bluuebunny/crossref_metadata_2025 huggingface dataset:
Co-creation of migrant health interventions in Portugal: Insights from the VO(I)CES project
Authors: Marques M J , Seyfulayeva A , Hamwi S , Machado A S , Gama A , Osbourne R , Dias S
Published: October 2024

Background

International migration is increasing both globally and in Europe, highlighting the need for responsive interventions that cater to the diverse needs and strengths of migrants. Although genuine involvement of stakeholders in the design and implementation of interventions is vital to enhance their relevance, responsiveness, and ownership, co-created migrant health interventions remain limited. This study aims to address this gap by collaboratively developing health literacy interventions with meaningful involvement from migrants and professionals from both the social and health sectors.

Methods

As part of the VO(I)CES project, twelve idea-generation workshops were conducted in Portugal, applying the Ophelia (Optimising Health Literacy and Access) process, engaging over 70 stakeholders (migrants, social and healthcare professionals). To guide discussions, these workshops used case vignettes developed from 16 health literacy profiles that were identified in a previous study among 1,126 migrants. The discussions aimed at eliciting detailed insights into the potential actions that are responsive to migrants’ challenges.

Results

Several key interventions were identified by the stakeholders, including the enhancement of cultural and linguistic training for healthcare providers, the use of community health agents/mediators to improve service delivery and community engagement, and the creation and dissemination of multilingual, multi-format health information materials. Specific interventions for groups experiencing increased vulnerabilities such as pregnant women were also proposed, alongside suggestions for creating citizen spaces and improving digital skills among healthcare staff.

Conclusions

The co-creation approach facilitated the development of tailored context-specific interventions that are anticipated to enhance health literacy, improve healthcare accessibility, and promote health equity for migrants.

Key messages

• Ideas Generation Workshops provide a platform for a wide range of groups to have their say and know their voice is being heard.

• Co-creation tailors interventions to diverse needs, avoiding a one-size-fits-all approach.
Correlates of using behavioural sciences to design health promotion interventions and programs
Authors: Belanger-Gravel A , Lavoie K L , Desroches S , Barnett T , Paquette M C , Therrien F , Gauvin L
Published: October 2024

Background

The World Health Organization highlighted the need to better integrate behavioural science in the field of public health. Based on the theoretical domains framework, this study examined correlates of public health practitioners’ use of behavioural science principles to plan public health actions aim at promoting physical activity and healthy eating.

Methods

This study adopted a cross-sectional design. A convenience sample of 160 public health practitioners were recruited from different public health agencies (non-profit organizations, governmental and para-governmental agencies). They were asked to complete a survey questionnaire online and self-reported their use of behavioural science to plan health promotion interventions. Regression analyses were conducted to examine correlates of behaviour and behavioural intentions. All analyses were controlled for sex, number of years of experience in public health and the type of organization they work for.

Results

Skills (OR = 4.1, 95%CI: 1.3, 13.5) and intentions/goals (OR = 9.2, 95%CI: 2.3, 36.1) were the two domains significantly associated with the use of behavioural science. Perceived capacity to overcome the fact that none of their colleagues rely on behavioural sciences in their organization (OR = 7.2, 95%CI: 1.7, 30.3) was also associated with behaviour. Knowledge (OR = 8.6, 95%CI: 1.9, 39.1) and beliefs about consequences (OR = 4.0, 95%CI: 1.1, 14.7) were in turn associated with intentions/goals.

Conclusions

This unique study provides important insights for the development of future knowledge transfer activities aim at supporting positive attitudes and motivations toward the use of behavioural science as well as developing competencies and a normative use of behavioural science. The development of a strong knowledge basis would also need to be a core component of trainings to support the integration of behavioural science in public health to design physical active lifestyles and healthy eating interventions.

Key messages

• Increasing knowledge and skills in behavioural sciences is a key for a better integration in public health practices.

• Changes in norms and attitudes toward the use of behavioural sciences will also support a better uptake.
Geographical variation in prostate cancer testing explained by socio-economic position in Stockholm
Authors: Rai B , Clements M
Published: October 2024

Background

Prostate cancer screening using prostate-specific antigen (PSA) testing is controversial but remains prevalent in many countries. Despite its prevalence there is little information in Sweden or globally on the spatial heterogeneity in PSA testing. This study aims to describe the spatio-temporal variation in PSA testing in the Stockholm region specifically at the municipality and small area level. Additionally, it aims to quantify the extent to which socio-economic position (SEP) indicators such as education, income, and country of birth explain the observed variation in PSA testing.

Methods

A retrospective population-based register study was conducted, encompassing men aged 40 years and older residing in the Stockholm region from 2007 to 2016. Utilizing spatial smoothing techniques, we calculated the age-standardised proportion of men undergoing PSA testing prior to any prostate cancer diagnosis within each area for every calendar year. Furthermore, we used Bayesian logistic regression models with spatial random effects to estimate the individual-level association between PSA testing and socio-economic position. The proportion of variance in PSA testing explained by various measures of SEP was also estimated at both the municipality and small area levels.

