bluuebunny/crossref_metadata_2025 huggingface dataset:
Trajectories of sickness absence among young people with prior depression/anxiety symptoms
Authors: Alaie I , Svedberg P , Ropponen A , Narusyte J
Published: October 2022

Background

Depression and anxiety are associated with elevated risks of sickness absence (SA), but less is known about the development of SA over time in young people experiencing these mental health conditions. This study aimed to identify latent trajectories of SA in young people with a history of depression and/or anxiety symptoms, while accounting for sociodemographic factors.

Methods

This was an observational cohort study of 1,445 twin individuals who had elevated depression/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), as assessed in Swedish surveys completed in 2005. Through linkage to the national registries, the individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual net days of SA, which were analyzed using group-based trajectory modeling with zero-inflated Poisson regression. Multinomial logistic regression estimating odds ratios (OR) with 95% confidence intervals (CI) was used to examine the influence of age, sex, and educational level on the resulting trajectory groups.

Results

Four distinct trajectories of SA were identified: ‘high-increasing’ (6%), ‘low-increasing’ (12%), ‘high-decreasing’ (13%), and ‘constant-low’ (69%). The constant-low was used as the reference in all analyses. Increasing age was found to be associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95% CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95% CI = 1.10-2.53), compared to men. Higher education was associated with lower odds of belonging to the high-increasing (OR = 0.34, 95% CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95% CI = 0.43-0.81) trajectories, compared to lower education.

Conclusions

Distinct group-based trajectories of SA were identified in young people with early depression/anxiety symptoms. Targeted and timely public health strategies aiming to improve adolescent and young adult mental health may help reduce SA in the long run.

Key messages

• We identified four trajectories of sickness absence in young people with common mental health problems.

• Public health efforts to improve mental health may reduce sickness absence in vulnerable groups.
Positive mental health and COVID-19 pandemic in Slovenia
Authors: Vinko M , Mikolič P , Roškar S , Jeriček Klanšček H
Published: October 2022

Background

The COVID-19 pandemic is having a major impact on mental health. In contrast to studies on mental disorders, our study contributes to the under-researched area of the impact of the pandemic on positive mental health. We compare the prevalence of positive mental health before and during the pandemic and identify factors associated with flourishing and languishing mental health during the pandemic.

Methods

We used data from two nationally representative cross-sectional surveys of Slovenian adults conducted in 2019 and 2021. Outcome included positive mental health (Mental Health Continuum - Short Form). Cross-sectional prevalence estimates were calculated and logistic regression assessed associations between positive mental health and the COVID-19 specific and other health-related factors.

Results

In 2021, 38.6% (95% CI, 37.0%-40.2%) had flourishing mental health, compared to 61,5% (95% CI, 60.5%-62.5%) before the pandemic. In contrast, the share of people in languishing mental health during the pandemic (8.0%; 95% CI, 7.1%-8.9%) was nearly two times higher than in 2019 (4,5%; 95% CI, 4.1%-4.9%). Both flourishing and languishing were significantly associated with changes in family relations, social interactions and dietary habits, resilience and COVID-19 literacy.

Conclusions

Positive mental health in Slovenia worsened drastically during the pandemic compared with before. Results indicate important role of family relationships, social interactions and dietary habits on positive mental health. Both prevention of mental disorders and mental health promotion need to be considered in order to address the full range of public mental health needs, with increased attention to strengthening resilience and health literacy.

Key messages

• We noted an substantial decline in flourishing and rise in languishing mental health during the pandemic.

• Public health efforts need to address the impact of the pandemic on family relations and social interactions.
Sleep quality in the Croatian adult population during the COVID-19 pandemic
Authors: Miskulin I , Fotez I , Miskulin M , Milas J , Palenkic H , Kristic M
Published: October 2022

Background

The COVID-19 pandemic as a worldwide public health issue is a traumatic event that has affected both the sleep and mental health of the general population. This study aimed to evaluate the quality of sleep in the Croatian adult 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 data, as well as Pittsburgh Sleep Quality Index (PSQI) and Coronavirus Anxiety Scale (CAS) was self-administered to a convenient sample of Croatian adults from central and northwestern Croatia.

