bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the covid-19 pandemic on GP contacts for respiratory infections in children under 5 years
Authors: Foley K A , Hargreaves D S , Quint J K , Bottle A , Viner R M , Kenny S E , Majeed A , Saxena S
Published: October 2023

Background

Social distancing measures to reduce transmission of SARS-CoV-2 during the covid-19 pandemic also impacted the transmission of many other respiratory pathogens. We describe the impact of the covid-19 pandemic on general practitioner (GP) contact rates for respiratory tract infections (RTIs) that may have been affected by social distancing in children <5 years in England.

Methods

Trends analysis from 1 April 2016 to 31 March 2021 using electronic health records from a nationally representative primary care database. We included all children aged <5 years registered with a primary care practice during the study period. Our main outcome was GP contact rates for transmissible RTIs including otitis media, tonsillitis, and pneumonia. We also calculated the rates of urinary tract infections as an index non-transmissible condition.

We calculated annual rates for each year of age (<1, 1-<2, 2-<3, 3-<4, 4-<5) by summing the GP contacts divided by the number of days each child was registered with the GP practice.

Results

There were 415 622 RTIs among 1 955 946 children <5 years over the study period. From 2016-2020 GP contact rates for RTIs were falling steadily by ∼14%/ year in all age bands, with rates of otitis media, tonsillitis and pneumonia declining by 5-11% per year. However, in 2021 marked falls of around 80% occurred for all RTIs, otitis media, tonsillitis, and pneumonia. By contrast, trends for GP contact rates for urinary tract infections before and during the covid-19 pandemic steadily declined by ∼5%/year.

Conclusions

Our study shows major reductions in the incidence of RTIs in under 5s during the pandemic, probably a result of SARS-CoV-2 containment measures. The impact of reduced exposure to RTIs during childhood on long term respiratory health is unknown. At the conference, we will report results up to March 2023.

Key messages

• GP contacts for respiratory infections in under 5s fell during the covid-19 pandemic in England.

• Fewer respiratory infections in childhood may impact future health service use and requires monitoring.
Associations between physical activity and digital gaming activity among Finnish adolescents
Authors: Ng K , Karhulahti V-M , Koskimaa R , Sokka M , Husu P , Kokko S P , Koski P
Published: October 2023

Background

Physical activity (PA) for adolescents is an important health promotion habit to develop, yet other activities may be more appealing during this stage in life. According to the displacement hypothesis, time on digital games takes away the opportunity to be physically active. As there is a notable decline in PA levels between the ages of 11y- 15y in Finland, there is an urgent need to investigate potential areas that contribute to the decline. According to the 2021 Finnish Player Barometer, 65% of Finns play digital games regularly. The aims of this study were to investigate the associations between PA and digital gaming, and to examine how these associations may change by gaming genres.

Methods

A Finnish national representative sample (n = 1979) of 11y-15y olds, completed a self-report survey in spring 2022. Variables included PA behaviour, the frequency of digital gameplay, by sport simulation and Esports genres, and various confounders (gender, age, disability, economic status). Analyses were carried out by chi-square tests and multi-logistic regression analyses (no/low activity as reference categories).

Results

A third (32%) reported daily PA. Daily digital gameplay was more common among males (74%) than females (26%) and decreased from 11y (53%), 13y (30%) to 15y (17%) olds. After controlling for confounders, playing ball sport simulations (e.g. FIFA) was associated with taking part in 5 or more days/week of PA, or sport club participation (OR = 2.8, CI = 1.7-4.4), whereas playing a lot of first-person shooter games, as an Esport, was negatively associated with sport club participation (OR = 0.6, CI = 0.4-0.9) when compared to the reference categories.

Conclusions

The displacement hypothesis was supported partly among Esport players, but not by simulated sport gamers. Targeted interventions to promote physical activity with digital gaming, require a genre-specific approach.

Key messages

• Associations between physical activity and digital gaming activity among young adolescents is genre specific.

• Frequent playing of digital games were more common among male 11-15y olds than females.
Assessing mental health from registry data: what is the best proxy?
Authors: Beerten S G , De Pauw R , Van Pottelbergh G , Casas L , Vaes B
Published: October 2023

Background

Medical registries frequently underestimate the prevalence of health problems compared with surveys. This study aimed to determine the registry variables that can serve as a proxy for variables studied in a mental health survey.

Methods

Prevalences of depressive symptoms and antidepressant use from the 2018 Belgian Health Interview Survey (HIS), stratified by sex and age, were compared with same-year prevalences from INTEGO, a Belgian primary care registry. Participants aged 15 and above were included. We assessed correlation and agreement using Spearman's rho (SR), the intraclass correlation coefficient (ICC) and the limits of agreement (LOAs).

