bluuebunny/crossref_metadata_2025 huggingface dataset:
Three months follow-up of children infected with COVID-19
Authors: Turunc O , Emecen AN , Keskin S , Basoğlu E , Suner AF , Siyve N , Belet N , Karaoglu H , Unal B
Published: October 2021

Background

There is limited research on children infected with Covid-19 after initial diagnosis. The aim of this study was to describe changes in symptoms in children infected by Covid-19 after 1st and 3rd months of diagnosis.

Methods

Covid-19 patients age under 18 admitted to the Dokuz Eylul University Hospital, Izmir, Turkey during December 2020 (n = 144) and completed three months follow-up (n = 123) were included in this prospective cohort study. Data on age, sex, parents' educational status, perceived economic status, presence of Covid-19 patient at household, chronic diseases history, initial and existing symptoms and perception of recovery were collected via telephone interviews. Persistent symptom was defined as any symptom reported within a week of the interview. Chi-square and Mann-Whitney U Test were used for univariate analyses.

Results

Out of 124 patients, 89.3% reported a symptom at time of diagnosis, 21.0% at 1st month and 11.4% at the 3rd-month follow-up. Median number of symptoms was 2 at diagnosis, 0 at 1st and the 3rd month. The most common initial symptoms were fever (52.4%), weakness (40.3%), flu like symptoms (25.8%) and cough (24.4%). The most common persistent symptoms by the 1st month were fatigue (5.7%), cough (4.1%) and gastrointestinal symptoms (4.1%), and by the 3rd month were fatigue (2.4%), weakness (2.4%), respiratory symptoms and chest pain (2.4%). 10.6% of the patients were not fully recovered by the 3rd month. Persistent symptoms at the end of 1st month were more common in children with chronic diseases (36.6% vs 13.3%, p = 0.003) and who were not recovered fully (63.6% vs 15.5%, p = 0.001). Parents' education level, perceived economic status, and presence of Covid-19 patients at household were not associated with persisting symptoms.

Conclusions

COVID-19 symptoms may persist by three months of infection, especially in children with chronic conditions. Health care providers should consider following up those children with special care.

Key messages

COVID-19 symptoms may persist by three months of infection, especially in children with chronic conditions. Health care providers should consider following up those children with special care.
High school students’ attitudes towards SARS-CoV-2 pandemic: an online cross-sectional survey
Authors: Komorzycka J , Sobieraj E , Ganczak M
Published: October 2021

Background

Adolescents play a major role in SARS-CoV-2 spread. The study objective was to assess COVID-19 attitudes among Polish final year high school students.

Methods

An online cross-sectional survey was conducted between December 2020-March 2021; 24 high schools were randomly selected in Lubuskie region, followed by a random selection of 51 classes. Students' attitudes were assessed by an anonymous questionnaire before an online lecture on SARS-CoV-2.

Results

Response rate was 72%, 638 students responded (360 females, mean age 18.4±0.6 years); 438 attended schools in towns with <100,000 inhabitants; 201 were in the science program; 7.4% reported past SARS-CoV-2 infection (5% females vs 10.8% males; p = 0.006). 52.2% believed COVID-19 is a serious disease (more females, those in larger cities and in the science program, p = 0.02; p < 0.001; p < 0.001 respectively). However, 71.3% were not afraid of getting SARS-CoV-2 infection (more males and those not in the science program, p = 0.0007; p = 0.01 respectively); 59.1% were concerned that their parents and 68.7% their grandparents will get COVID-19 (more females, those in larger cities and in the science program, both: p = 0.0004; p = 0.004; p = 0.0005 respectively). Only 16.5% believed that government recommendations effectively control the epidemic (more in the science program; p = 0.01); 44.6% supported lockdown as an effective strategy (more those in larger cities and in the science program; both: p < 0.001).

Conclusions

The findings show low awareness of SARS-CoV-2 infection risk, deficiencies in appropriate attitudes and lack of trust regarding the epidemic management among the high school students. Given attitudes determine people's actions, to limit SARS-CoV-2 transmission and strengthen positive attitudes further investigation into the factors underlying the lack of risk perception is warranted.

Key messages

The study provides perspectives of youth for policymakers that should be taken into account while implementing educational programs related to COVID-19. We recommend implementing COVID-19 knowledge into school curricula to improve students’ risk perception and attitudes.
Effects of COVID-19 on maternal, child healthcare (MCH) services in slums: lessons from India
Authors: Agarwal S , Kothiwal K , Verma S , Sharma M , Sharma C B , Verma N
Published: October 2021

Background

The study aims to understand the effect of COVID lockdown on MCH for slum dwellers and coping mechanisms adopted in Indore and Agra, India. Slum women's perspectives on seeking, delaying, avoiding healthcare in COVID-19, barriers and facilitators were explored.

