bluuebunny/crossref_metadata_2025 huggingface dataset:
“A basic frame existed but was not followed” – Finnish public health system's response to COVID-19
Authors: Huhtakangas M , Kihlström L , Karreinen S , Keskimäki I , Tynkkynen L-K
Published: October 2022

Background

Crisis management Managing crises often requires diverging from predetermined plans. In this paper, we investigate how public health authorities in Finland acted, what kind of roles they adopted and how the expected roles and actions appeared in relation to the legislative framework and preparedness plans during the COVID-19 pandemic. Based on inter-country comparisons, Finland has managed COVID-19 pandemic relatively well. The study provides qualitative insights on pandemic governance in a decentralized multi-stakeholder public health system.

Methods

Semi-structured interviews (n = 53) with key public health actors at central, regional and local levels were conducted during March 2021-February 2022. The data was analysed with thematic analysis.

Results

The predetermined roles and duties for pandemic management were not unequivocal in practice and appeared unrealistic considering the resources of the public health system. Responsibility was divided between several actors, but lack of interaction enhanced emerging tensions between them. Local and regional actors experienced national steering intervening in operational decisions. At central level distrust towards the capabilities of local and regional actors was expressed. The pandemic was framed and managed as a health crisis despite of its wider societal effects. This challenged local and regional decision-making, where wider societal impacts had to be considered.

Conclusions

Public health authorities in Finland interpreted their roles and responsibilities in pandemic governance in various ways: some actors adopted more active agency than others and the roles were not always in line with the existing regulative framework.

Key messages

• Interpretation of the roles outlined in preparedness plans are context dependent and may lead to conflicts between different actors.

• In a system with multiple actors at multiple levels, building trust and improving interaction are important for coordinated action.
Breast cancer incidence and mortality in Georgia by regions and municipalities in 2015-2019
Authors: Tkeshelashvili V , Gvazava T , Beruchashvili T , Shvelidze E
Published: October 2022

Background

According to the NCDC, in 2015-2019, breast cancer ranked first in the structure of cancer in Georgia. Additional studies are needed to identify breast cancer incidence and mortality by regions and municipalities of Georgia.

Methods

Electronic dBase of cancer population registry for 2015-2019 (52,178 cancer cases), Tbilisi registry database for 2002-2004 (33,478 deaths from all causes), methodology recommended by IARC and UICC, SEER program and 2014 Georgian census data were used in the study. Standardized cancer incidence and mortality rates (ASR, TASR, AAR, SRR, CR64, CR74, SIR, SMR, PIR, 95% CI) were calculated.

Results

29,303 cases of cancer (56% of all cancers) were registered in the Georgian female population in 2015-2019, including 18,432 (62.9%) cases of breast cancer. In the mentioned 5 years, breast cancer ranks first in the general structure of cancer incidence in female population of Georgia and Tbilisi. According to ASR (world standard) and AAR (Georgia and Tbilisi standards, 2014), annual incidence was 62,9%000 /95,7%000 in Georgia, and 85.3%000 /123,6%000 - in Tbilisi. According to the SRR, incidence of breast cancer in Tbilisi was 1.4 times higher than general incidence of breast cancer in Georgia. In 2015-2019, compared to 1988-1992, i.e., in 27-year dynamics, rate of breast cancer in Tbilisi according to the SRR increased 2.4 times, and according to SIR- by 140,2% in dynamics. ASR of breast cancer deaths in Tbilisi in 2015-2019 annually made up 112,2%000. According to the SRR, in 2015-2019, the rate of breast cancer deaths in Tbilisi increased by 3.4 times, compared to 2002-2004. In 13-year dynamics, the incidence of breast cancer deaths according to SMR increased by 238%.

Conclusions

In order to advocate for breast cancer control it is recommended to develop regional and municipal screening programs based epidemiological maps of cancer and ensure effective screening services for each woman through the State program prevention guideline.

Key messages

• Epidemiological maps of breast cancer are recommended for use in planning regional and municipal programs of cancer control, including screening which will help breast cancer control advocacy.