Results

HIS questions about depressive symptoms were compared with the following variables from INTEGO: symptom codes (SR 0.763, ICC 0.026), diagnosis codes (SR 0.653, ICC 0.195), free text (SR 0.653, ICC 0.322), antidepressant prescriptions (SR 0.793, ICC 0.391) and the combinations symptom + diagnosis codes (SR 0.640, ICC 0.270) and symptom + diagnosis codes + free text (SR 0.653, ICC 0.386). LOAs varied from [-0.120, 0.021] for antidepressants to [-0.015, 0.061] for the full combination. HIS questions about antidepressant use were compared with prescription frequencies in INTEGO of at least once (SR 0.899, ICC 0.586) and at least three times yearly (SR 0.895, ICC 0.835). Corresponding LOAs were [-0.093, -0.008] and [-0.053, 0.007].

Conclusions

Correlation between the HIS and INTEGO was high, agreement fair to poor. Agreement increased by combining certain variables, by including free text, or by increasing the prescription frequency to resemble chronic use. Prevalences from INTEGO were mostly underestimates. A considerate choice of variables and prescription chronicity is needed to accurately use a registry as a surveillance tool for mental health.

Key messages

• The external validity of medical registries can be poor, especially compared with survey data.

• Researchers should be aware of the choice of variables when using registry data as a proxy for population measures.
Mental distress during the COVID-19 Infodemic in Ireland, a prospective national survey over time
Authors: Arnott J M , Joyce M , Corcoran P , Troya M I , Khashan A , Perry I , Arensman E
Published: October 2023

Background

The World Health Organisation (WHO) declared an ‘infodemic’ in 2020, that resulted in distrust in health authorities and impacted public mental health promoting confusion, worry, and fear. The aim of this study is to identify indicators associated with mental distress during the first year of the COVID-19 pandemic in Ireland.

Methods

A nationally representative cross-sectional telephone survey conducted data collection during 3 study periods: May, July, September 2020. Mental health outcomes were assessed by the Patient Health Questionnaire Anxiety Depression Scale (PHQ-ADS), mental distress defined as a score of 10 or more. Analysis included descriptive and logistic regression.

Results

Of the 2,914 participants, 27.6% experienced mental distress during 2020(n = 804). The prevalence of mental distress did not significantly change over time, from 28% in May2020 to 25.3% in Sept2020. Women were significantly more likely to experience mental distress than men; 34% compared to 21% (OR:1.91;95%CI:1.62-2.26). Mental distress was highest in the youngest age groups (43% in < 30years,OR:3.24;95%CI:2.36-4.45), with a significant decreasing trend with increasing age. Mental distress was associated with trust in the pandemic response, those with the lowest levels of trust had the highest levels of mental distress at 37% (OR:1.84;95%CI:1.26-2.68), with a significant decreasing trend with increasing trust. During May2020, those experiencing mental distress were significantly less likely to seek healthcare when required, 41% compared to 21% (OR:2.59;95%CI:1.94-3.46). Education, employment and household income were also studied.

Conclusions

This study identified indicators associated with mental distress, such as trust and healthcare avoidance, which can inform future emergency management policy. The WHO recommends promoting the understanding of risk to mitigate harm to the public's mental and physical health, which could increase public trust and reduce mental distress.

Key messages

• The COVID-19 ‘infodemic’ impacted the public's mental health, with 27.6% of the study experiencing mental distress.

• Mental distress is associated with trust and healthcare avoidance which can inform future management strategies.
10.B. Workshop: Combatting AMR: European collaboration to ensure sustained access to effective antibiotics
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Dimitra Panteli (Belgium), Elias Mossialos (UK)
Published: October 2023

Antimicrobial resistance (AMR) is one of the greatest public health threats facing the world today. The health and economic impacts of AMR are a major challenge for all healthcare systems and societies worldwide. It is estimated that antibiotic-resistant infections are responsible for a substantial number of deaths in Europe each year, with a health burden comparable to that of influenza, tuberculosis and HIV/AIDS combined and a cost of about €1.1 billion to the healthcare systems of EU/EEA countries. Holistic and multicomponent strategies in accordance with the ‘One Health’ perspective are key to curbing the development and spread of AMR. One crucial component of such strategies is ensuring broad and timely availability of effective antibiotics; this captures both investing in R&D for new antibiotics and safeguarding continued access to new and existing products. Scientific, economic, structural and regulatory barriers continue to limit the development of novel antibiotics with innovative characteristics despite intensified international efforts. Indeed, only a handful of new antibiotics have been developed and launched over the last few decades, and almost none have any innovative characteristics. This means that they are vulnerable to cross-resistance with existing antibiotics. At the same time, while ensuring timely access to new and existing antibiotics is critical, new antibiotics are often only launched in larger markets while supply-chain problems or withdrawals due to low profitability impact the availability of older antibiotics as well. This panel session aims to discuss the challenges facing health systems regarding how to foster research and development for new antibiotics and ensuring sustainable access to new and pre-existing antibiotics in the context of addressing AMR. In particular, it will aim to highlight avenues for collaboration and the potential role of the EU for addressing these challenges. Following a short presentation of the key findings of a policy brief published by the European Observatory on Health Systems and Policies at the request of the Swedish Presidency of the Council of the European Union, participants will hear reflections from the national and international levels and discuss potential implications and ways forward. Panelists will reflect on the relevant priorities of the upcoming Belgian Presidency of the Council of the European Union in the first half of 2024, as well as the WHO Regional Office for Europe's Regional Roadmap on AMR.

