bluuebunny/crossref_metadata_2025 huggingface dataset:
Early life social and health determinants of higher education across three generations
Authors: Hossin M Z , Björk J , Grünberger I
Published: October 2023

Background

Associations of social and health disadvantages at birth with educational attainment are well-documented. Less is known about the magnitude of the associations across different historical contexts. We investigated associations between a range of early life disadvantages and higher educational attainment across three successive generations.

Methods

The data were from the register-based Uppsala Birth Cohort Multigenerational Study in Sweden. The study samples include three generations born in 1915-1929 (G1, n = 10 587), 1933-1972 (G2, n = 6566), and 1973-1978 (G3, n = 6684). The outcome was attainment of higher education (more than senior high school) assessed at age 30+ years. Exposures were parental socioeconomic position (SEP), mother's marital status, parity, gestational age and birth weight for gestational age. Multiple logistic regression models were fitted to evaluate the associations across three generations. Results are presented as Average Marginal Effects (AME).

Results

Low parental SEP was associated with lower probability of higher educational attainment in all three generations. The difference between low versus high parental SEP among men declined by 32 percentage points in G2 (AME: 0.32; 95% CI: 0.27, 0.38) and 27 percentage points in G3 (AME: 0.27; 95% CI: 0.21, 0.33) compared to G1. Among women, the corresponding declines in G2 and G3 were 35 and 28 percentage points. Mothers’ unmarried marital status and high parity were associated with lower probability of education, with no evidence of decline across generations. The association between small for gestational age and education among men persisted across generations while showing a decline in G3 women.

Conclusions

Associations between early life factors and education persisted across three generations. The influence of parental socioeconomic background on educational attainment appeared to level off in the youngest generation after becoming attenuated in the preceding generation.

Key messages

• Association between small for gestational age and educational attainment persisted across generations, with an attenuation among the youngest cohort of women.

• High parity was associated with lower chance of educational attainment, with no evidence of effect attenuation across generations.
Psychosomatic complaints at age 15-16 and later educational achievement in upper secondary school
Authors: Wahlström J , Östberg V , Åhlén J , Låftman S B
Published: October 2023

Background

Psychosomatic complaints are common among adolescents, and the reporting has increased in recent decades. Yet, knowledge on the potential consequences of such complaints is scarce. Given the importance of educational success for health throughout life, investigating the relationship between psychosomatic complaints and academic outcomes is important. This study's aim was to investigate the prospective links between psychosomatic complaints at age 15-16 and, firstly, the likelihood of not completing upper secondary school, and secondly, grade point average (GPA) among those who graduated from upper secondary school.

Methods

Data was obtained from Futura01, a national cohort study of Swedish adolescents attending grade 9 in 2017 (n = 5,198). Psychosomatic complaints were measured by self-reports on the frequency of headache, stomach ache, and difficulties to fall asleep, which were summed to an index. Information on graduation and GPA from upper secondary school was based on registry data from 2020-21. Binary and linear regression analyses were performed stratified by sex. Covariates included parental education and country of birth, medication for depression and anxiety, and conduct problems.

Results

Higher levels of psychosomatic complaints were prospectively associated with an elevated risk of not completing upper secondary school (males: OR = 1.08, 95% CI 1.03-1.14; females: OR = 1.10, 95% CI 1.04-1.16). Among those who graduated from upper secondary school, higher levels of psychosomatic complaints were prospectively associated with lower GPA for males (b=-0.04, 95% CI -0.07, -0.00), but not for females (b=-0.01, 95% CI -0.04, 0.02).

Conclusions

Psychosomatic complaints in adolescence may have long-lasting consequences for individuals’ living conditions and health by affecting later educational performance and success. Interventions targeting youth with self-reported mental health issues could positively impact later academic achievements.

Key messages

• Psychosomatic complaints at age 15-16 are associated with later educational achievement in upper secondary school.

• Interventions targeting youth with self-reported mental health issues could positively impact future academic success.
Quality Improvement Process in Childcare Facilities: Results of a Qualitative Study
Authors: Decroix C , Essilini A , Duboys Fresney M I , Casso-Vicarini N , Côté S M , Alla F
Published: October 2023

Introduction

Access to quality educational facilities is a major determinant of children's well-being and a means to tackle social health inequalities. In France, ‘Accompagne-moi...!’ (AM) intervention, tested in a pilot study, was adapted from evidence-based interventions developed in Quebec. The objective of AM was to improve professional practices allowing children to develop their social and emotional skills. This research aimed to assess viable validity of AM. Viable validity “refers to stakeholders’ views and experience regarding whether an intervention program is practical, affordable, suitable, evaluable and helpful in the real-world” (Chen, 2010).

Methods

A qualitative study was realised in 13 childcare facilities from 4 French deprived areas (2019-22). Eight exploratory interviews, 33 semi-structured interviews with professionals were conducted. A comprehensive thematic analysis was performed.

