bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining impact of Twitter sentiment & source on COVID-19 info sharing by public
Authors: Parveen S , Garcia Pereira A , McHugh P , Surendran A , Vornhagen H , Vellinga A
Published: October 2023

Introduction

Public health communication programs have the power to affect change in people and groups by increasing awareness, enhancing knowledge, modifying attitudes and altering behaviours when they are properly designed, meticulously executed and maintained over time. There has been an influx of public health communication on social media during COVID-19.

Aim

To investigate if the Twitter user category (source) and/or message type (sentiment) impacts sharing behaviour of the public during COVID which would help understand how to use social media when communicating health messages.

Methods

All tweets in English were extracted using Twitter API and Python script. Data was extracted from 1 Jan 2020 to 31 Mar 2022 for Ireland and UK which resulted in 867,485 tweets in total. Four coders identified user categories by studying the user descriptions in an iterative process and sentiment analysis was conducted to identify message types during the pandemic. For sentiment categorisation, a similar approach was followed where four message categories were identified from existing public health literature and additional categories were created through the analysis of Twitter messages by five coders. Different Machine learning (ML) models and Chat GPT were applied to assign user categories and sentiments to the entire dataset and the model with the highest level of agreement with human coders was chosen.

Results

Overall the public sentiment was negative during the pandemic. Twelve user categories and seven message types were identified from our analysis.

Conclusions

Further detail of this ongoing analysis will be presented at the conference.

Key messages

• The abstract introduces a study that investigates the impact of Twitter user categories on the sharing behaviour of the public during COVID-19.

• The study investigates the impact of message types on the sharing behaviour of the public during COVID-19 on Twitter.
A Guide to AI in epidemiology: ChatGPT and the STROBE checklist for observational studies
Authors: Golinelli D , Sanmarchi F , Nuzzolese A , Toscano F , Bucci A , Nante N
Published: October 2023

Background

Chat-Generative Pre-training Transformer (ChatGPT) is a recently developed Artificial Intelligence (AI) model capable of generating high-quality scientific text and answering complex tasks. This study aims at investigating how AI-based transformers can support public health researchers in designing and conducting epidemiological studies. To accomplish this, we used ChatGPT to reformulate the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) recommendations for observational studies into a list of questions to be answered by the transformer itself. We then qualitatively evaluated the coherence and relevance of the transformer's outputs.

Methods

We first chose a study to be used as a basis for the simulation. We then used ChatGPT to transform each STROBE checklist's item into specific prompts. Each answer was evaluated by independent researchers in terms of coherence and relevance.

Results

The mean scores assigned to each prompt were heterogeneous. On average, for the coherence domain, the overall mean score was 3.6 out of 5.0, and for relevance it was 3.3 out of 5.0. The lowest scores were assigned to items belonging to the Methods section of the checklist.

Conclusions

ChatGPT can be considered as a valuable support for researchers in conducting an epidemiological study, following internationally recognized guidelines. It is crucial for the users to have knowledge on the subject and a critical mindset when evaluating its outputs. The potential benefits of AI in scientific research are undeniable, but it is crucial to address the risks, and the ethical and legal consequences associated with its use.

Key messages

• Our analysis showed the ability of AI-based transformers to generate answers and human-like text, which could potentially be used to conduct epidemiological studies or write research articles.

• We advocate the necessity for taking a proactive stance towards this evolving context, in order to ensure a careful governance of this inevitable process.
Role of digital media in vaccination promotion. Second report on VaccinarSinToscana.org experience
Authors: Caldararo R , Bechini A , Cosma C , Cerini G , Guida A , Monaci P , Velpini B , Chiesi F , Boccalini S , Bonanni P
Published: October 2023

Background

Since March 27, 2017, the Department of Health Sciences, University of Florence, has been managing and editing an online portal of medical and scientific information, focused on preventive health care and vaccinations: “VaccinarSinToscana.org” (Get vaccinated in Tuscany). The aim of this study is to analyze website's consultation activity over the past four years by single users, visits and single webpage consultation.

Methods

VaccinarSinToscana website activity during the study period April 01, 2019-March 31, 2023 was investigated using Google Analytics. Microsoft Excel was used for data analysis.

Results

During the study period 365,070 new single users visited the portal and nearly 15% of them entered more than once for about 447,000 sessions. A total of 815,800 single web pages were visited individually, with an average of 2.23 web pages consulted per visit and an average session duration of 58 seconds. The largest increase in visits occurred in January 2021-June 2021 with the highest peak in March (155,737 single web pages). The most visited pages were about the national vaccination calendar, regional vaccine clinics, and the types of anti-COVID-19 vaccines available (particularly, the viral vector vaccines). Analysis of socio-demographic characteristics showed that the users most attracted to web consultation were female (57%) and the most ‘digital’ age group was 25-34 (24%). Other age groups account for 14% (18-24 years), 22% (35-44 years), 17% (45-54 years), 13% (55-64 years), and 11% (over 64 years). Mobile phones were the most used devices to access the portal (69%), personal computers for 28% and tablets for 3%.

