bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of COVID-19 on persons with concurrent mental health and substance use disorders
Authors: Leonhardt M , Lien L
Published: October 2022

Background

The COVID-19 pandemic with its restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for persons with mental health (MHD) and substance use disorders (SUD), who are particularly vulnerable to social exclusion. In this project, we aim to explore the impact of the pandemic on persons MHD/SUD, nearer, how the lockdown effected their daily life and further, the utilization of health care services under the consecutive waves of the pandemic.

Methods

The project has two parts: First we conducted 17 individual interviews and one focus group with persons with MHD/SUD, using thematic analysis. Second, we merged the Norwegian Patient Register, the Register for Infectious Diseases and data from Statistics Norway. We matched data of 41500 individuals with MHD/SUD after gender, age and health region with a sample from the general population as a control group and study the health care service utilization under the consecutive waves of the pandemic in Norway in 2020-2021.

Results

Within the qualitative study, we identified four interrelated main themes: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show further that people with MHD/SUD have challenges with digital tools and/or do not have the appropriate equipment. Persons with MHD/SUD face greater barriers in accessing the health care system compared to the general population as a control group. Results of the register study are still preliminary.

Conclusions

Persons with MHD/SUD face major challenges during the COVID-19 pandemic There is reason to believe that new pandemics will emerge in the future. In this context, it is essential to gain knowledge of how to care for vulnerable groups in society and how to reach them in emergencies.

Key messages

• Continuous maintenance of low-threshold services for persons with MHD/SUD during a pandemic is essential.

• Improvement of digital skills of service users or alternatives to digital consultations should be considered.
Uptake and impact of COVID-19 preventive measures amongst migrant populations in the Netherlands
Authors: Torensma M , Harting J , Boateng L , Agyemang C , Lassooy-Tekle Y , Jacob Y , van den Muijsenbergh M , el Fakiri F , Prins M , Stronks K
Published: October 2022

Uptake of preventive measures to reduce transmission of viruses such as SARS-CoV-2, is crucial in the control of pandemics. To ensure equitable uptake we explored contextual factors that shaped uptake of COVID-19 preventive measures amongst smaller, albeit substantial, migrant populations in the Netherlands. 39 persons of Eritrean, Ghanaian, Indonesian and Filipino origin, with diverse legal status and length of stay in the Netherlands, participated in five online focus group discussions. Thematic analysis of data was informed by concepts from the Precaution Adoption Process Model and Protection Motivation Theory. Awareness and knowledge of preventive measures was shaped by limited Dutch proficiency, access to understandable information and interference of misinformation. Engagement by preventive measures was subject to COVID-19 threat appraisal and the ease with which complex behavioural messages could be translated to individual situations. Perceived vulnerability of undocumented migrants in particular, motivated information-seeking. A strong social norm to keep with cultural and religious practices, and limited opportunity for preventive behaviour in work and home context hindered uptake of preventive behaviour. Preventive measures brought about job, food, and housing insecurity, and increased barriers in access to healthcare for undocumented migrants. Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures. Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants. Our results suggest importance of multilingual information tailored to literacy needs; education and modelling of behaviour; and, regulations to ensure continued access to financial and material resources to minimise negative spill-over effects. Results were incorporated in two policy briefs advising local and national government. Collaboration with municipal health services lead to multilingual public health information.

Key messages

• Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures.

• Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants.
COVID-19 vaccination intent and associated factors in healthcare workers: cross-sectional study
Authors: Zhelyazkova A , Kim S , Klein M , Prueckner S , Horster S , Kressirer P , Choukér A , Coenen M , Adorjan K
Published: October 2022

Background

Considering the vaccine hesitancy recorded among healthcare workers (HCW) during the 2009/10 influenza pandemic, we aimed to examine the COVID-19 vaccination intent of HCW at one of the largest hospitals in Germany and to identify associated factors.

Methods

We conducted a cross-sectional anonymous survey at LMU University Hospital in Munich, Germany, between February 25 and March 20, 2021. Data was collected on COVID-19 vaccination intent as main outcome and on potential associated factors.

Results

In total, 2555 HCW completed the survey; 48,3% (n = 1325) of them had already received at least one COVID-19 vaccine dose. Of those not yet vaccinated 51,7% (n = 1320), 83,6% (n = 1104) reported intention to get vaccinated, while 10,2% (n = 134) were undecided and further 6,2% (n = 82) reported refusal. Disagreeing that everyone should receive the generally recommended vaccines was associated with refusal (RR = 529,500, p = 0,000) while being vaccinated against influenza in the 2020/21 season was linked with lower likelihood of refusal or indecisiveness (RR = 0,124, p = 0,000; RR = 0,182, p = 0,000). Low or partial conviction of the effectiveness and safety of COVID-19 vaccines were linked to refusal (effectiveness; RR = 485,471, p = 0,000; RR = 9,247, p = 0,000; safety: RR = 116,829, p = 0,000; RR = 5,423, p = 0,025). Feeling ill informed about COVID-19 vaccines was associated with refusal and indecisiveness (RR = 25,900, p = 0,000; RR = 21,104, p = 0,000).