Results

Childcare facilities were systems characterised by involved professionals evolving in difficult working conditions amplified in times of health crisis. The interviews showed the potential of the approach to address needs (e.g. professional training, increased awareness of children's emotions) and perceived positive effects (e.g. support for management in implementing change in the facilities, perceived effects on children). Professionals expressed a negative experience of AM (e.g. sense of failure, insufficient appropriation of the approach by the group) linked to the challenges of deploying an intervention in highly stressed environments.

Conclusions

This study highlights: i) potential of AM, ii) that children's well-being cannot be separated from the professional's well-being, iii) inflluence of certain structural determinants on educational practices and the quality of childcare facilities, iv) need to address these structural determinants prior to the intervention implementation. Prior to the deployment of AM on a larger scale, adaptations were proposed.

Key messages

• The well-being of children and professionals in childcare facilities are interdependent.

• Structural determinants are key determinants of the quality of childcare facilities.
Qualitative communication research with environmental health scientists and stakeholders
Authors: Friedman D B , Altman K , Yelton B , Viado H F , Carson M A , Schandera L , Kelsey R H , Porter D E
Published: October 2023

Effective research translation and science communication are necessary for successful implementation of environmental health initiatives to improve public health. The Community Engagement Core (CEC) of the Center for Oceans and Human Health and Climate Change Interactions in the southeastern United States conducted a trio of qualitative studies to assess perceptions, experiences, and training needs relative to science communication and research translation of investigators and stakeholders. Interview transcripts were coded using open and axial coding and analyzed for emergent themes. (1) Interviews were conducted with 13 Center investigators. Most preferred in-person and written communication channels and felt comfortable communicating uncertain findings to the public despite no formal training. They asked for training on plain language messaging for communities, assessment of audience needs, and formatting research findings for various groups. (2) Interviews were conducted with 13 CEC stakeholders to learn more about their research translation needs, communication and dissemination tactics, and experiences interacting with scientists. Findings indicated the need for collaborative scientist-stakeholder training to include plain language development, communication evaluation, and audience engagement. (3) Follow-up interviews with 7 stakeholders examined specific topics of understanding, trust, and access and how those can become barriers or facilitators of public engagement with environmental activities. Findings showed the public may have limited understanding of scientific processes, establishing trust takes time, and ensuring access should be incorporated into all programs. Together, these analyses demonstrate the importance of engaging investigators and partners on all aspects of research. This presentation is relevant to other partner-engaged research and provides insights on practices for equitable and effective stakeholder engagement and collaboration.

Key messages

• Effective research translation and science communication are necessary for successful implementation of water resources management initiatives.

• Qualitative research is important for assessing perceptions, experiences, and training needs relative to science communication and research translation for researchers and community partners.
Impact of COVID-19 on DTP3 Vaccination Trends in Africa: A Joinpoint Regression Analysis
Authors: Guillen Grima F , Aguinaga-Ontoso I , Guillén-Aguinaga S , Guillén-Aguinaga L , Alas-Brun R , Onambele L , Aguinaga-Ontoso E
Published: October 2023

Background

Vaccine-related death is one of the leading causes of death among African children. Vaccine coverage is a very important measure to decrease infant mortality. WHO has set a 90% vaccination coverage target of 3 doses of DTP (DTP3) by 2015. Covid-19 Pandemic has affected the healthcare system and may have disrupted vaccine coverage.

Methods

DTP3 Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) was calculated for Africa and the regions. Countries’ DTP3 vaccination rates in 2019 and 2021 were compared to see if they complied with the WHO target of 90% DTP3 coverage.

Results

According to the findings, vaccine coverage decreased by an absolute 4% between 2019 and 2021, with a negative annual percentage change (APC) of -2.9% starting in 2019. With a relative fall of -6.25 percent, Eastern and Southern Africa have experienced the largest relative decrease in coverage. A joint point was found in Sub-Saharan Africa in 2019, with a downward tendency from 2020 onward. In East and South Africa, the APC turned negative in 2020, with an APC of -3.5 percent. The number of African countries meeting the WHO's 90 percent coverage goal for the third DTP dose fell by 22.7 percent, from 22 in 2019 to 17 in 2021. This decrease suggests that the COVID-19 pandemic has harmed DTP vaccination trends in Africa, with half countries reporting a drop in vaccination coverage

Key messages

• The COVID-19 pandemic disrupted DTP3 vaccination in Africa, causing a 4% absolute decrease in coverage between 2019-2021.

• The number of African countries meeting WHO's 90% DTP3 coverage target dropped by 22.7% due to the pandemic impact.
Childhood vaccinations in conflict-affected settings: a case study from a frozen conflict zone
Authors: Agopian A , Musheghyan L , Sargsyan Z , Abrahamian D , Lazaryan Z , Dorian A
Published: October 2023

Background

Disruptions in healthcare are common in conflict-affected settings, particularly in frozen conflict zones where an already fragile health system is affected by the uncertain geopolitical context. Childhood vaccinations are vital in such settings to prevent illness in an already vulnerable population. To better understand health services in a frozen conflict zone, we examined vaccination coverage among children in Nagorno-Karabakh.