Results

The study sample included 939 subjects with, median age of 42 years (interquartile range 35-48), 35.4% males, and 64.6% females. At the PSQI 22.6% of subjects presented sleep disturbances while at the CAS 0.4% of subjects presented dysfunctional anxiety associated with the COVID-19 pandemic. Sleep disturbances were more frequent among females (p < 0.001), inhabitants of the Croatian capital Zagreb (p = 0.001), subjects who were not infected with COVID-19 virus (p = 0.042), subjects who had fear of coronavirus infection in the workplace (p < 0.001), subjects who had fear of coronavirus infection during daily life activities (p < 0.001), subjects who had fear of coronavirus infection during daily physical activities (p < 0.001), subjects who worked with limited social contact (p = 0.005), and subjects with dysfunctional anxiety associated with the COVID-19 pandemic (p = 0.003).

Conclusions

Poor sleep quality is common during the COVID-19 pandemic in Croatia. Identifying factors associated with poor sleep would help develop specific intervention programs that enhance mental health and sleep quality during pandemics.

Key messages

• The COVID-19 pandemic has a significant negative influence on the mental health of the Croatian general population.

• Appropriate supportive programs and interventional approaches directed toward the general population are needed to address mental health problems in Croatia during the COVID-19 pandemic.
The Werther effect: adherence of Italian newspapers to the “reporting on suicide” recommendations
Authors: Scaioli G , Giacomini G , Galvagno P , Bert F , Lo Moro G , Siliquini R
Published: October 2022

Background

Reporting a case of suicide on a newspaper could lead to an emulation effect (Werther effect). It is important to report suicide cases by following specific recommendations implemented by World Health Organization (WHO). This study aimed to analyze articles published on Italian newspapers to quantify the adherence to the WHO recommendations in suicide report.

Methods

All the articles published in the three most important Italian newspapers from June 2019 to May 2020 that described one or more cases of suicide were included. Two researchers analyzed all the articles through an ad-hoc checklist, constructed on the basis of the WHO recommendations, that included 18 “negative” items (e.g. “presence of suicide-related words in the title”) and nine “positive” items (e.g. “the article reports the contacts of a suicide-prevention hotline”). For each negative item a “-1” point, and for each positive item a + 1 point, was assigned. Multivariable linear regressions were performed to identify factors related with a lower adherence to the WHO recommendations and with higher social engagement of the articles.

Results

A total of 110 articles were analyzed. In the 73% of the cases, the individual was male. The 14.5% of the suicide cases were homicide-suicide, while 9% were femicide-suicide. The median score of the checklist was -6 (IQR 3). Only 5% of the articles had at least one positive item. The word “suicide” (or related words) were present in 90% of the titles. Multivariable analyses showed that female suicides were associated with a higher score of the checklist (coeff 0.816, p = 0.039). No correlation was retrieved between the score of the checklist and the social media engagement of the articles included.

Conclusions

Italian newspapers do not follow WHO recommendations on how to report suicide cases, leading to a potential emulation effect. Public health professionals should raise decision makers’ and journalists’ awareness about the importance of these recommendations.

Key messages

• Since Italian newspapers are not compliant with the recommendations of the World Health Organization on how to report a suicide case, there is the risk of a potential emulation effect.

• Specific training for journalists and other professionals in the field of communication should be implemented, to raise the awareness on the importance of the “reporting on suicide” recommendation.
Analysis of suicides in one of the administrative regions of Bulgaria for 10-year period (2009-2018)
Authors: Veleva I , Stoychev K , Stoimenova M , Mineva E
Published: October 2022

Background

Suicide is an important medical and social problem responsible for nearly one million deaths per year globally. However, distal and proximal risk factors for suicide, expect being mentally diagnosed, are not enough studied. The aim of the study was to analyze the dynamics, structure, socio-demographic and clinical characteristics of all suicides committed by persons with mental disorder for 10-year period (2009-2018) in Pleven district.

Methods

Retrospective analysis of medical records of all mentally ill persons who committed suicide was done. Data were extracted from the databases of all in- and outpatient mental health centers in the region. Data processing was performed by IBM SPSS Statistics v.25. Statistical associations between a number of socio-demographic and clinical characteristics and the age of suicide victims was studied by dispersion analysis and Mann-Whitney test. Statistical significance was set at p ≤ 0.05.

Results

Among all 281 registered suicide cases during the studied period, 77 (28%) were with mental disorders. The most common were mood disorders (44%), followed by schizophrenia, anxiety disorders, substance abuse disorders and organic mental conditions. The mean age of all suicides was 55.62 years; significantly lower in males than in females (p = 0.042); lower in divorced or never married/single living persons compared to married or who had lived with a partner (F (2.74) =17.682, p < 0.001]; the lowest in patients with schizophrenia (44.62 years), and the highest in organic disorders (66.83 years). Higher educational degree was associated with lower age of suicide (U = 3.713, p < 0.01) and the earlier age of onset of the psychiatric disorder (r = 0.754, p < 0.001). Most of the suicide cases had occurred in March and September. Tuesdays and Fridays were most suicidal.