Results

Significant geographical disparities in PSA testing were observed across small areas within Stockholm. The proportion of variance explained in PSA testing at the small area level was highest for income (32.6%), followed by education (9.7%) and country of birth (7.4%). Incorporating all SEP measures led to a higher proportion of explained variance at the small area level (41.6%) compared to the municipality level (24.8%).

Conclusions

PSA testing was significantly associated with various socio-economic indicators and some of the spatial variation could be explained by SEP. It would be useful to ascertain whether similar patterns are observed in other regions or countries.

Key messages

• The findings suggested widespread and consistent opportunistic prostate cancer screening practices within the Stockholm region, raising concerns regarding potential overdiagnosis and overtreatment.

• The socio-economic differences in prostate cancer screening could partially explain the differences in cancer incidence and mortality.
Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK
Authors: Chaudhry T , Zenner D , Tum P , Morrow F , Kielmann K
Published: October 2024

Introduction

Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK.

Methods

We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines.

Findings

Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns

Conclusions

Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake.

Key messages

• Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine.

• Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.
Factors influencing protective gear use in crisis-affected Afghanistan during COVID-19
Authors: Lee J W , Kim Y J , Kim K B , Noh J W
Published: October 2024

Background

Afghanistan has faced considerable challenges in healthcare delivery during the COVID-19 pandemic. These challenges were compounded by limited health literacy, shortages of skilled health workers, and fragile health infrastructure, which increased the country’s double burden of disease. The World Health Organization (WHO) recommended the use of masks as part of a comprehensive strategy to mitigate the spread of SARS-CoV-2. Nevertheless, research on mask-wearing practices in Afghanistan is limited. This study aims to investigate the factors influencing the wearing of protective gear, including masks, during the COVID-19 pandemic in Afghanistan.

Methods

This study analyzed 16,058 households from the 2020 Afghanistan Multi-Sector Needs Assessment (MSNA) survey data. This survey was conducted between August and September 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative. Sampling weighted multivariable binary logistic regression analysis was performed.

Results

Recent internally displaced persons (IDPs) and returnees in Afghanistan were more likely to wear protective gear to prevent COVID-19 compared to non-recent IDPs. Factors such as household sizes, household income, knowledge of humanitarian support, and the distance to healthcare facilities were significantly associated with the likelihood of wearing protective gear.

Conclusions

The study suggests that certain factors place crisis-affected populations in Afghanistan at high risk in COVID-19 preventive behaviors, especially in wearing protective gear. The findings in this study indicate that public health interventions should focus on improving healthcare accessibility and enhancing information dissemination while considering socioeconomic factors. Additionally, this study highlights the need for access to personal protective gear during outbreaks of infectious disease, such as the COVID-19 pandemic.

Key messages

• Socioeconomic factors and accessibility on health services and information can affect COVID-19 preventive behaviors in crisis-affected populations.

• This study can inform public health professionals to develop adequate interventions during infectious disease outbreaks.
Vaccine-preventable diseases in migrants to Europe: a systematic review
Authors: Morais B , Halliday R , Deal A , Bouaddi O , Carter J , Knights F , Hayward S E , Hargreaves S
Published: October 2024

Migrant populations in Europe are at increased risk of under-immunisation and therefore likely to be at high risk of vaccine-preventable diseases (VPD), yet the relationship between migration and VPD incidence is not fully understood. This study aimed to explore the prevalence of VPDs in migrant populations in Europe and to define at-risk groups. Following PRISMA guidelines, Embase, MEDLINE and Global Health were searched for peer-reviewed papers published from 1st January 2010. Inclusion criteria comprised primary research on VPD cases (measles, mumps, rubella, diphtheria, pertussis, tetanus) among migrants to/within EU/EEA and Switzerland. We defined migrants as foreign-born nationals. Forty-seven eligible studies from 15 EU/EEA countries and Switzerland were included, with a total of 1357 migrant VPD cases reported. Analysis revealed 1357 migrant cases across measles (28 publications; 926 cases), pertussis (9; 267 cases), mumps (9; 107 cases), diphtheria (11; 67 cases), rubella (2; 6 cases imported from Romania and Pakistan), tetanus (2; 2 cases). Over-representation of measles cases was observed among migrant children and adolescents, predominantly from the WHO Europe region (particularly Bulgaria, Bosnia and Herzegovina and Serbia). Migrants of East African origin were over-represented among diphtheria cases. This study underscores the association between migration and VPD cases in EU/EEA and Switzerland, establishing a clear association between European migrant children and adolescents in measles outbreaks, and adult migrants from East Africa in diphtheria cases. This study suggests strengthening systems for targeted catch-up vaccination for migrants is imperative upon arrival in European countries to align them with national schedules, alongside the need to improve data collection and surveillance systems to inform effective public health interventions.