Methods

Multistage cluster sampling was used to sample households in Nagorno-Karabakh during the summer of 2022. From each household, one woman between the ages of 18 and 49 participated in an interviewer-administered survey. Vaccination status was reported by mothers who had at least one child less than 5 years-old.

Results

Among the 299 mothers with at least one child under 5 years-old, 288 (96.3%) reported all children as vaccinated, 4 (1.3%) reported some as vaccinated, and 7 (2.3%) reported all as unvaccinated. Among those vaccinated, 279 (95.5%) reported their children as fully vaccinated while 12 (4.1%) were not up to date, mostly due to illness at time of vaccination (41.7%). Similarly, women with only some children vaccinated reported illness as the main reason (50.0%). Women whose children were unvaccinated cited lack of trust (42.8%) and general unwillingness (42.8%) as the main reasons. A majority of the mothers (94.6%) reported receiving a call from the local polyclinic to remind them of the next vaccination and most (91.0%) sought reliable information about vaccinations from physicians.

Conclusions

Vaccination coverage was high demonstrating the ability of Nagorno-Karabakh to provide health services. Most women were informed by the clinic and consulted with their physicians which should be utilized to enhance child health services. Future studies should examine vaccination access and delivery in Nagorno-Karabakh to provide a model for vaccination services and to bolster health security in frozen conflict zones.

Key messages

• Despite healthcare-related challenges in a frozen conflict zone, vaccination delivery services in Nagorno-Karabakh were effective, with almost all children under 5 years-old fully vaccinated.

• Reminders from clinics and trust in physicians likely influenced vaccination coverage in Nagorno-Karabakh and should be considered to build sustainable vaccination systems in frozen conflict zones.
Irish people’s views on electronic health records and data security
Authors: Flaherty S J , Barry O , Duggan C , Foley B , Flynn R
Published: October 2023

Background

Electronic health records (EHRs) can enhance the quality of care by ensuring timely and improved access to data and enabling linkage to facilitate better communication and coordination between healthcare teams. People differ in their views on EHRs, mainly due to perceived concerns relating to data security. It is important that people's views are considered in the design and implementation of EHRs to support successful implementation. The aim of this research was to explore public views on EHRs and data security to inform future policy in this area.

Methods

Qualitative secondary analysis of open-ended survey questions included in a National Public Engagement Survey on Health Information was conducted. A total of 433 respondents, from a nationally-representative sample of 1,228, provided a response that related to data security and EHRs. The national survey was carried out between October and December 2020 using a computer-assisted telephone interviewing (CATI) approach. Verbatim responses to the open-ended questions were captured and inductive thematic analysis was conducted.

Results

Four themes were identified: attitudes towards a move to eHealth; trust in relation to information security; technical infrastructure to support EHRs; and protective measures to safeguard EHRs. Most people view EHR implementation positively but cited concerns in relation to both the security of the electronic systems and the individuals that process this data and manage these systems.

Conclusions

As more countries introduce national EHRs, there is a need to establish and maintain a balance between the security of electronic systems and the competency of individuals that manage such systems. Equal consideration should be given to addressing both elements as the effectiveness of one is contingent on the other. A rise in cyber security attacks and growing public concern surrounding data breaches creates a sense of urgency to address such issues.

Key messages

• Trust was an important influence on people’s attitudes to electronic health records which was shaped by people’s trust in the individuals and organisations that have access to their health data.

• There is an interdependent relationship between security systems and the individuals that manage them; both must be equally considered to provide assurance to the public on data security.
Impact of digital intervention on antenatal paper records: results from audit of antenatal records
Authors: Das S , Radovich E , Karki S , Shakya R , Shrestha A , Karmacharya B , Penn-Kekana L , McCarthy O , Campbell O , Shrestha A
Published: October 2023

Background

Good recordkeeping is important in antenatal care (ANC). The mIRA study aimed to improve ANC quality through tablet-based electronic decision support systems (EDSS). Electronic data entry was implemented alongside existing paper-based ANC records, adding an additional record-keeping requirement for health care providers. This study assesses the impacts of the EDSS on paper-based ANC records.

Methods

The audit was conducted in 19 primary healthcare facilities in Nepal. We examined pregnant women's records before (n = 136) and after (n = 138) EDSS implementation. For eight selected indicators in the ANC card and ANC register, we estimated the percentage completeness (any value recorded) and agreement (whether values matched), comparing results before and after intervention, additionally examining EDSS records.