Methods

In-person qualitative interviews were conducted in slums in Sept-Oct 2020 with mothers who had deliveries; pregnant women needing ante-natal care; mothers with children <2 yrs needing immunization during COVID lockdown. 30 mothers requiring these MCH services during April -June 2020 (lockdown phase) were interviewed. We chose qualitative study over quantitative as a shorter and useful precedent to replicate in similar situations.

Results

Govt. and most private hospitals refused non-COVID services during lockdown.; Police restricted movement on roads. Being on COVID duty, frontline health functionaries were not doing outreach health sessions. Women missed ante-natal check-up, Iron Folate, Tetanus toxoid; Demand side challenges included fear of COVID infection, lack of money due to livelihood loss; Home deliveries by self, neighbors were resorted to; Maternal, neonatal deaths ensued; Children missed immunization e.g., Measles, DPT. Few peri-urban slum families visited nearby rural health facility for delivery. Some families borrowed money from community saving's groups for delivery in private hospitals. Few families visited low-cost private doctor/nurse for immunization of pregnant mother, children.

Conclusions

Demand and supply side factors led to pregnant women and children not receiving care during lockdown. Peri-urban slum families should be encouraged to link with nearby rural health facility for MCH services during COVID-19 or similar situations. Govt. partnering with private providers near slums will help access during challenging times. Promoting community savings groups as mandated under National Urban Health Mission can enable slum families borrow with ease when in need.

Key messages

Government health system should set up emergency (e.g., mobile clinic) MCH services for future epidemic, disaster, should partner with private doctors/nurses near slums. Rural health infrastructure serving nearby peri-urban slums formally recognized by Govt. despite separate jurisdictions is an approach adaptable in LMIC cities.
Attitudes towards Refugees in the Political Center of Germany: A Re-Analysis
Authors: Boege R , Budde S , Rees J , Zick A
Published: October 2021

The German political center is often viewed as democratic and moderate, untouched by right-wing outsiders. Evident right-wing terrorism was often treated as a peripheral phenomenon. In 2015, the peak of the refugee movement constituted a challenge for that German political center and was vividly discussed in the media. Expressions such as “refugee wave” or “crisis” dominated the public discussion. These expressions could spur on Othering processes because not only do these expressions carry a negative valence, but they also put a spotlight on categorial ascriptions. Between 2014 and 2018, attacks on refugee shelters in Germany multiplied by five, and votes for right-wing populist parties rose in Europe. The center studies are representative studies that regularly assess right-wing attitudes in the German political center since 2006. In a re-analysis, we investigated attitudes towards refugees in specific. From three studies, run in 2014, 2016, and 2018/19 (total N = 6,021), relevant questions and questionnaires were identified via word stem search. Fourteen scales were deemed as relevant for attitudes towards refugees, including attitudes towards migration and perceived sayability, group-focused enmity, social dominance orientation, and right-wing authoritarianism. Correlations between the participants' self-categorization as German and European with rejecting attitudes toward refugees are discussed. Further, demographic information was used to assess the distribution of (non-)rejecting attitudes towards refugees depending on region, income, and education. The development of these attitudes and their correlations with other attitudes will be presented. Whilst manifest right-wing attitudes are rare in the German center, aspects of rejection of refugees are shared by up to a third of the participants. Implications for Othering as an iterative process will be discussed.
Evaluation of the direct and indirect impact of the COVID-19 pandemic in Tuscan nursing homes
Authors: Scardina G , Collini F , Mazzilli S , Forni S , Privitera GP , Tavoschi L
Published: October 2021

Background

Residents in long-term care facilities (LTCFs) are at higher risk of contracting and developing serious outcomes from COVID-19. Despite the media attention and the specific survey launched by the Istituto Superiore di Sanità, official data on Italian LTCFs are scarce. The objective of our study was to provide an estimate of the direct and indirect impact of COVID-19 in Tuscan LTCFs by assessing the rate of hospital admissions and the overall mortality rate among LTCF residents in 2020, comparing them with those observed in the period 2018-2019.

Methods

For the analysis two regional administrative data flows were linked. The first one providing data on the number of LTCFs residents - and deaths - affiliated with the regional health system, while the second on hospital discharges. The monthly hospitalization and mortality rates for 2020 were compared with those of the two previous years.

