bluuebunny/crossref_metadata_2025_split huggingface dataset:
It never rains but it pours: COVID-19 pandemic impact on mental health in older adults
Authors: Amerio A , Stival C , Lugo A , Fanucchi T , Cavalieri d'Oro L , Iacoviello L , Odone A , Zucchi A , Gallus S , Serafini G 
Published: October 2022

Abstract
Italy was the first country to be hit by the 2019 coronavirus disease (COVID-19) in Europe holding one of the highest clinical burdens. Older adults are those paying the highest price for the COVID-19 emergency. Within the Lost in Lombardy project, a web-based cross-sectional study assessing the prevalence of depressive and anxiety symptoms, hopelessness and insomnia before and during the COVID-19 pandemic, was conducted on a representative sample of 4,400 older adults aged 65 years or more from the Lombardy region recruited between November 17th and 30th 2020. The prevalence of depressive symptoms increased by + 112% during the pandemic, anxiety symptoms by + 136%, insufficient sleep by + 12%, unsatisfactory sleep by + 15%. Feelings of hopelessness were more frequent among women compared to men (15.1% vs. 10.4%) and increased with increasing age. A worsening in each of the four specific mental health outcomes was more frequently observed in women (OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, sleep quantity), in subjects who decreased their physical activity during the pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic diseases (p for trend&lt;0.001 for depression and anxiety; p for trend=0.010 for sleep quality; p for trend=0.012 for sleep quantity). A worsening in depressive symptoms was more frequently observed in more educated subjects (p for trend=0.008), while a worsening in anxiety symptoms in subjects living in main towns compared to outskirt with an economic status below the mean. The use of at least one psychotropic drug - mostly antidepressants/anxiolytics - increased by + 26% compared to pre-pandemic. The protection of the mental health status of this vulnerable segment of population needs to be recognized as a real public health priority.
Attitudes and experiences towards the IMMUNI App among Sapienza university students: a pilot study
Authors: De Blasiis MR , Isonne C , Turatto F , Mazzalai E , Marzuillo C , De Vito C , Villari P , Baccolini V 
Published: October 2022

Abstract

Background
IMMUNI is an app that was created to help fight epidemics, starting with COVID-19. The app has a contact tracing feature but its diffusion in Italy was low. In this pilot study, we investigated university students’ attitudes and experience towards the IMMUNI app.

Methods
This cross-sectional study was conducted at Sapienza University of Rome between 14 April and 19 April 2021. An online survey was administrated to university students of medical area. A multivariable logistic regression model was built to identify app download's predictors. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated.

Results
We collected 247 questionnaires (response rate: 78.2%). More than half of the students (65.0%) didn't download IMMUNI app mostly because of the belief that it was useless (30.0%). By contrast, the main reason for downloading was sense of duty (40.0%). Experience with the app was limited but the process was judged as lacking for the technical difficulties. As for hypothetical incentives, feedback on how the download could help against the pandemic was considered as the most effective (3.5 out of 5). In the multivariable analysis, higher likelihood of download was associated with higher fear of contagion for family and acquaintances (aOR:1.50, 95% CI: 1.01-2.23) and higher rating to the health management of the emergency (aOR: 1.33, 95% CI:1.00-1.76). The highest odds of download were found for participants who have been advised to download the app (aOR: 3.21, 95% CI:1.80-5.73). On the other hand, greater belief that the virus came from a laboratory was negatively associated with the download (aOR: 0.75, 95% CI: 0.60-0.93).

Conclusions
Strategies aimed at raising students’ awareness on the importance of health technologies, restoring confidence in health authorities, and limiting disinformation around SARS-Cov-2 should be devised. In addition, the app could be enriched with positive feedbacks for users, and some technical issues should be fixed.

Key messages
• The spread of digital technologies for public health purposes is fostered by trust in health institutions and improving health literacy and user engagement.
• An efficient and user-friendly technology is recommended.
The Italian investment in telemedicine: a breakthrough model of care in primary care
Authors: Borghini A , Mantoan D , Paone S , Leta I , Siccardi G 
Published: October 2022

Abstract

Issue/Problem
Aging populations, worsening burden of chronic disease and recent pandemic has accelerated awareness and the importance of telemedicine in providing continuity of healthcare.