Results

Completeness of paper ANC records was high before intervention (>90% for all indicators, except for tetanus toxoid vaccination). There was general trend towards variables being more complete after implementation of the EDSS for both the ANC card and the ANC register. There was >15% improvement in completeness and in agreement of tetanus toxoid vaccination date records in ANC cards and ANC registers after the intervention. Completeness of variables in the EDSS was low, suggesting recordkeeping in ANC cards and ANC registers was prioritized. Percentage agreement increased slightly in all eight indicators after intervention. Amongst the selected eight indicators, only women's age records showed >90% agreement both before and after the intervention.

Conclusions

EDSS did not have a negative impact on paper-based ANC records. Digital records are widely being used in high-income countries and the increasing implementation of electronic health records in low-resource settings increases the demand for evidence to understand the feasibility and impacts of digital health interventions in real-world settings.

Key messages

• The additional recordkeeping required by the EDSS resulted in general improvements in the completeness and agreement of ANC paper records.

• Large-scale EDSS implementation should consider how to integrate digital and paper-based records to decrease burden on healthcare providers, and improve the standard of records.
Sex differences in disease burden in Norway: an analysis of the Global Burden of Disease Study 2019
Authors: Forthun I , Clarsen B , Knudsen A K
Published: October 2023

Background

Sex differences in premature mortality is well documented, but we have less knowledge about sex differences in disability, how this varies across the life course, and what risk factors attribute to these differences. Using data from the Global Burden of Disease Study (GBD) 2019, we examined sex differences in diseases burden in Norway.

Methods

Data for years of life lost (YLLs), years lived with disability (YLDs) and the sum of these two; disability-adjusted life-years (DALYs), were extracted from GBD 2019 by sex and age groups, in addition to data on risk factors (data will be updated upon the release of GBD 2021).

Results

In 2019, the age-standardized DALY rate was similar in males (18 901, 95% CI 16 338-21 823) and females (18 165, 95% CI 14 875 - 21 791) in Norway. However, in women, a larger proportion of the disease burden was due to causes leading to years lived with disability (YLD), compared to in men. This was found across all age groups, starting in adolescence. A larger proportion of the disease burden among males could be attributed to known and preventable risk factors (41.0%, 95% CI 38.3-43.7) compared to in females (32.4%, 95% CI 29.3-35.6%).

Conclusions

The total burden of disease is equally shared by men and women in Norway. However, women have a larger share of the total burden of years lived with disability. As we know much less about what contributes to disability compared to premature mortality, we also have less knowledge about the causes of disease burden in women. This in turn, affects our ability to develop targeted and effective health policies to address sex differences in disease burden.

Key messages

• Women carry a larger share of the total number of years lived with disability, while men have higher premature mortality.

• We know less about how to prevent disease burden in women than in men.
Healthy lifestyle in the first 1000 days and childhood overweight and obesity in 4 European cohorts
Authors: Aubert A M , Lecorguillé M , Schipper M C , Douglass A , Kelleher C C , Murrin C M , Lioret S , Heude B , Gaillard R , Phillips C M
Published: October 2023

Background

The high prevalence of overweight and obesity in young children suggests the involvement of early life exposures. Based on the Developmental Origins of Health and Disease paradigm, we investigated associations of healthy lifestyle (HL) behaviours around the first 1000 days of life with adiposity and weight status throughout childhood.

Methods

Cohort-specific analyses were conducted in four European birth cohorts (EDEN, Elfe, France; Generation R, the Netherlands; Lifeways, Ireland), implementing a harmonized data and analysis approach. Composite HL scores were calculated during pregnancy (maternal/parental) and infancy periods based on parental diet quality, BMI, smoking status, alcohol consumption; and for infant score breastfeeding, age of solid food introduction and exposure to passive smoking. Associations with child BMI (measure of overweight and obesity) and waist-to-height ratio (WHtR, measure of abdominal obesity) at age 5 and 9 were assessed using linear (BMI z-scores and WHtR) and logistic regression (IOTF categories).

Results

Current results are based on the Lifeways data; other cohort-specific analyses are ongoing. Depending on the period, up to 50% of the sample had unfavourable lifestyle factors, determined by a HL score of less than half of the possible points. Lower maternal and parental pregnancy HL scores, indicating lower adherence to HL factors, were associated with a higher child BMI at age 5 and 9. Associations with WHtR were non-significant. A low infancy HL score was strongly and consistently associated with both a higher child BMI and WHtR at age 5 and 9.

Conclusions

A low adherence to HL factors around the first 1000 days of life was associated with a higher risk of childhood obesity. If confirmed in the other birth cohorts, these findings will inform the development of future early family-based lifestyle obesity prevention interventions.

Key messages

• Low adherence to healthy lifestyle behaviours around the first 1000 days of life is associated with a higher risk of childhood obesity and abdominal adiposity.