Results

The number of residents in LTCFs decreased significantly (-10.4%) and consistently in 2020 compared to the average of the previous two years. The rate of total admissions decreased slightly in 2020 (32.5%, -8.2% compared to 2018/19). However, excluding admissions due to COVID-19, the reduction was more pronounced (-21.9%), with large monthly variations (-33% and -43% in March and November 2020) statistically significant (RR2020/2018-19=0.66 and 0.57; 95%CI: 0.57-0.77; 0.48-0.68). A total of 581 admissions for COVID-19 occurred in 2020, with a monthly average of 0.6% and two peaks observed in April and November (1.86%; 1.82%). The overall mortality rate increased by 31% (2018/19= 18.6%; 2020= 24.4%), with a maximum (+201%) in November 2020 (RR2020/2018-19=3.01; 95%CI: 2.5-3.56).

Conclusions

The impact of the pandemic on Tuscan LTCFs in terms of deaths and patient care by hospitals has been considerable, with the greatest reduction in hospital admissions occurring mostly in the months characterised by the highest mortality rate and admissions for COVID-19.

Key messages

The direct and indirect impact of the pandemic on Tuscan LTCFs has been considerable, probably due to the reorganisation of LTCF services and limited coordination with hospital health care. The greatest reduction in hospital admissions, especially those not COVID-related, occurred mostly during the months characterised by the highest mortality rate and admissions for COVID-19.
Excess mortality in England during the COVID-19 pandemic
Authors: Fryers PT , Barnard S , Burton PR , Fox S , Waller Z , Fitzpatrick J
Published: October 2021

Introduction

Excess mortality monitoring is not dependent on completeness or consistency of coding of causes of death and captures deaths caused directly and indirectly by COVID-19. It takes account of existing inequalities in the baseline rates and shows the additional impact of COVID-19. We report weekly on excess mortality by age, gender, geographical area, deprivation, and ethnicity.

Methods

A quasi-Poisson model was fitted to deaths data for 2015-2019 to estimate expected mortality in population sub-groups each week during the COVID-19 pandemic. This was compared with observed mortality reported each week. Information on deaths registered was obtained from death certificates. Ethnicity was obtained from hospital records linked to deaths data.

Results

Early in the pandemic, excess deaths exceeded official reported COVID-19 deaths every week. Throughout the pandemic there were stark inequalities in excess death rates. Based on data from 21 March 2020 to 9 April 2021, people living in the most deprived areas in England experienced more excess (1.21 times; 95% CI 1.21-1.22) compared with people living in the least deprived areas (1.17; 1.16-1.18). Black (1.56; 1.53-1.58) and Asian groups (1.55; 1.53-1.56) experienced more excess than the White group (1.16; 1.16-1.17). There was wide variation between English regions.

Conclusions

Reporting overall excess mortality early in the pandemic is important to inform policy makers and public about the true scale of the death toll when coding is inconsistent and developing. This approach has highlighted the large increases in already established inequalities in mortality. It provides rapid surveillance of developing disparities for national and local decision makers. It has been used to inform policy around reducing disparities and to revise messaging to encourage hospital attendance for non- COVID-19 health problems.

Key messages

Excess deaths from all causes is a robust measure of overall impact, unaffected by coding consistency. COVID-19 has dramatically worsened established inequalities between ethnic groups and deprivation groups.
COVID-19: Identifying and addressing determinants of adherence to physical distancing guidance
Authors: Durand H , Bacon SL , Byrne M , Farrell K , Kenny E , Lavoie KL , McGuire BE , McSharry J , Meade O , Molloy GJ
Published: October 2021

Background

Optimising physical distancing measures has been a critical part of the global response to the spread of COVID-19. Adherence to these recommendations has been poorer than adherence to other key transmission reduction behaviours. The current project aimed to identify psychosocial determinants of adherence to physical distancing, and to determine whether Government of Ireland COVID-19 communications adequately address the determinants.

Methods

A nationally representative cross-sectional survey as part of the International COVID-19 Awareness and Responses Evaluation (iCARE) study, a qualitative interview study, and a content analysis of COVID-19 poster communications were conducted to identify psychosocial determinants of adherence and determine the extent to which these were addressed in government communications.

Results

The iCARE survey showed adherence to physical distancing measures varies by sociodemographic group (e.g., age, sex, COVID-19 risk category) and beliefs. Poorest adherence was reported by younger people, males, those at lower risk of serious illness from COVID-19, and those who were less concerned about the impact of COVID-19 on public health and the economy. The qualitative interview study revealed maintaining and negotiating close relationships, public physical environments, habituation to threat, risk-taking to maintain wellbeing, and confusion and uncertainty around government guidelines as barriers to physical distancing behaviour. Having a sense of personal responsibility and control over one's own behaviour was identified as a potential facilitator of adherence to distancing. Content analysis revealed some important gaps, particularly in terms of rationale for specific public health guidelines.