Key messages

• Migrant populations in Europe face heightened risk of vaccine-preventable diseases and need to be better incorporated into catch-up vaccination initiatives on arrival.

• Improved data collection and surveillance systems are crucial for informing effective public health interventions targeting migrant populations.
Inequalities in Primary Care Provision in Gwangju Metropolitan City, South Korea
Authors: Choi Y , Kweon S , Baek M
Published: October 2024

Background

Primary care clinics play a crucial role in community health promotion by facilitating early disease detection and management. The number of these clinics in Gwangju Metropolitan City increased from 931 in 2000 to 2,400 in 2022, but this growth was not evenly distributed within the city. This study aims to examine the spatial inequalities in the distribution of clinics in Gwangju Metropolitan City.

Methods

This study utilized local administrative licensing data on medical institutions classified as clinics. To estimate healthcare resource imbalances, Lorenz curves and Gini indices for the number of clinics per 100,000 individuals and per square kilometer were calculated by district.

Results

The number of primary care clinics per 1,000 individuals or per square kilometer was highest in Dong-gu and Seo-gu, while Gwangsan-gu had relatively fewer facilities. In particular, Buk-gu, Seo-gu, and Nam-gu had more than 40% of areas with a high number of healthcare facilities relative to population or area, whereas less than 50% of Gwangsan-gu fell into the lower tier in these categories. The Gini index, used to measure the geographical inequality of healthcare facility distribution, showed a slight improvement from 2000 to 2023. However, Seo-gu and Buk-gu exhibited different trends compared to other districts.

Conclusions

Geographical disparities in the distribution of primary care clinics in Gwangju Metropolitan City have slightly improved since 2000, but show different patterns by district. Addressing healthcare imbalances is essential for enhancing health equity, requiring multifaceted efforts to mitigate disparities and improve medical service accessibility in underserved areas.

Key messages

• Significant disparities exist in the distribution of primary care clinics across Gwangju, with higher densities in Dong-gu and Seo-gu, and fewer facilities in Gwangsan-gu.

• The Gini index for clinic distribution has improved since 2000, but disparities remain, particularly in Seo-gu and Buk-gu. Continued efforts are essential to reduce healthcare inequalities further.
Work- & family-related stress & the risk of hazardous alcohol use: role of sex and social support
Authors: Amin R , Goppers J S , Möller J , Engström K , Sidorchuk A , Mittendorfer-Rutz E , Gémes K
Published: October 2024

Background

There is a lack of longitudinal studies investigating the effect of individual stress factors on alcohol use behaviour, and how sex and social support may mitigate the effect of these stressors. We aimed to determine the association of work- and family-related stressors with developing hazardous alcohol use over time among habitual drinkers, and to examine the role of sex and social support in these associations.

Methods

A sample of 4,046 individuals, working and living in Stockholm, age 25-55 years, habitual drinkers, who answered the PART study (Swedish acronym for Mental Health, Work and Social Relations) questionnaire regarding work- and family-related stress (exposures) in 1998-2000 (wave1) and 2001-2003 (wave2) were followed until 2010 (wave3) regarding hazardous alcohol use (outcome) measured using Alcohol-Use-Disorder-Identification-Test (AUDIT) score ( > =8 in men, > =7 in women). Weights for selective attrition were calculated, and crude and multivariate (adjusting for sociodemographic, health- and previous stress-related factors) logistic regression models, yielding Odds Ratios (OR) with 95% Confidence Intervals (CI), were used to estimate the exposure-outcome associations. Analyses were stratified for sex and social support in general and at work.

Results

Job strain (a combination of high demand and low control) was not statistically significantly associated with hazardous alcohol use (OR, CI: 1.3, 0.9-1.9). Among those reporting any family-related stress, a significantly higher risk was observed (OR, CI: 1.5, 1.1-2.1), particularly among women (OR, CI: 1.7, 1.02-2.7) and those with low social support (OR, CI: 2.1, 1.2-3.6). These associations became non-significant after adjusting for previous family-related stress.

Conclusions

Public health measures aiming to prevent transitions from habitual to hazardous alcohol use should give special attention to individuals with family-related stress, especially among women and those with low social support.

Key messages

• While job stress was not significantly associated, those experiencing family-related stress had a higher risk of hazardous alcohol use, especially among women and those without social support.