• If confirmed in the other cohorts, these results call for further research exploring family and multi-behavioural approaches to prevention of childhood obesity.
Mortality burden due to COVID-19 in 14 countries or regions in Southeastern Europe and Central Asia
Authors: Cawley C , Glushkova N , Santric-Milicevic M , Terzic N , Fedorchenko V , Cilovic Lagarija S , Gabrani J , Kalaveshi-Osmani A , Kazanjan K , Wengler A
Published: October 2023

Background

Between 2021 and 2023, an international collaboration to estimate the burden of disease due to COVID-19 in 14 countries and regions in Southeastern Europe, the Southern Caucasus and Central Asia was funded by the German Federal Ministry of Health, under its Global Health Protection Programme. As part of the project, the indicators Years of Life Lost (YLL) and Excess Mortality (EM) were estimated in order to compare the mortality burden of COVID-19 across countries and regions.

Methods

Data on COVID-19 deaths, all-cause mortality and population numbers were collected by all partner institutions for the period March 2020 to December 2021. YLL were calculated using standard burden of disease methodology, disaggregated by sex, age and month. EM was calculated in Excel using exponential smoothing, taking trend and seasonality into account. The EM estimates generated were compared to existing estimates published by the WHO, in order to explore similarities or differences.

Results

In nearly all countries, YLL rates per 100,000 were higher among men than women, and among those aged 60 and older compared to younger age-groups. YLL rates per 100,000 were also higher in most countries in Southeastern Europe and in the Southern Caucasus as compared to Central Asia. In general, the YLL burden was considerably greater in 2021 compared to 2020. In most countries, the highest YLL rates were seen in the autumn and winter months. However in some countries, peaks were also seen in spring or summer. WHO estimated EM rates were largely in line with our own, except in Ukraine, Türkiye and Azerbaijan, where WHO estimates were substantially higher.

Conclusions

A significant mortality burden due to COVID-19 was observed, particularly in 2021, and among men and older individuals. The disaggregation of data over time facilitates the use of burden of disease metrics in pandemic monitoring, providing an additional tool in response efforts.

Key messages

• The mortality burden due to COVID-19 was significant in the regions investigated, particularly in 2021.

• Data disaggregations over time facilitate the use of burden of disease indicators in pandemic monitoring and response.
The right of transgender people to be resilient!
Authors: Verguchten J , Demeyer C , Vanoverbeke I , Vandenbussche O K , Kerckhof M
Published: October 2023

Background

Anti-trans violence has become the focus in European and international policy as stipulated in the LGBTIQ Equality Strategy 2020-2025. Despite the legal European anti-discrimination law, transgender people are still unable to be themselves without risks of social exclusion, feeling threatened, bullying at school, gender-related violence and hate crimes which negatively impacts their mental health (suicidality, hiding the trans identity).

Methods

Instead of making society more ‘trans sensitive', this study aims to strengthen the resilience of transgender youth (16-25 years old) bottom up, using a co-creative research approach. Inspired by the Lundy Model of child participation, transgender youth received a voice, platform and safe space to influence society. Thematically-analyzed data was gathered through focus groups (using creative techniques) in a co-creation session at the university hospital of Ghent.

Results

To increase their resilience, transgender youth want to (1) provide training for educational staff, develop didactic material and create safe coming-out environments, (2) participate in social activities focusing on gender expression, create social scripts, (3) improve self-confidence with techniques like Rock and water and self-defense programs, (4) participate in creative workshops to cope with stress and anxiety, (5) tell positive stories to tackle stereotypes. Based on this input from the co-creation session we will set up modules to strengthen their resilience.

Conclusions

The central question in research and practice should be how to take what they believe is necessary to become more resilient, take their challenges into account and how to use this to raise awareness on transphobia among trans people and international (trans)organizations.

Key messages

• To strengthen resilience in transgender youth by listening to their voices.

• To increase awareness, knowledge and skills of professionals regarding transgender people.
Social categorisation of asylum seekers: Free-listing by professionals in German reception centres
Authors: Ziegler S , Bozorgmehr K
Published: October 2023

Background

Newly arriving asylum seekers in Germany mostly live in large reception centres. Goods and services are provided by professionals. Their social categorisations may impact discretionary decisions and determine the scope of access to health and social services. We sought to explore what social categories were mostly applied to asylum seekers in that context.

Methods

We conducted a modified, verbal free-listing with health care, security, translation, social work and administrative staff in two German reception centres, asking what kind of asylum seekers were there. After qualitative content analysis, categories were quantitatively mapped using the Excel Macro “Flame” showing frequencies, ranks and salience of those social categories.

Results

40 professionals listed on average 16 items (min = 4, max = 31). In total 624 items were analysed. Categorisations were of individual, interactional, professional, and societal nature. Professionally relevant categories like needs were not mentioned with the highest frequencies. The leading social categorisations of asylum seekers referred to asylum seekers attitudes professionals derived from their behaviour mostly in combination with socio-demographic variables, such as countries and regions of origin and sex. The most relevant social categories were “demanding and expectant” and “polite and friendly” behaviour, also the effort to adapt to the German environment was often evaluated. The category “economic refugees” ranked forth.

