bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevention indicator system of the German Federal States – a tool to monitor prevention policies
Authors: Finger JD , Oberwoehrmann S , Zeiher J , Haftenberger M , Hermann S
Published: October 2022

In 2015 the German Prevention Act was implemented. The National Prevention Conference published the first National Prevention Report in 2019 to evaluate the health promotion activities. The second National Prevention Report is planned for 2023. Development of a harmonized prevention reporting system for the German Federal States is needed to form the basis for the contribution of the Federal States to the next National Prevention Report. A working group mandated from the sub-national health authorities has developed a harmonized prevention reporting system for the German Federal States since 2018. The Robert Koch Institute collaborated as representative of the national level during the process. Subject areas for indicators were selected based on a survey in which all 16 State Ministries of Health participated. Indicator subgroups developed indicators for each subject area based on predefined indicator selection criteria. Final set of indicators was adopted by indicator rating and majority voting process. The German Health Ministers Conference acknowledged the indicator system in June 2021. The conceptual framework is adapted from the health determinants model of Dahlgren and Whitehead. The indicator system is divided into 14 subject areas categorized into upstream, midstream and downstream level of prevention indicators. Seventy-three prevention indicators were included as a whole. The indicator short list consists of 32 Core indicators. An overview of the prevention indicator system will be given. First results of a pilot data collection will be shown. Health promotion and prevention reporting tools are needed to monitor prevention policies and evaluate health promotion measures. The prevention indicator system of the German Federal States will be used for the National Prevention Strategy in Germany of which one component is the next National Prevention Report 2023.

Key messages

• The prevention indicator system of the German Federal States is a useful tool to monitor prevention policies.

• The indicator system will form the basis for the German Federal States’ contribution to the National Prevention Report 2023.
Monitoring the burden of disease in Scotland and the contribution of risk factors
Authors: Fletcher E , Grant I
Published: October 2022

Background

The Scottish Burden of Disease (SBoD) Study monitors the contribution of over 100 diseases and injuries to the population health in Scotland, in the context of disability-adjusted life years (DALYs). Providing robust estimates of burden is the first step in identifying areas of prevention which could have the biggest impact on health; including identification of modifiable risk factors and changes in the underlying risk factor prevalence. Our aim was to estimate DALYs for 2019, to describe the current burden in Scotland and as a baseline for future burden scenarios.

Methods

The SBoD 2016 study estimated the burden using routine data and patient-level record linkage. For this update, years lived with disability were estimated using 2016 age-sex-deprivation specific rates, assuming no change in disease prevalence from 2016, but taking account of changes to the population structure. Years of life lost were calculated from 2019 observed deaths and the application of the Global Burden of Disease (GBD) aspirational life table. Population attributable fractions (PAFs) were sourced from the GBD 2019 and risk factor prevalence from the Scottish Health Survey.

Results

In 2019 the leading causes of burden were ischaemic heart disease (IHD), Alzheimer's/other dementias, lung cancer, drug-use disorders and cerebrovascular disease, representing over a quarter (27%) of the total DALYs in Scotland. Application of PAFs shows that a proportion of the burden for each of these causes can be attributed to modifiable risk factors.

Conclusions

IHD continues to be the leading cause of health burden in Scotland in 2019. However recent years show an increase in burden of social causes and diseases affecting the ageing population. Application of PAFs demonstrate the importance of continuing to monitor both the burden of disease in Scotland and the prevalence of risk factors, to provide robust evidence for planning of local and national services.

Key messages

• The Scottish Burden of Disease continues to monitor the population health landscape of Scotland.

• Ischaemic heart disease continues to be the leading cause of burden in Scotland.
Undetected hypertension in primary care – a public health iceberg?
Authors: Young L , Bibi H , Rasheed R
Published: October 2022

Background

Hypertension is largely asymptomatic and contributes to considerable lifetime cardiovascular morbidity and mortality, costing the NHS £2.1 billion annually. The national prevalence of hypertension is 13.7 % and lack of a national screening programme, despite meeting aspects of the Wilson Junger criteria, adds to delays in detection and treatment. Earlier detection could mitigate future cardiovascular risk. We wanted to understand the potential of detection of prehypertension in primary care to see if this fits the Wilson and Junger criteria for a screening programme.

Methods

GP records of adult patients n = 2178 with a known diagnosis of hypertension on the hypertension register from a practice population of 10,000 patients (prevalence is 22%.) were analysed for the prevalence of prehypertension systolic 120-139 mm hg and diastolic bp of 80-89. The average length of prehypertension, the time delay in detection and treatment were assessed, alongside the prevalence of clinical and therapeutic inertia.