Conclusions

At the beginning of the vaccination campaign in Germany, a small proportion of HCW at LMU University hospital was hesitant on receiving a COVID-19 vaccine. Factors associated with refusal or indecisiveness were a sceptical attitude towards vaccines in general as well as feeling ill informed about COVID-19 vaccines, especially regarding their effectiveness and safety. Having received an influenza vaccine was associated with COVID-19 vaccination intent.

Key messages

• The presented results provide insight into the reasons for hesitancy of HCW against COVID-19 vaccines, indicating a pattern-like behaviour in the acceptance of novel vaccines by HCW.

• The evidence from our analysis can help inform the communication aims and emphases of vaccination campaigns among HCW within similar organizational contexts or in future outbreak scenarios.
Non-COVID activity in French emergency department during COVID-19 pandemic (March 2020 to March 2022)
Authors: Fouillet A , Forgeot C , Pontais I , Pedrono G , Caserio-Schönemann C
Published: October 2022

Background

The COVID-19 epidemic and mitigation actions had major impacts on health and healthcare use by the French population. Since 2004, the French public health agency daily collects individual data of visits in the emergency departments (ED) OSCOUR® network (94% of national visits in 2022). We aimed to analyse the evolution of non-Covid ED visits from 2020 to March 2022, in order to identify potential indirect impact of the epidemic.

Methods

The main medical diagnosis (MD) coded in ICD-10 from each ED visit from 2017 to March 2022 was classified into 17 ICD-10 chapters and in 95 disjoint subgroups of pathologies. The observed numbers of ED visits by age group and by chapters/subgroups were compared to expected numbers, estimated using an overdispersed Poisson regression model based on 2017-2019 data.

Results

The observed numbers of ED visits for all chapters and for a large part of subgroups were significantly lower than the expected numbers during the three lockdowns in all age groups and progressively returned to the expected level in 2021. A change in the pattern of a limited list of subgroups was observed: ED visits for purpura, chronic blood diseases and neurologic disorders in children decreased during the first lockdown and remained under the expected level until March 2022. Inversely the number of ED visits for mental health and wheezing in children, for pulmonary embolism in adults and for neoplams in the elderly increased and remained over the expected values until 2022.

Conclusions

Syndromic ED system was a pillar of the French reactive surveillance of direct and indirect impacts of COVID-19 epidemic. The changes observed for different subgroups of pathologies may reflect a negative impact of the epidemic, a positive effect of protective measures on the spread of other infectious diseases, a modification in the organization or in the use of health care in specific domains. Further studies using hospitalization data could explore these hypotheses.

Key messages

• Existing syndromic surveillance system implemented before the emergence of SARS-COV2 enabled to monitor non-Covid-19 visits to emergency departments and assess changes in patterns of pathologies.

• An increase in the number of emergency department visits during the COVID-19 epidemic was observed for mental health in children, for pulmonary embolism in adults and for neoplams in the elderly.
Bulgarian population – before COVID-19 and now
Authors: Tsanova D , Valentinova Ts , Vitkova Ts , Statev K , Mineva-Dimitrova El , Seizov A
Published: October 2022

Background

The demographic picture in Bulgaria became worse and worse since the democratic changes at the end of the 20th century. Our country was at one of the first positions according to the level of death rate and the rate of population decline. The study aims to analyse the effect of the COVID-19 pandemic on the main demographic indicators in Bulgaria.

Methods

Data from Bulgarian National Statistical Institute were used to analyse population growth and life expectancy and to calculate the death rate, birth rate, infant mortality rate, and the share of people over 65 years of age for 2019 in comparison with 2021.

Results

In 2019 before the onset of COVID-19, the Bulgarian population consists of 6 951 481 people. In 2021 it declines to 6 838 937 people. The decrease in birth rate is not very significant - from 8.9‰ /2019/ to 8.5‰ /2021/. The analysis provides estimates of excess deaths observed during the peak of the COVID-19 outbreak in Bulgaria. The death rate is very much increased - from 15.5‰ to 21.7‰. The increase affects the female and male populations equally - from 19.6‰ for men in 2019 to 23.2‰ in 2021 and from 16.4‰ for women to 20.2‰. The life expectancy shows a certain decrease - from 74.8 years /2019/ to 74.64 /2021/. Correspondingly, life expectancy was reduced for females- by 78.34 - 78.22 and for males by 71.37 - 71.11 years. The level of infant mortality is not changed - 5.6‰. People over 65 years are 21.6% of the total population during the compared period.