Conclusions

Social categorisation is permeable to public and political discourses related to motives for flight, or integration efforts and chances, impacting on negotiations of deservingness. Since categorisation structures perception, it potentially influences interaction and decision-making, it can trigger empathy and support as well as rejection and discrimination. Free-listing provides a suitable tool, to explore real world categorisation without leaning on pre-given social categories.

Key messages

• Public health studies on bias, racism and discrimination could benefit from free-listing as useful methodological tool to explore real world social categorisation without using pre-given categories.

• Health sciences should foster awareness on political and societal discourses about migrant and minority populations seeping into professional cognition, which can trigger support or discrimination.
Counting the Cost: The Economic Toll of Discrimination Against LGBTQAI+ Individuals in Italy
Authors: Altamura G , Lontano A , Nurchis M C , Raspolini G M , Heidar Alizadeh A , Santoli G , Laurenti P , Damiani G
Published: October 2023

This study investigates the financial consequences of perceived discrimination towards LGBTQAI+ people in Italy, focusing on psychological support and medication costs. It highlights the burden of discriminatory experiences, emphasizing the need for policies to minimize costs. A cost analysis was performed according to the NHS perspective. A purposive sample was recruited through a web-based survey spread on Italian researchers’ social networks, asking any LGBTQAI+ readers to answer about discriminatory experiences, access to psychological support, and medication use. Costs of health services use were estimated according to the Italian NHS tariffs and Italian Psychologists’ Board. The time horizon was set at one year and discounting was not necessary. Robustness was checked by a one-way sensitivity analysis. A total of 75 LGBTQAI+ people completed the survey. Most of them (aged 26-35 years, 85%; residing in big cities, 70%; unaffiliated with LGBTQAI+ associations, 88%) reported discriminative actions (60%), with 15% seeking psychological help soon after being victim of a single discriminatory act. Verbal and physical abuse were reported by 88% and 6% respectively. 40% of respondents claimed to have resorted to psychotherapy sessions because of the discomfort felt after acts perceived as discriminatory or violent, amounting to 810 total therapy hours. The total therapy cost was €72,900, of which 60% paid as out-of-pocket expenses, and 40% partially covered by regional Local Health Units. Additionally, 12% of respondents used SSRI or benzodiazepines, costing the National Health System an esteemed €3054. The sensitive analysis confirmed the robustness of results. The study demonstrates the significant economic burden of discrimination against LGBTQAI+ individuals in Italy, emphasizing the need for inclusive policies and accessible mental health support. Further research is required to explore indirect costs, for a comprehensive understanding of the total economic impact.

Key messages

• Discrimination against LGBTQAI+ individuals in Italy causes significant financial burden due to costs of psychological support and medication.

• Inclusive policies and accessible mental health support are needed to address the economic impact of discrimination against LGBTQAI+ individuals in Italy.
Perception of the quality of medical care in patients from the LGBT+ community
Authors: Villegas-Dominguez J , Cárdenas Rendón D , Pérez Gómez T I , Cacho Alvarado A A , Coria Montiel J J , Barran Prior G , Marquez-Celedonio F G , Trujillo Peña G J
Published: October 2023

Background

Mexico does not have comprehensive care services for members of the LGBT+ community, who also still suffer from a social context that still develops between traditions of inequality and lack of inclusion. Objective: To determine the factors associated with the perception of good quality of medical care in patients from the LGBT+ community

Methods

A cross-sectional, observational, prospective and analytical study was carried out between November and April 2023. Members of the LGBT+ community of Veracruz, Mexico were included; Subjects with visual or hearing disabilities or some psychological disorder that affects the perception of behavior were excluded. Data collection was done through Google Forms. The SPSS v22 program was used, X2 test, Odds Ratio (OR) and confidence interval (CI95%).

Results

489 subjects were included, 295 (60.6%) use the public medical system, 155 (31.7%) consider a medical specialty is necessary to care for the LGBT+ community and 150 (30.7 %) indicates that the specialty should only be for care of patients with gender change; 297 (60.7%) perceive that they receive good quality medical care and 69 (14.1%) have perceived that they have been denied consultation because they belong to the LGBT+ community. The factors associated (OR/CI95%) to the perception of good medical care is the lack of: a family doctor (0.4/0.3-0.6), discomfort on physical examination (13.1/6.9-24.0), verbal abuse (13.3 /6.7-26.0), sexual harassment (5.1/2.7-9.5), physical harassment (11.5/4.7-28.0), discomfort of the doctor during the consultation (10/6.0-19.2), breach of confidentiality (7.2/3.7-14.1), denying care (12.7/6.3-25.6) (p < 0.05).

Conclusions

The factors associated with the perception of a good quality of care in patients from the LGBT+ community are similar to those reported in the literature within any community, which invites health institutions to reinforce their inclusion programs, to reduce acts of discrimination.

Key messages

• Health systems need to consider care for the LGBT+ community from specialists who can make a comprehensive assessment that favors adequate medical care.