• Ensure effectiveness of screening services for each woman through the State program prevention guideline.
Enhancing COVID 19 vaccination coverage in Sierra Leone
Authors: Moretti R , Scognamiglio T , Zoli A , Miozzo A , Lansana P , Nunie A
Published: October 2022

The project aim to support Sierra Leone in enhancing vaccination coverage. BACKGROUND In November 2021, the vaccination coverage rate was 7% for one dose and 4% for two. According with EPI program, the main problem was not the lack of vaccines (already provided by different donors) but the need of support (training, motivation, allowances) to health personnel. Lombardy project involved 31 local vaccination teams performing a refresh training, followed, by micro-planning meetings. SIGNIFICANCE The Covid epidemiology in SL is not well known, but the possible new waves makes this intervention a high public health priority. USEFULNESS. The model is based on training, motivation, follow up and a very simple monetary allowance system based on performance. An online daily report available on smartphone was provided to follow up performances and manage allowances system. PROBLEM The objective was a donation of vaccines, but after a short assessment the issue changed to the need of supporting the local health staff. The goal shifted to train, give incentives for health workers, support to micro-planification and also to work on timely reporting to follow up the project results. QUESTIONS ANSWERED. Can support to microplanning be effective in enhancing vaccination numbers? Can monetary incentives to personnel based on performances enhance vaccination numbers? Can a setting approach (school, workplaces,..) enhance vaccinations numbers? RESULTS the numbers of vaccination Increased from an average of 5 per team by day in early December (after the refresh training) up to an average of 15 by day after the support to micro-planning, the monetary progressive incentives based on performance and the introduction of settings approach. Up to 85.000 doses was performed in 4 months.

Key messages

• Planning, performance based payement and training can enhance vaccination coverage.

• African countries can performe good vaccination programs if supported in organization and non only in vaccine donation.
Factors associated with hospitalization for aortic stenosis in Portugal from 2015 to 2017
Authors: Avelar FG , Alves J
Published: October 2022

Background

Severe aortic stenosis prevalence has been growing worldwide and constitutes a public health challenge. The gold-standard treatment is Surgical Aortic Valve Replacement (SAVR) however Transcatheter Aortic Valve Implantation (TAVI) has been increasing, especially in high-risk surgical patients. This study aims identifying the factors associated to the implementation of TAVI to minimize possible disparities in access to health services.

Methods

This study used data on inpatient discharges from the Portuguese NHS, from 2015 to 2017. SAVR and TAVI, were classified according to the International Classification of Diseases (ICD). Chi-square test and independent T-tests with 1% significance level in the SPSS® were performed to identify the factors associated with both interventions.

Results

A total of 8398 hospitalizations were analysed, 88.5% SAVR and 11.5% TAVI. The mean (SD) age for SAVR was 70 (±11) years old and 81 (±7) years old for TAVI (p < 0.001), 56.9% were male among SAVR and 44.6% among TAVI (p < 0.001). Year (p < 0.001), type of admission (p < 0.001), geographic location (p < 0.001), severity (p < 0.001) and Charlson Comorbidity Index (CCI) (p < 0.001) were associated with the type of intervention.

Conclusions

TAVI was performed in more severe patients and there was an increase in TAVI over the years, which is consistent with the growing use of the technology among other patients, e.g., the high-risk surgical patients. We also found a geographic pattern in the use of SAVR and TAVI. This might reveal the existence of geographic disparities regarding availability and access to health services.

Key messages

• In Portugal, there is an increase in the performance of TAVI, with geographical concentration that reflects on access.

• TAVI is more often performed in more severe patients as an alternative to SAVR with similar discharge outcomes.
Towards Better Oral Health Prevention: the Value for Money of Fluoride Toothpaste
Authors: Hofbauer T , Coughlan J , Gierth J , Gkekas N , Listl S , Pattamatta M , Põld A
Published: October 2022

Background

Although largely preventable, tooth decay (dental caries) is among the most common health conditions worldwide and contributes to substantial dental treatment expenditures. While Fluoride Toothpaste (FT) is considered an essential strategy for oral health prevention, its market price has been shown to vary substantially across various settings. Against this background, the present study aimed to develop a decision analytical model to evaluate the cost-effectiveness of FT in various settings.

Methods

Leaning on WHO CHOICE methodology, evidence scoping and an expert consensus were facilitated to extract model input parameters which were then fed into cost-effectiveness-analyses (CEA) for FT. The cost-effectiveness of the interventions was expressed as cost per Disability-Adjusted Life Year (DALY) averted.