• Individuals experiencing family-related stress, particularly women and those lacking social support, require special attention in public health prevention strategies for risky alcohol consumption.
Gender and Education Differences in Mental Health in Belgium: a Bayesian Age-Period-Cohort Analysis
Authors: Smith P , De Pauw R , Spruyt B , Van Droogenbroeck F , Van Den Borre L
Published: October 2024

Background

Mental illnesses (MI) constitute a growing public health problem, with reports of a higher prevalence among middle-aged adults (age effect), during specific periods such as economic crisis (period effect) and in recent birth cohorts (cohort effect). However, few studies have assessed whether these age-period-cohort (APC) effects were related to general population trends or if they are driven by changes in the mental health status of more vulnerable groups. Therefore, this study aimed to assess gender and educational differences underlying observed APC effects in the prevalence of MI in the Belgian adult population.

Methods

This study used data from six cross-sectional waves of the Belgian Health Interview Survey (1997-2018, ∼ 10,000 respondents per wave). Mental health was assessed using the 12-item General Health Questionnaire. Bayesian hierarchical APC models were applied on the prevalence of MI, taking into account gender and educational differences, as well as some potential confounding factors.

Results

Overall, this study confirmed the higher prevalence of MI in middle-aged adult, in 2013, and in more recent birth cohorts (1980-2000). Accounting for the interaction between gender and education, we found that the MI educational gradient was more pronounced for women than men. Finally, we found that APC trends were different between gender. The odds of having MI tended to be stable across age groups for women, while men showed an increased odds between 50-60 years and a decrease between 60-65 years. Regarding period and cohort effects, the increase odds in 2013 was mainly present in men, while the increase in recent birth cohorts was mainly present in women.

Conclusions

This study emphasizes that the age-period-cohort effects on mental health are different depending on gender and education, thus enriching our understanding on the underlying mechanisms to better guide future public (mental) health policies.

Key messages

• This study shows the importance of studying not only the overall trends in mental illness, but also the underlying differences in its distribution.

• Insights into gender and educational differences in Age-Period-Cohort effects on mental health is crucial for the development of timely and efficient public health interventions.
Long-term mental health impairments in survivors of critical illness
Authors: Egger M , Finsterhölzl M , Wippenbeck F , Müller F , Huge V , Jahn K , Bergmann J
Published: October 2024

Background

Survivors of critical illness frequently suffer from long-term disabilities, including physical, cognitive, and mental impairments (post-intensive care syndrome). However, long-term studies are scarce and healthcare services for critical illness survivors are limited, not only in Germany. Therefore, we followed-up on anxiety, depression, and post-traumatic stress disorder (PTSD) during post-intensive care unit (ICU) rehabilitation and up to 1 year after critical illness onset.

Methods

Patients at Schoen Clinic Bad Aibling in Germany were eligible for this prospective cohort study after receiving ≥5 days of mechanical ventilation. The Hospital Anxiety and Depression Scale (HADS; subcategory score ≥8) was conducted after ICU discharge (V1), at discharge from inpatient rehabilitation (V2) and 1 year after critical illness onset (V3). The Impact of Event Scale-6 (score ≥1.75) was conducted to assess PTSD at V3. Multiple logistic regressions were performed.

Results

We included 250 patients (62±14 years, 34% female, median stay on ICU 55 days, median duration of rehabilitation 65 days). 10% died before V3. Anxiety decreased during rehabilitation (effect size r = 0.35, p<.001), but increased again until V3 (r = 0.42, p<.001). At V3, 54% suffered from anxiety. Depression also decreased during rehabilitation (r = 0.46, p<.001), and increased again until V3 (r = 0.39, p<.001). At V3, 44% showed depressive symptoms and 38% suffered from PTSD. COVID-19 diagnosis was associated with increased anxiety (p<.001), depression (p=.068), and PTSD at V3 (p=.028), compared to non-COVID-19 patients. Furthermore, longer duration of mechanical ventilation was associated with increased anxiety (p=.041) and depression (p=.019) at V3.

Conclusions

Mental health impairments frequently occur in critical illness survivors, and they seem to worsen after rehabilitation. As these impairments can significantly impact daily functioning and quality of life, tailored healthcare services are urgently needed.

Key messages

• Anxiety, depression, and PTSD are frequent in critical illness survivors, even 1 year after critical disease onset. This calls for tailored healthcare services.

• Patients with COVID-19 and longer mechanical ventilation suffer from more severe mental health impairments.
Buildings as reflectors of societal values: what features of psychiatric wards reveal about stigma
Authors: Chrysikou E
Published: October 2024