Results

A retrospective analysis of a sample size of 1809 patients out of 2178 patients (83.1%) with known hypertension across 3 primary care sites over 20 years was undertaken. Of these 1809 patients, we found that 1095 patients (60.5%) were prehypertensive prior to being diagnosed. The mean time interval between detection of prehypertension to a formal hypertension diagnosis was 10.6 years, with a standard deviation of 7.89 years with no variation with age or sex. However, 588 patients (32.5%) did not have readings within the prehypertensive ranges prior to diagnosis and were opportunistically detected. 51 patients (2.82%) never had readings recorded within the prehypertensive range.

Conclusions

Prehypertension predates hypertension by an average of 10.6 years. Offering annual screening nationally to patients of risk groups e.g., those with a family history, obesity, and alcohol excess, would enable earlier detection, treatment, and considerable cost saving.

Key messages

• Prehypertension predates hypertension; therefore, hypertension meets the Wilson Junger criteria for earlier detection by a screening programme, which is lacking in the UK.

• Offering a national scheme to screen for hypertension to those at a higher risk, can only be considered a benefit to the public and should be implemented.
Changes in perceived health status in older men and women during the COVID-19 pandemic
Authors: Autric-Tamayo G , Sánchez-Román M , Rodríguez-Blázquez C , Rojo-Abuín JM , Ayala A , Forjaz MJ , Molina MA , Rojo-Pérez F , Rodríguez-Rodríguez V , Fernández-Mayoralas G
Published: October 2022

Background

The COVID-19 pandemic has severely impacted older people. The disease and the measures to combat it have had a differential impact according to gender, with higher mortality rates in men and worse psychological and social consequences in women. The objective of this work is to analyze the changes in perceived health of older people in Europe during the first months of the pandemic and to assess the combined role of age and gender.

Methods

Wave 8 data of SHARE-corona (Survey of Health, Aging and Retirement in Europe) (n = 51,695, aged≥50) collected between Jun-Aug 2020 were used. Perceived health status was explored with a question on whether there has been a change compared with the health status before the COVID-19 outbreak (response options: worse, the same and better). Two-way ANOVA with interaction and Student's t-test with Bonferroni correction were used to compare the effects of gender and age group (50-59 years, 60-69 years, 70-79 years, and ≥80) in changes in perceived health.

Results

Differences in perceived health were observed by age, as well as by gender in participants aged ≥70 years (F = 91.94; p < 0.001). These differences were significant both by gender (F = 19.39; p < 0.001) and age (F = 191.79; p < 0.001). No interaction was detected between both factors (p = 0.170), which allowed their effect to be studied individually. Among the people who reported a worsening in their perceived health, women aged 70 to 79 years predominated (11.1%), followed by men aged 80 and over (15.3%) and women of the same age group (16.4%).

Conclusions

The results suggest an association between the change in perceived health during the pandemic and age. Women have a slightly worse health status than men in all age groups. Therefore, gender can be considered as an influential factor in perceived health in old age, which in turn can have a potential impact in the quality of life of older people.

Funding

Projects Ref. H2019/HUM-5698 and Ref. 202010E158.

Key messages
COVID-19 and religion: evidence and implications for future public health challenges
Authors: Sisti LG , Buonsenso D , Moscato U , Malorni W
Published: October 2022

Background

Religious and cultural beliefs strongly influence people's attitudes and behaviors that, in turn, may positively or negatively affect both individual and public health. In this regard, we aimed to collect and analyze evidence on the impact of religion in the current COVID-19 pandemic.

Methods

We performed a scoping review investigating both scientific and grey literature available on the topic from the onset of the pandemic to September 2021. Pubmed, Web of Science and Google Scholar were investigated and a hand-search on Google was also performed. Studies dealing with religion and COVID-19 were included and narratively summarized according to topics.

Results

46 articles were included in the review. Predominant topics emerged were 1) religious pilgrimages and rituals worldwide being relevant to COVID-19 outbreaks, especially in the first pandemic wave 2) difficulties to engage the Closed Religious Communities (e.g. Haredi, Amish, etc.) in which community way of life, restrictions in using media and resistance to comply to preventive measures were identified as significant COVID-19 risk 3) COVID-19 unofficial treatments and vaccine hesitancy also supported by concerns on the religious acceptability of vaccine composition or firm interpretation of the Ramadan fasting 4) a fuel of religious discrimination 5) religious communities and leaders strongly trusted in conveying COVID-19 information.

Conclusions

Our findings highlighted how religion has represented both a risk for the spreading of the virus and a precious opportunity to convey evidence-based and culturally-sensitive COVID-19 information engaging people in fighting the pandemic. To be prepared for similar future challenges, scientists, politicians and health professionals need to acknowledge the role that culture and religion have in influencing people's lives to design specific health policies and strategies to ensure that all people are effectively engaged in health production and protection.