Results

The CEA identified a high likelihood for FT to be a cost-efficient treatment strategy in settings with comparably low market prices for FT. FT was less likely to be a cost-efficient treatment strategy in settings with comparably high market prices for FT.

Conclusions

The developed decision analytical model is suitable to inform policymakers about the extent to which FT represents good value-for-money under different market prices.

Key messages

• Fluoride toothpaste can provide high value for money as an oral health preventive strategy.

• Policymakers need to ensure the affordability of fluoride toothpaste in order to harvest relevant efficiency gains.
Implementation of “COVID-19 case investigation and contact tracing” training program in Armenia
Authors: Grigoryan Z , Musheghyan L , Abrahamian D , Petrosyan V , Dorian A
Published: October 2022

Background

Comprehensive contact tracing and case identification (CICT) is key to preventing the SARS-COV-2 transmission. During the COVID-19 waves in Armenia, the effectiveness of CICT practices was suboptimal due to weak capacity of evidence-based CICT. The American University of Armenia and the University of California, Los Angeles offered a continuous education program for the public health workforce in Armenia which is relevant for any country aiming to improve its CICT capacities.

Objectives

We developed and implemented a fully remote yet synchronous ‘COVID-19 case investigation and contact tracing” training program through didactic lectures, demonstrations of CICT interviews, small-group skill labs, and opinion polls. It covered the basic principles of public health and epidemiology, the main methods of CICT in relation to COVID-19, and health coaching techniques. We evaluated the knowledge improvement through a pre-experimental evaluation design at baseline and follow-up. The training sessions were held from November 2020 to June 2021. The participants received 10 CME credits upon completion of the training course.

Results

The online modality allowed to reach professionals across the country, though affected the participation in the evaluation surveys. Overall, 93 professionals participated in the training program, yet only 57 returned completed surveys. The paired analysis showed an increase in the mean knowledge scores (0-24) at baseline and follow-up (14.5 vs 15.82 (p = 0.0083). A more notable increase was detected on questions that measured knowledge of health coaching techniques (0-6) (2.76 vs 3.44 (p = 0.0052)).

Conclusions

New knowledge and skills penetrated into daily CICT practices across Armenia. This was a good example of a quick mobilization of local and international expertise to assist the national efforts in responding to a public health emergency by utilizing evidence-based approaches and lessons learned from the past infectious diseases’ outbreaks.

Key messages

• Our training program strengthened the human resource capacities of Armenia’s existing public health system and assisted Armenia’s COVID-19 response efforts.

• The model of our training program can be effectively adapted and extrapolated for various countries and settings which aim to improve response capacities to other threats of public health importance.
The impact of the AstraZeneca suspensions on the public’s vaccination intentions and trust
Authors: de Vries M , Claassen L , Lambooij M , Timen A
Published: October 2022

Background

In spring 2021, several countries, among which the Netherlands, suspended vaccinations against COVID-19 with the Vaxzevria vaccine from AstraZeneca (AZ) after reports of rare but severe adverse events (SAE). We investigated the impact of this news and the suspension on the Dutch public’s COVID-19 vaccination intentions, COVID-19 vaccination perceptions (attitudes and feelings) and their trust in the government’s COVID-19 vaccination campaign.

Methods

We conducted two surveys (N = 2628), one shortly before the AZ suspension in the Netherlands and one shortly thereafter when all vaccinations were resumed. Chi2 tests were conducted to study changes in COVID-19 vaccination perceptions, intentions and trust before and after the suspension, and differences between perceptions and intentions regarding AZ vaccines compared to COVID-19 vaccines in general. All variables were measured on a 5-point Likert scale.

Results

No significant changes were observed in COVID-19 vaccination perceptions and intentions, but trust in the campaign declined slightly (mean diff.(ΔM)=-0.2, 95% CI=-0.3/-0.2). In addition, compared to COVID-19 vaccinations in general, respondents were less likely to vaccinate with AZ (ΔM=-0.7, 95% CI=-0.7/-0.7), reported less positive vaccine attitudes (ΔM=-0.7, 95% CI=-0.7/-0.7), and more negative feelings (ΔM=0.5, 95% CI = 0.4/0.5).

