experiencing LEA in England and Scotland, using large databases held by the Royal College of General Practitioners (RCGP) and the Scottish Diabetes Register (SCI-DC).

Methods
Observational retrospective study of T2D adults 18+ years with LEA between 1/1/2008-1/1/2018 from 1,800 general practices in England (7.4%) and all primary, secondary care units in Scotland. Significance tests were carried out using univariate odds ratios within each database.

Results
On 1/1/2018, N = 127,100 people with T2D were registered alive in RCGP, with N = 1,052 (832 per 100,000) experiencing prior LEA, vs N = 2,200 (783 per 100,000) out of 280,908 in SCI-DC. Among them, England recorded N = 405 patients (72.5%) with prior DFU diagnosis vs N = 993 in Scotland (74.3%), with a median time DFU to LEA of 2.0 vs 2.4 years. The median time spent with LEA was 3.4 years in England vs 3.9 years in Scotland. After including those dying earlier, different univariate patterns were found for England and Scotland. In both networks, increased risk was found for those aged 50+ at first LEA, with prior history of acute myocardial infarction, peripheral arterial disease, ischemic heart disease, cerebrovascular event, higher glomerular filtration rate and major LEA first. In England, reduced risks were found for males (OR = 0.77, 95%CI: 0.64-0.93) and people with retinopathy (0.69; 0.57-0.82), while higher risk were found for hypertension (1.29; 1.09-1.54). In Scotland, lower risks were found for obese (0.59; 0.52-0.66) and those with DFU after LEA (0.74; 0.62-0.89), vs higher rates among those of non-white ethnicity (1.63; 1.19-2.23) and dyalisis (2.31; 1.75-3.07).

Conclusions
Notable differences were found between England and Scotland in terms of characteristics associated with different outcomes following LEA among T2D adults. Multivariate analyses of aggregate patterns are currently ongoing to adjust for potential confounding.

Key messages
• Routine datasets from England and Scotland showed a differential impact of case-mix characteristics on lower extremity amputations among adults with Type 2 diabetes.
• Information available from different clinical networks can be mapped against the available standard sets to compare health care outcomes of people with different complex conditions.
Knowledge, attitudes, practices on hepatitis C and HCV screening: an Italian cross-sectional study
Authors: Lo Moro G , Scaioli G , Frattin R , Guastavigna L , Vola L , Bert F , Siliquini R 
Published: October 2022

Abstract

Background
Hepatitis C has the highest burden in the Eastern Mediterranean Region and European Region. This study aimed to explore knowledge, attitudes and practices towards hepatitis C and HCV screening, which has been large-scale implemented in Italy recently.

Methods
An online nationwide cross-sectional survey was conducted (Italy, December 2021). Five outcomes were used: HCV knowledge (from 0 to 100%: 100% represents the lowest knowledge); not being aware of the screening; wrong attitudes in case of contact with positive people (from 0 to 5: 5 represents more wrong attitudes); having performed an HCV test; sharing of blood-contaminated objects. Multivariable regressions were run.

Results
Participants were 813 (74.7% females; mean age 37 years, SD 12.4). The median score of HCV knowledge was 20% (IQR 16-24). There was a positive correlation between poor knowledge and wrong attitudes (p = 0.001). People who underwent an HCV test were less likely to have poor knowledge (p = 0.040). The 23.2% was not aware of screening existence. People who had a postgraduate degree were less likely of not being aware (p = 0.004). Investigating attitude score, the median was 0 (IQR 0-1). Increasing age was associated with wrong attitudes (p = 0.020). The 43.4% underwent an HCV test. This likelihood was greater for: residence in a municipality with more than 50000 inhabitants (p = 0.032); having at least one child (p = 0.009); considering oneself at risk (p = 0.004); being informed about HCV (p &lt; 0.001). The 31.8% shared objects. Increasing age was associated with reduced odds of sharing (p = 0.033). The 72.4% would like to receive more information on HCV, preferring brochures and short videos.

Conclusions
This study showed good knowledge and attitudes, with a substantial frequency of individuals who never underwent an HCV test or shared contaminated objects. It also suggested brochures and short videos may be the most acceptable ways to implement awareness campaigns in comparable European contexts.

Key messages
• Italian general population had good knowledge and attitudes towards hepatitis C and its screening, while it showed poor practices.
• Most of participants were willing to receive more information on HCV, especially through brochures and short videos.