Built Environment (BE) features bearing domestic attributes align with the concept of psychosocial re-integration. To understand the level of de-institutionalisation in relation to mental health infrastructure, a series of 29 case studies occurred in four countries from 2000 onwards. We collected data from Europe, the UK, New Zealand and more recently in the US: England (n = 15), France (n = 5), New Zealand (n = 4) and the US (n = 5). This included five acute wards in England and five in France in 2000-2004, two further acute wards in England in 2015-2017, four facilities in New Zealand in 2017-2020 (catering also for the Māori population), six further wards (older adult rehab, older adult dementia, acute, rehab, PICU, older adults) and two forensic wards in England and five wards in the US in three different hospitals (one mental health and four mental health wards in general hospital: two adult and two adolescent) in 2023-2024. An architectural checklist was developed to evaluate the traits of the exterior and interior and measure the degree of institutionalisation vs homelikeness for mental health buildings. Cross-country comparison revealed recent case studies to be closer to the institutional end with increased anti-ligature features. Most NZ and the US samples were the most institutional ones. The checklist revealed that acuity was potentially not a determinant of institutional versus domestic buildings. Data shown that very few features were universally present, questioning what is the absolute minimum in relation to the illness rather than the policies. The US sample provides further food for thought, especially in relation to the location of psychiatric wards inside general hospitals and the reasons that lead to this. Finally, by looking at the BE for mental health, we uncover issues regarding the service provision and institutional prejudices connected to stigma. This questions the adequacy of de-institutionalisation policies in certain contexts.

Key messages

• The study of the architecture of healthcare facilities can depict aspects related to the health service provision and raise questions about the effectiveness of rehabilitation strategies.

• The architecture of psychiatric wards questions the success of some de-institutionalisation decision-making in a cross-country comparison.
Measuring social environment factors of depressed inpatients: A cross-sectional study
Authors: Schoenweger P , Eder J , Pfeiffer L , Falkai P , Kirschneck M , Brunoni A , Gensichen J , Ditzen-Janotta C , Simon M S , Jung-Sievers C
Published: October 2024

The course and management of mental illness are both influenced by social contextual factors. Standardised questionnaires are required to monitor inpatients’ social environment and to design interventions. This study aims to describe the social environment of inpatients with depression using standardised instruments, and to analyse the instrument’s applicability. This cross-sectional study included depressed adult inpatients admitted to a German psychiatric hospital. We used three standardised questionnaires to evaluate social risk factors: the Lubben Social Network Scale (LSNS), the WHO Disability Assessment Schedule (WHODAS) and the Social Cohesion and Trust Scale (SCTS). The appropriateness of the questionnaires was assessed with a context-specific quality appraisal. Our study included 196 patients with depression having a mean age of 38.8 (SD = 13.7) years of whom 50% were female. A total of 164 (85%) of patients reported a family history of mental health problems, and 31 (38.8%) had experienced discrimination. Analyses of the LSNS and WHODAS showed that the prevalence of social isolation and disability was significantly higher among inpatients compared to the general population. The WHODAS scores were highest in patients aged 18-30, while social isolation was elevated but stable among different age groups (range 18.7- 19.4%). Both, the WHODAS and LSNS showed good clinical applicability, comparability, and test properties. A lack of validation in a young population of the LSNS was considered a weakness. The SCTS showed imperfections in its applicability and comparability. Depressed inpatients have a limited social network compared to the general population. We emphasise the importance of assessing the applicability of questionnaires representing social environment as the basis for developing interventions. We recommend systematic monitoring of social characteristics to identify potential targets of intervention and thereby facilitate the management of depression.

Key messages

• Hospitalised patients with depression have a decreased social functioning and a smaller social network compared to the general population.

• Standardised social environment questionnaires should be consented and used to plan and enrich depression management.
Association between mental and physical health with poly-substance use among adults in 33 U.S. states
Authors: Phillips M , Thompson M , Massey J , Phillips K
Published: October 2024

Leveraging national data from 33 states in the U.S. for adults 18 and over (N = 347,060), from the 2020-2022 Behavioral Risk Factor Surveillance System (BRFSS), we investigated the association between current self-reported physical and mental health outcomes and substance use, focusing on alcohol, nicotine, cannabis, and all combinations of poly-substance use. Specifically, we conducted multiple weighted linear regression analyses using self-reported outcomes for poor mental and physical health in the last 30 days to examine seven mutually exclusive combinations: alcohol (A) only, nicotine (N) only, cannabis (C) only, A+N, A+C, N+C, and A+N+C. We adjusted for race, sex, age group, education level, and marital status in our analyses. For poor mental health, mean number of days ranged from 3.49 (SD = 7.07) for A-only to 10.39 (SD = 11.54) for N+C and for poor physical health, means ranged from 2.38 (SD = 6.24) to 7.17 (10.61) for N+C. All adjusted β coefficients were significant for poor mental health days, notably with the three highest being 4.36 (95%CI: 3.72-5.00) for C-only, 5.68 (95%CI: 5.06-6.30) for N+C, and 5.27 (95%CI: 4.76-5.79) for A+N+C. For poor physical health, all adjusted β coefficients were significant except for A+N, with the two highest being 2.88 (95%CI: 2.31-3.45) for C-only, 3.16 (95%CI: 2.62-3.69) for N+C, and 1.83 (95%CI: 1.54-2.11) for N-only. Recent poly-substance use containing nicotine and cannabis was both associated with 5+ days of poorer mental health and 3+ days of poorer physical health. Overall, our findings hold implications for informing future policy discourse, shaping public health campaigns, and designing educational initiatives aimed at the link between mental health and substance use. Understanding the dynamics of poly-substance use involving the three most commonly utilized substances globally among adults is critical for crafting targeted interventions.