Conclusions

Though adherence was high overall, there was variability among sociodemographic groups. Government communications to promote physical distancing could be refined to better address key barriers and facilitators of the behaviour.
Falsified medicines and shortage as urgent challenges in health care
Authors: Vardanyan L , Kazaryan I , Sevikyan A , Amirkhanyan A
Published: October 2021

Background

Worldwide healthcare systems are faced with certain challenges related to medicines which can compromise population health. These include shortage of medicines, falsified products and so forth. Identifying these problems and informing policy-makers are the first steps in a process of developing appropriate policy strategies. The objective of this work was to identify pressing problems related to medicines which are able influence population health in Armenia.

Methods

209 pharmacy practitioners from different regions of Armenia participated in survey by completing specially designed questionnaire. Data were analysed with SPSS statistical software.

Results

The great majority of participants (89.5%) consider that substandard and falsified medicines are a threat to public health. 77.0% of respondents thinks that substandard and falsified medicines are present on the local pharmaceutical market. The percentage of professionals reporting this problem is higher among those who completed continuing education courses (p = 0.007). 81.8% of professionals suppose that unauthorized/unlicensed medicines are also available. 96.2% of participants are sure that strengthening Health care system in Armenia by introducing additional tools for assuring quality of medicines is necessary. 84.7% of responders consider that shortage of medicines for priority diseases is also a threat to public health. A half of participants (50.2%) suppose that there is a shortage of medicines needed for treatment of priority diseases in Armenia. 90.0% of participants believe that strengthening Health care system by introducing strategies to manage medicines shortage is essential.

Conclusions

Many pharmacy practitioners consider that there are problems with substandard and falsified medicines, as well as shortage of medicines needed for treatment of priority diseases in Armenia. There is an urgent need in developing strategies aimed to solve problems identified. Recommendations are developed.

Key messages

Substandard and falsified medicines are a public health concern and introducing additional tools for assuring quality of medicines considered to be necessary. Shortage of medicines needed for treatment of priority diseases is a public health concern and introducing strategies to manage medicines shortage is essential.
Health assets in transgender adolescents: The role of socio-political engagement and competence
Authors: Moreno-Maldonado C , Ciria-Barreiro E , Rivera F , Luna S , Moreno C
Published: October 2021

Background

Research has shown lower mental health in transgender youth compared to cisgender peers. However, little is known about assets in their development. Self-determination theory posits that certain behaviours increase wellbeing, such as engaging in activities that meet the psychological need for competence and relatedness. This study analyses the mediator roles of political interest, sense of unity, and social self-efficacy in the association between gender identity and health.

Methods

Two samples of Spanish adolescents (15-18 years-old) were analysed. The first sample included 170 transgender and 575 cisgender (selected through a matching process) students who participated in the 2018 Health Behaviour in School-Aged Children study. The second sample included 67 transgender and 2,100 cisgender participants who collaborated in the UNICEF OPINA Barometer. Political interest, social self-efficacy, and sense of unity scales were used to measure community engagement and were considered as sources of resilience. Health-related quality of life (HRQL) was measured using the Kidscreen-10 scale. Data analysis was conducted using linear regressions and parallel mediation effects.

Results

Gender identity predicted well-being, showing lower HRQL in transgender adolescents than cisgender peers. Furthermore, sense of unity and social self-efficacy - but not political interest - significantly predicted wellbeing (higher levels have a positive impact on HRQL) in both groups, and indirectly mediated between gender identity and HRQL.

Conclusions

Sense of unity and social self-efficacy act as sources of resilience, increasing adolescent wellbeing. Thus, social inclusion and active citizenship can help adolescents to better cope with pressure and promote health. Moreover, the positive contributions of sense of unity and social self-efficacy was similar for cisgender and gender minority adolescents, suggesting similar underlying mechanisms.
Role models and well-being among trans and non-binary youth
Authors: Taylor AB , Chan A , Saewyc EM
Published: October 2021

Background

It is important for young people to see themselves represented in stories, on television and in different job opportunities, so they can have an awareness of what is possible. While we often hear the words “representation matters,” research on how representation affects health outcomes of trans and non-binary (TNB) youth is lacking. In this presentation, we will use the Social Cognitive Theory to identify how the presence of role models relates to social and health outcomes of TNB youth across Canada.

Methods

The 2019 online Canadian Trans Youth Health Survey included 1,519 TNB youth ranging from 14-25 years old. Youth identified as 43.7% trans masculine, 12.3% trans feminine, and 44% non-binary. Analyses explore differences in the relationship between the presence of TNB role models and social and health outcomes using crosstabulations and chi square tests, logistic regressions, and ANOVAs, by age and across gender identity groups.