Conclusions

The analysis of web pages consultation trend showed a relevant exponential increase of visits in the period January 2021-June 2021. The greatest interest of users, in this period marked by the early stages of the national SARS-CoV-2 vaccination campaign, was for searching news regarding anti-COVID-19 vaccination.

Key messages

• Institutional websites with evidence-based information could be useful tools for users to increase public confidence in vaccination.

• The anti-COVID-19 vaccine campaign has increased website visit, demonstrating how this period has been characterized by curiosity, doubt, and citizens’ search for more information.
Identifying infodemic sources of exposure, its effects, response capacities and needs in Serbia
Authors: Mandić-Rajčević S , Stevanović A
Published: October 2023

Background

Serbia has secured adequate quantities of COVID-19 vaccines and ensured continuous access and delivery. However, vaccine uptake has remained a major public health issue due to the infodemic - an overwhelming amount of information, making it difficult for the population to make the right decisions regarding their health. This study aimed to identify the sources of exposure to the infodemic, its effects, existing capacities, and the needs of public health practitioners in Serbia.

Methods

Infodemic management (IM) training and discussions were organized for public health (PH) professionals, civil society organizations (CSOs), and academia in three different regional Institutes of Public Health in Serbia. After learning about the basic terms in IM, the participants discussed infodemic topics in small groups using the “gallery walk” method. Facilitators wrote down their answers and moderated the discussion.

Results

Overall, 57 PH practitioners participated in the lessons, discussions, and the “gallery walk”. Participants identified media, including social media, public figures, healthcare personnel and community members as the main sources of infodemic exposure. The most recognized topics were infectious diseases, natural disasters, immunization, nutrition, and environmental issues. Participants identified the reduced trust in health authorities, lower compliance with health recommendations, and lack of satisfaction in both patients and healthcare workers as possible effects of the infodemic. Most participants underlined the lack of support regarding the production of high-quality health information and science communication.

Conclusions

The PH community in Serbia has identified infodemic and infodemic management as a priority in the future and has already conducted activities that are part of the Framework for managing infodemics. Their work could be supported by organizing a network for the exchange of materials, knowledge, and experience.

Key messages

• PH professionals identified media, public figures, healthcare personnel, and community members as sources of infodemic exposure.

• The main infodemic effects are reduced trust in health authorities, lower compliance with health recommendations, and lack of satisfaction in patients and healthcare workers.
ChatGPT for Systematic and Scoping Reviews in Public Health Research: An Applicable Approach
Authors: Miranda P , Kaur J , Abhari S , Morita P P
Published: October 2023

Background

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) is a well-defined framework that guides researchers in compiling knowledge from a domain and presenting it with clarity, objectivity, and relevant information to their peers. PRISMA has been widely used in public health research to conduct systematic and scoping reviews and contribute to the body of knowledge. However, with the ever-increasing production of new studies, a valid sample of the number of papers available may not be represented by any systematic review in the future.

Methods

In this work, we propose the utilization of technologies such as chat-GPT as a tool to automate parts of the PRISMA process and increase the proportional representation that one systematic review can provide. We present an unguided exploratory experiment with chat-GPT that retro-fed information about PRISMA until chat-GPT created a data structure suitable to be used by crawlers to conduct PRISMA data collection. We also used the created data structure as input to chat-GPT in an attempt to summarize the information contained in the document in the format of a systematic review.

Results

The created data structure was also used to help do a systematic review summary using chat-GPT.Also, results indicate that this approach has the potential to increase the efficiency and scalability of systematic reviews.

Conclusions

The proposed approach has the potential to enhance the effectiveness of systematic and scoping reviews and increase the proportional representation of the number of papers available. While further research is necessary to assess the feasibility and scalability of using chat-GPT in this context, this study highlights the promise of leveraging new technologies to improve the quality and efficiency of systematic reviews in public health research.

Key messages

• PRISMA is a systematic review framework that is both effective and intricate, requiring significant time and effort to execute.

• The utilization of chat-GPT can automate parts of the PRISMA process and increase proportional representation in systematic reviews.
Food emulsifiers and risk of type 2 diabetes: results from the prospective NutriNet-Santé cohort
Authors: Salame C , Srour B , Viennois E , Huybrechts I , Hercberg S , Deschasaux-Tanguy M , Cosson E , Tatulashvili S , Chassaing B , Touvier M
Published: October 2023

Background

Emulsifiers are the most ubiquitous food additives. Experimental studies showed an emulsifier-induced gut microbiota dysbiosis stimulating inflammation. This study is the first to investigate the association between food additive emulsifiers and type 2 diabetes risk in a large population-based cohort.

Methods

Repeated 24h dietary records with brand-specific information were administered within the French NutriNet-Santé cohort (2009-2022), allowing qualitative and quantitative assessment of food additive exposures. Multi-adjusted cox models were used for statistical analysis.