Conclusions

Severe mental disorders are major risk factors for suicide with the additional contribution of certain socio-demographic and disease related characteristics.

Key messages

• Suicide monitoring should be constant in all patients with chronic and severe mental disorders.

• Suicide registration in Bulgaria needs to be improved in terms of collecting sufficient and reliable information about the mental health of suicide victims.
Social inequality and change in psychological distress during the Covid-19 pandemic in Norway
Authors: Aasan BEV , Lillefjell M , Kvaløy K , Krokstad S , Sund ER
Published: October 2022

Background

Emerging research findings suggest that the Covid-19 pandemic may have affected various social groups differently. Using follow-up health data from Norway, the aim of this study was to investigate whether change in psychological distress in adolescents during the Covid-19 pandemic differed across socioeconomic position (SEP).

Methods

Data consisted of 1254 Norwegian adolescents who participated in Young-HUNT4 (2017-19) and Young-HUNT COVID (spring 2021). Psychological distress (PD) was assessed by the Symptom Checklist-10, using a cut-off point of ≥ 1.85 to identify adolescents with high PD. Based on the adolescents PD score prior to and during the Covid-19 pandemic, four groups were identified: persistent low PD, improved PD, worsened PD, and persistent high PD. Adolescents reported their parents’ education level which was used as an indicator for SEP. SEP was dichotomized separating low and high SEP, where having at least one parent with a higher education was defined as high SEP. Multinomial logistic regression models were used to investigate if the likelihood of the outcome groups varied across SEP, adjusted for age and sex.

Results

Compared to the persistent low PD group, no statistically significant difference was found between low and high SEP in the improved PD and worsened PD group (RR 1.33 95% CI 0.77 - 2.31, RR 1.22 95% CI 0.82 - 1.81, respectively). However, adolescents of low SEP had a higher likelihood to be in the persistent high PD group compared with the high SEP group (RR 1.93 95% CI 1.30 - 2.87).

Conclusions

These preliminary findings suggest that the pandemic may not have led to greater social inequality in mental health among Norwegian adolescents. However, the results showed that social inequality that existed prior to the pandemic has persisted, as adolescents of lower SEP had a higher likelihood of reporting high PD that persisted from prior to and throughout the Covid-19 pandemic.

Key messages

• Social inequality in psychological distress among Norwegian adolescents has persisted prior to and during the Covid-19 pandemic.

• The Covid-19 pandemic does not seem to have increased existing social inequalities in psychological distress among Norwegian adolescents.
Project SELfit: training socio-emotional skills in a school environment in Porto
Authors: Malcata F , Rodrigues A , Machado A , Saraiva MT , Antunes D
Published: October 2022

Issue/Problem

Mental disorders are the main cause of years lived with disability (YLD) in 5-14-year-old people around the world, in Western Europe, and particularly in Portugal. Young people who experience anxiety during childhood have a 3,5-fold likelihood of suffering from depression or anxiety during adulthood. COVID-19 has aggravated this situation, namely regarding socio-emotional competencies.

Description of the problem

SELfit, a project based on the Socio-emotional learning (SEL) methodology, aims promoting mental health, by training teachers and community nurses to develop socio-emotional skills in students from primary schools. The project includes a theoretical and a practical/training session, and monthly supervision sessions by a team that includes a psychologist, a public health doctor and public health nurses. The period of implementation is between February to July 2022.

Results

A total of 8 community nurses and 13 teachers from 3 primary schools in Porto enrolled in this project, which corresponds to a total around 272 students from 5 to 8-year-old. Knowledge of nurses and teachers regarding mental health literacy, and social emotional learning was assessed, before and after the theoretical session. The mean percentage of correct answers before was 49% (54% regarding nurses and 45% teachers) compared to 84% (92% regarding nurses and 78% teachers) after. Concerning socio-emotional skills of the primary school students, possible improvement will be evaluated at the end of the project (July 2022).

Lessons

Mental health literacy and social emotional learning knowledge increased 35%, which highlights the importance of these theoretical sessions promoting mental health literacy. By the end of this project, it is expected to exist an improvement on socio-emotional skills of the primary school students. This is a very important project, expected to be implement and replicated in other schools in Porto and in Portugal.