Results

Youth with role models had a higher odds of participating in school sports [OR = 1.3, 95% CI: 1.03 - 1.59] and youth who had a role model they want to be like were significantly more likely to report living in their felt gender (p = .036). The relationship between TNB youth's identification of role models and being able to think of something they are good at, living in their felt gender, avoiding public spaces, future school plans, sports involvement, self-rated physical and mental health, emotional wellbeing and general health outcomes across developmental groupings will be discussed. Demographic and contextual factors that moderate the relationship between role models and social/health outcomes will also be presented.

Conclusions

Youth with role models have better social and emotional well-being. The importance of role models for TNB youth should not be diminished. We will share the implications of our findings for health promotion and public health policy, as well as recommendations for further research.
Identifying trans and non-binary youth in population-based school health surveys in western Canada
Authors: Saewyc EM
Published: October 2021

Background

Most research about gender-diverse adolescents is with clinical samples, skewing population estimates of health and risk. With trans youth estimated at around 0.5% of the population and no reliable measures, school health surveys have not asked gender diversity items. In 2018, the British Columbia Adolescent Health Survey (BCAHS) in Canada trialled measures to differentiate cisgender, trans, and non-binary youth, to capture a representative picture of health for gender-diverse young people.

Methods

The 2018 BCAHS is a stratified random survey of 2,175 classrooms of grades 7-12 (ages 12-19) in 58/60 school districts province-wide (N = 38,015). Two measures asked about sex assigned at birth and current gender identity, combined to identify cisgender boys and girls, trans boys, trans girls, non-binary and questioning youth. We examined patterns of missingness by demographics.

Results

Overall, nearly 99% of youth responded to both items, with very low missing (0.5% for sex, 0.8% gender identity) with no differences by school or district, or by age. Missing responses were higher among international students and English language learners but still low (1.1%). Youth living in foster care or with a disability or chronic condition also had higher odds of skipping both items, but the highest missing was only 3.7% among youth with FASD. Overall, 48.9% identified as cis girls, 48.6% as cis boys, 0.13% as trans girls, 0.33% trans boys, 0.75% non-binary, and 1.28% as not sure (479 trans/non-binary, and 484 unsure). Preliminary analyses show positive assets also support gender diverse youth well-being.

Conclusions

A two-step measure of gender identity is feasible for adolescents as young as 12 years old in large scale school surveys, with very low missing responses in western Canada. Although <1% identified as trans, in large samples stable estimates for population comparisons are possible. Future studies should pilot gender identity measures in other nations/languages.
Perceived need of health care and barriers in access to health services among migrants in Portugal
Authors: Gama A , Marques MJ , Pedro AR , Mendonça J , Fernandes AC , Dias S
Published: October 2021

Health care has been pointed out as a key determinant of migrants' health and social integration, but there is evidence of disparities in its access across subgroups. A deeper understanding of the barriers in access to health care, particularly among vulnerable groups, is needed. Our study aims to examine perceived need of health care, access to health services and barriers among migrants in Portugal. A cross-sectional survey was conducted with 1126 adult migrants (53.4% females), originated from African, Middle East, Asian countries and Brazil, living in Portugal for no longer than 10 years. The collected data included sociodemographic characteristics, perceived need of health care, access to health services and difficulties experienced. Differences between groups were analysed through chi-square tests. Results showed that most of the participants (64.7%) have needed health care in the previous 12 months in Portugal. Of these, 87.8% accessed a health care service. However, even needing health care, 3.3% decided not to seek care and 8.8% were not able to access a health care service. Reporting no access to health care was more frequent among migrants with shorter length of stay in the country (<1 year: 19.4% vs. 1 to 5 years: 7.3% and 6 to 10 years: 4.6%; p = 0.001) and those with non-regular migration status (in regularisation process: 11.5% and undocumented: 9.5% vs. documented: 7.2%; p = 0.040). Most common barriers were lack of the National Health Service user card (38%), financial constraints (15%), undocumented status (11%) and language difficulties (7%). Although efforts have been made over the past decades in Portugal to adopt inclusive policies and promote migrants' access to health care, strategies are needed to improve information on migrants' health rights, especially of those undocumented and recently arrived. Economic and language difficulties should be further addressed in comprehensive interventions to promote equal access to health care.