Key messages

• Fostering innovation and ensuring sustained access to effective antibiotics are paramount for addressing AMR.

• Collaboration across countries, supported by the EU and the WHO will be key to achieving these goals.
Partial substitution of red or processed meat with plant-based foods and colorectal cancer risk
Authors: Tammi R , Kaartinen N E , Harald K , Maukonen M , Tapanainen H , Pajari A M , Männistö S
Published: October 2023

Background

Consumption of plant-based foods, particularly whole grains, may decrease colorectal cancer (CRC) risk, while red and processed meat consumption increases it. Moreover, shifting to more plant-based diets promotes sustainable food systems. Yet, few studies have examined the impact of dietary shifts towards more plant-based diets on CRC risk. We modelled a partial substitution of red or processed meat with whole grains, vegetables or fruits in relation to CRC risk in Finnish adults.

Methods

Our data comprised 43 788 participants (79% men) aged ≥25 years from five Finnish cohorts. The median follow-up was 29 years, during which 1124 CRC cases were diagnosed. Diet was assessed by a validated food frequency questionnaire. We modelled substitutions of 100g/week of red meat or 50g/week of processed meat with an equivalent amount of plant-based foods. In a two-stage meta-analysis, cohort-specific hazard ratios (HR) were calculated using Cox proportional hazards model and pooled together. We adjusted the analyses for sex and other relevant confounders.

Results

We observed a small decrease in CRC risk when red or processed meat was partially substituted with vegetables (red meat: HR 0.97, 95% CI 0.94-0.99, P = 0.008; processed meat: 0.99, 0.98-1.00, P = 0.029) or fruits (red meat: 0.97, 0.94-0.99, P = 0.007; processed meat: 0.99, 0.98-1.00, P = 0.036). No association occurred between the partial substitution of red or processed meat with whole grains and CRC risk.

Conclusions

Our results suggested that already small and easily implemented substitutions of red or processed meat with vegetables or fruits could reduce CRC risk in Finnish adults. The findings highlight the need for effective nutrition policy actions to promote the shift towards more plant-based diets that would benefit both public health and sustainable food systems. Further research on similar substitutions in relation to CRC risk is required in different populations and real-life settings.

Key messages

• Already small and easily implemented substitutions of 100g/week of red meat or 50g/week of processed meat with vegetables or fruits could reduce colorectal cancer risk in Finnish adults.

• The findings highlight the need for effective nutrition policy actions to promote the shift towards more plant-based diets that would benefit both public health and the sustainability of food systems.
Impact of COVID-19 pandemic on health care attention on breast cancer patients
Authors: Bruning González P , Quintana M J , Requeijo C , Savall O , Bonfill X
Published: October 2023

Background

Health care in relation to breast cancer has been negatively affected by COVID-19 pandemic. This study aims to estimate the impact of the pandemic on health care related to breast cancer at Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain.

Methods

This retrospective cohort study estimated the impact of pandemic during its first year on patients diagnosed with breast cancer undergoing treatment, follow-up, and control at HSCSP, and performed a comparative analysis with patients diagnosed the previous year in relation to the clinical characteristics, the treatments and the health care received.

Results

Data from 408 patients were analyzed, 217 (53.19%) from the group diagnosed the year before the pandemic (GC) and 191 (48.81%) from the group diagnosed during the pandemic (GP). No differences (p > 0.05) were found in clinical characteristics such as ECOG at diagnosis, histological type, presence of hormone receptors and HER2 receptors and prognostic stage. No significant differences (p > 0.05) were found in relation to survival at year. Most patients were diagnosed in HSCSP in assistencial circuit, a decrease of 10.02% was observed in the number of diagnoses in screening program. A difference of 3 days (p = 0.047) in diagnostic delay was found in GP in HSCSP. 10.93% fewer surgeries (p = 0.021) were performed as first treatment in GP.