Key messages

• Recent poly-substance use (alcohol, nicotine, and cannabis) is related to poorer mental and physical health in the past 30-days.

• Recent nicotine and cannabis co-use is associated with 5+ days of self-reported poorer mental health and 3+ days of physical health.
Introduction of wastewater surveillance of SARS-CoV-2 in Ukraine
Authors: Rodyna R , Ponomarenko D , Shcherbak-Verlan B , Venczel L , Shields L , Bogdanov A , Gamazina K , Dravniece G
Published: October 2024

Since the Russian invasion, Ukraine has faced humanitarian crises and challenges in diseases surveillance. The primary healthcare (PHC) system struggled with growing numbers of internally displaced and wounded people. In October 2022, the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project, supported implementation of wastewater surveillance (WWS) for SARS-CoV-2 in four oblasts on request of the Ministry of Health (MoH), expanding to 18 oblasts by October 2023. Samples were collected from 64 sites twice per week and tested for SARS-CoV-2 and influenza A/B using BioExtract® Premium Mag test kits in regional laboratories. From October 2022 to April 2024, 4,784 samples were collected at municipal aqueducts, with SARS-CoV-2 delta and omicron variants detected across all regions. WWS sample results were compared with routine surveillance to assess trends in concentrations and reported cases among population. Gradual decrease in SARS-CoV-2 concentration to zero by May 29, 2023, coincided with a decrease in morbidity. In the last week of August 2023, the concentration of the SARS-CoV-2 in wastewater began its gradual increase with the beginning of new cases registration among the population within 2 weeks, by mid-September. From October 2023, SARS-CoV-2 dominated in 96.6% of positive WWS testing results; in other specimens, influenza and respiratory viruses have been identified. The implementation of WWS in Ukraine highlighted its effectiveness as a public health tool in settings where traditional surveillance methods are disrupted, providing timely data on the viral pathogens for outbreaks prediction and responses, underscoring its role in preventive health measures. The MOH of Ukraine recommended extending the method nationwide for routine surveillance of SARS-CoV-2 and other pathogens, enhancing Ukraine’s capacity to manage public health threats and strengthen the resilience of its health system against future crises.

Key messages

• WWS in Ukraine underscores its effectiveness as a public health tool, providing timely data on viral pathogens for outbreak prediction and response in disrupted settings.

• Notable decline in SARS-CoV-2 concentration in wastewater correlates with reduced morbidity, highlighting WWS’s predictive value.
Food additive preservatives and antioxidants and risk of type 2 diabetes - NutriNet-Santé cohort
Authors: Hasenböhler A , Javaux G , Payen de la Garanderie M , Szabo de Edelenyi F , Agaësse C , De Sa A , Deschasaux-Tanguy M , Fezeu L , Srour B , Touvier M
Published: October 2024

Background

Experimental studies suggested potential detrimental effects of some food additive preservatives and antioxidants (PA) on metabolic health, but epidemiological data is lacking. This study aimed to investigate for the first time the associations between exposures to a wide range of PA and type 2 diabetes (T2D) risk in a large population-based cohort.

Methods

Participants (n = 108,723, 79.2% women, mean age=42.5y, SD = 14.6) from the French NutriNet-Santé prospective cohort (2009-2023) completed repeated 24h-dietary records including specific brands of industrial products. PA exposure was assessed using composition databases and laboratory assays. We characterised associations between time-dependent exposures to PA and risk of T2D using multivariable Cox models adjusted for known confounders.

Results

1131 T2D cases were identified during follow-up. Exposures to the following PA were associated with a higher risk of T2D: potassium sorbate E202 (HR per a 25 mg/d increment=1.12, 1.08-1.17, p < 0.001), sodium nitrite E250 (HR 0.25 mg/d = 1.06, 1.00-1.12, p = 0.04), calcium propionate E282 (HR 25 mg/d =1.07, 1.02-1.12, p = 0.008), lecithins E322 (HR 100 mg/d =1.02, 1.01-1.04, p = 0.008), citric acid E330 (HR 500 mg/d=1.08, 1.04-1.12, p < 0.001), and phosphoric acid E338 (HR 50 mg/d=1.11, 1.05-1.18, p < 0.001).

Conclusions

This large prospective cohort revealed positive associations between T2D risk and exposures to several PA widely used in industrial foods.