Results

This study included 104,168 adults (79.2% women, mean age at baseline=42.7y (SD 14.5)). 1,057 incident T2D were diagnosed. Intakes of total emulsifiers (HR = 1.18[1.00-1.39] for tertile 3 vs 1, p-trend=0.049), total carrageenan (HR = 1.20[1.01-1.42], p = 0.04), tripotassium phosphate (E340, HR = 1.45[1.10-1.91], p < 0.001), triphosphates (E451, HR = 1.39[1.16-1.67], p < 0.001), polyphosphates (E452, HR = 1.36[1.14-1.62], p < 0.001), total polyglycerol esters of FAs (HR = 1.34[1.10-1.63], p < 0.001), polyglycerol esters of interesterified ricinoleic acid (E476, HR = 1.26[1.03-1.54], p < 0.001), sodium citrate (E331, HR = 1.19[1.02-1.40], p = 0.03), carob bean gum (E410, HR = 1.19[1.01-1.40], p = 0.03), guar gum (E412, HR = 1.35[1.14-1.59], p < 0.001), xanthan gum (E415, HR = 1.29[1.09-1.52], p < 0.001) and ammonium salts of phosphatidic acid (E442, HR = 1.31[1.03-1.66], p = 0.01) were positively associated with T2D risk. The only inverse association was observed for sodium bicarbonate (E500, HR = 0.84[0.71-1.00], p = 0.047).

Conclusions

This study revealed direct associations between T2D risk and exposures to nine individual and two groups of food additive emulsifiers widely used in industrial foods in a large prospective cohort of French adults. If confirmed, these findings could lead to a reevaluation of regulations governing the use of food additive emulsifiers in the food industry for a better consumer protection.

Key messages

• Study finds positive associations between certain emulsifiers and type 2 diabetes risk in French adults.

• Results highlight the need for re-evaluation of regulations for food additive emulsifiers to protect consumer health.
Patterns in tobacco attributed mortality in Belgium for 2019
Authors: Guariguata L , Nayani S , Gorasso V , Scohy A , De Pauw R , Devleesschauwer B
Published: October 2023

Introduction

Tobacco use is one of largest contributors to preventable disease burden in the world. In Belgium, tobacco use is a public health concern and prominent on the policy agenda. To monitor tobacco use and understand the impact on associated outcomes, we estimated the population attributable fraction (PAF) to tobacco use in Belgium and used that to compute the attributable mortality.

Methods

We used comparative risk assessment to calculate PAF and attributable mortality to tobacco use. Using estimates of tobacco use from a time series based on five waves of the Belgian Health Interview Survey and relative risk estimates from the Global Burden of Disease Study 2019, we calculated PAFs for risk-outcome pairs by age and sex for the three regions of Belgium for 2019. We then used these fractions to estimate the deaths attributable to tobacco use with mortality estimates taken from the Belgian Burden of Disease Study.

Results

In Belgium, 9323 deaths among adults 30+ years in 2019 were attributable to tobacco use (PAF=13%). Tobacco-attributable deaths were highest in the Wallonia (PAF=16%, n = 3786) followed by the Brussels-Capital region (PAF=15%, n = 894) and Flanders (PAF=11%, n = 4642). Almost three times as many attributable deaths occurred in men as women (19%, n = 6803 vs PAF=7%, n = 2519, respectively). Almost half attributable deaths occurred in people under 70 (n = 4469). The majority of tobacco-related deaths were due to cancer of the trachea, bronchus and lung (PAF=50%, n = 3671) followed by chronic obstructive pulmonary disease (PAF=29%, n = 1580), and ischemic heart disease (PAF=7% n = 673).

Conclusions

Tobacco use is a major contributor to mortality in Belgium. The majority of deaths attributable to tobacco use are considered premature. Tobacco prevention and control should remain high on the public health agenda.

Key messages

• Tobacco use contributed to 13% of deaths in tobacco associated outcomes in Belgium among adults in 2019.

• Tobacco control and prevention should remain high on the Belgian public health agenda.
Epidemiological and clinical characteristics of Mpox Cases in Serbia in 2022
Authors: Jovanovic V , Djuric P , Drakulovic M , Plavsa D , Jovanovic S , Medarevic A
Published: October 2023

Introduction

Mpox viral infection, previously known as an endemic zoonosis typical for West and South Africa, appeared in the Republic of Serbia in early summer among young and middle-aged men, particularly Belgrade's citizens. The aim of this study is to evaluate the epidemiological and clinical characteristics of Mpox cases registered in Serbia in 2022.

Methods

We conducted a national observational study using the national surveillance anonymized data of people who met case definition criteria on Mpox infection and confirmation by the polymerase chain reaction method. Clinical data were collected by standardized case investigation form used for epidemiological and clinical evaluation of cases.