• Discrimination is still present within the medical care of patients from the LGBT+ community, so it is essential that the doctor is trained and sensitized in the processes of inclusion.
Determinants of COVID-19 vaccine uptake in the Netherlands: A nationwide registry-based study
Authors: Pijpers J , van Roon A , van Roekel C , Labuschagne L , Ferreira J A , Smagge B , de Melker H , Hahné S
Published: October 2023

Introduction

By September 2022, uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies indicated lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination programme and generate hypotheses for research on drivers and barriers of vaccination.

Methods

A retrospective database study was performed including the entire Dutch population >18 years. Vaccination data (5 January 2021-18 November 2021) were at individual level linked to sociodemographic data. Voting proportions for political parties were added at neighbourhood level. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake.

Results

The most important determinant for COVID-19 vaccine uptake was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years and 88% in those >80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower in individuals in the lowest income group (69%), receiving social benefits (56%), and individuals with two parents born abroad (59%).

Conclusions

Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. Lower uptake was found in individuals with lower income, lower socioeconomic status and a migration background. How to best address these inequalities for future vaccination campaigns requires further research.

Key messages

• COVID-19 vaccination likely contributed to increasing health inequity in the Netherlands.

• Targeting vaccination efforts towards elderly aiming to maximise the impact of vaccination in reducing the burden of COVID-19 seems to be effective.
Incidence and cost of COVID-19-related work absence based on social insurance data from Poland
Authors: Łyszczarz B
Published: October 2023

Background

COVID-19 pandemic and public health measures aimed at limiting the spread of the disease caused widespread work absence. This research aimed to identify the incidence of COVID-19-related short-term work absence and to estimate the cost associated with this absence.

Methods

The study used quarterly (Q) social insurance data from Poland (2020-2022). COVID-19-related absence was identified with four ICD-10 classification diagnoses: COVID-19; personal history of COVID-19; post-COVID-19 condition; and multisystem inflammatory syndrome associated with COVID-19. To identify work absence, the study relied on real-life, disease-specific data on the number of absence days from the Social Insurance Institution. Additionally, excess caregiving resulting from the pandemic was estimated based on all-cause caregiving days. To estimate the cost of work absence, the study relied on the human capital method.

Results

There were 15.2 million absence days resulting from four COVID-19-related diagnoses (2.1% of total all-cause absence days). Of these, COVID-19 caused 12.2 million absence days, followed by post-COVID-19 condition (2.9 million). Excess caregiving was a dominant pandemic-related work absence category, with 37.7 million work days lost. COVID-19 absence was concentrated in Q4-2020 and high in Q1-2021 and Q3-2022. On the other hand, the incidence of the remaining three diagnoses was the highest in Q1-2022. The total indirect cost of work absence was €4.3 billion, and 69.2% of this loss resulted from excess caregiving. For this cost category, 79.1% of costs were borne in Q2- and Q3-2020 when severe lockdowns were imposed.

Conclusions

The estimates show that COVID-19-related short-term absenteeism was a significant public health burden and translated to severe economic losses. The economic loss from caregiving resulted in more burden than the COVID-19 health-related absence.

Key messages

• There were 52.9 million work absence days from the COVID-19 pandemic in Poland until the end of 2022, resulting in an indirect cost of €4.3 billion.

• Most (∼70%) of the pandemic work absence and its cost resulted from caregiving responsibilities, which applied to care for the sick and children unable to attend educational facilities.
Beneficiaries of Temporary Protection (BOTPs) in Mid-West, Ireland: a retrospective analysis
Authors: McNamara R , Rushe E , Evans L , Niranjan V , Barnes M , O'Donnell P , Tobin M , Beatty K , Walsh F , Dee A
Published: October 2023

Since the outbreak of war in Ukraine, over 78,000 migrants have come to Ireland seeking protection. It is necessary to capture their demographics, to understand their immediate health concerns and to identify their additional service requirements to ensure that this cohort can continue to shelter healthily in Ireland. A retrospective cohort analysis was carried out on Health Needs Assessments (HNAs) undertaken for BOTPs in congregated settings. Date of entry to Ireland was captured on 1820 HNA forms returned to the Department of Public Health Mid-West Area E. Patterns in the demographics and the health service utilisation of arrivals, over the first year of conflict, were analysed. Participants were grouped by arrival date, Cohort 1 (24/02/22-20/09/22) (n = 1130) and Cohort 2 (21/09/22-03/03/23) (n = 690). The proportion of male adult arrivals increased from 32% in Cohort 1 to 36% in Cohort 2 and the proportion of older adults (>65 yrs) increased by 40% in Cohort 2. The respondents that reported being pregnant increased from 0.5% of females (aged >14) in Cohort 1 (n = 3) to 2.9% in Cohort 2 (n = 9). Cohort 2 reported lower uptake of COVID-19 vaccines, with 30% self-reporting as doubly vaccinated, compared with 44% of Cohort 1 (p < 0.01). There were no significant differences in child immunisation rates between Cohort 1 + 2. Chronic disease status in both cohorts were consistent, with some exceptions. Statistically significant differences were noted (p < 0.01) across different age groups for some chronic diseases, including heart disease and Diabetes Type 2. Differences in age and sex distributions between Cohort 1 and Cohort 2 will impact on the utilisation of health services. Higher rates of pregnancy may impact on primary care and maternity services. Low rates of child immunisation have resulted in the roll-out of a targeted catch-up vaccination programme for those aged 0-23 years. Predicting HNA trends will help to re-orient health services to meet the needs of these groups.