Key messages

• This large prospective cohort revealed positive associations between T2D risk and exposures to several PA widely used in industrial foods.

• If these results are confirmed, regulations governing PA’s use by the food industry could be re-evaluated for better short- and long-term consumer protection.
The effect of Covid deaths on premature mortality trends in Northern Dimension partnership countries
Authors: Jousilahti P , Harald K , Vienonen M , Laatikainen T
Published: October 2024

Background

Potential Years Life Lost (PYLL) is an established method to measure, follow trends and compare disease burden within and between countries. Northern Dimension Partnership in Health and Social wellbeing (NDPHS) network was established in 2003 and includes the following countries: Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden. Due to the Russian invasion to Ukraine, Russia is now excluded from the collaboration.

Methods

Premature mortality is defined as a death before the age of 70 years. PYLL-rates per 100,000 population are presented in six cause of deaths categories: total mortality, external causes, vascular diseases, cancers, alcohol-related deaths and suicides. Furthermore, 2021 data included deaths due to the Covid infection. Data were obtained from Eurostat and analyses are standardized to EU standard population.

Results

PYLL-rates declined from 2003 to 2017 in all countries and in most causes of death sub-groups. The total (all causes, all countries) PYLL-rate declined between 2003 and 2017 from 7072 to 5154 in men and from 3263 to 2532 in women. However, from 2017 to 2021 the total PYLL-rate increased to 5469 in men and 2623 in women. The increase was explained by Covid mortality. When Covid deaths were excluded, a minor decrease was observed also between 2017 and 2021. In 2021, total PYLL-rates vary largely between countries: from 2804 to 12,393 in men and from 1781 to 4460 in women. Differences between countries in Covid-related and other cause-specific PYLL-rates were also large. In all countries and causes of death sub-groups PYLL-rates were markedly higher in men compared to women.

Conclusions

The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries in the last two decades. Between 2017 and 2021, some increase was observed due to the Covid-related deaths. Differences between countries in premature mortality are still large.

Key messages

• The number of years lost due to premature preventable mortality have declined markedly in all NDPHS countries since 2003 but still, in 2021, differences between countries were large.

• Covid-related deaths caused an increase in premature mortality between 2017 and 2021.
Night shift work increases the risk of irritable bowel syndrome, which is mediated by inflammation
Authors: Yao Y , Ma J
Published: October 2024

Background

The impact of long-term night shift work on the incidence of irritable bowel syndrome (IBS) is still largely unknown, and the underlying mechanism remains unclear. We aimed to investigate the association of night shift work with IBS risk and further explore whether low-grade inflammation mediated this relationship.

Methods

This cohort study included 239,760 participants who were in paid employment or self-employed from the UK Biobank. In-depth lifetime employment information was used to calculate duration and frequency of night shifts. Low-grade inflammation index (INFLA-score) was calculated from five circulating inflammatory biomarkers. Cox proportional hazard models were used to estimate the relationships between long-term night shift work and IBS risk, and mediation analyses were also performed.

Results

An increasing trend of IBS incidence was observed from day workers to regular night shift workers. Compared to day workers, rarely/some night shift workers (HR 1.097, 95% CI 1.007-1.195) and usual/permanent night shift workers (HR 1.213, 95% CI 1.046-1.407) had higher risk of IBS. Workers with longer duration (≥3 years) (HR 1.241, 95% CI 1.073-1.436) and higher frequency of night shifts (>7 shifts/month) (HR 1.248, 95% CI 1.045-1.491) also showed higher IBS risks. INFLA-score significantly mediated the association of long-term night shift exposure with increased IBS risk (mediation proportion 3.6%, P < 0.05).

Conclusions

Long-term exposure to night shift work is associated with a higher risk of IBS, the potential underlying mechanism may be the heightened low-grade inflammation.

Key messages

• Current night shift exposure, longer night shift duration and higher night shift frequency were significantly associated with higher risk of IBS.

• Our findings indicate that night shift work may increase the IBS risk by triggering a cascade of low-grade inflammatory processes.
Impact of Covid19 on chronic respiratory diseases
Authors: Iannaccone R , Serafini A , Sposato B , Lacerenza G , Messina G , De Luca A , Nante N , D’Urso A
Published: October 2024

Introduction

This study was created to test the hypothesis that Covid19 pandemic may have influenced the increase in chronic respiratory diseases, particularly asthma, COPD, and mixed forms. This aspect does not seem to have been investigated previously in the literature.