Results

A total of 43 cases reported from the 17th of June to the 5th of October 2022 were men, aged between 20 and 54 (median age, 35 years), 74,4% living in Belgrade. Three-quarters of cases reported sex with other men as a potential disease transmission route. Out of the total, 15 (34,9%) Mpox cases had HIV co-infection. HIV-positive patients were older than negative cases (p = 0,023). The mean incubation period among patients who reported exposition to a probable or confirmed case was 9,3 (2-22) days. The most common systemic symptoms were fever (86%) and lymphadenopathy (44,2%). Three patients with common symptoms of fever were hospitalized. All cases presented a rash, mostly in pustule form (90,7%). The dominant localization of the skin lesions was the anogenital region (62,5%), whereas 9,3% of the patient's lower extremities were affected.

Conclusions

In Serbia, the outbreak of Mpox infection affected young and middle-aged men, mainly situated in the capital of Serbia. The disease had a polymorphic presentation, including a characteristical rash of the anogenital region implying the main transmission route.

Key messages

• Health promotion and community engagement regarding Mpox are very important in large urban settings.

• Risk communication should be prioritized to promote safe sexual practices in vulnerable populations.
Eating behaviour of the Croatian working population during the COVID-19 pandemic
Authors: Miskulin M , Milas J , Miskulin I , Kovacevic J , Vukoja I , Pavlovic N , Nujic D
Published: October 2023

Background

Disruption in the defined daily work and life routine caused by the COVID-19 pandemic has led to changes in the eating habits of the population. Home confinement during pandemics could change eating patterns, reduce diet quality, and promote overconsumption. This study aimed to evaluate the eating habits of the Croatian working population during the COVID-19 pandemic.

Methods

This cross-sectional questionnaire study was conducted from February to June 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic and anthropometric data, and data on eating habits, was self-administered to a convenient sample of Croatian working adults from central and northwestern Croatia.

Results

The study sample included 939 subjects with, a median age of 42 years (interquartile range 35-48), 35.4% males, and 64.6% females. Overweight and obesity were more frequent among males (p < 0.001), subjects with a lower level of education (p < 0.001), and subjects living in households with more household members (p < 0.001). In comparison to subjects with normal weight, during pandemics, overweight subjects more frequently gained weight (p < 0.001), more frequently consumed a larger amount of food than usual (p < 0.001), consumed snacks more frequently (p = 0.001), and cooked more in their households (p = 0.042). Consumption of more snacks during the pandemic was more frequently detected among females (p = 0.007), and subjects with a higher level of education (p = 0.045), while latter subjects also cooked more in their households (p < 0.001).

Conclusions

This study highlights that COVID-19 preventive measures have affected the eating behaviours and dietary habits of the Croatian working population. To avoid possible negative health effects of observed changes organized nutritional education and support should be implemented at the population level, particularly for the most vulnerable groups, including overweight and obese subjects.

Key messages

• The COVID-19 pandemic has changed the eating behaviour and dietary habits of the Croatian working population.

• To avoid an increase in chronic diseases connected with an imbalanced diet there is a need for the implementation of organized nutritional education and support at the population level.
Burden of heart failure in Kazakhstan: data from the unified national healthcare system 2014-2021
Authors: Zhakhina G , Gusmanov A , Sakko Y , Yerdessov S , Mussina K , Gaipov A
Published: October 2023

Background

Heart failure (HF) affected 64.3 million people worldwide and contributed to 9.9 million years lived with disability globally in 2017. Despite its global relevance, there is a lack of comprehensive statistics on the prevalence, incidence, and burden of HF in developing Central Asian countries. This study aims to fill the gap and present the data for Kazakhstan, the largest Central Asian country.

Methods

HF cases were identified through the Unified National Electronic Healthcare System records for 2014-2021 using the appropriate ICD-10 codes. Descriptive and survival analyses were used to present demographics, incidence, prevalence, and mortality rates. The calculation of DALYs is done according to the WHO methods. The information on comorbid conditions based on respective ICD-10 codes was collected by merging the databases using unique deidentifying patient numbers.

Results

During the observation period between 2014-2021 years, 501,663 patients with HF were identified, of them 52% were females, 86% were older than 50 years of age, and 58% were of Kazakh ethnicity. Hypertension, history of cerebrovascular diseases, and myocardial infarction were present in 40%, 34%, and 22% of the cohort, respectively. The age and sex-specific incidence show that women have higher incidence before 30 years of age compared to men. In addition, incidence rates for both sexes and all age categories decreased in 2021 compared to 2014. The prevalence dramatically increased from 4393 people per million population (PMP) to 22,088 PMP, while mortality rates changed from 367 to 721 PMP during the observation period. In 2021, 2,964,062 age and disability-adjusted life years (DALYs) were lost due to HF in Kazakhstan. More than 2 million DALYs belong to years of life lost (YLLs).

Conclusions

The DALYs show high economic and social loss due to high mortality among patients. Healthcare policymakers should prioritize the enhancement of cardiac services and the mitigation of its risk factors.

Key messages

• This study highlights the high burden of heart failure in Kazakhstan, with over 2 million DALYs lost in 2021 alone. Healthcare policymakers must prioritize cardiac services and risk factor reduction.