Description of the problem
AGENAS is the public body responsible for the implementation of telemedicine investment (€1 billion) in the context of the NextGenerationEU plan. AGENAS has built up a working group expert panel to define the technical and informatics features of the investment. The project consists of the realization of the national telemedicine platform and the regional telemedicine services. Italian regions will implement telemedicine services based on the national guidelines defined by AGENAS, that will also monitor it through key performance indicators outlined on the basis of best practices and scientific evidence of multidimensional evaluation.

Results
National telemedicine platform will improve, optimise and standardise telemedicine services throughout the Country, considering what may already be available in regional and local healthcare contexts. Regarding telemedicine services in regional context, that will be implemented within the NextGenerationEU, they will be focused on the telemonitoring of high prevalence conditions (i.e. cardiological, respiratory, diabetes, neurological and oncological) as well as other services such as televisit, teleconsultation and teleassistance. Connecting patient's home with healthcare system provide benefits for patients and their families, who will be able to interact with healthcare professionals, obtaining consultation and monitoring of their health.

Lessons
The implementation of the investment, aiming at improving equity and integration of care, will contribute to provide real world evidence about usage, benefits and potential risk of the telemedicine in primary care for the management of chronic diseases.

Key messages
• The investment under the Next Generation EU plan it is the lifetime chance to transform Italian healthcare service and draw a new framework to cope with the high demand in telemedicine.
• Improving telemedicine services will determine a breakthrough in management of patient with chronic diseases in the Italian primary care sector.
Validation of a national checklist for continuous service improvement in a decentralised framework
Authors: Cardinali F , Carzaniga S , Martini L , Loiudice M , Carinci F 
Published: October 2022

Abstract

Background
Previous studies allowed defining a novel checklist for the participatory evaluation of person-centredness in hospital care using 243 items, grouped in 4 main areas, 12 sub-areas and 29 criteria. We aimed to validate a reduced set of core items that could be continuously used for service improvement in Italy.

Methods
Validation was performed using data collected during the last national survey carried out in 2017-2018 in N = 387 acute care hospitals from 16 out of 21 Italian regions. Descriptive measures for each item were used to assess eligibility for factor analysis, applied separately on each of the 4 main areas originally identified. Varimax rotation with eigenvalues&gt;1 was used to optimise factor structure. Items with an item-total correlation&gt;0.30 and factor loadings&gt;0.4 were attributed to individual factors. Items with inter-item correlation coefficient&gt;0.70 were included in a list of candidate mergers, submitted to expert opinion. Cronbach's alpha was used to assess overall internal consistency.

Results
A total of 183 out of 243 items included in the original checklist were submitted to factor analysis. Overall values of Cronbach's alpha ranged between 0.77-0.90, indicating a high consistency. A total of 67 items were finally attributed to 4 main areas, allocated as follows: 16 items in 4 sub-areas for ‘Person-oriented organisational and care processes’, 16 items in 4 sub-areas for ‘Physical accessibility, livability and comfort of the facilities’, 15 items in 3 sub-areas for ‘Access to information, streamlining and transparency’, and 20 items in 4 sub-areas for ‘Taking care of the relationship with patients and citizens’.

Conclusions
A simplified checklist including a manageable number of items that can be easily managed to evaluate hospital services was identified through an objective validation process. The national experience can provide valuable lessons for the application of participatory approaches of person-centred care.

Key messages
• A standardised checklist has been validated using survey data collected through a participatory process in Italian regions.
• The checklist can be used to evaluate and improve person-centered hospital services through a manageable number of items and factors.
7.H. Workshop: Lessons Learned Workshop from JAHEE- the importance of evaluation
Authors:   Organised by: JAHEE,   Chair persons: Raffaella Bucciardini (Italy), Bernadette Kumar (EUPHA-MIG)
Published: October 2022

Abstract

Joint Action Health Equity (JAHEE) was a Joint Action financed by the Third Health Programme 2014-2020 of the European Union. It was developed in the period June 1, 2018 - November 30, 2021, and involved 24 countries. It represented an important opportunity for member states to work together to address health inequalities and achieve greater equity in health outcomes across all groups in society in all participating countries and in Europe at large. The results of JAHEE show that almost all participating countries have increased their level of action to address health inequalities and strengthened their capacities in some important policy domains. 76 actions to contrast health inequalities were started during the Joint Action and a final Consensus Policy Document was produced including a set of cross-cutting recommendations. The proposed workshop will discuss the 3-year JAHEE project in the European region and through presentations and active participation review JAHEE actions, results of internal and external evaluations and discuss the main lessons learned. The session will go beyond sharing information and disseminating results and focus on what the JAHEE evaluation has taught us and how it can help improve health equity interventions in the future.
We plan to have:
a) Presentations
1. Short introduction to JAHEE and Actions
2. Presentation Internal Evaluation
3. Presentation External Evaluation
After the presentations there will be opportunity for interactive sessions with the participants to further explore the case studies and issues raised around evaluation and equity
b) Interactive Group Discussion
• What do the JAHEE evaluations findings add?
• What aspects of the evaluation were missing? What could have been improved?
• How can the lessons learned from the evaluation be applied to interventions in equity/ migrant health?
3) Feedback from Groups
4) Summary and Conclusions