Conclusions

The Bulgarian population is very strongly affected by COVID - 19 pandemic. The COVID-19 pandemic has caused a significant number of deaths worldwide but Bulgaria ranks first in the world in terms of mortality rates. Life expectancy decline reflects the impact of temporary epidemic mortality. The impact on children from the pandemic is not very significant for the country. Society should be making major and cost-effective efforts to reduce mortality.

Key messages

• The sharp change in demographic realities has significant effects on the country’s economy.

• The deterioration of natural growth exacerbates the need to increase labour productivity in areas with the fastest declining populations.
Lessons from the epidemiological investigation efforts during the COVID-19 epidemic in Israel
Authors: Inchi L , Bord S , Madjar B
Published: October 2022

Background

The COVID-19 pandemic caused a crisis in the Israeli healthcare system. The wave-like morbidity created an overload of epidemiological investigations, which led to delays and less than successful efforts to prevent infection. For this reason, Israel decided to mobilize the military for this purpose, creating a forced cooperation between the Ministry of Health (MOH) and the IDF, an expert in dealing with crises.

Aim

To examine the implications of the forced encounter between the IDF and the healthcare system, including both tensions and cooperation efforts.

Methods

Twenty in-depth interviews were carried out with MOH and IDF personnel in different roles at various levels towards the end of the second pandemic wave in Israel.

Findings

The findings present a dual picture of cooperation and mutual respect, side by side with contradictions and conflicts. The feeling that the IDF came in to ‘save the day’ placed the healthcare people in an inferior position. Clearly, there was no explicit plan for division of authority. It was clear to the healthcare staff that they have the authority as the professionals, and to the IDF people that they have it as the ‘saviors’ brought in for this purpose. The healthcare people did see the potential of the military force mobilized for this purpose, but felt they were asked for their opinion only initially, when the military personnel had to study the system. As soon as they became familiar with it, they were no longer asked for advice, and control was given to the IDF. The findings also show that the MOH’s qualitative professional approach often clashed with the IDF’s action-based approach.

Conclusions

The military was mobilized as a crisis expert in order to assist the healthcare system in managing said crisis, but in fact this assistance had many side effects. Managing expectations, division of authority and open, sharing communication may have been useful in preventing the conflicts and managing them.

Key messages

• It is important to be aware of the a-symmetrical power relations of the military-healthcare system interface in order to create effective work and true, coherent cooperation.

• Management of expectations, organized division of authority and open, sharing communication may have assisted in preventing the conflicts raised and managing them.
Vaccine Literacy, Covid-19 and influenza: a cross-sectional survey in Prato in the 2nd pandemic wave
Authors: Bruschi M , Stacchini L , Stancanelli E , Velpini B , Lastrucci V , Puggelli F , Berti R , Lorini C , Bonaccorsi G
Published: October 2022

Covid-19 is a pandemic and an infodemic, with contrasting information regarding risk and preventive measures, including vaccination. This study aims to assess Vaccine Literacy (VL) of a sample of workers in the province of Prato (Tuscany, Italy) in the second wave of the Covid-19 pandemic (November-December 2020) and to analyze the relationship between VL and attitudes about Covid-19 and flu vaccination. A cross-sectional design was adopted. Sociodemographic characteristics, health information, vaccination behaviour for past and current flu season and intention to get vaccinated against Covid-19 were collected. A multivariate logistic regression was performed to identify predictors of getting a Covid-19/flu vaccination. The Italian Health Literacy tool on Vaccination (HLVa-IT) tool was used to measure VL. A total of 117 questionnaires were analyzed. Among them, 64.9% intended to get Covid-19 vaccine. The mean VL was 3.18 ± 0.43 (functional 2.87 ± 0.72; interactive-critical 3.36 ± 0.45) out of 4. Having more than one comorbidity was a negative predictor of intention to get Covid-19 vaccine (OR: 0.21 95%CI: 0.04 - 0.91). Regarding the flu vaccine, being vaccinated in the previous season was the only positive predictor of being vaccinated in the current season (OR = 24.25 95%CI 7.96 - 87.73). The study was conducted before the authorization of Covid-19 vaccines: little information about them may have contributed to VL not being related to the intention to get vaccination. The negative role of comorbidities could be due to fear of adverse effects on fragile health status. For flu vaccination, VL may have exerted a lower impact because of the positive experience with the flu vaccine in terms of safety and effectiveness in the previous seasons.

