bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of COVID-19 cases with breakthrough infection in the governorate of Sousse, Tunisia
Authors: Ben Fredj S , Ghammem R , Zammit N , Maatouk A , Hadded N , Laadhari H , Maatoug J , Ghannem H 
Published: October 2022

Abstract

Introduction
In early 2021, Tunisia implemented a national COVID-19 strategy of vaccination aimed at disease elimination. In this study, we aimed to investigate the characteristics of the breakthrough COVID-19 infection in the governorate of Sousse, Tunisia.

Methodology
We conducted a cross-sectional study including all post-vaccination COVID-19 cases from March 2021 to August 2021. We collected data via 15-minute telephonic call interviews. We estimated the specific incidence rates (SIR) of confirmed cases by vaccine type and expressed them as cases per 100 000 inhabitants. Statistical analyzes were carried out using anonymous and codified Excel tables and SPSS 20.

Results
Overall, we included 618 cases of breakthrough COVID-19 infection. The majority were female (sex-ratio=0.8), and the average age of the overall cases was 55.7±14.5 years (range:19-91). Nearly half (49%) of participants had comorbidities, 19.6% were healthcare workers, and 17.9% were smokers. The majority of cases (70%) received at least one dose of Pfizer vaccine followed by CORONAVAC (15.6%; n = 96). Nevertheless, we found a higher incidence rate of COVID-19 among those vaccinated with SPUTNIK V (SIR=1551.2) followed by SINOPHARM (SIR=823.7). Fifty-eight percent of patients reported a poor adhesion to preventive measures, whereas 38.6% reported high respect for the preventive measures. COVID-19 infection led to hospitalization in 8.1% of cases, hospitalization in intensive care units in 2.1% of cases, and death in 1.8% of cases.

Conclusions
The findings of our study highlight the low rate of severe cases of COVID-19 among the vaccinated population. Furthermore, we found a discrepancy in the effectiveness of vaccines in the prevention of transmission potential. Yet, many factors could influence the transmission and the severity of COVID-19 breakthrough infection from one region to another.

Key messages
• low rate of severe cases of COVID-19 among the vaccinated population.
• discrepancy in the effectiveness of vaccines in the prevention of transmission potential.
Gender inequalities in mortality in Lithuania: the HAPIEE Study
Authors: Pikhart H , Tamosiunas A , Pikhartova J , Paulikaite E 
Published: October 2022

Abstract

Introduction
Gender inequalities in morbidity and mortality are important problem in countries of Central and Eastern Europe. Mortality difference between men and women in Lithuania is one of the largest in Europe. The aim of this analysis was to identify factors that influence this difference in population-based sample of middle- and older-age men and women from Lithuanian arm of the HAPIEE Study.

Methods
Data come from the Lithuanian part of international Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) longitudinal cohort study. The analytical sample included 3729 women and 3062 men aged 45-74 years at the study baseline. The study outcomes were all-cause, CVD and cancer mortality (mean follow-up approx. 10 years). Gender difference in study outcomes, and the role of wide range of socioeconomic, demographic, behavioural, metabolic and psychosocial covariates in this association was tested by regression modelling.

Results
There were 913 deaths (576 in men) during the follow-up. Men had higher odds of mortality compared to women: for all-causes OR 2.42 (95% CI 2.09-2.81); for CVD 2.48 (2.03-3.08); for cancer 1.92 (1.54-2.38). BMI was identified as an effect modifier for all-cause and cancer mortality. When adjusted for confounders such as smoking, alcohol consumption or paid work, and stratified for BMI, the gender difference reduced a little for CVD mortality but remained virtually unchanged for all-cause and cancer mortality.

Conclusions
We found substantial and statistically significant gender inequalities in mortality in this Lithuanian study. We found that men aged 45+ years were approximately two times more likely to die than women, with CVD mortality difference being even larger. Additionally, most of gender difference in mortality remained unexplained by the main social, psychosocial, behavioural and metabolic risk factors.

Key messages
• Large gender inequalities in mortality have been observed in this Lithuanian study of middle- and older-age men and women.
• Most of the inequalities have not been explained by available social, psychosocial, behavioural and metabolic risk factors.
Chronic diseases and multi-morbidity in persons experiencing homelessness: a cross-sectional study
Authors: Lutchmun W , Froeschl G , Gach J , Bader C , Borup C 
Published: October 2022

Abstract

Background
Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases, yet face significant barriers in accessing health services. We describe and compare chronic diseases and multi-morbidity in PEH, housing exclusion and secure housing who lacked access to regular health services in the wake of the COVID-19 pandemic in Germany.

Methods
Study participants were adults who sought care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three groups according to the European Typology of Homelessness and Housing Exclusion (ETHOS). We described socio-demographic characteristics, self-rated health, chronic diseases, multi-morbidity and SARS-COV-2 infections in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity.