Key messages
Impact of COVID-19 pandemic on inequalities in mortality: an analysis in Piedmont and Emilia-Romagna
Authors: Strippoli E , Zengarini N , Di Girolamo C , Bartolini L , Aversa C , Costa G
Published: October 2022

Background

Italy was heavily hit by the COVID-19 pandemic. According to official statistics, during 2020 there were more than 75,000 excess deaths compared to the average expected mortality in 2015-2019. General mortality (GM) is a good measure of both the direct and indirect effects of the pandemic because it's exempt from potential bias due to misclassification of events. Evidence shows a greater burden of disease and mortality attributable to COVID-19 among disadvantaged populations, with the risk of an exacerbation of existing health inequalities. We aim to analyse the trend of social inequalities in mortality during the first pandemic year in two Italian regions (Piedmont and Emilia-Romagna) using data from Administrative Population Registries (APR) and statistical databases.

Methods

Data on deaths occurred between Jan 2015 and Jan 2021 in subjects ≥65, stratified by educational level, were obtained from Regional APR and the Census. Using a time series approach, we computed Standardized Mortality Rates (SMR), Relative Index of Inequalities (RII) and Slope Index of Inequalities (SII), adjusted by age, gender, month and region. SMR, RII and SII from March 2020 were forecasted using Holt-Winters method and compared to the observed values in the same period.

Results

SMRs were higher than expected during the two 2020 epidemic waves (Mar-Apr, Oct-Dec) in both regions. RII didn't increase significantly. Absolute inequalities instead rose in Piedmont during both pandemic waves, mostly among women, and in Emilia-Romagna in March among men.

Conclusions

The impact of the pandemic on inequalities in GM has been at least of the same size of the impact of other mechanisms of unequal mortality. APR coupled with sociodemographic data are a quick and reliable source for assessing the unequal impact of the COVID-19 pandemic on health. Further research is needed to explore mechanisms underlying these effects e.g. inequalities in cause-specific mortality and access to health services.

Key messages
Tobacco product menthol and flavour bans: their utility for LMIC and lessons from the EU ban
Authors: Hiscock R , Silver K
Published: October 2022

Background

Flavoured tobacco products increase smoking uptake and create dependence. By June 2020 all cigarettes with a characterising flavour, including menthol were banned across the EU, UK and Moldova but many low and middle income countries (LMIC) are yet to develop and implement bans despite high smoking prevalence. This paper has two objectives: to establish whether (1) flavoured tobacco products are present and marketed in LMIC and (2) the experience of bans in Europe can guide development of legislation elsewhere.

Methods

Research involved analysis of menthol/flavour market data, review of academic and commercial literature and online media.

Results

The median menthol/capsule market share of the cigarette market grew significantly in middle income countries (p < 0.05) between 2005 and 2019, both in lower and upper middle-income countries [lower: 2.5% (IQR: 0.5-4.0) to 6.5% (IQR: 3.6-15.9); and upper: 4.0% (IQR: 0.8-9.8) to 12.3% (IQR: 3.5-24.3)]. No market data were available on low-income countries, but the academic literature suggested high prevalence of menthol use in Zambia. Tobacco industry strategies underpinning growth of menthol/flavoured tobacco use in LMICs included in-store marketing and display, colourful packs and non-conventional flavour names. Tobacco industry attempts to circumvent the EU ban included introducing new flavoured tobacco products and accessories not included in the ban and exploiting the ban on characterising flavour (as opposed to an ingredient ban) by introducing cigarettes with lower levels of menthol.

Conclusions

Banning flavoured and menthol cigarettes in LMIC would impact a growing proportion of smokers in these countries. From the European experience, menthol and flavour bans that include all tobacco products and accessories and ban flavour as an ingredient rather than a characterising flavour is recommended. Currently, lack of marketing bans and standardised packaging in LMICs exacerbate the impact of flavours.