Key messages

• The introduction of new vaccines should be supported by effective communication.

• Better knowledge of current vaccines and not just routine administration is desirable for greater personal empowerment.
Training the Armed Forces personnel in COVID-19 contact tracing: a Portuguese case study
Authors: Carmezim Pereira S , Bicho A , Guerra I , Borges M , Vieira BS , Loyens D , Barcelos F , Carreira M , Calé E
Published: October 2022

Background

Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts’ workers.

Objectives

The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support.

Results

More than 200 personnel - sailors, soldiers and airmen - were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees.

Conclusions

This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities.

Key messages

• Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example.

• A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats.
Where are the children of working parents during school closures?
Authors: Mairhofer S , Plagg B , Flarer H
Published: October 2022

Italy was the first European country to be hit hard by the pandemic and in the context of the Covid-19 pandemic, there were several closures of education and care facilities. The first closure of education facilities lasted continuously from March to September 2020, followed by numerous shorter closures. However, if working parents continue to (have to) work, the question arises who will look after the children during this time when facilities close. To answer this question a quantitative survey of working parents during a ‘hard closure’ week in February/March 2021 was conducted in the province of Bolzano (Northern Italy). 3725 adults as parents of a total of 7,372 children from different households responded. Although not officially allowed, 53.4% of all participants sought help from people outside the nuclear family to bridge the situation, mostly from grandparents (79%; n = 1855). The situation that grandparents represented the main risk group at the time and could not yet have sufficient vaccination protection appears particularly worrying here. Other parents’ coping strategies included working early in the morning or at night (23 %; n = 850), or leaving children unsupervised (25 %, n = 929).

Conclusions

School closures shift families to new strategies, including unhealthy models of alternating work/childcare, ‘illegal’ involvement of third parties outside the nuclear family, and neglect of age-appropriate childcare. Our findings highlight that when childcare facilities are repeatedly closed, working families need additional support strategies to reduce contact and minimize secondary harms.

Key messages

• When schools close, parents have to find new strategies for where to take their children, many have contacts outside the home.

• Grandparents (also as a risk group) play a major role in childcare even during a lockdown.
Constructing a socioeconomic status index for colorectal cancer screening evaluation
Authors: Molina-Barceló A , Vanaclocha-Espí M , Pinto-Carbó M , Martín-Pozuelo J , Romeo P , Peiró-Pérez R , Barona C , Ortiz F , Nolasco A , Castán-Cameo S
Published: October 2022

Objective

To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP).

Methods

Cross-sectional study. The study population was composed of men and women aged between 50 and 69 who were invited to participate in the most recently completed round of the Region of Valencia CRCSP in 2020, n = 1,150,684. A multiple correspondence analysis was performed to aggregate information in the Segmented, Integrated and Geographical Population Analysis Code from the Population Information System of the Region of Valencia into an ISESI. Data from the 2016 Region of Valencia Health Survey was used for validation. The relationship between CRCSP participation and the ISESI was analysed by logistic regression models.

Results

The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175).

Conclusions

An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.

Key messages

• An individual socioeconomic status index was constructed and validated using Regional Population Information System data.

• The Individual socioeconomic status index constructed allows to systematically evaluates inequalities in colorectal cancer screening.
The effect of social deprivation on the dynamic of the SARS-CoV-2 infection in France
Authors: Smaili S , Pelat C , Chatignoux E , Kelly-Irving M , Delpierre C , Vandentorren S
Published: October 2022

Background

The association between health inequalities and the SARS-CoV-2 infection dynamic remains to be studied in France. The objective of this study was to analyse the relationship between an area-based deprivation indicator and SARS-CoV-2 infection indicators, during four epidemic waves running from August 4th 2020 to January 27th 2021 (second wave), January 28th to June 24th 2021 (third wave), June 25th to October 28th 2021 (fourth wave), and October 29th 2021 to March 29th 2022 (fifth wave).

Methods

We analysed weekly indicators of SARS-CoV-2 infection, extracted from the national testing information system: incidence, positivity and testing rates. The associations of these outcomes with the European Deprivation Index (EDI) quintiles were estimated with negative binomial generalized additive models adjusted for epidemic waves, population density (sparsely, moderately, densely populated), region (random effect) and interactions between epidemic waves and the variables EDI, population density, and region.

Results

The most deprived areas had a higher positivity rate than the least deprived ones during the second, third and fourth waves, but a lower rate during the fifth wave. They also had higher incidence during the third and fourth waves, but a similar incidence than the least deprived areas during the second wave, and even a lower rate during the fifth wave. The testing rate was lower in the most deprived areas than elsewhere, irrespective of the epidemic waves.