Key messages

• Mental disorders are the main cause of years lost due to disability (YLD) in primary school students in Portugal; hence, it was chosen for this mental health promotion project.

• This is a pioneer project in Porto, involving both community nurses and primary teachers, in which all are involved in training and promoting social-emotional learning in a school context.
The role of gender in the association between mental health and avoidable hospitalization
Authors: Catalini A , Mazza C , Cosma C , Stacchini L , Caminiti M , Minutolo G , Genovese D , Ferraguzzi G , Cavaretta E , Cedrone F
Published: October 2022

Background

Hospital discharge records (HDR) can indirectly assess the quality of primary care through algorithms proposed by the Agency for Health Research and Quality (AHRQ). Mental illnesses or substance addictions represent barriers to accessibility to medical care which, can lead to hospitalizations deemed potentially preventable. The aim of this study is to evaluate the gender differences in the association between potentially preventable acute hospitalizations whether mental health or addiction.

Methods

The study examined HDRs of the Local Health Authority of Pescara, Abruzzo, period 2015-2021. The aggregate Prevention Quality Acute Composite 91 (PQI-91) has been coded according to the indications of the AHRQ. Were selected HDRs with a diagnosis of depression, psychosis, alcohol or substance abuse according to Enhanced ICD-9-CM Elixhauser algorithm. Four univariate logistic regression models were implemented correcting for age.

Results

In the study period 252,775 HDRs of which 3,459 PQI-91 were analyzed. A diagnosis of depression is positively associated with a PQI-91 hospitalization only in the male gender (aOR 3.16; 95%CI 2.18-4.58) and not in the female one (aOR 1.13; 95%CI 0.75-1.72). The same is true for a diagnosis of psychosis, males (aOR 2.41; 95%CI 1.66-3.48) and females (aOR 1.19; 95%CI 0.67-2.12). In both genders there was an association with substance abuse, males (aOR 3.92; 95%CI 2.65-5.81) and females (aOR 2.68; 95%CI 1.19-6.07), while for the alcohol abuse the female gender is positively associated (aOR 2.52; 95%CI 1.11-5.73) and not the male one (aOR 1.24; 95%CI 0.80-1.92).

Conclusions

Gender is an innovative approach to health inequalities: women and men respond to a different diagnostic-prescriptive appropriateness, which depends both on biology and on social, cultural, psychological and economic distances. Research efforts must be made to observe the effect healthcare access disparities have on patients who experience mental illness or addiction.

Key messages

• Mental health can limit access to primary care for other comorbidities or acute diseases; poor-quality primary care can result in preventable hospitalizations that increase the cost of health care.

• The gender differences for the same diagnosis of mental illness/addiction that cause potentially preventable acute hospitalizations impose gender-specific strategies aimed at modifying care pathways.
Bullying victimization among middle school students in el kef governorate (Tunisia)
Authors: Amara A , Mtiraoui A , Nammouchi D , Sahli J , Mellouli M , Mtiraoui A , Zeddini C , El Ghardellou M
Published: October 2022

Background and aim

Bullying is a complex and widespread public health issue that one can be exposed to at any age and at any field, but it is considered particularly frequent during times of transition in children’s and adolescents’ lives. This study aims to investigate the prevalence and various forms of bullying victimization and explore culture of bullying victimization among students.

Methods

A cross-sectional study was conducted during the Academic year 2018/2019 among middle school students in the governorate of El Kef, Tunisia. The sampling method adopted for this research was a cluster sampling technique. Data were collected using self-administered questionnaires. The Students’ involvement in bullying victimization was assessed using a validated Arabic version of the revised Olweus Bully/Victim Questionnaire.

Results

A total of 1111 middle school students were enrolled. The prevalence of bullying victimization behavior in this study was 45.8 % [95% CI: 45.5- 46]. Looking at the forms of bullying experienced by students: “Being called mean names” was the most prevalent form of being bullied with 26.9% (n = 299), followed by 16.9% reported “being kicked in some place”, 16.3% reported “being bullied through false rumors” and 14.3% experienced bullying through messages, calls or images by means of mobile phones or Internet and 8.1% of the students reported being bullied with sexual gestures or comments. Verbal bullying (29.5%) was the most common type of victimization, followed by physical victimization, relational victimization and cyber victimization with 22.5%, 22.2% and 14.3% respectively. More than half of the students (58.5%) were more likely to inform others about incidents of bullying in their schools, mainly their parents (36.6%) or a friend (32.6%).