Key messages

• Differences in age and sex distributions between early (Cohort 1) and late (Cohort 2) arrivals will impact the utilisation of health services and must be accounted for when planning local services.

• Predicting trends of chronic disease and health needs has enabled local health service teams to carry out targeted interventions to ameliorate health and health service access for these groups.
Associations between retail food environment and organic food purchases in French households
Authors: Mejean C , Rollet P , Recchia D , Vonthron S , Perrin C , Somaraki M , Bricas N , Pérignon M , Charreire H
Published: October 2023

Background

The aim of our study was to assess the associations between organic food purchases of French households and their exposure to food outlets that sell organic foods, including organic food stores (selling only organic products) and standard food outlets, independently from households’ characteristics.

Methods

This cross-sectional study included 462 households from a quota sampling survey conducted in France. Share of expenditures for organic foods over a one-month period was assessed using food supply diaries and grocery receipts. The objective retail food environment (RFE) was assessed around the home and in activity space (AS) (i.e. areas around places of main activity and commuting journeys) using geographic information systems. Associations between RFE indicators and organic food purchases were assessed using multinomial logistic regression models, adjusted for households’ characteristics.

Results

Households exposed to organic food outlets around their home (OR presence vs. absence [95% CI]=2.27 [1.33; 3.89]) had higher expenses in organic foods. Households exposed to organic food outlets in their AS were also more likely to have medium (OR ≥ 3 organic food outlets vs. absence [95% CI]=2.52 [1.34;4.76]) or high organic food purchases (OR [95% CI]=1.90 [1.04;3.47]). The models that included different types of organic food stores confirmed the first ones: households who were exposed to organic specialized food stores (greengrocers, bakeries and butcher's stores) around home and in their AS were more likely to have medium or high organic food purchases. In addition, the distance to the nearest organic grocery food store was inversely associated with high expenses in organic foods (OR [95% CI]=0.57 [0.41; 0.80]).

Conclusions

These results suggest exposure to organic food outlets and their use are related, providing knowledge for cities’ commercial planning with the aim of promoting spatial access to organic food for their inhabitants.

Key messages

• Exposure to organic food outlets and their use are related.

• Food environment may influence consumers’ grocery shopping behaviors.
Ultra-processed food consumption, nutrition quality, and obesity prevalence in Israel
Authors: Keinan Boker L , Shimony T , Shahar D R
Published: October 2023

Obesity is associated with chronic disease and burdens individuals and health systems heavily. Obesity prevalence has increased globally in recent decades. Concurrently, consumption of natural and home-prepared foods has decreased while that of industrial and ultra-processed foods (UPFs) that may play a role in obesity etiology, has increased. Our aim was to assess the extent of UPF consumption, nutrition quality and obesity prevalence in Israel, using data from a cross-sectional National Health and Nutrition survey conducted in 2014-16 on a representative sample of 25-64Y individuals who were face-to-face interviewed and anthropometrically measured. Participants reported 24h dietary intake. Consumed foods were coded into 4 groups based on the NOVA method which classifies foods by their level of processing, from unprocessed foods to UPFs. Obesity prevalence was determined by body mass index (≥30Kg/m2), relative fat mass and waist circumference. Univariable and multivariable logistic regression models adjusted for potential confounders were used to assess associations between UPFs consumption and obesity prevalence. In 2,563 participants (mean age=42.2±11.1Y, 46.8% males), average UPFs consumption was 34.5% of total energy intake. Highest quartile of UPFs consumption was associated with younger age (p = 0.0015), lower physical activity (p < 0.001) and current smoking (p = 0.0162). High consumption of UPFs was significantly associated with higher intake of energy, carbohydrates, saturated fat, and thiamin, and lower intake of protein, monounsaturated fatty acids, dietary fiber, folic acid, vitamin B12, Vitamin C, zinc and total fats. No association was found between UPFs consumption and obesity prevalence. In conclusion, high consumption of UPFs is associated with higher likeliness of unhealthy behaviors and lower nutrition quality in 25-64Y Israeli individuals. No association was found between UPFs consumption and obesity prevalence.

Key messages

• Consumption of ultra-processed foods is associated with lower nutrition quality.

• Consumption of ultra-processed foods was not associated with obesity prevalence.