Conclusions

The news on SAE and the AZ suspension might have caused a decline in trust in the government’s COVID-19 vaccination campaign, as well as negatively impacted AZ vaccination perceptions and intentions. These results stress the need to adapt vaccination policies to anticipated public perceptions and responses following a vaccine safety scare, as well as the importance of informing citizens about the possibility of very rare SAE prior to the introduction of novel vaccines.

Key messages

• Trust in the COVID-19 vaccination campaign declined following the news on rare but severe adverse events (SAE) and the suspension of AstraZeneca vaccines.

• While the news on SAE and the vaccination suspension did not seem to impact COVID-19 vaccination intentions in general, intentions to vaccinate with AstraZeneca were considerably lower.
“My quality of life was not the best” experiences of Australians during the COVID pandemic
Authors: Green H , MacPhail C , Fernandez R
Published: October 2022

Background

The social and economic impacts that have occurred during the pandemic can disproportionally affect those already experiencing poverty. The social determinants of health aggravate inequalities and can adversely affect wellbeing. This study aims to gain rich insight into Australian adults’ experiences of the social determinants of health and the impact on their wellbeing during the COVID-19 pandemic.

Methods

A descriptive qualitative study using purposive sampling to recruit participants for semi-structured interviews, conducted via videoconferencing between March-August 2021. Thematic analysis was performed with the support of NVivo 12.

Results

Participants included 20 Australian adults from various socioeconomic areas ranging in age from 21 to 65 years. Three main themes emerged from the analysis of the data: Food-related concerns; Housing outcomes; and Psychological and emotional impact. Accessing food, during the COVID-19 pandemic, for most participants who resided in low socioeconomic areas, was described as stressful and challenging. Along with the burden of food security, many participants from low socioeconomic areas expressed emotional distress in relation to securing and maintaining adequate housing.

Conclusions

The pandemic has amplified existing social determinants of health experienced by those within low socioeconomic areas, particularly those who are female and from migrant communities. The wellbeing of participants from low socioeconomic areas decreased in response to their experiences and challenges with food insecurity and housing instability, highlighting the need for housing affordability strategies and funding of emergency food relief initiatives. Food access for those in areas with high socioeconomic disadvantage, can be improved to address some of the barriers associated with food security by providing supermarket meal vouchers, access to community gardens, and school food programs.

Key messages

• The housing and food insecurity experienced by participants in this study during the pandemic has influenced their overall wellbeing.

• The pandemic has amplified existing social determinants of health experienced by those in low socioeconomic areas.
Impact of mask-wearing on child and adolescent psychosocial development: a systematic review
Authors: Freiberg A , Horvath K , Hahne TM , Drössler S , Kämpf D , Spura A , Buhs B , Seidler A
Published: October 2022

Background

Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents.

Methods

A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. A search update will be conducted shortly before the conference.

Results

Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask-wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the “mask” and “no mask” conditions. The results are preliminary and may be extended due to the search update.

Conclusions

Only little evidence can be derived on the effects of face masks on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behaviour, school success, and participation. Further cluster-randomized controlled trials or longitudinal studies are required.

Key messages

• Empirical and experimental evidence shows that mask-wearing impairs facial expression among children, adolescents, and teachers in (pre)schools.

• Research on the following developmental areas is missing: psychological development, language development, emotional development, social behaviour, school success, and participation.
Total, sex and age-specific excess mortality during 2020 in 20 countries part of the C-MOR consortium
Authors: Demetriou CA , Achilleos S , Quattrocchi A , Nicolaou N , Gabel J
Published: October 2022

Nationally published COVID-19 mortality estimates might underestimate the actual mortality burden attributed to COVID-19. Estimations of excess all-cause mortality can provide more accurate estimates of the toll of the pandemic. This study aims to estimate the overall, sex and age-specific excess all-cause mortality in 20 countries, during 2020. Total, sex and age-specific weekly all-cause death counts for 2015-2020 were extracted from national vital statistics databases. Percent excess mortality for 2020 was calculated by comparing average weekly 2020 mortality rates against average weekly mortality rates from the past five years (2015-2019). Comparisons were performed for the total population, per sex, and per age groups (<65 vs. 65+ or < 70 vs.70+) depending on data availability. Percent difference in average weekly mortality between 2020 and 2015-2019 ranged from negative for Australia and Norway, to < 5% for Denmark, Cyprus, Estonia, Israel, and Sweden, 5-10% for Georgia, Mauritius, Ukraine, Austria, France, Scotland and Northern Ireland, to ∼10-21% for England & Wales, Italy, Brazil, USA, Slovenia, and to 89% for Peru. The percent difference in average weekly mortality between 2020 and 2015-2019 for males was higher than for females except for Cyprus, Estonia, Slovenia and the USA. Lastly, in age specific analyses, for the majority of countries the % increase in average weekly mortality between 2020 and 2015-2019, was higher in the oldest age group investigated, however, for Peru and the USA (<65 vs. 65+ years) and for Cyprus and Mauritius (<70 vs. 70+ years), mortality increased similarly in both age groups. This study highlights that the excess mortality burden during the COVID-19 pandemic disproportionally affected specific countries, males, and in most, but not all countries, the oldest age groups. Strengthening of health resilience in the most affected countries, while targeting population groups impacted the most, is of paramount public health importance.