Conclusions

Bullying is serious and major public health issue that have a negative impact on adolescents’ well-being, and require special attention at the family, school, and community level

Key messages

• High prevalence of bullying victimization with predominace of verbal type.

• Culture of bullying victimization and taking care of victims is still weak.
Opportunities and Challenges in community-based inclusive science education
Authors: Scheer S , Orban O
Published: October 2022

Background

This research is part of a Horizon2020 funded project named C4S - Community for sciences. The project aims to implement co-created inclusive science activities with children 0-16 years and their families in vulnerable communities. Best practice strategies will be developed to promote the empowerment of children in vulnerable situations. In six European cities, community-based inclusive science activities will be realized and evaluated. What is the impact of inclusive science education on vulnerable communities' health in Europe? Why is community-based inclusive science education an urgent issue to improve health conditions of children and families?

Methods

Guided by the research questions this method includes an integrative literature review to explore barriers and facilitators to delivering inclusive science in European countries and a questionnaire delivered to 6 Hubs involved in the C4S project. The questionnaire identifies core elements of a community, e.g. “Joint action”, “social ties” and “Diversity”. Both the literature review and the community questionnaire are performed in co-creation with inclusive science activities.

Results

Preliminary findings of 214 bibliographical references show the importance and evidence of inclusive science education. When it comes to specific groups of people who are in vulnerable situations, only a few references could be identified. Most results are related to children with disabilities in comparison to children from ethnic minorities. However, ongoing discussions about intersectionality and decolonial theories were identified topics to answer our research questions.

Conclusions

The literature shows evidence about inclusive science but lack of specific information for specific target groups. Therefore, the questionnaire distributed to the Hubs may offer new perspectives and will lead to specific knowledge about communities' needs and resources to ensure inclusive science with and for children in vulnerable situations.

Key messages

• Inclusive and community-oriented science education is relevant to empower children in vulnerable situations.

• New perspectives and deeper knowledge about context specific factors that facilitate inclusive science education may contribute to sustainable health.
Cross-sectional nutrition assessment in a refugee camp in Gambella region, Ethiopia
Authors: Benoni R , Sartorello A , Paiola E , Moretti F , Buson R , Tsegaye A , Tardivo S , Manenti F
Published: October 2022

Minors account for 20 percent of the world’s migrants, reaching 33 million in 2019. The prevalence of malnutrition has been reported between 17 and 21% among refugees. However, data about Sub-Saharan African refugees is lacking. The study evaluates the nutritional status of refugees in the Nguenyyiel camp in Gambella (Ethiopia). The retrospective cohort study included all children under five attending the first visit to the refugee camp’s health post between 01/06/2021 and 31/08/2021. Sociodemographic data, body weight, and upper arm circumference (MUAC) were recorded. The z-score of weight for age (WFA) and MUAC for age (MUACZ) were estimated using the R ‘anthro’ package developed by the World Health Organization (WHO). Children with WFA <-2 standard deviations (SD) were considered underweight, those >2SD overweight. A MUACZ <-2SD defined acute malnutrition. Among the 782 patients admitted, 415 (53%) were under five. Females were 195 (47%). The mean age was 2.1 years (SD 1.6). The mean body weight was 11kg (SD 5). Considering the WFA, 200 (48%) children were within +2 SD. Children with WFA <-2SD were 92 (29%), those > 2SD were 28 (9%). The frequency of children with WFA <-2SD was higher in boys (p = 0.049). There were no differences in the frequency of children with WFA >2SD based on sex (p = 0.998). WFA decreased as age increased (p = 0.048). MUAC was recorded for 273 (66%) children. The mean MUAC was 14.2mm (SD 2.4). Children with MUAC z-scores within +2SD were 245 (77%). Children <-2SD were 92 (8%). The frequency of children with MUACZ <-2SD was not significantly different based on sex or age (p = 0.125, p = 0.324). The prevalence of malnutrition was moderate in the Nguenyyiel camp. At the same time, the frequency of underweight children was high, particularly among boys (34%) and with increasing age.

Key messages

• Nutrition remains a problem in refugee camp settings, especially in children.

• Ensuring the health of refugees, as vulnerable population, should be a priority for both governments and international organizations.
Understanding clinician barriers to providing equitable healthcare for ethnic minority populations
Authors: Patel M , Newell R , George S , Clark H
Published: October 2022

Background

It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring “cultural competence”. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the “culture of medicine” framework proposed by Boutin-Foster et al, which examines the impact of these factors.

Aims and Methodology

This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster’s framework used as a structure.