Key messages

Migrants residing in the country for less than a year and those with non-regular migration status reported more frequently not being able to access health care. Despite the efforts to adopt inclusive policies and promote migrants’ access to health care, strategies are needed to improve information on migrants’ health rights and promote equal access to care.
The International Assessment of COVID-19-related Attitudes, Concerns, Responses and Impacts in Relation to Public Health Policies (iCARE) study
Authors: Stojanovic J , Lavoie KL , Bacon SL ,   for the iCARE study
Published: October 2021

Issue/problem

COVID-19 global pandemic has had significant health, social and financial impacts on global communities. Many of the national mitigation strategies to curb the virus spread have been targeting human behaviours. Insights from behavioural sciences are crucial for effective community engagement and positive behaviour change on a population-level.

Description of the study

The iCARE Study (which is co-funded by CIHR and the Quebec government) is a multi-wave, international observational study of public awareness, attitudes, concerns and behavioural responses to public health policies implemented to reduce the spread of COVID-19 (www.icarestudy.com). Survey data is being continuously collected in 6 week rounds (since March 2020) using representative sampling (in Canada, Italy, Israel, France, Ireland, Australia, Colombia etc.) and convenience sampling methodology (globally). The survey was constructed around the: (1) The COM-B (Capability, Opportunity, Motivation-Behaviour) model; and the (2) The Health Beliefs Model, which provide a framework for understanding factors that predict behaviour change on a population level.

Results

The iCARE study leverages an existing online assessment platform, and has received over 90,000 survey responses to date. This research initiative provides real-time evidence to support COVID-19 policy strategy and communication around the world, through a global multi-stakeholder engagement that gathers expertise from almost 200 collaborators in 40 countries. Of note, the study has received a range of local, national and international media coverage and directly inputted into several government policies.

Lessons

iCARE study is an example of a successful intersectorial, collaborative research and policy initiative that leverages multiple stakeholders to bring behavioural perspective at the forefront of the development and delivery of public health policies globally.
Trends in incidence of uterine cancer in England, 1985-2017
Authors: Apata A , Bannister P , Memon A
Published: October 2021

Background

Cancer of the corpus uteri (hereafter, uterine cancer) is the fourth most common cancer in women in the UK, accounting for 5% of all cancers in women. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of uterine cancer in England during the past four decades.

Methods

Individual level data for women diagnosed with uterine cancer in England during 1985-2017 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 six five-year time periods (1985-89 to 2010-14) and the recent three-year period (2015-17). 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 (2015-17). Index of Multiple Deprivation (IMD) quintiles (2015-17) were examined to determine the social gradient of the disease.

Results

During the 33-year study period, a total of 169,768 women with uterine cancer were registered in England. In women aged 0-49 years, the average annual incidence rates increased by about 51% (from 1.8/100,000 in 1985-89 to 2.8/100,000 in 2015-17), and in women aged 50+ years, the rates increased by about 74% (from 39.0/100,000 in 1985-89 to 67.7/100,000 in 2015-17.). At all ages combined, the rates increased by 88%. With regard to the social gradient, in the young age group the highest proportion (46%) of cases occurred in women from the most deprived areas, whereas in the older age-group the highest proportion (43%) occurred in women from the least deprived areas.

Conclusions

There has been a steady and substantial increase in the incidence of uterine cancer in England over the last four decades. The observed dichotomy in risk between the young and older women by social gradient needs further investigation.

Key messages

Considering that 34% of the cases of uterine cancer in the UK are associated with obesity, the study informs formulation of public health programmes to reduce the prevalence of obesity. The difference in risk between the young and older women by social gradient highlights the importance of reducing health and social inequalities.
Factors associated with organized and non-organized colorectal cancer screening
Authors: Tran T-N , Van Hal G , Peeters M , Jidkova S , De Schutter H , Hoeck S
Published: October 2021

Background

Data on non-organized colorectal cancer screening using fecal occult blood tests (FOBTs) is currently lacking. We identified factors associated with organized and non-organized FOBT screening.

Methods

Data of 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017 were analyzed. Logistic regression with generalized estimating equations was used to assess associations between municipal characteristics and organized and non-organized screening coverages.

Results

Median organized screening coverage increased (36.4% to 40.1%) while non-organized screening coverage decreased (4.8% to 3.3%) in 2015-2017. Organized screening coverage was negatively associated with average income (OR = 0.97, 95%CI: 0.96-0.98) and percentage of people with a non-Belgian/Dutch nationality (OR = 0.962, 95%CI: 0.957-0.967). More older people (70-74) in the target screening population were related to lower coverages by both organized (OR = 0.98, 95%CI: 0.97-0.99) and non-organized screening (OR = 0.98, 95%CI: 0.96-0.999). Education level was positively associated with organized screening coverage (OR = 1.010, 95%CI: 1.008-1.011). While GP visit was positively associated with both organized and non-organized screening coverages, average number of patients per GP and having a global medical dossier handled by preferred GP showed more pronounced associations with non-organized screening (OR = 1.021, 95%CI: 1.016-1.026 and OR = 1.025, 95%CI: 1.018-1.031, respectively) compared to organized screening coverage.