Conclusions

People living in the most deprived areas were less likely to be tested and more likely to test positive than people living in less deprived areas. The lower incidence, positivity and testing rates during the fifth wave in the most deprived areas may be explained by the enacted change in policy whereby screening tests were no longer free. These findings may reflect structural differences in access to care and lower capacity to benefit from prevention measures by deprived populations.

Key messages

• People living in the most deprived areas were less likely to be tested for COVID-19 irrespective of the epidemic waves.

• Health authorities should address the issues of social inequalities more rapidly and target prevention strategy to disadvantaged populations.
Factors influencing the implementation of school interventions: a systematic review
Authors: Butscher F , Ellinger J , Mall C
Published: October 2022

Background

To investigate contextual factors that influence the implementation of obesity prevention interventions in school addressing children with low socioeconomic status (SES) is very important. Evidence about these factors helps to improve the implementation, which can promote the health of children with low SES and therefore reduce health inequity. We aimed to systematically identify, critically appraise and summarize the evidence on implementation of school-based interventions promoting obesity prevention for children with low SES.

Methods

A systematic search in seven databases was conducted with the main inclusion criteria 1) school-based interventions and 2) age group 5-14 years. The Consolidated Framework for Implementation Research and its five domains and 39 categories was used to analyze the data deductively. If necessary, inductive sub-categories were defined within the categories. Contextual factors are assessed in the domain Outer Setting with four categories (A-D).

Results

6.446 studies were screened and 16 studies fulfilled all inclusion criteria. Seven studies reported contextual factors in the four categories A. Needs & resources of parents (N = 4), B. Cosmopolitanism (N = 4), C. Peer pressure (N = 2), and D. External policy (N = 4) with seven sub-categories in total. In the following are examples for reported aspects in the sub-categories. In the sub-category D.2 Existing policy, policy in line with the intervention was a facilitator for implementation (N = 2), whereas lack of control over administrative changes and food served in cafeteria due to policy were reported as barriers (N = 2).

Conclusions

Intervention research as well as applied health promotion should consider the complexity and interdependency of influencing factors for successful implementation. Albeit contextual factors are hardly changeable, they should be considered and addressed to reduce health inequity.

Key messages

• More research is needed with detailed reporting of influencing factors, as detailed information is those of relevance for practice.

• Contributing to standardized analysis and reporting in implementation research by using a comprehensive framework.
Prevalence of chronic diseases among United Arab Emirates University students: cross-sectional study
Authors: Bashir MM , Alshamsi M , Almahrooqi S , Alyammahi T , Alhammadi W , Alshehhi S , Alhosani H , Alhammadi F , Al-Maskari F
Published: October 2022

Background

Chronic disease burden is increasing globally. In Arab Gulf Countries, the burden has increased exponentially over the past five decades due to rapid economic growth and urbanization. In the United Arab Emirates (UAE), chronic diseases are the leading cause of mortality and economic burden, hence, there is need to explore their patterns for targeted interventions. Studies among university students in Europe and the United States show chronic diseases prevalence ranging from 16.5% to 30.0%, respectively. To our knowledge, this is the first study in the Gulf region to assess multiple chronic diseases among university students. Our study describes the prevalence and patterns of multiple chronic diseases among UAE University (UAEU) students.

Methods

We conducted a descriptive cross-sectional study among UAEU students ≥18years from July to October 2021. Online questionnaire was used to collect data. Self-reported chronic diseases were described and compared between male and female students using chi-square and t tests. Other students’ characteristics were also explored. All analyses were conducted using STATA statistical software.

Results

902 students participated in the study with mean age of 21.9±5.2yrs. 79.8% were females. 80.7% were undergraduates. The prevalence of self-reported chronic diseases was 23.0%. Obesity, Diabetes and Asthma/Allergies were the commonest (12.5%, 4.2% & 3.2%, respectively). 34.8% of the students were either overweight or obese. Overall chronic disease prevalence was similar between males and females [27.5% vs 21.8%, 0.104] though it was significantly higher among postgraduates, students who are older, married and have family history of diabetes. 4.7% of the students reported 2 or more chronic diseases.

Conclusions

Our study showed that more than 1 in 5 of the students reported at least one chronic disease. This shows the need for proactive chronic disease screening and prevention programs to meet the health needs of the students.

Key messages

• Prevalence of chronic diseases (Diabetes, Prediabetes, Obesity, Hypertension, Asthma/Allergies, Lipid disorders, Thyroid disorders, GI disorders, and CVDs) was high among the university students.