Results

The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups.

Conclusions

Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education.

Key messages

• Clinician implicit bias within the “Culture of Medicine” is a barrier to equitable healthcare for ethnic minority populations.

• Awareness of our own culture and preconceptions is paramount to addressing these barriers.
Diverse perspectives on social determinants of multicultural adolescents: A focus group study
Authors: Lee H , Lee H , Lee M , Kim Y , Kim S , Lee J , Shim SY , Seo J
Published: October 2022

Background

As Korea transforms into a multicultural society, social vulnerability of the multicultural adolescents (MAs) puts them at risk for poor health and health disparities. However, there is shortage of evidence on social determinants of health (SDH), which refers to the circumstances of people from birth to death, which affects their health outcomes, for MAs. Thus, this study aims to explore the SDH of MAs from diverse stakeholders’ perspectives.

Methods

This qualitative study comprised 17 focus group interviews with 99 participants (MAs, peers, parents, teachers, neighbors, and community leaders), conducted from June to September 2020. The directed content analysis was conducted using the Minority Health and Health Disparities Research Framework with a high rigor level based on the four criteria of Lincoln and Guba’s trustworthiness.

Results

The participants addressed SDH of MAs in five domains: biological (vulnerability and mechanism); behavioral (health behavior, family/school/peer functioning, and policies and laws); physical/built environment (school/community environment); sociocultural environment (MAs'/parental sociodemographic, language proficiency, MAs'/parental acculturation, social network, and response to/interpersonal/local/societal structural discrimination); and health care system (insurance coverage, MAs'/parental health literacy, availability of services, and health care policies). However, limited SDH in biological and physical/built environment domains were identified.

Conclusions

SDH in sociocultural environment domain and interpersonal influence level were the most commonly addressed. Interpersonal discrimination of both MAs and parents were found to be the most important SDH. These findings suggest that future programs to enhance MAs’ health may be targeted toward reducing discrimination and involving their parents.

Key messages

• Sociocultural environment was found to be the most salient SDH domain to affect MAs’ health.

• SDH of MAs are linked to discrimination and their parents’ sociocultural aspects such as acculturation.
Being a refugee in childhood and health in adulthood
Authors: Mattelin E , Khanolkar AR , Korhonen L , Froberg F
Published: October 2022

Aim

To examine whether individuals who migrated to Sweden as refugees in childhood are more likely to experience poor mental and general health and violence in adulthood, compared to individuals born in Sweden, or who were migrants but not refugees.

Methods

This study included 151,614 individuals who answered the Swedish National Public Health Survey in 2018 or 2020. We grouped the participants into refugees in childhood, migrants in childhood, or non-migrants. Information about outcomes - mental health, general health, and risk behaviors - was collected through questionnaires. We analyzed the associations using logistic regressions.

Results

Overall, having been a refugee in childhood was generally not associated with poor general health and mental ill-health, risk behaviors, or exposure to violence, compared to those who were migrants or born in Sweden. However, there were some exceptions. For example, young men, who were refugees in childhood, had a higher likelihood of suicide attempts than non-migrants. Interestingly, childhood refugees and childhood migrants were less likely to use drugs and to have risky alcohol use as adults, compared to non-migrants, but were more likely to be risk gamblers.

Conclusions

Being a refugee in childhood was not, in general, associated with negative health consequences in adulthood with some exceptions, such as gambling, that will be discussed in the presentation.

Key messages

• In this study, refugee experience in childhood is not, in general, associated with worse health outcomes in adulthood.

• There are certain risk groups that need to be highlighted such as young males with refugee experience in childhood.
Quality of national cancer control programmes in Europe
Authors: Jelenc M , Albreht T
Published: October 2022

Background

Cancer remains among the leading causes of death worldwide and the COVID-19 pandemic had a negative impact on its diagnosis and treatment. National Cancer Control Programmes (NCCPs) are key documents in the field of cancer control. As they are directed at reducing cancer morbidity, mortality, and improvement of the quality of life of cancer patients, they can make a significant contribution in tackling the challenges posed by cancer in Europe. The aim of the present study, which is unique of its kind, was to evaluate the situation regarding the presence of NCCPs in Europe in 2016, as well as to analyse the presence and implementation status of the key elements of NCCPs that European Guide for Quality National Cancer Control Programmes (Guide) recommends.

Methods

In the frame of the Cancer Control Joint Action a policy survey was carried out through 35 countries: EU member states, Iceland, Montenegro, Norway and Turkey, focusing on inclusion of the chapters from the Guide, participation of stakeholders, preparation, implementation and dissemination.