Key messages

• Excess mortality burden during the COVID-19 pandemic disproportionally affected specific countries, and even within countries specific sex and age groups.

• Further investigation into the determinants of excess mortality is needed to suggest steps to strengthen health resilience in the countries and target population groups impacted the most.
Mortality in Covid-19 patients hospitalized in a teaching hospital in Italy during the first 3 waves
Authors: Bertolotti M , Betti M , Ferrante D , Giacchero F , Odone A , Franceschetti G , Carotenuto M , Pacileo G , Maconi A
Published: October 2022

Introduction

In Italy a Covid-19 pandemic pattern was observed, characterized by several waves, with an excess total mortality of 178000 deaths. Alessandria, Italy is the Piedmont province with the highest proportion of mortality from Covid-19 in the first 4 months of 2020, compared to the rest of the region.

Objectives

To analyze mortality in patients hospitalized for Covid-19 in the Alessandria Hospital (AO AL), considering the first 3 waves.

Materials and methods

Subjects aged ≥18 with a diagnosis of Covid-19 admitted to the AO AL in the first 50 days of the first 3 waves were included. The first wave started on 24 February 2020 (first day of available data by the Ministry of Health), the second wave on 14 September 2020 (first day of the 2020/21 school year), the third wave on 15 February 2021 (peak of cases detected by the Italian College of Health). The causes of death were obtained from the National Institute of Statistics death cards and codified according to the International Classification of Diseases, 9th revision, classification.

Results

We included 825 subjects (median age: 73 years; male prevalence: 60.7%). The subjects hospitalized in the first wave were 464, in the second wave 255, in the third wave 106. A total of 309 subjects died (37.5%), of which 218 in the first wave (70.6%), 69 in the second wave (22.3%), 22 in the third wave (7.1%). The most frequent causes of death were “Covid-19 pneumonia” (61.5%) and “respiratory distress syndrome” (19.4%). Death occurred after hospital discharge in 40% of cases. 6 months after admission, the survival rate was 53% among patients of the first wave, 73% and 78% for those of the second and third wave. Patients hospitalized in the first and second waves showed a greater risk of death compared to patients of the third wave (HR = 2.8; 95% CI 1.8-4.4 and HR = 1.4; 95% CI 0.8-2.2).

Conclusions

Data showed a difference in mortality between the 3 waves with a statistically significant variation between the first and third waves.

Key messages

• Data showed a difference in mortality between the 3 waves.

• Data showed a statistically significant variation in mortality between the first and third waves.
Determinants of COVID-19 vaccine uptake among healthcare workers and the general population in Cyprus
Authors: Giannakou K , Fakonti G , Kyprianidou M
Published: October 2022

Background

Vaccination is a critical intervention in the fight against the coronavirus disease 2019 (COVID-19) pandemic. Various levels of COVID-19 vaccination acceptance have been observed around the world. However, a high percentage of the general population and healthcare professionals (HCPs), refuse the COVID-19 vaccination. This study aims to examine the factors influencing COVID-19 vaccine uptake among HCPs and the general population in Cyprus.

Methods

An online cross-sectional study was conducted, using a self-administered questionnaire to collect information covering various potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information, and general vaccination knowledge.

Results

A total of 2582 participants completed the survey, with 53.5% of individuals in the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by one year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00-1.03, p-value=0.035), whilst those with increased trust in national healthcare authorities’ guidelines (OR = 3.96, 95% CI: 3.41-4.61) and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05-1.18) were significantly more likely to be vaccinated. Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01-3.59), and those who reported increased trust in national healthcare authorities’ guidelines (OR = 5.38, 95% CI: 3.65-7.95) were significantly more likely to be vaccinated.