Key messages
Quantifying the burden of Hypercholesterolemia among Adolescents in India
Authors: Kirti K , Singh SK
Published: October 2022

Hypercholesterolemia is a kind of hyperlipidemia in which an individual's blood contains excessive non-high-density lipoprotein (non-HDL) cholesterol and low-density lipoprotein (LDL) cholesterol, which has emerged as a significant covariate of coronary heart disease. Descriptive, bivariate and multivariable regression analyses were used to unearth the current hypercholesterolemia levels, probable risk factors, and its impact on other metabolic diseases among adolescents using data on 35,830 adolescents aged 10-19 years from the Comprehensive National Nutrition Survey, India, 2016-18. Findings suggest that the mean lipid levels for total cholesterol, LDL, HDL, and triglycerides were 140.6, 84.1, 47.3, and 95.3, respectively, with females bearing the higher burden. The study further identified early adolescents, urban residents, and overweight individuals at a higher risk of having elevated non-HDL. Western and Eastern regions bore higher LDL levels. Further, for a unit increase in TSFT risk of having high LDL increased by 2.55 times. Zinc deficits are at 2.13 times higher risk compared to zinc sufficient. Adolescents consuming unhealthy diets were at higher risk of elevated LDL. The study contends that it is essential to prevent the increasing levels of lipid profiles among Indian adolescents. Vitamin and mineral deficiencies and unhealthy dietary habits are significantly associated with high LDL and non-HDL levels. In the longer run, this might cause the early onset of complex cardiometabolic disorders, which would disrupt the individual's social and economic well-being. Hence, appropriate interventions are needed to curtail these early onsets by primarily focusing on adolescents.

Key messages
The design of a user-centred m-health application for caregivers of children undergoing ORL surgery
Authors: Dobrina R , Cassone A , Brunelli L , Zanchiello S , DeVita C , Starec A , Bicego L
Published: October 2022

Background

In the context of common surgical procedures in pediatric otorhinolaryngology (ORL) patients, providing for education to families for hospitalization, surgery, and postoperative home management has been shown to improve peri-operative outcomes. In this regard, the use of Mobile Health Applications (MHA) is increasing. However, for these tools to be needs-appropriate and effective, their development requires a user-centred approach.

Methods

Our study aimed to explore the informational needs and preferences - in terms of features and functionalities - of health care providers and ORL patients’ caregivers (end-users) to inform the development of an MHA supporting ORL peri-operative process effectively. The study was conducted at a 136-bed maternal and child health hospital in Trieste. A user-centred participatory study design was employed, and the methodology steps were informed by the 3 cycles of the Information System Research Framework (Schnall et al., 2016).

Results

The Relevance cycle was performed to better understand the environment as well as end users’ (64 participants) informational needs and desired features for the MHA. Five critical information/education moments of the ORL perioperative period were identified. In the Rigour cycle a literature review was performed to identify further key topics relevant to understanding ORL end-users’ needs and relevant features for the MHA. In the Design cycle the final contents were defined to be displayed on the MHA spread across the 5 identified moments. A randomized controlled trial will then be conducted to evaluate the effectiveness of the MHA compared to standard care.

Conclusions

Triangulation of data sources collected by experts, ORL patients’ caregivers, and healthcare professionals ensured the rigour of the methodology adopted in the study. Moreover, such a MHA user-centred developed MHA favours end-users positive health outcomes and organizational benefits of health services.

Key messages
Maternal respectful care and Post-Traumatic Stress Disorder among postpartum mothers in Israel
Authors: Abu-Hamad S , Daoud N
Published: October 2022

Background

Maternal Respectful Care (MRC) approach was recommended by the WHO for improving maternal birth experience and mental health. We examined the association between MRC and Post-Traumatic Stress Disorder (PTSD) among postpartum women.

Methods

A cross-sectional study took place between November 2020 and October 2021. 817 postpartum women (Jewish- 444 Arab-373) were interviewed via Zoom due to Covid-19 limitations. MRC was measured by 26 statements from disrespectful/ abusive care during childbirth in facilities (DACF); 4 statements from the Mother on Respect questionnaire (MOR-feeling mistreatment based on ethno-national background, level of command of the Hebrew language and disagreement with the staff); and 4 statements regarding abuse of the NorVold Abuse Questionnaire (NorAQ). PTSD was measured by Solomon et al.'s tool, and dichotomized into 12 score cutoff. (Yes /No PTSD).

Results

PTSD prevalence was 14.3%, significantly higher among Palestinian-Arab compared to Jewish women (22.0%,7.9%, respectively), and it was higher in women who had lower MRC scores: did not receive postpartum education (19.9%,11.9 % respectively) received; received midwife support 11.7%,18.4% didn't receive; reported racism 26.1%,11.4% not; Felt humiliated at healthcare services vs. not (16.8% , 10.6%, respectively); women who reported mistreatment based on national/cultural background, compared to others (MOR) (36.6%,13.1%, respectively). In the multivariate analysis after adjusting to different independent variables, Palestinian-Arab women were 6.04 times at risk for PTSD (OR = 6.04,95% CI = 3.38-10.78),Women who reported racism are 2.14 times more likely to PTSD (OR = 2.14, 95% CI = 1.30-3.54). Women who reported feeling humiliated visiting the health care system are 2.08 times more likely to PTSD (OR = 2.08,95% CI = 1.23-3.52).