Results

Thirty countries responded and 28 out of those had a NCCP or a similar cancer document. NCCPs were mostly single documents; 9 documents were defined as programmes, 8 as plans and 6 as strategies. The terminology was mixed in 5 countries. NCCPs were managed by the Ministries of Health and communicated to the public via websites and/or press. Drafting of NCCPs was mostly done through discussions, consensus meetings and negotiations. Only 10 countries included all elements suggested in the Guide in their NCCPs.

Conclusions

The results of the survey showed that there are still countries without a NCCP. Regarding the content of NCCPs and other cancer documents the results indicated that the quality of the documents should be improved by covering all key elements suggested in the Guide and adding other innovative approaches.

Key messages

• Instruments for more efficient cancer management are needed; they should encompass the entire pathway of cancer control from health promotion, to survivorship and supportive care.

• The ongoing and quickly developing activities on NCCPs in Europe should be monitored regularly.
The gaps in health-adjusted life Expectancy (HALE) by income and region in Korea
Authors: Jung YS , Kim YE , Ock M , Yoon SJ
Published: October 2022

This study aims to calculate the health-adjusted life expectancy (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in sex, income level and region. The study was carried out on total population receiving national health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. The primary outcome was HALE in the Korean population. The second outcome was the HALE’s gap in terms of sex, income, and region. Our results revealed that HALE increased from 2008 (68.89 years) to 2019 (70.58 years). HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2019, the gap in HALE between Q1 and Q2, the lower income group, was about 5.70 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to increase HALE at the national level.

Key messages

• Males’ health level may be more sensitive to the socioeconomic level than females’ health level.

• In the 5th National Health Plan (HP2030), it was decided to set a target value for the overall goals based on this result.
Strengthening National Public Health: first steps towards the Spanish Public Health Agency
Authors: Barbaglia G , García-Abiétar D , Beltrán-Aguirre JL , García AM , García-Armesto S , Gutiérrez-Ibarluzea I , Segura-Benedicto A , Franco-Tejero M , Urbanos-Garrido R , Hernández-Aguado I
Published: October 2022

Issue/Problem

The social, ecological, health and economic crisis exacerbated by COVID-19 is a challenge of extraordinary magnitude and complexity for global public health. Part of the response to these challenges requires strong public health institutions.

Description of the problem

Component 18 of the Government of Spain’s Recovery, Transformation and Resilience Plan proposes the creation of a Spanish Agency of Public Health (SAPH), a centre of excellence to perform surveillance and health system preparedness functions in the face of new or emerging public health threats. The government has opened the debate on what design and functions it should have.

Results

SESPAS, the Spanish Society of Public Health and Public Administration, set out a proposal for the design and organization of the future Spanish Agency for Public Health [SAPH]. A large working group, made up of experts from various fields of public health and from its ten federated scientific societies, has designed the SAPH proposal. The scope of the public health functions to be assumed include: the strategic planning of the State’s public health (including health security), the prioritisation of public health policies and communication strategies, the assessment of the population’s health status and social conditions, the guarantee of the transversality and horizontality of health policies (health and health equity in all State policies), as well as their verticality (serving as an enriching link between the European Union level and the administrations of the Autonomous Communities and local authorities). The proposal also include 11 recommendations on the main elements to be taken into account in the establishment of the future SAPH.

Lessons

COVID19 pandemic has highlighted the need of creating strong public health institutions. Spain is giving its first steps toward the creation of the SAPH, which constitute a key step in addressing the current and future challenges of public health in Spain.

Key messages

• Spanish Public Health Agency is an opportunity to transform health policies and to improve the health of the Spanish population.

• Strengthening public health starts with building national institutions that ensure comprehensive and integrated health policies.
The health impact of the Triple Challenge of Brexit, COVID-19 and Climate Change in Wales
Authors: Green L
Published: October 2022