Conclusions

11.98% less breast cancer was diagnosed in HSCSP during COVID-19 pandemic. The difference in diagnostic delay was 3 days, with a scarce clinical relevance. A reduction of approximately 10% was found in patients diagnosed through the screening program, which could explain the lower number of surgeries performed as first treatment (91.7% patients diagnosed through screening have surgery as first treatment). No significant differences were found in the clinical characteristics, probably because the lockdown (3 months) was not enough, although studies with longer follow-up times are lacking.

Key messages

• During the COVID-19 pandemic, there were fewer breast cancer patients diagnosed through the screening program and fewer patients whose first treatment was surgical.

• A delay of a few weeks in the start of treatment could result in a significant increase in mortality, this study showed that health care in the HSCSP was not greatly affected by the COVID-19 pandemic.
Forecasting the future burden of disease in Scotland
Authors: Grant I , Fletcher E , Wyper G , Lakha F
Published: October 2023

Scotland is expected to see a rapidly ageing population within the context of an overall decrease in population. Public Health Scotland's Scottish Burden of Disease (SBoD) Study has recently been adapted to forecast how these demographic and population health trends are expected to combine, to anticipate the extent of future public health challenges. Our initial aim was to forecast the burden of disease for 12 disease groups, over the next two decades, based solely on projected changes in the population. Further work is underway looking at the additional impact of changing morbidity and mortality at individual disease level, using an age period-cohort approach, and the possible impact of disease treatment through scenario analyses. We sourced Disability-adjusted life years (DALY) rates for 12 disease groupings from the SBoD study for 2019. Age-sex specific disease burden rates were assumed to remain constant over the forecasting period, thus assuming no changes to the underlying epidemiological rates. Population projections at 5-year age group, separately for males and females, were sourced from National Records Scotland up until the year 2043. Despite a projected decrease in the Scottish population, the annual disease burden is forecast to increase 21% in the next 20 years. Absolute increases in annual disease burdens are forecast to be largest for cardiovascular diseases, cancers, and neurological diseases - together accounting for 68% of the total increase in forecasted disease burden. Forecasted relative increases in annual disease burdens highlight increases for common infectious diseases; unintentional injuries; diabetes and kidney diseases; and chronic respiratory diseases. By indicating how the changing demographic situation in Scotland will impact the causes of disease burden, these forecasts are useful to inform priorities for workforce and care service planning and redesign, and for prioritising areas for disease and injury prevention.
Incidence and persistence of psychotic experiences among young people
Authors: Staines L , Healy C , Cotter D , Cannon M
Published: October 2023

Background and Hypothesis

Psychotic experiences (PEs) are associated with increased risk for mental disorders, in particular persistent PEs. PEs therefore might be useful within intervention research. We sought to systematically determine the incidence and persistence of PEs in the general population. Study Design: A double-blind search of databases (Embase, Pubmed PMC, Psychinfo, Medline, and Web of Science) from inception to January 2023 and data extraction, were conducted. Study quality was assessed using the NIH assessment tool. Random effects models were conducted to calculate pooled incidence rate per personyear and proportion of persistent PEs per year. Age and study design were all examined using subgroup analyses. Demographic, risk factors, and outcomes for incidence and persistence of PEs were reported in a narrative synthesis.

Results

Using a double-blind screening method for abstract (k = 5763) and full text (k = 250) were screened. In total 91 samples from 71 studies were included, of which 39 were included in a meta-analysis (incidence: k = 17, n = 56 089; persistence: k = 22, n = 81 847). Incidence rate was 0.023 per person-year (95% CI [0.0129;0.0322]). That is, for every 100 people, 2 reported first onset PEs in a year. This was highest in adolescence at 5 per 100(13-17 years). The pooled persistence rate for PEs was 31.0% (95% CI [26.65,35.35]) This was highest in adolescence at 35.8%. Cannabis was particularly associated with incidence of PEs, and persistence of PEs were associated with multiple mental disorders.

Conclusions

Each year incidence of PEs is 2 of every 100 people, and persists each year in 31% of cases, this risk is highest in adolescents.
Human Dignity: Exploring the Implications of the Dying Patient Act in Home-Hospice Care
Authors: Yakov G , Spector-Mersel G , Halevi-Hochwald I
Published: October 2023

Background

Human dignity is a vital value in democratic countries, forming the foundation for essential values such as autonomy, informed consent and appropriate clinician-patient relationships. The Israeli Dying Patient Act of 2005 aims to balance the sanctity of life and patient autonomy by standardizing medical care for dying patients. The law mandates that clinicians respect dying patients’ wishes and not artificially prolong their lives, providing palliative care administered by a multi-professional team. This study explores the implications for the human dignity of dying patients in home hospice care in Israel.

Research Methodology

The study employs a qualitative approach, utilizing 17 semi-structured interviews with multi-professional team members working within a home hospice framework. The collected data was analyzed using a narrative analysis approach.