Key messages
• No data no progress.
• Apply an equity lens: Evaluation in health equity actions is important for the sustainability of actions and contributes to the implementation of good practices.
The influence of onset of disease on exit from paid employment among workers in The Netherlands
Authors: Hijdra RW , Robroek SJW , Burdorf A , Schuring M 
Published: October 2022

Abstract

Background
This study investigates the influence of onset of disease on exit from paid employment, and whether this differs across diseases and sociodemographic groups.

Methods
Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010, and who did not use medication for the selected disease in 2009 (n = 5,889,036) were followed-up during 9-years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, psychological disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Cause-specific Cox Proportional Hazards regression analyses were performed, with interaction terms for age, sex, and migration background.

Results
Onset of disease increased the likelihood to exit paid employment, with strongest associations for psychotic disorders (HR 2.91, 95% CI 2.81-3.02) and psychological disorders (HR 2.01, 95%CI 1.98-2.04). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of psychological and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males.

Conclusions
Onset of diseases, especially mental health disorders, is a risk for early exit from paid employment. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.

Key messages
• Onset of all diseases increased the likelihood of exiting paid employment, through disability benefits, followed by unemployment.
• Onset of psychological and psychotic disorder had the strongest association with exiting paid employment, especially among males and workers with a migration background.
Citizens’ perspective on ‘the right care in the right place’
Authors: Damen L , De Jong JD , Van Tuyl L , Korevaar JC 
Published: October 2022

Abstract

Background
Healthcare systems around the globe are facing challenges, from increasing demand and costs to a diminishing health workforce. Without change, healthcare will become unsustainable. In the Netherlands, the government aims to organize sustainable healthcare by among others the policy ‘the right care in the right place’. An important part of this policy is relocating healthcare, for instance, from the hospital to the general practitioner (GP) or from the GP to other healthcare providers or to citizens themselves. Relocation of care is expected to reduce costs and manpower shortages. There is, however, little known about how citizens think about this topic, although they are an important stakeholder. This research aims to investigate citizens’ perspectives on the right place for care.

Methods
A questionnaire was sent in December 2021 to 1.500 members of Nivel's Dutch Healthcare Consumer Panel, including 4 questions about the right care in the right place. The response was N = 796 (53%). In addition, two citizen platforms were organized in March 2022, to discuss the right care in the right place. A total of 23 citizens participated.

Results
First results indicate that most citizens related expertise and accessibility to the right care in the right place. Participants said that non-complex care could be relocated from the hospital to the GP if the GP has the right expertise. Expertise was mentioned as the most important aspect of care delivery. According to participants, care could be shifted from the GP to other primary care professionals, to social services or to self-sustainability, given that citizens know who to visit or what to do with health problems/worries. More results will be available by November.

Conclusions
Relocating care could be a possible solution to keep healthcare sustainable in the future in terms of costs and manpower. Among citizens, there seems to be support when certain conditions are met.

Key messages
• Citizens support the substitution of non-complex care from hospitals.
• Citizens are willing to improve self-sustainability when they have the tools.
The role of public health scientists within the German political discourse on the COVID-19 pandemic
Authors: von Köppen M , Piel J , Apfelbacher C 
Published: October 2022

Abstract

Background
During the COVID-19 pandemic politics was in search of scientific evidence to underpin decision making like never before. It is remarkable that voices from public health were less noticeable than those of virologists or immunologists. The aim of our ongoing study is to explore how public health scientists perceive their role in the relationship of their discipline and politics.

Methods
We conducted 10 reflexive interviews with epidemiologists and public health scientists from Germany and collected documents (official statements and policy briefs of scientific societies). Data from both sources were analysed using situational analysis (Clarke, 2018), an approach used to map and analyse discourses in complex situations. To ensure data quality we used respondent validation.