• Lack of comprehensive data on HF in Central Asia made it difficult to tackle the burden. This study fills this gap, presenting valuable information for policymakers to reduce social and economic loss.
The indirect effects of socioeconomic position on lung function: a mediation analysis
Authors: Quispe-Haro C , Pikhart H , Bobak M
Published: October 2023

Background

There is a strong link between socioeconomic position and pulmonary health, but less is known about their connecting pathways. We analyzed the direct and indirect effects of education and deprivation on lung function using air pollutants in a mediation framework.

Methods

We used spirometry tests, demographic, and health information on 5703 Czechs, with a mean age of 58.3 ± 7.1 years from the Health, Alcohol, and Psychosocial Factors in Eastern Europe (HAPIEE) cohort study between 2002 to 2005. The annual means of particulate matter 10 (PM10), particulate matter 2.5 (PM2.5), and nitrogen dioxide (NO2) estimated by Shen et al. (2022) for the years 2000 to 2003 were matched to the geographic addresses of the participants. Multiple mediation analyses assessed the relationship between socioeconomic variables (education and deprivation) and the predicted percentage of Forced Expiratory Volume in the first second (FEV1) and the role of mediators: PM10 or PM2.5 or NO2, smoking behavior, and body mass index (BMI). The models were adjusted for sex, age.

Results

9.27% of individuals had <70% of the predicted percentage of FEV1. We tested the first model using PM10, smoking, and BMI as mediators. We found significant indirect effects from education through PM10 (β = 0.17, CI95%: 0.10-0.25), BMI (β = 0.36, 0.25-0.47), and smoking (β = 0.17, 0.08-0.25) with indirect effects explaining 34% of the total effect of education. The indirect effect of deprivation was significant only through smoking (β=-0.11, -0.14 to -0.07), explaining 31% of the effect of deprivation. Similar results were observed when we tested a second model using PM2.5 instead of PM10, and a third model including NO2 instead of PM10.

Conclusions

Air pollutants seem to mediate the association between education and lung function, but not between deprivation and lung function, however, further research is needed to confirm our findings.

Key messages

• Higher education appears to be associated with better environmental factors that prevent loss of lung function.

• Most of the routes that connect socioeconomic factors and lung function remain unclear.
Prevalence of fatigue in the general population during the pandemic: cross-sectional study in Geneva
Authors: Graindorge C , Baysson H , Pullen N , Schrempft S , Zaballa M E , Stringhini S , Guessous I
Published: October 2023

Background

Fatigue is a frequent symptom, the determinants of which are numerous and poorly understood. Fatigue also predicts ischemic heart disease, cancer, physical decline, and mortality. While the COVID-19 pandemic constituted a major stressor, no previous studies have measured the prevalence of fatigue and its determinants since the beginning of the pandemic in a general population. This study aims (1) to assess the prevalence of fatigue among the general population of the canton of Geneva, Switzerland, two years into the pandemic and (2) to analyse its determinants.

Methods

A cross-sectional population-based study was conducted as part of the Specchio-COVID19 cohort study. Adult participants answered an online health survey between March and May 2022. The main outcome was self-reported fatigue measured by the Chalder Fatigue Questionnaire. Other variables included general and mental health status, quality of life, and sociodemographic data. Multivariable logistic regressions were used to evaluate the determinants of fatigue.

Results

4040 participants took part in the survey (participation rate 59%, respondents and non-respondents were comparable). The overall prevalence of fatigue was 31%. Significant determinants of fatigue were depression (aOR 10.49 [6.29-17.50], p < 0.001), diagnosis of a chronic disease in the past year (aOR 1.37 [1.12-1.68], p = 0.002), and an acute health event in the past year (aOR 1.44 [1.08-1.93], p = 0.014). 18-45-year-old people with a chronic disease were more likely to report fatigue (aOR 1.70 [1.04-2.77], p = 0.033). Male gender (aOR 0.72 [0.57-0.92], p = 0.007) or retirement (aOR 0.60 [0.43 - 0.85], p = 0.003) were protective factors. Age, level of education, and income were not significantly associated with fatigue.

Conclusions

Fatigue was still highly prevalent in the general population two years into the COVID19 pandemic, comparing to regional prepandemic data. The cohort Specchio will monitor the evolution of fatigue after the pandemic.

Key messages

• Fatigue was still highly prevalent two years into the COVID19 pandemic among the general population in Geneva, comparing to regional prepandemic data.

• Longitudinal follow-up is crucial to assess how fatigue is evolving after the pandemic.
Effect of job guarantees on youth unemployment: its impact on socioeconomic and health inequalities
Authors: Molenberg FJM , Riumallo-Herl C J , Burdorf A , Schuring M
Published: October 2023

Background

The first aim is to investigate the effect of the Rotterdam job guarantee on enrolment into educational trajectories, graduation, and employment outcomes among vocational education students. Second, whether the Rotterdam job guarantee reduced inequalities in these outcomes for youth from lower SEP and youth with a mental health condition.