Conclusions

Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and educate and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavorable scenarios, such as future pandemics.

Key messages

• Our results revealed the importance of vaccination knowledge and trust in healthcare system in respect to COVID-19 vaccination uptake.

• The urgent need for national campaigns and long-term planning to build public trust in national healthcare authorities.
Facing COVID-19 in Georgia - left behind children coping better with COVID-19 precautions
Authors: Antia K , Berner-Rodoreda A , Winkler V
Published: October 2022

Background

Georgia, a major migrant sending country, with about 39% of children living with their caregivers while at least one of the parents migrated (left-behind children, LBC) has been severely affected by the COVID-19 pandemic. The main aim of this study was to qualitatively explore LBC’s perception and experience during the pandemic.

Methods

Between December 2021 and January 2022, we conducted 39 (29 LBC, 10 non-LBC) individual in-depth interviews with schoolchildren aged 12-18 in a public school from a migrant sending region. We conducted life history narrative interviews and used a thematic analysis approach.

Results

Preliminary findings show four salient themes: (1) Family members’ first reactions to the pandemic influence children’s emotional health irrespective of parents’ working arrangements. Children express less stress and anxiety when families show emotional stability and are not overwhelmed by the pandemic; (2) All interviewed children find COVID-19 and home-schooling a challenge. (3) LBC express more intense fear about infecting their grandparents than non-LBC. (4) Closer family ties to parents and siblings and access to better equipment help LBC to cope better than non-LBC. LBC view a positive side of Covid-19 in being able to enjoy more time with a parent, who would have otherwise worked abroad.

Conclusions

Overall, all children perceive the COVID-19 pandemic as a challenge, yet closeness with a returned parent and with siblings and more affluence helps LBC to cope better than non-LBC with COVID-19 precautionary measures like home-schooling.

Key messages

• All children are affected by the COVID-19 pandemic. Emotional stability in the family is important in fostering resilience and coping mechanisms among children.

• LBC experience the added benefit of better equipped homes and enjoy the presence of the migrant parent at home.
Are we socially equally at risk of smoking during the COVID-19 pandemic? French data from 2009-2021
Authors: Andersen AJ , Melchior M , Mary-Krause M , Wallez S , Hecker I
Published: October 2022

Background

Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021.

Methods

The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression.

Results

The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]).

Conclusions

Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic.

Key messages

• The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic.

• From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.
Over-the-counter Medication Use during Pandemic: Lessons Learned from Covid-19 in Lithuania
Authors: Bikniūtė I , Paric M , Clemens T , Commers M , Brand H , Vladičkienėa J , Elands RJJ
Published: October 2022

Background

Despite the growing awareness about nonprescription misuse of anxiolytics, there is not much evidence about people’s behavior during the covid-19 lockdown when access to healthcare specialists was limited. Over the counter drug use has risen sharply in the past decades among college students and junior health care workers, yet, there are few studies reporting on the use of nonprescription medicine groups during the COVID-19 pandemic.

Methods

A cross-sectional study among 163 second-year medical students of the Lithuanian University of Health Sciences was conducted in Kaunas, Lithuania with self-reported measures of anxiety and insomnia and comparing nonprescription medicine use for anxiety and insomnia before and during the covid-19 pandemic.

Results

A near two-fold increase in the prevalence of anxiety and insomnia among Lithuanian medical students was reported during the covid-19 pandemic compared to before the onset of the pandemic (p < 0,001). The use of nonprescription medication increased during the pandemic (p < 0,001), in particular anxiolytics (p < 0,05). Once-weekly anxiolytic medication use increased from 8,0% before the pandemic to 14,7% during the pandemic. Regular nonprescription medicine use (2-3 times weekly) had more than tripled, from 2,4% to 9,2%. During the pandemic, almost a fifth of the respondents were increasingly searching for information on anxiolytic nonprescription medication online during the pandemic compared to before the pandemic.

Conclusions

During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications. Lithuanian medical students increasingly practiced self-medication during the pandemic and found the information on nonprescription medication increasingly online, which offers opportunities for telemedicine.