Results
According to participants, (1) improving population health was the top priority. Politicians tended to focus on short-term goals rather than long-term consequences. (2) Recognition of public health was increased by the pandemic in Germany. (3) However, politicians favoured virology, biomedical and clinical perspectives. (4) The strong motivation of public health scientists to support politics at the beginning of the pandemic turned into disillusionment. (5) The composition of advisory boards was described as non-transparent. (6) Initiatives by the public health community were not sufficiently impactful. (7) Expectations of policymakers regarding future cooperation were not clear to participants.

Conclusions
The results present different facets of a delicate relationship between public health sciences and politics. The pandemic increased the visibility and impact of public health in Germany on the one hand but also demonstrated that the realms of public health (science) and politics were not well connected. Involving scientific expertise in politics requires more transparency and the normative assumptions underlying the logics of science and politics need to be made more explicit.

Key messages
• The potential of public health to address the covid-19 pandemic has not been sufficiently acknowledged by policymakers, and the involvement of its experts requires greater transparency.
• Reflecting on the normative assumptions underlying the different logics of public health sciences and politics can support their cooperation in the future.
An enhanced version of the PHIRI infrastructure: improving the analytical services
Authors: Estupiñán F 
Published: October 2022

Abstract
The PHIRI federated approach has consisted of the development of four research queries (use cases) mobilising individual data from a number of data hubs (nodes in the federation). Methodologically speaking, use cases have required the creation of specific cohorts of patients, population subgroups or populations, and the identification of events of interest - over-time differences in health status and care healthcare utilisation before and during the pandemic. Technologically speaking, PHIRI infrastructure consists of a distributed end-to-end analytical pipeline containing the statistical analysis workflow, including data quality assessment at origin and the mathematical algorithms. Once datasets are prepared in each data hub, partners run the analyses and produce a research output (dashboards containing the research results and tables with aggregated data) that is shared for results compilation and comparative analysis. An enhanced version of the PHIRI infrastructure should allow more complex data distribution. The research questions covered so far are aiming inference on populations or providers, which implies a very simple distribution methodology, as described. However, when the research questions requires inference on the individuals (eg, quasi-experimental study on the effectiveness of a real-life intervention), when the inference requires a hierarchical approach (ie, part of the variance is at individual level and part at cluster level) or when, several rounds of training are needed (eg, validation of an artificial intelligence) the approach would require sharing coefficients, distances in n-dimensional spaces or models, and, some times various rounds of distribution. Finally, an enhanced version of the PHIRI infrastructure should generalise the current FAIR approach limited to the publication of the analytical pipeline in ZENODO, setting up the services and tools required for an improved version of the PHIRI open-science strategy.
How to involve ‘hard to reach’ population groups in research projects
Authors: van der Ven LGL , van Baar JM , Wispelweij RS , Jambroes M 
Published: October 2022

Abstract

Issue
Addressing and reducing health inequalities is a major challenge in public health. Actively involving the most vulnerable populations groups in research projects in order to assess and address their needs is an important step towards reducing health inequalities. However, the most vulnerable groups are often perceived as the most difficult to reach for researchers.

Description
We conducted a research project to assess and address the health effects of the COVID-19 pandemic in vulnerable population groups. In three neighbourhoods, we identified the 2-3 most vulnerable population groups. We aimed to interview at least 20 participants per neighbourhood, evenly distributed among the groups, using creative and adaptive recruitment methods.

Results
Successful strategies differed per group. Strategies that proved successful were: rewriting information and consent letters together with the target population to help make them more accessible and attractive; using simple language in texts and while interviewing; asking the target population what type of compensation for the interview they would find most attractive; identifying persons who function as social hubs in the neighbourhood, asking them to help recruit participants, and providing them with financial compensation for their time; asking professionals in care and welfare organisations to help recruit among their clients; interviewing people in the places they would normally go to; snowball sampling. We met our recruitment goals.

Lessons
When working with ‘hard to reach’ populations, it takes researchers time, flexibility and creativity to find the right strategy to recruit participants while still respecting the boundaries set by GDPR and ethics committees. We recommend researchers to think about various possible recruitment strategies before starting a project, and to be prepared to change strategies during a project if necessary.

Key messages
• ‘Hard to reach’ populations are not really hard to reach, they just require a different mindset and skillset from the researcher.
• We encourage researchers to be creative and flexible in finding the right recruitment strategies in their project, and to think about various possible strategies before starting a project.