Conclusions

MRC is an important factor for maternal PTSD among postpartum women and it should be considered specifically among minority women.

Key messages
Direct and indirect costs attributable to musculoskeletal disorders in Belgium
Authors: Gorasso V , Van derHeyden J , De Pauw R , Pelgrims I , De Ridder K , Vandevijvere S , Vansteelandt S , Vaes B , De Smedt D , Devleesschauwer B
Published: October 2022

Background

Within the European Union, musculoskeletal (MSK) disorders represent the most prevalent and costly work-related health problems affecting about 45 million workers. Since middle-aged people during their formative and peak income-earning years are predominantly affected, MSK disorders are the major contributors to the loss of productive life years in the workforce compared with other non-communicable diseases. This study aimed to summarize the average yearly economic impact of low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) in Belgium from 2013 to 2017.

Methods

Direct costs, measured by reimbursed expenditures for medical services and medications, were derived by the national health insurer. Indirect costs were computed by multiplying the mean number of days absent from work (derived by the Belgian health interview survey, as prevalence data) with the average gross daily wage. Multivariate regression models were used to explore the extent to which average yearly costs were associated with MSK disorders. The method of recycled predictions allowed to estimate the marginal effect of each MSK disorder on costs.

Results

25% of Belgian adults were affected by at least one MSK disorder that incurred on average to 1,524€ per capita. LBP was the most costly disorder (2,405€ per capita) followed by NKP (2,260€ per capita). In the working population, 15% had at least one MSK disorder with an average indirect cost of 3,083€ per capita. People with LBP were the only showing a significantly higher indirect cost compared to a population without LBP, with an adjusted cost per capita of 5,875€.

Conclusions

The adult Belgian population is largely affected by MSK disorders. Every year the total adjusted healthcare cost amounted to more than 3 billion Euros. Additionally, on average every year Belgium spends around 2 billion Euros for work absenteeism related to one of the MSK disorders.

Key messages
Development and internal validation of a new life expectancy estimator for multimorbid older adults
Authors: Gastens V , Chiolero A , Anker D , Feller M , Bauer D , Rodondi N , Del Giovane C
Published: October 2022

Background

Multimorbidity is highly prevalent among older adults and associated with a shorter life expectancy. Many guidelines recommend tailoring preventive care of multimorbid people according to life expectancy. Indeed, patients with a relatively short life expectancy might not have the time to benefit from a preventive care intervention. Our objective was therefore to develop and internally validate a life expectancy estimator for older multimorbid adults.

Methods

We analysed data of the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people) cohort study in Bern, Switzerland. 822 hospitalized participants aged 70 years old or more, with multimorbidity (3 or more chronic medical conditions), and polypharmacy (use of 5 drugs or more for >30 days) were included. Our main outcome was time to all-cause mortality assessed during 3 years of follow-up. Candidate predictors included demographic variables (age, sex), clinical characteristics (Charlson-Comorbidity-Index, number of drugs, body mass index, weight loss), smoking, functional status variables (Barthel-Index, falls, nursing home residence), and hospitalization. We internally validated and optimism corrected the model using bootstrapping techniques. We transformed the 3-year mortality prognostic index into a life expectancy estimator using the Gompertz survival function.

Results

At baseline, the participants (58% men) had a median age of 79 years (min: 70; max: 99). They took daily a median of 10 chronic medications (min: 5; max 38). During 3 years of follow-up, 292 participants (36%) died. The analysis is ongoing and results will be presented at the congress.

Conclusions

A life expectancy estimator eventually helps personalising care to prevent under- and overuse of preventive care in the growing older population.

Key messages
Changing epidemiology and trends in incidence of kidney cancer in England, 1985-2019
Authors: Salari Y , Bannister P , Memon A
Published: October 2022

Background

Kidney cancer is the 7th most common cancer in the UK, accounting for 4% of all new cancer cases. The risk factors for kidney cancer include obesity, smoking, hypertension, and exposure to certain environmental and occupational carcinogens. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of kidney cancer in England during the past four decades.

Methods

Individual level data for patients diagnosed with kidney cancer in England during 1985-2019 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates were calculated by two age categories (0-49, 50+ years) and all ages combined during the seven five-year time periods (1985-89 to 2015-19). The percentage change in incidence was calculated as change in the average annual incidence rate from the first (1985-89) to the last time period (2015-19).