Results
Of the 695 study participants, 333 experienced homelessness, 292 housing exclusion and 70 had secure housing. 92.3 % had no or limited health insurance and 96.7% were below the poverty line. Males and EU citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and higher rates of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, being 35-49 and ≥50 years was associated with greater odds of chronic diseases (AOR= 2.33, 95% CI = 1.68-3.24; AOR=3.57, 95% CI = 2.55-5.01, respectively), while being male was associated with lower odds of multi-morbidity (AOR=0.602, 95% CI = 0.38-0.9). Of the 18 symptomatic patients tested for SARS-COV-2 infection, 15 were PEH, of whom one tested positive.

Conclusions
Housing was not a risk factor for chronic disease and multi-morbidity in this study. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to health services for persons experiencing homelessness and housing exclusion are much needed in Germany.

Key messages
• Research to highlight the health inequity, both in access and outcomes, in persons experiencing all forms of homelessness is much needed.
• This study provides data on a population disconnected from the formal healthcare system. Making such data visible is a step towards addressing the structural causes of social exclusion.
The association between depression and quality of life in the elderly
Authors: Papageorgiou A , Bakola M , Kitsou KS , Mousafeiris V , Mavridou K , Kallianezos P , Kampouraki M , Charalambous G , Jelastopulu E 
Published: October 2022

Abstract

Background
Depression is the most common cause of emotional disorder in older adults causing functional impairment and leading to lower quality of life (QOL). The aim of the study was to investigate the prevalence of depression, measure the perceived QOL and evaluate the impact of depression on life quality of older people in the community.

Methods
We conducted a cross-sectional study in older people, enrolled in open day care centers and other healthcare facilities. To all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied to screen for depressive symptoms and the EQ-5D-5L scale to estimate their self-reported health status.

Results
A total of 634 seniors participated in the study, 53% were females, mean age 78 years. 45.6% of the participants showed moderate to severe depression. Those who suffered from at least two chronic diseases (75.6%) were more likely to develop moderate or severe depressive symptoms compared to those with only one (19.3%) or none (2.2%) chronic disease. Increased risk of depression was observed in people with Parkinson’s disease (56.5%), mental illness (47.1%), respiratory disease (40%) and stroke (35.1%). Regarding the EQ-5D-5L scale, 72% reported slight to extreme anxiety or depression, 68.2% slight to extreme pain or discomfort, 59.8% slight to extreme problems in performing usual activities, 59.8% in mobility and 40.1% in self-care, respectively. Significant differences were found between people with or without depression. Specifically, participants who reported slight to severe problems in all five domains of the EQ-5D-5L, showed higher levels of depression in the GDS-15.

Conclusions
Our results revealed that elderly with depressive symptoms have a lower quality of life. Given the mutual relationship between chronic diseases, lower life quality and depression, assessment of depressive symptoms are needed in elderly population, mainly in people with multiple chronic diseases.

Key messages
• Depression can be a predictor of poorer quality of life in older population.
People with diabetes have a substantial lower life expectancty
Authors: Hilderink H , Poos R , Leemrijse C , Heins M 
Published: October 2022

Abstract

Background
People with diabetes live shorter lives on average than people without diabetes. This is not only because they have diabetes, but also more often other chronic diseases. This causes a greater risk of death. It makes a difference what kind of diabetes someone has. In type 1 diabetes, the natural immune system does not work properly. In type 2, an unhealthy lifestyle plays a role. An unhealthy lifestyle increases the chance that someone will get type 2 diabetes and the chance that that person will die of another disease, such as cardiovascular disease.

Methods
RIVM has linked general practitioners’ data from 2012-2019 to the vital statistics of the Dutch National Statistical Office. The population of people registered with and without diabetes were coupled with the mortality data. Making use of life tables, associated life expectancies were calculated. For people under the age of 45, no robust analysis could be made.

Results
People aged 45 with type 1 diabetes live on average 13 years shorter than people without diabetes. For a 45-year-old with type 2 diabetes, that is on average 4 years shorter. The chance of dying is about 5 times greater for people aged 45 to 60 with type 1 diabetes than for people without diabetes of this age. This difference becomes smaller as they get older, because people without diabetes also get one or more diseases more often. In type 2 diabetes, the mortality rate for people aged 45 to 60 years is about 2 times greater than for people without diabetes. Again, the difference decreases as they age.

Conclusions
A substantial lower life expectancy of 13 years for type 1 and 4 years for type 2 diabetes has different societal and policy consequences. Since type diabetes 1 is unavoidable, more attention should be given to living with this condition, while for type 2 prevention of for example overweight should get attention.