Results

The findings reveal a nuanced understanding of the challenges of implementing the human dignity value in the home hospice, based on the Dying Patient Act. The challenges include managing a care framework that is also the patient's home, dealing with the tension between patients’ wishes and those of their families, and managing patients’ changing wishes, such as when they initially wish to die at home but later ask to be taken to the hospital.

Conclusions

Clinicians should be trained in end-of-life communication to respect patients’ wishes at the home hospice under the spirit of the Dying Patient Act. Patients and families should be partners in addressing these challenges. Human dignity is essential in providing quality care. This study offers insights for policymakers and clinicians to improve end-of-life care in the home hospice setting.

Key messages

• In the home hospice, human dignity plays a crucial role in delivering quality and ethical care, especially when dealing with the balance between the Inconsistent wishes of patients and families.

• Clinicians should be trained in end-of-life communication to respect patients’ wishes, and patients and families should be partners in addressing the challenges to provide quality care.
Evaluation criteria of evidence-based practices in health and wellbeing promotion in Finland
Authors: Kylänen M , Kostiainen E
Published: October 2023

Decision makers and experts have a great need to receive independent and credible knowledge about the effectiveness of evidence-based practices (EBPs) for promoting health, wellbeing, and equity. Best practice portals that evaluate EBPs have developed for this need. However, the evaluation criteria by which the portals determine the degree of effectiveness, evidence, and practical applicability of EBPs may differ between portals and need further investigation. There do not exist a single framework for evaluation criteria. Although the randomised control trials may meet a gold standard, there are alternative approaches to evaluate EBPs, considering the complexity of health promotion and wellbeing interventions. The Finnish Institute for Health and Welfare started to develop the best practice portal in health and wellbeing promotion in 2019. In this workshop, we present the evaluation criteria of EBPs in Finland and how the approach may contribute to the evaluation of EBSs, knowledge base and management in health promotion and disease prevention policy. We will also reflect on the way we capture the complexity in our criteria.
Comparative study on school health promotion in Switzerland and Malaysia: qualitative evidence
Authors: Betschart S , Adams D , Sandmeier A , Skedsmo G
Published: October 2023

Background

The Ottawa Charter emphasized schools as a central location for health promotion. In particular, a holistic approach involving all members of a school and the school community is considered desirable for school health promotion (SHP). School principals are seen key players in SHP implementation, but little is known about how contextual factors such as the governance of health and education affect their roles. The project aims to study the governance mechanisms and contextual factors affecting SHP implementation in schools in two national contexts: in Malaysia and Switzerland.

Methods

18 principals were interviewed in expert interviews. The interviews were transcribed verbatim and analyzed with MAXQDA using qualitative content analysis with deductive and inductive categories.

Results

Results indicate that there are significant differences in how Malaysia and Switzerland govern SHP. In Malaysia, there are clear structures and responsibilities for SHP. The health and education sectors work closely together, with top-down decision-making on a national level. In contrast, Switzerland has no governmental policy regarding SHP for schools with SHP organized mainly by NGOs. It appears that in Switzerland, decisions regarding SHP are made more bottom-up and at the local level, typically by municipalities. Malaysia has a very distributed leadership model, with a school leader specifically responsible for student affairs and SHP at each school. Enablers of SHP include clear structures and well-defined responsibilities, while a lack of time and staff are among the primary barriers to successful implementation.

Conclusions

The governance and policies of SHP are very different in Malaysia and Switzerland. Clear structures and high centralization in Malaysia are contrasted by very high autonomy and a federal structure in Switzerland. Advantages and disadvantages of these differences in educational governance will be discussed within the presentation.
The mental health and well-being of senior school leaders in Wales and Northern Ireland
Authors: Marchant E
Published: October 2023

Background

Research has demonstrated the impact of COVID-19 school closures on pupils’ health, well-being, learning and development and the challenges faced by teaching and support staff. There was, however, no evidence on the effects on school leaders. The COVID-19 Leadership Survey explored this by surveying senior school leaders (headteachers and other teachers with senior leadership duties e.g. deputy head teachers) in Wales and Northern Ireland to understand the impact of COVID-19 school closures and restrictions on their mental and emotional well-being. It also was undertaken against a backdrop of a potential crisis in recruiting and retaining senior school leaders in the UK.

Methods

The COVID-19 School Leadership Survey (translated into English) was emailed to all primary and secondary schools in Wales (June-November 2021) and all primary, post-primary and alternative education provision for 5-16 year olds in Northern Ireland (March-May 2022). The response rate was Wales N = 172 and Northern Ireland N = 151. It should be noted the survey in Northern Ireland was undertaken after the last COVID-19 related legal restrictions were removed.