• Universities should commit to researching students’ health and creating targeted health policies and interventions, as chronic diseases have direct and indirect negative impact on students’ education.
The economic burden of Diabetes Mellitus in Belgium from 2013 to 2017
Authors: Pinheiro V , Gorasso V , Devleesschauwer B
Published: October 2022

Background

Considering the growing prevalence of chronic disease and diabetes mellitus (DM) in Belgium, alongside population aging, insight into the economic burden of DM is essential for decision makers. To the best of our knowledge, there is no research on the subject in Belgium. Thus, our aim was to estimate the direct and indirect costs associated to DM in Belgium between 2013 and 2017.

Methods

On a first phase, we performed a retrospective observational study, calculating the direct (i.e., ambulatory care, hospitalizations and medications) and indirect (work absenteeism, by multiplying mean daily wage and days absent from work) costs in the Belgian population with DM in 2013-2017. Data was retrieved from the Belgian Intermutualistic Agency (which manages compulsory health insurance) database and the Belgian Health Interview Survey database, namely DM prevalence, healthcare costs, days absent from work and sociodemographic and health factors. Subsequently, negative binomial regression models were used to assess the association of mean yearly costs to DM and adjustments for age, education level, physical activity, sugared drink consumption and body-mass index were included. Mean incremental costs were estimated through recycled predictions, considering the observed DM prevalence in Belgium in the study period and a counterfactual scenario with null prevalence.

Results

We found a direct mean yearly incremental cost of €2 477 per DM patient, in Belgium, associated with age, low educational level and low physical activity. In the total Belgian population, the total yearly incremental healthcare cost of DM was €1.5 billion. Indirect yearly incremental cost of DM resulted to be not significantly different from the population without DM.

Conclusions

DM has a major economic burden in Belgium, one that is expected to continue to rise in the future, alongside population aging. These results are essential for health planning and resource allocation.

Key messages

• DM has a major economic burden in Belgium, especially when it comes to direct health expenditures with ambulatory care, hospitalizations and medications.

• Considering the growing prevalence of DM and population aging, these results are essential for health planning and resource allocation.
Mitigating effects of desert dust storms in asthmatic children: health visitors’ perceptions, Cyprus
Authors: Kinni P , Kouis P , Charalambous M , Kakkoura MG , Elia SA , Kampriani E , Achilleos S , Panayiotou A , Middleton N , Yiallouros PK
Published: October 2022

Background

Countries of the Mediterranean basin such as Cyprus are experiencing frequent desert dust storm (DDS) events that adversely impact children with asthma. As school health visitors (SHVs) have important role in asthma management, we examined SHVs practices and perceptions on asthma management and their level of engagement in school-based interventions to mitigate DDS- health effects.

Methods

A descriptive cross-sectional survey was conducted among SHVs across state schools in Cyprus via an anonymous questionnaire, which rated the importance of asthma management measures (10-point scale), current implementation of these practices (1=never - 5=always), and regulatory authorities’ preparedness to respond to DDS events (1-5 Likert scale).

Results

Responses from 78 of the 93 SHVs (84%), with an average work experience of 13.5 years (SD 7.3), revealed discordance between high perception of the importance of asthma management measures and their actual implementation, with poor scoring especially in assessment of asthma control (M = 2.4, SD = 1.5), tracking school absenteeism (M = 2.1, SD = 1.0) and monitoring of asthma triggers (M = 1.9, SD = 1.4). Any DDS-related measures (e.g. air quality real-time monitoring, warnings, recommendations, awareness campaigns, etc) were implemented very infrequently. Ratings of authorities’ preparedness were moderate (<3.5), and only slightly higher in the health versus the educational or other government services. SHVs who recognized the severity of DDS and potential impact on asthmatic children were more likely to support school-based interventions for DDS events (OR = 7.3, 95% CI: 2.1-25.3).

Conclusions

Asthma management practices in school settings in Cyprus are suboptimal and responses during DDS are fragmented. While SHV’s awareness and support for interventions is high, this is not reflected in current practices. A concerted effort is needed for adoption of policies and implementation of action plans for DDS within school settings.

Key messages

• Suboptimal asthma management policies and practices were found to be implemented in schools in Cyprus, a country highly exposed to dust events.

• School health visitors recognize the health impact of desert dust on asthmatic children and support the plan for dust-mitigation programmes in schools, despite authorities’ low preparedness.
Expectations of patients for the implementation of new nursing technology
Authors: Klawunn R , Dierks ML
Published: October 2022

Background

New technologies, including robots, incidence detection or patient mobilization units, are increasingly assumed to support nurses in their routines while improving care quality. In the Nursing Care Centre Hanover study (funded by the German ministry of education and research), new technologies are implemented in a hospital ward and used by nurses in their routines. As part of this study, hospital patients were interviewed regarding the question: What are patients’ expectations for the implementation of new technology into care delivery?