Key messages
• People with for type 1 and type 2 diabetes have 13 and 4 years lower life expectancy.
• More attention should be given to prevention and to living with diabetes.
Association of HDL subfractions with cardiovascular risk in Hungarian general and Roma populations
Authors: Pikó P , Werissa NA , Kosa Z , Sandor J , Seres I , Paragh G , Adany R 
Published: October 2022

Abstract

Background
High-density lipoprotein (HDL) cholesterol levels are inversely associated with cardiovascular risk (CVR). However, HDL cholesterol is not a homogeneous lipid and can be subdivided into subfractions, which are not uniformly associated with CVR. Among Roma populations, the prevalence of reduced HDL cholesterol levels and, consequently, that of cardiovascular diseases is very high. However, it is not known how this reduction affects the different HDL subfractions and whether changes in their representation are associated with changes in CVR.

Methods
The study aimed to investigate whether there is a difference in the HDL subfraction profile between the Hungarian general (HG) and Roma populations and to determine the association of the different subfractions with the CVR estimated by the Framingham Risk Score (FRS) and the Systematic COronary Risk Evaluation (SCORE) algorithms. HDL cholesterol was separated using the Lipoprint system, which separates 10 subfractions into three classes: large HDL (HDL-L), medium HDL (HDL-I), and small HDL (HDL-S). Analyses were carried out on samples of 100 control subjects (50 Hungarian general and 50 Roma individuals with normal lipid profiles) and 277 individuals with reduced HDL-C levels.

Results
Our results show that Roma has reduced levels of the overall HDL subfraction profile, with significant decreases in HDL-6, and -7. Regardless of the estimation method, elevated levels (in mmol/L) of HDL-1 to 3 and HDL-L were significantly associated with reduced risk. A higher representation (in %) of HDL-1 to 3 subfractions have a significant risk-reducing, while HDL-8 to 10 have a risk-increasing effect estimated by FRS.

Conclusions
The results of our study show that levels of CVR protective HDL subfractions are significantly lower in Roma individuals and their reduced levels are associated with increased CVR, suggesting that the distribution of HDL subfractions contributes to the overall unfavourable CVR profile of Roma.

Key messages
• Levels of HDL-6 and -7 subfractions were significantly lower in the Roma population than in the Hungarian general one.
• The HDL subfraction profile of the Roma population is associated with a higher cardiovascular risk among them.
Anticipating the unimaginable: Heat Health Warning Systems in Europe and Australia
Authors: Parkes M , Bone A , Csutoros D 
Published: October 2022

Abstract

Background
It has long been a maxim of climate and health research that heatwaves kill more people than all other natural disasters combined. Heatwave frequency, severity and duration have increased as climate change intensifies, and recorded temperatures during recent heat events now regularly surpass previous worst-case projections. Temperate zones, between 40°-60° north or south of the Equator, are particularly vulnerable, as small variations in mean temperature can trigger large-scale increases in morbidity, mortality and concomitant health service strain. Heat Health Warning Systems (HHWSs) combine temperature forecasts with public health actions to mitigate these impacts. However, in the absence of a consensus definition of heatwaves multiple systems have developed, and comparative analysis of the effectiveness of different HHWS and their interventions are hindered by lack of a common threshold metric for defining and predicting heatwave severity.

Methods
This paper provides a comprehensive review of current HHWS and their evidence base in temperate zones in Europe, the United Kingdom and Australia - contiguous landmasses containing multiple jurisdictions with high heterogeneity in local HHWSs, in which single heatwave events trigger vastly different public health responses. A systematic review of available published and grey literature was undertaken to generate a schema of HHWSs in these zones. Results were then narrowed to review and synthesise evidence for each, with a focus on threshold effectiveness in predicting health impacts.

Results and conclusions
Over twenty distinct HHWS are reviewed, with substantial variation in the evidence for their effectiveness. We make the case for a unified threshold metric for defining heatwaves, to facilitate research and identify warning systems which accurately predict health impacts and effectively communicate risk.

Key messages
• Lack of definitional consensus and heterogeneity in threshold metrics hinders comparison of Heat Health Warning Systems.
• Accurate prediction and rapid communication of heat risk is crucial to prevent health impacts of heatwaves.
Use of Hashtags related to Covid-19 infodemics by bot accounts
Authors: Suarez-Lledo V , Ramos-Fiol B , Ortega-Martin ME , Carretero-Bravo J , Alvarez-Galvez J 
Published: October 2022

Abstract

Background
Along with the Covid-19 pandemic we need to fight an ‘infodemic'. Some of the most widespread social media platforms such as Facebook, Instagram and Twitter have implemented policies to combat the spread of misinformation about Covid. However, the online ecosystem is still full of health myths, hoaxes, and fake news that-either consciously or unconsciously-is propagated by social media users with different purposes, messages that can lead to attitudinal and behavioral changes which might result in inadequate health decision making

Methods
We use Twitter Stream API to collect tweets about Covid-19 during the early outbreak. Then we filtered those tweets with hashtags related to three infodemic topics: 5g, bill gates, UV and hydroxychloroquine. Then, we use Botometer to obtain the probability that each account is a bot or not. We use bot classification along with network analysis (Louvain community detection) to delve into the subtopics and the use of hashtags.