Methods

A register-based longitudinal cohort study among Dutch individuals who started secondary vocational education between 2011 and 2017 and lived in intervention (n = 20,865) or control neighborhoods (n = 17,157) in the city of Rotterdam. Educational tracks were categorized in Type A education, with a job guarantee for students living in intervention areas, and Type B education, without a job guarantee. The effect of a job guarantee on enrolment into educational trajectories, graduation and employment outcomes was analyzed with difference-in differences analyses. Stratified analyses were performed based on 1) migration background, 2) employment status of the parents, and 3) medication use for mental health problems.

Results

The job guarantee offered to vocational education students living in deprived neighborhoods did not have an impact on educational enrolment or employment. A small decrease in graduation was seen. Implementation of job guarantees increased enrolment into tracks with a job guarantee for students with a non-native Dutch background and for youth with a mental health condition.

Conclusions

This study did not find evidence that job guarantees offered to youth living in deprived neighborhoods had an impact on unemployment. The intervention was targeted at educational tracks where youth were about 90% of the time employed, leaving little opportunity for job guarantees to contribute to employment. Better promotional activities to inform students about the intervention, and expanding job guarantees to other employment sectors, is needed to maximize possible gains of job guarantees.

Key messages

• This study did not find evidence that job guarantees offered to youth living in deprived neighborhoods had an impact on unemployment.

• Better promotional activities to inform students about the intervention, and expanding job guarantees to other employment sectors, is needed to maximize possible gains of job guarantees.
A Comparative Study of Financial Support and Resilience of Self-Employed people in Sweden and Canada
Authors: Hansson J , MacEachen E , Landstad B J , Vinberg S , Tjulin Å
Published: October 2023

Background

Globally the COVID-19 pandemic presented major difficulties for self-employed people such as financial decline, restrictions and business closures. A plethora of financial support measures was rolled out worldwide to support them, but there is a lack of research looking at the effectiveness of the policy measures on small businesses. The aim of the study was to compare policies addressing government financial support in Sweden and Canada to get an understanding of how different governmental financial support measures enhanched self-employed people's resilience and improved their chances to manage the pandemic. In addition, individual interviews with Swedish and Canadian self-employed people were conducted to get an understanding of how they experienced the support measures and how these measures factored into their resilience during and after the restrictions had ended.

Methods

We conducted a mixed-method study encompassing document analysis and semi-structured interviews with self-employed people in Sweden and Canada. The constant comparative method guided the data analysis and documentary and interview data were analysed together. Three categories were formed: Welfare protection and effects, Self-employed well-being and Agility during COVID-19, based on their ability to represent the overall sense of the phenomena.

Results

Key results were that self-employed people in both countries unable to telework, were less resilient during the pandemic due to financial problems, restrictions and lockdowns, and that this negatively affected their well-being.

Conclusions

Potential future policy responses in Sweden and Canada to support self-employed people during crises or adversity should consider the diversity among small businesses and tailor programmes towards viable businesses in greatest need of support, such as those in businesses unable to telework.

Key messages

• Self-employed people in Sweden and Canada unable to telework, were less resilient during the pandemic due to financial problems, restrictions and lockdowns.

• Future policy responses to support self-employed people during adversity should tailor programmes towards viable businesses in greatest need of support.
Employment quality, past unemployment, mental health and wellbeing in the UK
Authors: Balogh R , De Moortel D , Gadeyne S , Vanderleyden J , Warhurst C , Vanroelen C
Published: October 2023

Background

Low employment quality (EQ) has been associated with adverse mental health. Past unemployment may also be linked to reduced mental health and wellbeing later on and may influence subsequent EQ. However, understanding of the role (past) unemployment history may play in the association of (present) EQ and mental health and well-being is limited. This paper aims to fill this gap.

Methods

We drew on a subsample of employees aged 25 to 60 from wave 4 of the UK Household Longitudinal Study. We applied Latent Class Analysis (LCA) to derive typologies of EQ within 6 dimensions. We fitted logistic regressions to assess the links between EQ, lifetime unemployment, and mental well-being and psychological distress (measured using the Short Warwick-Edinburgh Mental Wellbeing Scale and the 12-item General Health Questionnaire, respectively).

Results

The LCA yielded an optimal solution of 6 EQ clusters, with some similarities to previous typologies. Men and women in precarious employment forms characterised by unfavourable employment conditions including lower labour income and potential underemployment reported higher odds for low mental well-being (men OR:1.54, 95% CI:1.06-2.24; women OR:1.37, 95% CI:1.04-1.81), and so did women in precarious forms characterised by, amongst others, lower labour income and more prevalent long and irregular hours (OR:1.44, 95% CI:1.08-1.93), compared to those in the most standard and favourable arrangement. Some further well-being inequalities were observed across the EQ spectrum. Simultaneously, prior unemployment (of length) was also linked to reduced well-being among both genders, with no dose-response relationship. Precarious clusters were, however, not linked to increased odds of psychological distress.