The COVID-19 pandemic has revealed the complex relationships between health, well-being, economy and society. The United Kingdom’s (UK) withdrawal from the European Union (Brexit) and climate change are having a cumulative, magnifying impact. UK nations have to tackle the multifaceted nature of Brexit, COVID-19 and climate change (‘Triple Challenge’ or TC) not only in isolation, but as a cumulative whole.This study provides a strategic overview of the interactions of the TC on determinants of health and equity in Wales and proposes opportunities to take forward. Using findings from existing Welsh Health Impact Assessments (HIAs) undertaken on the single challenges, rapid searches of the academic and grey literature were undertaken to identify evidence which focused on the TC and its impacts.From this, key determinants impacted and spotlight examples were identified and analysed. Evidence indicates the TC will have a wide range of compounding impacts across multiple determinants and inequalities. These will need to be viewed in synergy, not singularly. Determinants affected include i.e mental well-being, food insecurity, employment.Population groups potentially affected include rural communities, fishers/farmers, young people. Policy responses need to be constructed in an integrated way with cross sector involvement as actions intended to have positive impacts for one challenge could also have negative unintended impacts for others. This innovative work has highlighted the significant interconnectedness of the challenges. Developing an overarching policy approach could support lasting change.Having the TC as the underpinning focus point for new policies and strategies will help to maximise impact when addressing concerns in relation to post Brexit policy/actions, COVID recovery and climate change adaptation/mitigation.This work can be utilized by other nations as an example for challenges they may face in their context and nations in the UK/Europe affected by the TC.

Key messages

• Brexit, COVID-19 and climate change have cumulative health impacts which must be considered together.

• Health impact assessment can provide a core framework through which to explore inequalities and health impact of multiple policy and practical issues.
Map of Health Needs – basis for the national strategic frameworks
Authors: Olminski J , Koziol-Rostkowska M , Smiglewska A
Published: October 2022

As the economies transform into data-centred, so do the health systems. Responding effectively to emerging challenges through right decisions and setting up adjusted policies require a well-functioning evidence-based tool. The one developed in Poland is called ‘Maps of Health Needs'. It provides key stakeholders with unbiased data to support decision making processes. The Map depicts the current situation in the system, and forecasts the changes in upcoming years. The system is shown widely: starting with the background of demography and epidemiology, later moving to the out- and in-patient care, including long term care and rehabilitation, concluding with resources (staff and infrastructure). This broad and unbiased view on the system now and in the years to come, allows the public sector institutions to plan the short, medium and long term actions. It regards both strategic and operational levels, for the whole country and for the regions respectively. The documents juxtapose the current and the desired state of the system in the future, outlining necessary actions and goals in order to achieve it. In the recent years a few strategic frameworks have been developed in Poland, as the preparation for the next EU programming period advanced and in reaction to the pandemic crisis. The main documents include:

1) Healthy Future, the umbrella-like framework for the period 2021-2027,

2) Recovery and resilience plan,

3) Transformation plans.

The first and the second one became a part of the negotiation conditions at the European level, as they form a reliable source for modelling the flux of investments’ financing. In that way the maps shape the national policies, becoming the basis for strategic frameworks.

Key messages

• Reliable data is nowadays a key factor in strategic planning, also in the healthcare system.

• The tool developed in Poland, called Maps of Health Needs, serves as a base for strategic national frameworks.
Paid Sick Leave and Sickness Benefits for employees’ economic and job security: A Scoping Review
Authors: Kwon Y , Lee H , Ryu K , Moon D , Chung H
Published: October 2022

In health emergencies, such as in the COVID-19 pandemic, the need to expand or introduce the Paid sick leave(PSL) and Sickness benefits(SB) increases. They are key components of the universal health coverage(UHC) and active labor market policies(ALMPs) that enable workers to take care of their health and guarantee return-to-work after recovery. This study examines effects those policies in achieving economic stability and job security of covered workers through a scoping review. Studies were selected using the search terms ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ in PubMed and Web of Science. Our search conducted on 6th April 2021 yielded 1,030 articles, of which 22 articles were included in the review. All articles were analyzed by the 4 sub-groups(employees, families, employers, and government) and we investigated indicators of socio-economic impacts on their lives. Articles are largely PSL(90.9%)-focused. PSL guarantees not only workers’ job security by securing employment agreement, but also their income security by promising part of wages enough to afford healthcare and living expenses during the medical treatment and recovery. Additionally, PSL attenuates employers’ financial risk, as it reduces presenteeism while increasing the return-to-work rate. Moreover, PSL and SB reduce the total healthcare and social security expenditures of the government. To sum up, PSL and SB guarantee health and labor rights by ensuring income and job security to employees while assuring financial stability to both employers, and the government. However, as the previous studies paid less attention on the equity of these impacts at the system levels, future research should more focus on the dimension.

Key messages

• PSL and SB guarantee health and labour rights by ensuring income and job security for employees, while assuring financial stability for both employers and the government.

• The previous studies that examined the effects of PSL and SB paid less attention on the equity of ensuring income and employment security, therefore future studies should focus more on this dimension.