Conclusions

Higher average income, lower average education level, more older people and people with foreign nationality were associated with lower organized screening coverage. GP involvement showed a positive association with non-organized screening. It seems that some GPs and screening-invited individuals are still not fully aware of the benefits of organized screening. Available instruments in screening programs should be optimized to fill this gap in knowledge.

Key messages

We identified factors associated with both organized and non-organized colorectal cancer screening using fecal occult blood tests (FOBTs). Based on this knowledge, strategies can be developed to promote screening among non-participants and encourage non-organized participants to switch to organized screening.
Experience with in-action reviewing at points of entry
Authors: de Rooij D , van de Watering M , van Dijk R , Appels R , Veenstra T , Swaan C , Timen A
Published: October 2021

Background

Lessons learned and experiences gained ask for enhancing the response even during a crisis. We present the application of the in-action review (IAR) of Dutch ports and airports, based on methods developed by the World Health Organization (WHO) and the European Centre for Disease Control (ECDC).

Methods

We performed two separate IARs among Dutch airports (5/5) and ports (15/16) respectively. 1) A questionnaire among participants was used to decide upon most urgent matters to discuss during a 4-hour online meeting. 2) a 4-hour, interactive, online meeting was held among local representatives of points of entry, regional public health professionals, safety professionals, the national institute of public health and the ministry of health. Best practices, lessons, barriers and actions on different topics were first prepared in small groups, and discussed and finalized in plenary sessions. Follow-up of actions was performed during the consecutive 6 weeks at the moment of writing. A questionnaire among participants evaluated satisfaction and impact of the IAR among participants.

Results

Main items for the online meetings were the implementation of measures, and regional and supra-regional collaboration. Most urgent actions formulated were a better integration of local needs into national policy making, and enhancing contacts among different points of entry. Implemented actions include the integration of local public health authorities involved at airports into an existing meeting structure at the national level; and an inter-port meeting structure that was developed leading to 3-weekly meetings to discuss upcoming challenges and exchange practices and advice.

Conclusions

This is to our best knowledge the first time that an in-action review has been performed specifically for the point of entry setting. Performing IARs, online with operational partners led to quick wins and a better network during the COVID-19 pandemic.
Healthcare service provision and injuries in the time of COVID-19 pandemic: A legal and regulatory perspective
Authors: Lingri D , Petelos E
Published: October 2021

This study will describe the current legal and regulatory frameworks implemented during the different phases of the COVID-19 pandemic, assessing how well they worked. It will offer insights regarding coverage and reimbursement for specific health and social care services for people having suffered severe injuries in the context of providing work under particular circumstances, often far removed from their regular working space. Working environments and spaces, as well as overall working conditions, have been radically changed in a sudden and unexpected way. Jobs have been placed at risk, with many disproportionally affected by the lack of supporting mechanisms. New working routines have impacted the lives of many, altering not only working, but also disrupting living patterns. There is a strong emerging need to adapt the legal and regulatory framework related to health and social care services provision, in terms of prevention but also in relation to coverage and reimbursement. New injury patterns and new forms of injury, incl. in relation to mental health, have arisen. They are coupled with burden-of-proof challenges and the need to rebalance social rights. Unprecedented legal and regulatory measures were required to mitigate the social and economic effects of this global health emergency on businesses, workers and citizens. In this context of limitation of individual rights and social freedoms, questions of implementation of EU and international conventions arose (TFEU, ECHR, ILO), while legal and regulatory measures had to be enacted in order to create effective framework for pricing and reimbursement of the specific injuries, during emerging circumstances. Balancing sustainability, burden-of-proof issues and social rights through a comprehensive methodological framework can help resolve ambiguities that often leaded to litigation and, at the same time, resolve the issues of proportionality and legitimate aim in terms of the adopted regulations.
Children of problem gamblers: need for support, utilization of services and prevention policy
Authors: Fischer L , Klein M
Published: October 2021

Background

Problem gambling is an emerging European public health concern. In Germany, 25 to 33% of the approximately 229,000 problem gamblers are also fathers or mothers of minor children. This suggests a high number of children exposed to parental gambling, who are a high-risk group for the development of addictive disorders and other psychological, somatic, and social problems. Unlike in children of parents with a substance-related addiction, the effects of parental problem gambling are under-researched and exposed children often remain underserved. In Germany, this study is the first of its kind to explore the service needs and use of services of the targeted group.

Methods

Survey research with an explorative mixed-methods design was conducted in a non-representative sample (n = 67) of adolescent and adult children of problem gamblers in Germany. Data on the need for support and use of services was assessed in structured interviews and analysed using descriptive statistics and qualitative content analysis.