Conclusions

Men and women in low EQ or with prior unemployment experience had higher odds of low mental well-being in the UK. Our analysis shows the need to consider employment trajectories regarding mental health outcomes.

Key messages

• Low multidimensional EQ and past unemployment experience of length are both related to reduced mental well-being in the UK.

• No links were observed with regards to low employment quality and elevated psychological distress.
Life course patterns after parental leave: a 10-year Swedish cohort study with sequence analysis
Authors: Virtanen M , Gémes K , Farrants K , Mittendorfer-Rutz E , Alexanderson K
Published: October 2023

Background

Knowledge on long-term life course patterns after parental leave is limited. We examined future work-, family-, and sickness absence (SA) and disability pension (DP) life courses after parental leave in Sweden and the baseline factors associated with them.

Methods

A prospective cohort study using nationwide register microdata, including all women (n = 43,959) and men (n = 43,514) with their first parental leave benefit in 2010. We used sequence analysis to examine their work-, family-, and SA/DP-related life-course patterns for the 10-year follow-up. Multinomial regression analysis was used to analyse the associations of baseline sociodemographics and morbidity with specific cluster membership.

Results

Four life-course sequences were identified for both women and men. ‘Employment/studies’ (47% of women, 88% of men); ‘Employment/studies & parental leave’ (37% of women); ‘Rapid return to employment/studies’ (6% of men); ‘Slow return to employment/studies’ (9% of women); ‘Low level of employment/studies’ (6% of women, 5% of men); and ‘Increasing sickness absence & disability pension (SA/DP)’ (1% of men). In women, low education (OR range 4.31-58.02), immigrant background (OR range 1.37-3.95), and morbidity (OR range 1.08-1.91) were associated with being in the ‘Employment/studies & parental leave', ‘Slow return to employment/studies', or ‘Low level of employment/studies’ life courses compared with the ‘Employment/studies’ life course. In men, the associations with low education (OR range 4.30-12.98), immigrant background (OR range 2.64-5.71) and morbidity (OR range 1.54-8.01) were found for ‘Rapid return to employment/studies', ‘Low level of employment/studies’ and ‘Increasing SA/DP'.

Conclusions

After the first parental leave, women have more often than men life course patterns of slow return to work or alternating periods of employment and parental leave. Education, birth country, and morbidity are associated with future life course patterns in women and men.

Key messages

• After the first parental leave, women have more variable working life courses than men, with more women with patterns of slow return to work or alternating periods of employment and parental leave.

• Prior low education, immigrant background, and morbidity are associated with more variable life course patterns among both women and men.
The effect of mental disorders in youth on NEET and the mediating role of high school dropout
Authors: Hijdra R , Oude Groeniger J , Burdorf A , Schuring M
Published: October 2023

Introduction

In the EU, over 13% of 15-29 years olds are not participating in Education, Employment or Training (NEET), which increases their risk of health problems and lower well-being later in life. This study investigates whether mental disorders in childhood impacts i) high school drop-out during adolescence, and ii) NEET in their early twenties. Secondly, it assesses to what extent the effect of mental disorders on NEET is mediated by high school drop-out.

Methods

Longitudinal nationwide register data from Statistics Netherlands were used for persons born in 1994. These included medication prescription for mental disorders (ages 12-15 years), high school dropout (ages 16-19 years) and participation in education or employment (age 21-26 years). NEET was defined as the proportion of time a person was not in employment or education between the ages of 21 and 26. Linear regression analyses were performed on the association between mental disorders and NEET and logistic regression analyses on the association between mental disorders and having a high school dropout period. Causal mediation analysis was used to assess to what extent the effect of mental disorders on NEET could be reduced by eliminating high school dropout.

Results

Taking medication for mental disorders was strongly associated with a longer NEET period and also increased the risk of having a high school dropout period. Having a high school dropout period significantly contributed to having a longer NEET period among persons with mental disorders. Further results of this study will follow later.

Conclusions

Mental disorders in childhood are strongly associated with a longer NEET period in early adulthood, which can be reduced by preventing high school dropout. It is of paramount importance to prevent, detect and treat mental disorders from a young age and prevent persons from dropping out of high school, as it can affect outcomes later in life.

Key messages

• Mental disorders in childhood are strongly associated with a longer NEET period in early adulthood, which can be reduced by preventing high school dropout.

• It is of paramount importance to prevent, detect and treat mental disorders from a young age and prevent persons from dropping out of high school, as it can affect outcomes later in life.
Global inpatient utilization from 1990 to 2020: effects of the COVID-19 pandemic
Authors: Nekliudov N , Hamilton E , Pasovic M , Moberg M , Murray C , Vos T , Lim S
Published: October 2023

Background

Inpatient service utilization rate is a key indicator for estimating the performance of health care systems on global, regional, and national levels.