Results

During the 35-year study period, a total of 197,819 new cases of kidney cancer were registered in England (62.4% males, 37.6% females). In young people aged 0-49 years, the average annual incidence rates increased by 164% in males and 144% in females (from 1.4/100,000 in 1985-89 to 3.7/100,000 in 2015-19 in males and from 0.9/100,000 in 1985-89 to 2.2/100,000 in 2015-19 in females). In older people aged 50+ years, the rates increased by 129% in males and 147% in females (from 24.5/100,000 in 1985-89 to 56.0/100,000 in 2015-19 in males and from 11.9/100,000 in 1985-89 to 29.4/100,000 in 2015-19 in females).

Conclusions

There has been a steady and significant increase in the incidence of kidney cancer in England over the past four decades. The largest increase (164%) was observed in young males aged 0-49 years, which was unexpected. Considering the risk factors for kidney cancer, further research is needed to understand the role of environmental/occupational exposures in causing kidney cancer.

Key messages
The “grey” digital divide in older adults during COVID-19 in Germany: Who is most at risk?
Authors: Barnils N Pedrós , Schüz B
Published: October 2022

Background

During the COVID-19 pandemic, physical distancing was a recommended public health measure. For some older adults, distancing has not only been physical but also social due to a lack of access to the internet - either due to consciously opting out or lack of resources. This study aims to assess who is most at risk of not having access to the internet and the associated negative mental and physical health outcomes.

Methods

Participants were drawn from the 2020 German Ageing Survey (DEAS) in June and July 2020, and include community-dwelling adults above 45 years old (N = 4,823; 56.5% response rate). Two complementary analytic approaches were used to identify lack of access: logistic regression (LR) and Classification and Regression Tree (CART) analysis, using social indicators as predictors. LR provides information about main effects of the predictors; CART, through an exploratory, non-parametric procedure, illustrates the mathematical relationship of the variables.

Results

CART analysis revealed that the strongest discriminating factor for internet access was being over or under 75 years old (n = 3,131 Pr = 0.075 vs n = 1,545 Pr = 0.385). Moreover, for older individuals high education was a protective factor (n = 739 Pr = 0.260 vs n = 805 Pr = 0.499), while for younger individuals a monthly income of 2,000€ set the internet access cut-off point (n = 2520 Pr = 0.0504 vs n = 611 Pr = 0.177). Logistic regression revealed that gender (OR = 1.50; pv < 0.001), education (OR = 0.36; pv < 0.001), monthly income (0.93; pv < 0.001) and region in Germany (West-East) (OR = 2.42; pv < 0.001) explain 29.40% of internet access’ variance. Results are preliminary.

Conclusions

In times of forced physical distancing, the “grey” digital divide increases the vulnerability of disadvantaged groups. CART analysis helped identify groups at higher risk of not having access to the internet and yields the ground for tailored public health interventions.

Key messages
Assessment of Cyberostracism and Personality Inventory In First Year University Students In Turkey
Authors: Muz FN Öznur , Ünsal A , Arslantaş D , Kılınç A , Tözün M
Published: October 2022

Background

Being ignored, one of the most common problems among young people, can occur not only in face-to-face communication but also through social media communication tools over the internet and is called cyberostracism (CO). The effects of cyberostracism on people are at least as effective as in real social life and can cause a wide variety of affective disorders. It is thought that the family, environmental factors and the individual's own personality traits effectively control such negative emotions. This study aims to evaluate the CO level and personality types of students who have just started university in Turkey.

Methods

This cross-sectional study was conducted in 2021 spring semester and 3148 students in the first year of their university in Turkey constituted the study group. To evaluate the CO levels of the students, CO Scale (min-max score 14-70) and to evaluate the personality type, Ten Item-Personality Inventory (TIPI) was used. The questionnaire prepared in accordance with literature was filled out online by the students. Mann Whitney U, Kruskal Wallis analyses and Multiple Linear Regression was used.

Results

In the study, 1847 (62.5%) were female and the mean age was 19.9±1.8 years. The mean score obtained from the CO scale was 21.1±8.1; 41.8% of the participants had the Agreeableness personality type. Male gender, extended family, not good at face-to-face communication with friends, creating a membership by hiding their identity in social media and being ignored in social media were predictive for CO (F: 69.176, R2: 0.172, p < 0.001) was shown in multiple linear regression.

Conclusions

Distance education programs during the pandemic period have limited the face-to-face communication of young people, causing them to spend more time in cyberspace. Personality type has been an important factor affecting the level of cyberostracism by determining our behaviour when exposed to difficult life events.