Results

Nearly three-quarters (74%) of senior school leaders in Northern Ireland and over half (54%) of senior school leaders in Wales were categorised as having possible depression based on their results on the WHO-5 scale. Leaders reported that challenges faced managing their workloads as a result of the COVID-19 pandemic impacted on their mental health and wellbeing. Despite these challenges, the majority of senior school leaders still perceived their role and work situation as meaningful.

Conclusions

A more strategic approach to supporting the well-being of senior school leaders is essential in both Wales and Northern Ireland. Further research into what mental health supports are needed, as well as a greater focus on the extent and quality of leadership development provision that will specifically support leaders well-being.
Ukrainian refugees’ wellbeing and adaptation in Denmark
Authors: Castaner M , Schönemann A , Nørredam M
Published: October 2023

In Denmark - 28 765 individuals from Ukraine have been granted residency under the Danish Special Act. While Ukrainians share the war exposure with other groups of refugees in Denmark, they differ in many aspects. For example, the special act has allowed Ukrainians access to the welfare state benefits (including healthcare) relatively fast and they have been accommodated outside of asylum centers. In addition, the political climate in the reception of Ukrainians has been rather favorable compared to the last refugee crisis. Yet, we know very little about their health needs and access to care. The aim of our project is to identify and understand the health needs of Ukrainian refugees and how they access healthcare in Denmark in order to inform the development of strategies that help them cope with postmigration stress and improve their quality of life. We have developed a survey, in collaboration with a group of experts by experience (Ukrainian refugees). The survey combines validated tools and self-developed questions and includes several themes: i) factors influencing adaptation of Ukrainian refugees; ii) individual sociodemographic characteristics; iii) trauma/war exposure; iv) living and housing conditions in Denmark; v) experiences in access to Danish healthcare system; and vi) health needs and well-being including symptoms of trauma. The target population is Ukrainian refugees in Copenhagen aged 18 and above. Currently, there are 2916 refugees living across the city. The aim is to recruit at least half of them, located in three municipalities: Copenhagen Municipality, Frederiksberg Municipality and Gentofte Municipality. The survey has been launched May 2023, and by November 2023, we expect to have collected and analyzed all data, which we are going to present at workshop. Our participatory research methods involving Ukrainian refugees throughout the process include their engagement in intervention and policy suggestions based on the survey.
Impact of the COVID-19 pandemic on COPD patients: a nationwide mortality study in France
Authors: Poucineau J , Khlat M , Lapidus N , Espagnacq M , Chouaïd C , Delory T , Le Coeur S
Published: October 2023

Background

Chronic obstructive pulmonary disease (COPD) patients are a vulnerable population with an increased risk of death from COVID-19 if infected. To date, a reduction in hospitalizations for acute exacerbations of COPD has been reported in various contexts, but large population-based studies with mortality follow-up are lacking. We investigated the mortality patterns of COPD patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019.

Methods

COPD patients were identified in the French National Health Data System based on their healthcare use. Four COPD cohorts were created, and followed for one year in 2017, 2018, 2019 and 2020, respectively. Corresponding control cohorts (without COPD) were created, matched on sex, age and residence, with a ratio of two controls per case. Survival was analyzed using Cox regressions and standardized rates.

Results

The four COPD cohorts included about a million and a half individuals each. All-cause mortality increased in 2020 compared to 2019 in the COPD population (hazard ratio (HR) [95% confidence interval]: 1.04 [1.03-1.05]), but to a lesser extent than in the control population (HR: 1.10 [1.08-1.11]). Non-COVID-19 mortality decreased to a greater extent in COPD patients (HR: 0.95 [0.94-0.96]) than in the controls (HR: 0.98 [0.97-0.99]). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs 279 per 100,000 person-years).

Conclusions

The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing.

Key messages

• During the COVID-19 pandemic, COPD patients experienced a slight increase in all-cause mortality, but relatively less than the rest of the population of the same age and sex structure.

• In 2020, relative to a control population, COPD patients experienced substantially higher COVID-19 mortality and, at the same time, a greater reduction in non-COVID-19 mortality.
COVID19 lockdown impact on mental health of Reunionese in 2020: Confinaou cross-sectional study
Authors: Casimir A , Aissaoui H , Bouscaren N , Maillard O , Spodenkiewicz M , Fianu A , Chirpaz E
Published: October 2023

Introduction

On March 17, 2020, in Reunion Island, the lockdown was established for 8 weeks in order to limit the spread of the virus responsible for the COVID-19 pandemic. Beyond the beneficial aspects on the control of the infectious risk, questions arose around the repercussions of this universal preventive measure on the mental health of the Reunioneses. The objective of the study was to describe the impact of lockdown measures on the stress level of the adult population of Reunion Island and factors associated with changes in stress level.