Methods

We collected 1378 source-years of data, including administrative sources, nationally representative surveys, and government reports covering 130 countries overall, 29 of which are in the European region from 1990 to 2020. Inpatient admission was defined as an overnight stay at a formal healthcare facility for any cause. The data underwent age- and sex-splitting as per the available level of detail; survey sources were crosswalked to the gold-standard administrative data. The resulting data set was analyzed using Spatiotemporal Gaussian Process Regression (ST-GPR), a Bayesian meta-regression tool, to model the inpatient admission rate per capita across all countries, age groups, and sexes from 1990 to 2020. Admission rates were age- and sex-standardized to compute global proportions of hospitalized persons.

Results

In 2019, the global age-standardized inpatient utilization rate was 0.12 (95% uncertainty interval [UI] 0.09-0.15) admissions per capita. Globally, 0.93 billion (0.72-1.18) inpatient admissions were provided in 2019 compared to 0.68 billion (0.53-0.87) in 1990. In 2020, the global age-standardized inpatient utilization rate dropped to 0.057 (0.055-0.059) with a global proportion of hospitalized patients of 0.45 billion (0.43-0.46).

Conclusions

The increase in inpatient utilization from 1990 to 2019 may be attributable to population growth and increased capacity of health systems across most WHO regions. Health care utilization was highly variable between regions that was partly explainable by the variation in the socio-demographic index (SDI). The pandemic-mitigating measures limiting transportation and healthcare access were associated with the reduction in utilization in 2020.

Key messages

• The inpatient utilization rates were rising globally with large variation across regions, while decreasing in 2020 due the COVID-19 pandemic-related mitigating measures.

• Health systems may use the inpatient utilization estimates to assess the effectiveness of health care reforms, plan for future capacity, and to allocate financial and human resources appropriately.
Auctions Versus Fixed Prices: Lessons from a Procurement Pilot
Authors: Kuhmonen S
Published: October 2023

Objectives

Private health care providers are often acquired through procurement auctions to produce publicly financed services. In this study, we examine the costs and benefits of auctions compared to fixed price procurements. We analyze a procurement pilot that was conducted by Kela, the largest rehabilitation organizer in Finland. Kela piloted fixed prices instead of an auction in two different services in 2020.

Data and methods

Our data includes all procurements both for inpatient and outpatient rehabilitation courses by Kela in years 2012-22. The data includes 455 procurement auctions, which received 2584 bids, and 4 pilot procurements of fixed prices, which received 166 bids. Altogether 10 providers were contracted in the pilot procurements of the first service whereas the last two pilot procurements attracted 153 providers. Our preliminary results are based on simple statistical and graphical analysis regarding bid prices and their dispersion.

Results

Our preliminary main finding is that competition, calculated as number of bids per auction, is correlated with prices in the procurements. The main challenge of fixed prices is to determine the appropriate price-level. We find that the prices were set to be attractive in the pilots, as all providers who previously participated in auctions accepted the price, and several new providers entered the market in the pilot procurements of the second service.

Conclusions

Efficiently organized public procurements can yield large fiscal saving for the public economy. The procurements give information about the number of providers offering the service and their price. Fixed pricing eliminates the competitive setting, which means that the price is often set too high to ensure the availability of services.

Key messages

• Efficiently organized public procurements can yield large fiscal saving for the public economy.

• Fixed pricing eliminates the competitive setting, which means that the price is often set too high to ensure the availability of services.
Generic justification of medical exposure to ionising radiations in two European countries
Authors: Giusti M , O'Sullivan L , Harrington P , Ryan M , McGarry M , Dullea A , O'Brien K K , Persiani N
Published: October 2023

The European Directive 2013/56/EURATOM aims to safeguard patients, members of the public and workers by setting out basic safety standards for protection against the dangers arising from exposure to ionising radiation. However, each European member state must consider how the Directive should be transposed at a national level and this has led to different organisational models being adopted. With regard to medical exposure to ionising radiation (MEIR), Ireland and Italy are interesting countries to compare because they have transposed the Directive in contrasting ways. Comparison of these models may highlight ways to harmonise approaches and improve efficiency. Case studies were prepared by reviewing national laws, analysing scientific documents and conducting interviews with managers of organisations assigned the responsibility for MEIR. The case studies focused on the generic justification (GJ) of MEIR, determining if the benefits of a radiological practice outweigh the risks, at a population level. Ireland implemented a centralised model by designating responsibility for the regulation of MEIR to an independent competent authority, the Health Information and Quality Authority (HIQA). The Health Technology Assessment Directorate in HIQA has built upon their experience in conducting evidence synthesis to inform health policy, but it may experience challenges as the single gateway for GJ decisions. In Italy, GJ is entrusted to national professional scientific radiological societies. The decentralised Italian model facilitates an immediate response to GJ applications from stakeholders, but the absence of strong national coordination may lead to duplication, loss of information and or partial knowledge of processes. Collaboration between European member states in the area of GJ of MEIR could support the standardisation of practices in Europe. This could be facilitated through the creation of a European working group.

Key messages

• The creation of a European working group focused on generic justification in radiation protection exposure is advocated.

• A European working group would lead to less duplication of effort and a more streamlined process for generic justification.