Key messages
Impact of the MEDEA exposure-reduction strategies on indoor air quality during desert dust storms
Authors: Achilleos S , Michanikou A , Kouis P , Papatheodorou SI , Panayiotou A , Kinni P , Middleton N , Koutrakis P , Yiallouros PK
Published: October 2022

Background

Desert dust storms (DDS) impact the Mediterranean basin heavily, particularly in the context of climate change, reduced precipitation and increasing desertification. There is a pressing need to develop policies protecting EU citizens’ health from DDS. While Public Health authorities in affected regions commonly issue warnings, the effectiveness of recommendations to reduce exposure has not been documented.

Methods

This work is part of the wider “MEDEA” intervention studies, co-funded by LIFE 2016 Programme. Among other outcomes, the studies examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation and use of air cleaners) across homes of asthmatic schoolchildren and individuals with atrial fibrillation in Cyprus. Participants were randomized to either a control or indoor intervention group. The assessment took place in a sample of participants’ homes, during 2019 and 2021, with the collection of indoor and outdoor PM10 and PM2.5 samples, which were analyzed for mass and elemental concentrations.

Results

Indoor PM2.5 and PM10 mass and elements concentrations were significantly lower in the indoor intervention group compared to the control group, both during days with no dust (e.g., 55% and 48% reduction for PM2.5 and PM10, respectively) and days with desert dust (PM2.5: 47% and PM10: 40% reduction). In addition, the infiltration of PM2.5 and PM10 particles from the outdoor to the indoor air was significantly lower in the intervention vs. the control group (PM2.5: -55%, 95% CI: -42%, -65%; PM10: -41%, 95% CI: -61%, -12%).

Conclusions

The study assessed a realistic exposure-reduction strategy and provided first-time evidence that closing doors and windows along with air cleaners can reduce indoor exposure to DDS particles. This evidence can further inform decision-making and strategic planning for population-level mitigation of DDS health effects in Mediterranean Europe.

Key messages
Differences in labour market marginalisation among young immigrant groups and Swedish-born youth
Authors: Amin R , Geirsdottir G , Mittendorfer-Rutz E , Björkenstam E , Chen L , Dorner T
Published: October 2022

Background

There is a knowledge gap regarding the risk for labour market marginalisation among younger cohorts of refugees and non-refugee immigrants. We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated.

Methods

All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals.

Results

Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71-1.83) and around a 30% lower risk of DP (range aHR=0.66-0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1-6.1).

Conclusions

Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP.

Key messages
Risk behaviors among migrant adolescents in Italy
Authors: Koumantakis E , Bersia M , Berchialla P , Charrier L , Comoretto RI , Borraccino A , Lemma P , Nardone P , Vieno A , Dalmasso P
Published: October 2022

Background

Over the last decade, the student population migrated to Italy has quadrupled, but studies on their potentially harmful behaviors such as substance use are still scarce. The aim of this research is to monitor risk behaviors among migrant adolescents in Italy and provide appropriate indications for the definition of targeted policies and interventions.

Methods

A representative sample of 15 year-old adolescents was drawn from the 2018 Italian Health Behavior in School-aged Children (HBSC) survey data. Smoking habits, alcohol consumption and drunkenness were investigated and differences with Italian peers were assessed.

Findings

Results were based on more than 18,500 students, of which 16% were migrants: 32.7% from Western countries (We), 32.5% from Eastern European countries (Ee), and 34.8% from non-Western/non-European countries (nW). Compared with natives, students from nW countries showed a lower risk of smoking habits (OR: 0.72, 95%CI: 0.58-0.89) and weekly alcohol consumption (OR:0.57, 95%CI:0.43-0.75), whereas drunkenness was more prevalent among Ee migrants (OR: 1.42, 95%CI: 1.10-1.83). Overall, both migrant and Italian girls showed a lower risk of unhealthy behaviors than boys.

Conclusions

Compared to the native counterparts, migrant adolescents showed differences in substance use according to their ethnic background. We observed two different immigration patterns: the Western immigrants, who came from countries with higher affluence and share similar risk behaviors with native peers, and non-Western immigrants, who came from less affluent countries and seemed to maintain the risk behaviors of their culture of origin.

Key messages
Maternal care experience and postpartum depressive symptoms among migrant and native in Portugal
Authors: Teixeira C , Santos S , Guerra J , Barros H
Published: October 2022

Background

Migration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status.

Methods

This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017-2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having “good” or “less than good” experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off≥12). Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained.

Results

PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p < 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with “understanding information” (aOR=1.72 95%CI:1.14-2.60), “decisions according to maternal wishes” (aOR=1.56 95% CI:1.04-2.34), “time waiting for healthcare” (aOR=1.50 95%CI:1.04-2.18) and “healthcare provider's attitudes during pregnancy” (aOR=1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience.