Methods

Cross-sectional KABP-type study ‘Confinaou’ in general population (≥ 18 years), by online self-questionnaire accessible during the first lockdown, from April 30 to May 10, 2020. To identify the independent predictive factors of the increase in stress felt during lockdown, we performed a multivariate logistic regression.

Results

The analysis included 1,421 adults, of whom 706 (49.7%) reported an increase in lockdown-related perceived stress compared to baseline state. Factors independently associated with increased stress level were being female (OR = 1,33 [IC à 95%: 1,02-1,72]) and, living in crowded housing (OR = 1,30 [IC à 95%: 1,03-1,68]). Factors associated with reduced stress level were being 60 years of age or older (OR = 0,65 [IC à 95%: 0,45-0,95]) and feeling well or completely informed about Covid-19 prevention measures and lockdown rules (OR = 0,75 [IC à 95%: 0,58-0,96]).

Conclusions

This study confirms that psychological repercussions can occur in the population during lockdown as observed in the Reunionese population of the study. A targeted and adapted preventive public health response could be considered to prevent the mental repercussions of such situations of isolation and restriction of social interactions in the general population. Women, and youth could be a priority for prevention interventions using health literacy improvement approach. Social equality policy measures could focus on housing conditions.

Key messages

• Targeted mental health prevention actions adapted to at-risk populations (women, young people, people in precarious housing situations) have to be set up in these isolation situations as the lockdown.

• Prevention actions will have to integrate actions to improve communication and ‘crisis information’ to prevent the negative impacts of a new pandemic on mental health.
Labour market effects of the COVID-19 pandemic: A Dutch longitudinal study
Authors: Monteiro Sanchez G , van Zon SKR , Ots P , van den Berg G , Brouwer S , van Ooijen R
Published: October 2023

Background

The COVID-19 crisis has caused profound impact on societal, economic, and healthcare systems. The nature and distribution of these impacts, especially over longer periods of time, is still in need of further investigation. We aim to examine the prevalence of and determinants for poor labour market outcomes during the COVID-19 pandemic among adult workers in the Northern Netherlands.

Methods

We conducted a longitudinal study based on data from the Lifelines COVID-19 cohort. Data from 23 waves (March 2020 - November 2021) were used. Participants were workers between 18 and 64 years of age (n = 22,378). Dependent variables were labour market outcomes, i.e., unemployment, hours of work, quality of work and sickness absence. Independent variables are sociodemographic and work characteristics, pre-existing health conditions, COVID-19 disease, and government support measures. We employed logistic Generalised Estimating Equations (GEE) to estimate population effects.

Results

Decrease in hours and quality of work, and requiring sickness absence were markedly present in our sample. While the former seems to show partial recovery throughout the pandemic, the two latter seem to vary over time. The prevalence of unemployment was low. Using GEE, we have found erratic patterns of risk for the four labour market outcomes. Pointing to the vast heterogeneity of experiences and impacts on the labour market outcomes of workers. Women, for example, had higher odds of becoming unemployed (OR: 1.48, 95% CI: 1.23-1.79), but lower odds of decreasing their work hours (OR: 0.90, 95% CI: 0.86-0.93).

Discussion

The results of this study point to the unequal and heterogeneous impact of the COVID-19 pandemic, as well as the presence of less visible negative outcomes among workers, such as decrease in quality of work. For a complete rebound from this crisis, policy should be aimed at addressing these differential impacts among the population.

Key messages

• The impact of the COVID-19 pandemic on the labour market is more pervasive than can be attested by looking at unemployment rates.

• The impact of the COVID-19 pandemic differed by labour market outcome and population subgroup, and policies should aim to address these differential impacts.
The economic impact of treating hypertension in sub–Saharan Africa - A systematic review
Authors: Gnugesser E , Chwila C , Brenner S , Deckert A , Dambach P , Steinert J , Bärnighausen T , Horstick O , Antia K , Louis V R
Published: October 2023

Background

Hypertension is a leading risk factor for cardiovascular diseases, with high numbers of undiagnosed and untreated patients in sub-Saharan Africa (SSA). While the disease poses a substantial social and economic burden for patients and health systems, research on the economic consequences remains scarce. This systematic review compared hypertension treatment costs in SSA and identified possible cost drivers and opportunities to reduce the economic burden.

Methods

A systematic search was performed in six databases (PubMed, Web of Science, CINAHL, ISPOR, EconLit and Google Scholar) for peer-reviewed articles published in English from inception to Jan. 2022. We included studies assessing the direct or indirect costs of hypertension treatment across SSA. All results were converted to 2021 US Dollars.