Key messages

• During the covid-19 pandemic, the prevalence of anxiety and insomnia increased among Lithuanian medical students, along with the practice of anxiolytic nonprescription medications.

• During covid-19, Lithuanian medical students increasingly retrieved information on nonprescription medication online instead of consulting a pharmacist, offering opportunities for telemedicine.
Risk of SARS-CoV-2 infection in high and low-risk cohabitants, in Loures and Odivelas, Portugal
Authors: Mateus Cunha I , Marques JL , Subtil IM , Bragança Pereira M , Gabriel C , Vieira C , Cordeiro C , Abreu Gomes F , Bastos L
Published: October 2022

Background

Effective contact tracing, vaccination, and isolation of cases of SARS-CoV-2 infection and their high-risk contacts constituted measures to contain the spread of COVID-19. In Portugal, in October 2021, low-risk cohabitants were lifted the obligation to isolate. The aim of this study was to estimate the relative risk of infection for close contacts, regarding the type of close contact and being cohabitants.

Methods

A descriptive longitudinal study, with an analytical component was performed. Sociodemographic and epidemiologic data from close contacts and confirmed cases in Loures and Odivelas, between October and November 2021, was collected from a regional database and from Trace COVID-19 platform. We performed a descriptive analysis and estimated the relative risk of SARS-CoV-2 positive test, stratified by type of contact and cohabitation, with 95% confidence level.

Results

We identified 200 confirmed cases and 428 people who were close contacts, corresponding to 502 different close contacts (59 people had contact with more than a case). From 502 close contacts, 268 were classified as low-risk and 230 as high-risk. Full time cohabitation was present in 310 of close contacts. Between contact tracing day and the next 4 weeks, 58 (10.9%) of close contacts tested positive. Risk of high-risk contacts testing positive was 2.7 [1.5-4.6], compared with low-risk contacts. Risk of cohabitants testing positive was 3.5 [1.6-7.7], compared with non-cohabitants. Risk of a high-risk cohabitant testing positive was 2.2 [1.1-4.4], compared with low-risk cohabitants. There was no higher risk of high-risk cohabitants testing positive compared with high-risk non-cohabitants. Same was true for low-risk cohabitants and non-cohabitants.

Conclusions

These results allow us to understand how to better stratify close contacts and apply isolation measures, according to the risk of testing positive. Further studies should be developed to assess the impact of other variables.

Key messages

• We identified an increased risk of testing positive in high-risk contacts, and in cohabitants.

• Cohabitants could be stratified regarding being high or low-risk, with different measures being applied.
Characteristics of COVID-19 cases with breakthrough infection in the governorate of Sousse, Tunisia
Authors: Ben Fredj S , Ghammem R , Zammit N , Maatouk A , Hadded N , Laadhari H , Maatoug J , Ghannem H
Published: October 2022

Introduction

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

Methodology

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

Results

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

Conclusions

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

Key messages

• low rate of severe cases of COVID-19 among the vaccinated population.

• discrepancy in the effectiveness of vaccines in the prevention of transmission potential.
Gender inequalities in mortality in Lithuania: the HAPIEE Study
Authors: Pikhart H , Tamosiunas A , Pikhartova J , Paulikaite E
Published: October 2022

Introduction

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

Methods

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

Results

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

Conclusions

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

Key messages

• Large gender inequalities in mortality have been observed in this Lithuanian study of middle- and older-age men and women.

• Most of the inequalities have not been explained by available social, psychosocial, behavioural and metabolic risk factors.
Chronic diseases and multi-morbidity in persons experiencing homelessness: a cross-sectional study
Authors: Lutchmun W , Froeschl G , Gach J , Bader C , Borup C
Published: October 2022

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

• Research to highlight the health inequity, both in access and outcomes, in persons experiencing all forms of homelessness is much needed.

• This study provides data on a population disconnected from the formal healthcare system. Making such data visible is a step towards addressing the structural causes of social exclusion.
The association between depression and quality of life in the elderly
Authors: Papageorgiou A , Bakola M , Kitsou KS , Mousafeiris V , Mavridou K , Kallianezos P , Kampouraki M , Charalambous G , Jelastopulu E
Published: October 2022

Background

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

Methods

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

Results

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

Conclusions

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

Key messages

• Depression can be a predictor of poorer quality of life in older population.