Results

Preliminary findings in the sample (n = 67, 56,7% male, mean age 28 years (SD = 6.966)) show a great need for support in many areas of life (e.g. family, substance use and gambling behaviour, mental health) and a low utilization of services. Exploring the need for support retrospectively, primarily (1) professional support, especially systemic / family-based support, (2) support and exchange via a trustee, (3) easily accessible services, (4) the desire for psychoeducation and transparency, (5) distancing from the gambling parent, and (6) parental willingness and ability to maintain abstinence, were considered helpful.

Conclusions

Children of problem gamblers show great need of support, but low utilization of services. Further research on the practical implementation of targeted, early, easily accessible, sustainable and transgenerational prevention is a necessary measure in the delivery of care to (children from) families affected by problem gambling.

Key messages

Retrospectively, children of problem gamblers express a high need of easily accessible, professional and especially family-based support and the desire for transparency and psychoeducation. Next to universal prevention, selective prevention efforts targeting children exposed to parental problem gambling are needed to reach the families at risk.
Housing and health: a collaborative project for evidence-based policy-making
Authors: Sáenz de Tejada C , Daher C , Hidalgo L , Vidal Corsà L , Font Morera AM , Torrentó Marselles JR , Chamorro Moreno C
Published: October 2021

Issue

The potential to improve health and equity through better housing is well established. However, housing policies (mainly focused on energy efficiency) have not fully integrated health.

Description

Within the Urban Environment and Health Project of the Diputació de Barcelona, their Housing and Public Health Offices and the Barcelona Institute for Global Health undertook the first phase (May-December 2020) of a collaborative project on housing and health. Focused on the physical dwelling, a map of health risk factors (linked to thermal comfort, environmental and spatial quality), a literature review of each factor, and a list of local health-promoting housing programs were elaborated. Issues addressed included: (a) most relevant home factors affecting health; (b) evidence of poor housing conditions impacting physical, mental, and social health of residents; (c) housing improvements with documented positive health benefits. The second phase (March-December 2021) uses the same methods to address two new housing dimensions: residential environment and community.

Results

Recent research on housing and health explores the potential accumulative/synergistic effects of combined exposures, as additional poor housing parameters (e.g. low indoor air quality, lack of natural light, pest problems, material damage) correlate with poorer health status and higher use of medical resources. Through this collaborative project, increased awareness among local officers has led to preliminary context-specific criteria and parameters to promote healthy homes beyond compliance with current building codes, especially aimed at increasing maintenance and renovation standards in older neighborhoods of Barcelona.

Lessons

Collaboration between stakeholders allows for rich and innovative perspectives and encourages multisectoral actions. Context-specific health costs/benefits analyses are needed to facilitate development and implementation of housing policies with health at its core.

Key messages

Housing policies should have a holistic approach of health risks, redounding in housing policies improvement. Collaborative projects between academic institutions and local governments encourage pivotal evidence-based housing policy-making.
Impact of a CE-marked medical software sensor on SARS-CoV-2 disease pandemic progression estimation
Authors: Limingoja L , Antila KM , Jormanainen V , Jägerroos V , Soininen L , Nordlund H , Vepsäläinen K , Kaikkonen R , Lallukka T
Published: October 2021

Background

To address the current and any future pandemic, we need a robust, real-time and population-scale collection of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into our progress against the viral spread, and helps predict the need and timing of professional healthcare. We thus used a CE-marked medical online symptom checker service and validated the data against national demand of care to estimate the progression of the pandemic in Finland.

Methods

Our data comprised real-time ©Omaolo Covid-19 symptom checker responses (414 477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare 16th March-15th June, 2020 (the first wave of the pandemic in Finland). The questionnaires responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having the Covid-19 and provides graded recommendations for further actions. We trained linear regression and XGBoost models together with F-Score and mutual information feature pre-selectors to predict the admissions 1 week ahead.

Results

Our models reached a MAPE (Mean Absolute Percentage Error) between 24.2% and 36.4% and MdAPE (Median Average Percentage Error) between 20.1% and 25.1% in predicting national daily patient admissions. The best result was achieved by combining both ©Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the pre-selector with slight advantage over XGBoost.

Conclusions

Accurate short-term predictions of Covid-19 patient admissions can be made, and both the symptom check questionnaires and the daily admissions data contribute to the accuracy of the predictions. Thus, symptoms checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic.

Key messages

Digital surveillance of symptoms enables rapid and contactless tracing of epidemic progression. Prediction models can help support medical decision making in an epidemic to promote and protect public health and prevent health care system overload.