Methods

Between August 2019 and February 2020, 17 semi-structured interviews were conducted with patients from the project ward. To stimulate a response, 8 presentation of technologies by video and text (3 per interview) were given during the interviews. Interviews were recorded, transcribed and coded by evaluative, qualitative content analysis. The coded material was then interpreted in light of the research question.

Results

Patients anticipate positive and negative effects of new technology concerning themselves, but they also expect effects on nurses: Health, safety and health service quality improvements might be positive effects for patients, but they are concerned about emerging threads to health by unintended consequences. They raise concerns about the possible inabilities of elder patients to use technology properly. Patients expect physical and emotional stress release for nurses when using technology, but they fear the replacement of nurses. This would have negative consequences for patients, like social isolation due to being cared for by machines.

Conclusions

Patients have ambivalent perceptions of new technologies in nursing care. They have a differentiated view of possible consequences, not merely for themselves but also for nurses. In general, they are positive about the implementation, but this must be carried out under certain conditions, so that technology is used in a supportive, but not replacing, manner.

Key messages

• The patients’ perspective must be take into account for the implementation of nursing technology to avoid negative, unintended consequences.

• Inclusion and consideration of older patients and their technology skills can be a relevant factor for advancing the adoption of new technology into care delivery.
Locality based Approach for containment of COVID-19 Infections in Pakistan’s High risk Districts-ICT
Authors: Noreen N , Naveed I , Bashir F
Published: October 2022

Background

In May 2020, considering gradual restoration of all economical activities the Government of Pakistan updated containment strategy from locking down the whole country to locking down high-risk areas to mitigate COVID-19 spread. All districts having ≥300 cases/100,000 population. COVID-19 case incidence and test positivity rates by real-time RT-PCR before and after zonal lockdown were compared to assess whether the locality-based lockdowns can be used as an alternative to country lockdown to contain COVID-19 spread.

Methods

Smart lockdowns were implemented in ten localities in the Islamabad Capital Territory (ICT), having a population of 60,000 from 12 May 2020 to June 3, 2020. Movements were restricted. Entry and exit points were guarded by police. Any person with symptoms of fever, cough, or sore throat tested by real-time RT-PCR methods and reported within 24 hours of collection. To compare the rate of active cases and positivity rate by weeks, we performed a z-test for two proportions and set p < 0.05 as the level of significance.

Results

The red zone had 60,000 persons in 2.00 square kilometers. The rate of active COVID-19 cases significantly decreased (p < 0.0001) during intervention from 300/100,000 population pre-containment time to 22/100,000 population after the first three weeks of lockdown. The COVID-19 positivity rate also decreased significantly (p < 0.0001) from 24% (24/78) pre-containment to 5.3% during containment. A total of 3800 people were tested in the following three weeks of intervention and 26 cases were detected.

Conclusions

The smart lockdowns approach reduced COVID-19 transmission in the ICT district. This type of intervention was recommended to reduce the COVID-19 infection spread

Key messages

• Reduced COVID-19 transmission in the ICT district.

• Keeping balance between life and economy.
The effect of BMI at cancer diagnosis on survival of patients with head and neck carcinoma
Authors: Pastorino R , Boffetta P , Hashibe M , Yuan-Chin A , Boccia S
Published: October 2022

Background

Previous findings suggest a positive association between body mass index (BMI) and survival from head and neck cancer (HNC). The aim of this study is to investigate the prognostic role of BMI at the time of diagnosis in a large international cohort of HNC patients.

Methods

We performed a pooled analysis of studies included in the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx, and larynx. We used Cox proportional hazards models to estimate the adjusted hazard ratios (HR) for overall survival and HNC-specific survival, by cancer site. Subgroups analyses were performed according to smoking status and duration of follow-up.

Results

The study included 10,177 patients from 10 studies worldwide with a median follow-up of 48 months; 3654 patients (35.9%) died from all causes, including 1202 (11.8%) from HNC. Underweight patients had lower overall survival (HR = 1.69, 95% CI: 1.31-2.19) respect to normal BMI patients (BMI=18.5-24.9 kg/m2) with consistent results across the HNC sites. In HNC-specific mortality analyses, the survival for underweight patients was not significant, except for underweight patients with oropharyngeal cancer (HR = 1.43, 95% CI: 1.11-1.83). Overweight and obese patients for oropharyngeal cancers had a favourable HNC-specific survival (HR = 0.50 (95% CI: 0.33-0.75) and HR = 0.51 (95% CI: 0.36-0.72), respectively). Among never smokers, overall BMI status was not associated with HNC-specific survival. Among ever smokers overweight and obese categories showed a favourable HNC-specific survival (HR = 0.69 (95% CI: 0.56-0.86) and HR = 0.70 (95% CI: 0.61-0.80)).