Results
The resulting data collection contains ∼14M tweets from ∼285K of different Twitter accounts. We selected only tweets written in English. Regarding 5G, the most important communities link China with the virus, are about “democratshateamerica” or conspiracy theories. Tweets about Bill Gates contain hashtags about Trump, America, or mention the batflu. Communities related with UV are about Trump disinfectant, or pointing out that tv channels spread fake news. Those tweets that mention hydroxychloroquine mostly contain hashtags that mention qanon or maga content.

Conclusions
In this paper, we analyze the use of hashtags by accounts classified as bots. Using Louvain community detection we identify co-occurring hashtags. Using social network analysis we identify which hashtags are the most important within the conversation.

Key messages
• We identify several communities around most important infodemic topics. Bots activity in most of the cases is about political content than spreading health misinformation.
• This method allows to find subtopics based on the use of hashtags. Which allow public health policies to prevent the spread of infodemics.
How to design information strategies on e-mental health services for prospective healthcare providers
Authors: Braun P , Schwientek A-K , Loerbroks A , Apolinário-Hagen J 
Published: October 2022

Abstract

Background
Among prospective healthcare providers (HCPs) such as medical students, mental health problems are prevalent, but they seem reluctant to seek help. Barriers include fear of stigmatization or limited resources of counseling centers. Electronic mental health services (eMHSs) seem to be promising low-threshold and evidence-based tools for increasing treatment availability. However, uptake rates remain low. Reasons include skepticism and lacking awareness, which can be addressed through acceptance-facilitating interventions (AFIs) such as multi-attributes information strategies. To date little is known about how to design AFIs to meet prospect HCPs’ information needs and preferences.

Methods
Between August 2021 and June 2022, n = 21 semi-structured online interviews and n = 3 co-design workshops were conducted with medical and psychology students across Germany to define attributes and levels of information strategies. Interviews were recorded, transcribed and content-analyzed using MAXQDA.

Results
Most students reported having little knowledge about eMHSs but would have liked to be informed at the beginning of their studies or as an integral part of their study program. We identified 5 attributes that information strategies should consist of: information source (e.g., student counseling center), information path (e.g., flyer), timing (e.g., during freshman week), recommendation (e.g., from HCPs), and quality criterion (e.g., evidence-base). Attributes included 4 to 6 levels. Concerning design preferences, students favored green or blue as colors, and short texts with images.

Conclusions
For a comprehensive dissemination of eMHSs into the healthcare system, prospective HCPs need to be educated on eMHSs. This study gives first insight into how AFIs should be designed to inform prospective HCPs. Future research should focus on systematic variations of AFIs’ attributes and their levels mimicking real-world decision scenarios through discrete choice experiments.

Key messages
• Through tailored AFIs, prospective HCPs can be informed about eMHSs for both personal and professional needs.
• Our results give student counseling centers with limited resources clear guidelines on how to inform prospective HCPs on low-threshold eMHSs.
Use and barriers to the use of telehealth services among the Arab population in Israel
Authors: Laron M , Penn N 
Published: October 2022

Abstract

Background
Telehealth services tends to be used relatively infrequently by minority populations, thereby exacerbating health inequalities. This study examines the individual, circumstantial and environmental factors that facilitate or hinder usage of telehealth among Israeli Arabs, who constitute 21% of the Israeli population.

Methods
Data was collected through a telephone survey among the adult Arab population in October 2020 with 501 respondents (42% response rate). Analysis included logistic regression.

Results
Most of the Arab population use the internet several times a week (93%) and have a smartphone (96%). The most popular telehealth service was telephone appointments with a doctor (66%). Two thirds have never used the health plan’s mobile application, though most have no objection to using chat (75%) or video conversation (51%) with a medical professional. The most significant barrier to using telehealth is lack of awareness of services such as ordering medicines (23%). Conversely, factors that facilitate the use of telehealth include previous acquaintance with the doctor (91%); Arabic services (82%); and recommendation by health professionals (79%). Multivariate analyses indicate a strong positive correlation between education and the use of telehealth for written correspondence with a known health professional (p = 0.001).

Conclusions
Telehealth services (e.g., phone appointments) which are already used widely by the Israeli-Arab population, should be retained and developed further. In parallel, digital health literacy and linguistically and culturally adaptation of digital services should be promoted. Awareness of those services should be enhanced through culturally adapted marketing and via recommendations from the family doctor.

Key messages
• Identification of the barriers to the use of telehealth services among minority populations can help service providers reduce usage gaps between minority and majority population.
• The use of telehealth services should be simplified to suit people with a low digital health literacy.