Results

Of 3999 initial articles, 33 were included in the systematic review. Only 12 of 48 SSA countries provided data on the economic burden of hypertension, and results varied according to their perspective and setting. Total treatment costs per patient ranged from monthly 2.70$ for medicine collection visits in Ghana to 46.24$ for emergency visits in Kenya for patients and from 6.52$ in Ghana to 28.19$ in Rwanda for providers. Medication costs had the most significant impact and were the most reported cost item. Treatment in higher-level hospitals and private institutions was considered more expensive. Single or combinative use of angiotensin-converting enzyme inhibitors, calcium channel blockers and diuretics were the cheapest treatment options across SSA.

Conclusions

Hypertension care poses a significant economic burden for health systems and patients. While the costs were heterogeneous according to measuring and financing methods, medication was identified as the most critical cost factor. Reducing medication costs, supporting patients through subsidies, using generics and cheaper therapy options should be considered.

Key messages

• Hypertension costs in sub-Saharan Africa are a significant burden mainly driven by medications.

• Introducing targeted subsidies, generics, and low-priced therapies could reduce medication costs.
Frontline healthcare workers’ lived experiences of healthcare work during the COVID-19 pandemic
Authors: Lee BEC , Sheen J , Clancy E M , Dwyer A , Aridas A , Considine J , Tchernegovski P , Reupert A , Bufton K , Boyd L
Published: October 2023

Background

The COVID-19 pandemic changed the face of modern healthcare, with impacts felt by staff and organisations alike. Globally, hospital-based healthcare workers have identified increased stress, anxiety, insomnia, and reduced wellbeing related to their work roles. Hospitals have been plagued by increased demand, poor staff retention and a reduction in the working hours of remaining staff. This paper sought to explore the unique experiences of frontline healthcare workers (FHWs) with parenting responsibilities working in Australian hospitals during the COVID-19 pandemic.

Methods

Thirty-nine FHWs with parenting responsibilities from Australian public hospitals were interviewed from October 2020 and February 2021. Reflexive thematic analysis was used to interrogate transcripts arising from extended interviews with participants regarding their experiences with healthcare work and the workplace support they received during the COVID-19 pandemic.

Results

Key themes indicate that workplace changes during the early stages of the pandemic were rapid and placed significant burden on healthcare staff and leaders, impacting their physical, mental and social health. Support from leaders was seen as protective for staff but placed an additional burden on staff in leadership roles. Additionally, when leaders considered family safety and were flexible when family demands surged, staff reported better wellbeing and feelings of support. While staff felt a sense of pride in their role during this time and were motivated by family members, they reported reduced career enjoyment and were concerned about long-term mental health consequences.

Conclusions

The challenges and fatigue associated with healthcare work during a pandemic can impact FHWs in varied ways. However, findings during the COVID-19 pandemic sheds light on important areas that can be bolstered and enhanced during pandemic planning that can prevent negative impacts in future pandemics.

Key messages

• The COVID-19 pandemic has demonstrated how a pandemic significantly impact healthcare roles and the wellbeing of staff, indicating a need for better pandemic planning in the future.

• Important factors to consider during future pandemic planning are proper management of workplace changes, managing staff's work life balance and family safety, and enhancing support from leaders.
Maternal empowerment and gender equality for child undernutrition: a multilevel study in Africa
Authors: Eom Y , Kim R
Published: October 2023

Backgrounds

Women's empowerment is a complex construct that requires a multi-level conceptualization, yet its association with child undernutrition has been restricted to single-level analysis and the existing evidence are mixed.

Methods

We pooled recent Demographic and Health Surveys from 28 sub-Saharan African countries (N = 137,699 children <5 years old). Undernutrition was defined as stunting, underweight, and wasting. Maternal empowerment at individual-level was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making with each domain divided into terciles. As for country-level gender inequality, Gender Inequality Index (GII) was used. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII with child anthropometric failures as well as their interactions, adjusting for sociodemographic covariates.

Results

Compared to children of mothers with high-level of empowerment, children of mothers with low-level of empowerment had higher odds of stunting for all domains of SWPER (Ranging ORs=1·15 to 1·21). A similar pattern was observed for underweight and wasting. GII also increased the probability of underweight and wasting. Our interaction analyses indicates that for social independence and decision-making domain, the gap in probabilities of stunting between high versus low-level of empowerment was widest in countries with highest GII.

Conclusions

In countries with stricter gender norms, achieving mother's social independence and decision-making power are found to be the strategies that should be prioritized in the first place to reduce their children's anthropometric failures. Policies and interventions aimed at promoting maternal empowerment should be carefully tailored to the specific national context to effectively address child undernutrition in sub-Saharan Africa.

Key messages

• Advanced our understandings of the role of maternal empowerment on child undernutrition by discovering that each domain of empowerment differently functions across larger social contexts.

• In countries with stricter gender norms, achieving mother's social independence and decision-making power should be prioritized in the first place to improve their children's nutrition.