Conclusions

Our findings show that high BMI values increase the survival rates in smoking patients with HNC, suggesting that a nutritional reserve may help patients survive HNC cancer. This effect, however, may be partly explained by residual confounding, reverse causation, and collider stratification bias.

Key messages

• Our analysis reports the results of the largest available pooled analysis on the prognostic significance of BMI in the survival of 10,177 HNC patients from 10 studies worldwide.

• Lower overall survival was observed in underweight patients for all HNC sites and a lower HNC-specific survival was observed with oropharyngeal cancer. Adiposity could serve as a nutrient reserve.
Birth order and sickness absence: register-based evidence from Finland
Authors: Reini K
Published: October 2022

Background

In working ages, sickness absence is strongly related to persons’ health condition. We studied how birth order was associated with receipt of sickness absence, distinguishing mental disorders, musculoskeletal disorders and injuries.

Methods

A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt. Stratified Cox regressions were estimated using Stata 16.

Results

Each increase in birth order was associated with a higher risk of sickness absence. For mental disorders, the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98, 1.08) of second borns, 1.10 (95% CI: 0.99, 1.22) of third borns, and 1.52 (95% CI: 1.25, 1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (95% CI: 1.07, 1.17), 1.19 (95% CI: 1.09, 1.30) and 1.15 (95% CI: 0.96, 1.38), and for injuries 1.06 (95% CI: 1.01, 1.12), 1.09 (95% CI: 1.21, 1.14) and 0.96 (95% CI: 0.77, 1.20), respectively. These associations were notably stronger for women than men, but modestly influenced by mother’s age at birth, educational level, occupation, income and family composition.

Conclusions

The study was the first to provide evidence about an interrelation between birth order and sickness absence, utilising diagnose information and family fixed effects methods. A clear birth order pattern was observed for these main causes, but not for a residual group that consisted of other miscellaneous causes. Higher birth order was found associated with a higher risk of sickness absence, and particularly so for mental disorders and muscoloskeletal disorders in women. The underlying mechanisms behind these associations constitute an avenue for future research.

Key messages

• Using sibling fixed effects, the study was the first to analyse if sickness absence by main cause is associated with birth order in working ages.

• First-born siblings were the least likely to be sick because of mental or musculoskeletal disorders, and the associations were notably more accentuated for women than men.
Prevalence of hepatitis B and C, HIV, and syphilis among people who inject drugs in Germany
Authors: Steffen G , Krings A , Zimmermann R
Published: October 2022

Background

We piloted a future monitoring system among people who inject drugs (PWID) in Germany (DRUCK2.0). Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process in Germany by providing regular up-to-date prevalence and behavioural data for this key population.

Methods

PWID aged 16+ years who injected drugs within the last 12 months were recruited by time location sampling via low threshold drug services and opioid substitution treatment (OST) practices during routine services in Berlin and Bavaria between 01/06/2021 and 28/02/2022. All participants filled a questionnaire on sociodemographics, behaviour and access to care and were tested for hepatitis B and C (HBV, HCV), HIV and syphilis using capillary dried blood spots. All received a 10 Euro incentive voucher.

Results

In total, 495 PWID were included, median age was 39 years [range 18-66], 68% (336/494) were male, and 23% (114/492) born outside Germany, mostly in eastern Europe. Of all participants, 58% (275/477) reported recent use of unsafe needles/syringes and 77% (372/485) detention experience. Current OST was reported by 62% (304/487). Prevalence was 46% (229/495) for cured HCV, 26% (130/495) for active HCV, 17% (80/482) for cured HBV, 1.2% (6/483) for active HBV, 2.7% (13/482) for HIV and 2.1% (10/473) for previous Syphilis. Serological HBV vaccination coverage was 24% (115/475). Of all, 95% (453/475) reported previous HCV testing. Of those with cured/active HCV infection 88% (296/337) knew about their infection and 56% (161/285) of them reported previous/current treatment.

Conclusions

To decrease the heavy burden of infection among PWID in Germany, targeted measures regarding access to HCV treatment, HBV vaccination, and harm reduction (safer use measures, OST) need to be implemented and rolled out. Nationwide regular monitoring of indicators in this key population is needed to guide the elimination progress of viral hepatitis and HIV in Germany.

Key messages

• High burden of active Hepatitis C infection and low Hepatitis B vaccination coverage among people who inject drugs in Berlin and Bavaria require improved access to treatment and prevention efforts.

• National Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process among people who inject drugs in Germany.