Conclusions

Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS

Key messages
Reporting guidelines for burden of disease studies: why and how?
Authors: Devleesschauwer B , Haagsma JA , Charalampous P , Assunção R , Bari C Di , Gorasso V , Grant I , Hilderink H , Idavain J , Lesnik T , Majdan M , Santric-Milicevic M , Pallari E , Pires SM , Plass D , Wyper GMA , Von der Lippe E
Published: October 2022

Background

The Disability Adjusted Life Year (DALY) is a frequently used metric to assess burden of disease (BoD). Many independent BoD studies have been performed across Europe, showing wide variations and inconsistencies in the application and reporting of DALY specific methods. The European Burden of Disease Network (burden-eu) aims to develop guidelines for reporting DALY calculation studies which may enhance transparency and comparability of BoD estimates across Europe and beyond.

Methods

A burden-eu working group of experts generated a list of potential reporting items based on existing literature, guidance for developing guidelines and consultations with BoD experts. To pilot the drafted product, we asked BoD experts and non-experts to apply it to existing BoD studies. We received feedback and we revised the guidelines accordingly.

Results

The guide for DALY calculation studies comprises about 25 items that should be reported in BoD studies. We included information about the study setting, data input sources including methods for data corrections, DALY-specific methods (e.g., YLL life table, YLD approach, disability weights etc), data analyses, and data limitations. We also included information on how users can compare their new estimates with previously available BoD estimates.

Conclusions

We introduced a reporting instrument for DALY calculations that can be used to document input data and methodological design choices in BoD studies. The application of such guidelines will enhance usability of BoD estimates for decision-makers as well as global, regional, and national health experts.

Key messages
Understanding the relationships between dietary risk behaviour and social factors in older adults
Authors: Geigl C , Spagert L , Loss J , Leitzmann M , Janssen C
Published: October 2022

Background

The relationships between social factors and dietary risk behaviour in older adults have not yet been thoroughly investigated. In this analysis, we aimed to develop a brief index of dietary risk behaviour and examine its associations with sociodemographic, socioeconomic, psychosocial, and behavioural factors.

Methods

A community-based postal survey was conducted to collect cross-sectional data from German adults aged 65 and older (n = 1687; 33% response proportion; 52% female). Using principal component analysis, we developed a 3-item dietary risk behaviour index (DRB), including the food groups vegetables/fruit, whole grains, and dairy products. Dietary risk behaviour was defined as food group consumption frequencies below national dietary recommendations. Multiple linear regression was used to analyse associations between dietary risk behaviour and social factors.

Results

Physical activity, female gender, education level, and social support were negatively associated with dietary risk behaviour, while alcohol consumption and smoking were positively associated (Adj. R2 = 0.16, p < 0.001). The brief DRB based on vegetables/fruit, whole grains, and dairy products has proven to be appropriate in analysing dietary behaviour among older adults.

Conclusions

A better understanding of the relationships between social factors and dietary risk behaviour among older adults can assist in group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should address underlying social factors to reduce inequities in dietary risk behaviour among older adults. The results may be transferable to municipalities in high-income European countries.

Key messages
The situation of older Emergency Department patients. Results from a participatory observation study
Authors: Deutschbein J , Wagenknecht A , Schneider A , Moeckel M , Schenk L
Published: October 2022

Background

Elderly patients make up a substantial share of Emergency Department (ED) populations which will increase steadily in the coming decades. This poses a challenge for EDs that are not designed to care for multimorbid, frail, and care-dependent older patients. However, too little is known about the current situation of older ED patients and their specific needs. This study seeks to explore ED stays of older and geriatric patients from a patient-centered perspective.

Methods

Participatory observations of older patients’ ED stays were conducted in five different EDs in a central district of Berlin. This included the passive company of ED patients aged 65 years and older, as possible from admission to discharge or referral. The sampling strategy followed the logic of theoretical sampling. Observation notes were captured in a semi-structured protocol and subjected to systematic, comparative analysis based on the Grounded Theory approach.

Results

N = 71 cases of older ED patients were included. Patients’ mean age was 80 years and 52% were female. The total observation time amounted to 332 hours, the mean observation time was 4 hours and 40 minutes. Long waiting hours and uncertainty about the further course turned out to be burdensome for the patients. Other problems were the dependency of patients in their ability to satisfy basic needs such as toileting and hydration. Personnel mostly tried to address these needs but did not always have the capacities.

Conclusions

Like most health care institutions, EDs need to prepare for the consequences of aging societies. Older patients are more vulnerable to stressful situations such as ED stays and depend on more attention and nursing support. ED staff often lack the resources for this. Strategies are needed to adjust ED structures and processes to the specific needs of older patients. This includes the prevention of ED stays.

Key messages