Methods

The study population consisted of all residents in the province of Grosseto in the two study years (2019 and 2022) aged over 17 and under 90 (n. 368,326). For each of them, the presence of chronic lung disease (OUTCOME), Covid 19 positivity (between 2019 and 2022), age, sex, and Charlson index were reported in the database. To test the effect of the study variables on the identified outcomes (asthma, COPD, and mixed forms), a single-variable statistical analysis was conducted, followed by multiple logistic regression in which, in addition to the main variable, sex, age, and Charlson index were included to adjust the results, using STATA Vers. 17.0 Be-Basic Edition

Results

Multivariate statistical analyses showed that those who had COVID between 2019 and 2022 had a 75% higher risk of taking asthma therapy than those who did not (OR 1.75, p < 0. 001); all other variables were also significantly correlated with the outcome: fewer people were taking asthma therapy in the year 2022 than in 2019 (OR 0.89, p < 0.001); men had a lower risk (OR 0.79, p < 0.001); and those who had a higher CI had a higher risk (3.43, p < 0.001). In the study sample, 2.69% took asthma medication in the study years.

Conclusions

The Covid19 pandemic has had a significant impact on chronic respiratory diseases, especially asthma; patients with higher age and more comorbidities are more likely to develop asthma; males have a lower risk than females, and these data do not seem to have been analyzed in the scientific literature.

Key messages

• The Covid19 pandemic has had a significant impact on chronic respiratory diseases.

• Patients with higher age and more comorbidities are more likely to develop asthma.
Does the narrow-clawed crayfish, Pontastacus leptodactylus (Eschscholtz, 1823) (Decapoda: Astacidea: Astacidae), contribute to the decline of the noble crayfish, Astacus astacus Linnaeus, 1758 in the Belarusian Lakeland?
Authors: Śliwińska Karolina , Alekhnovich Anatoly
Published: October 2024

The noble crayfish, Astacus astacus  Linnaeus, 1758, is the rarest crayfish species in Belarus, distributed mainly within the Belarusian Lakeland, a region of numerous lakes of glacial origin in northern Belarus. The territory has been surveyed for the species to recognize its conservation status. From a total of 44 previously known A. astacus habitats, the species now occurs in 23 of them, five of which cohabit with the narrow-clawed crayfish, Pontastacus leptodactylus (Eschscholtz, 1823) which occupies the majority of habitats where A. astacus populations have been lost. Based on the long-term capture data, we tracked the displacement of A. astacus by P. leptodactylus in Karavaino Lake. To our knowledge, this observation represents the first published field evidence showing the progressive and successful outcompeting of A. astacus by P. leptodactylus. Based on our results, as well as by comparing it with previously published information on the crayfish distribution in Belarus, we highlight the unrealised scale of P. leptodactylus expansion in its non-native area of occurrence in Belarus. Due to the invasive potential of P. leptodactylus, we stress the need for research on the influence of P. leptodactylus on overall biodiversity within its introduced range.
Translating and validating the gay affirmative practice scale for nurses in mainland China
Authors: Zhang Han , Chen Lixia , Fei Wei , Chen Sihan , Daihong J I
Published: October 2024

Background

The gay affirmative practice (GAP) scale is an effective tool for evaluating the beliefs and behaviors of health care professionals toward gay and lesbian clients.

Aim

This study aimed to examine the reliability and validity of the GAP scale among Chinese nurses.

Methods

A quantitative cross-sectional study was conducted to evaluate the Chinese version of the GAP (C-GAP) scale after translation and cross-cultural adaptation and to examine its psychometric characteristics. The reliability and validity of the C-GAP scale were determined by item analysis, factor analysis, internal consistency, test-retest reliability, and discriminant construct validity.

Outcomes

The GAP scale was translated and adapted specifically for China. A total of 1440 participants completed the C-GAP scale, sociodemographic questionnaire, and Marlowe-Crowne social desirability scale.

Results

The C-GAP scale exhibited a Cronbach α of 0.95, with a high test-retest reliability coefficient of 0.92. Exploratory factor analysis identified 2 factors that accounted for 59.91% of the total variance. The results of the confirmatory factor analysis were as follows: χ2/df = 1.09, goodness-of-fit index = 0.98, adjusted goodness-of-fit index = 0.97, root mean square error of approximation = 0.01, Tucker-Lewis index = 1.00, comparative fit index = 1.00, incremental fit index = 1.00, parsimony goodness-of-fit index = 0.85, and parsimony normed fit index = 0.91. These findings confirm that all goodness-of-fit indices were satisfactory.

Clinical Implications

The C-GAP scale can be an effective tool for health care professionals and managers and for education and research; it can also identify the beliefs and behaviors of health care professionals toward gay and lesbian clients, facilitating cultural competence development and enhancing care quality awareness and skills.

Strengths and Limitations

The C-GAP scale demonstrates reliability and validity; however, because the sample consisted only of nurses, the findings may not be generalizable to other professional groups, such as counselors and therapists. Therefore, the occupational focus of the sample limited the broader applicability of the results.

Conclusion

The C-GAP scale is a reliable and valid tool suitable for assessing the practice attitudes and behaviors of Chinese nurses toward gay and lesbian clients.