bluuebunny/crossref_metadata_2025 huggingface dataset:
Trajectories of psychopathology among young people related to outcomes in young adulthood
Authors: Dooley N , Healy C , Cotter D
Published: October 2023

What does young adulthood look like for individuals who had mental health problems across childhood? Using the Growing Up in Ireland cohort (born in 1998 and studied from ages 9 to 20) we explored the association between mental health problems between ages 9 and 13, and subsequent poor outcomes in the same individuals at ages 17-20. We consider educational/economic outcomes, health service use, poor mental and physical health, social isolation, substance abuse, and subjective wellbeing in young adults. In a previous study that used latent class modelling, we identified four groups which captured mental health in a general population sample of children. Between ages 9 and 13, children could be grouped into: a low symptoms group (∼65%), an ‘externalising’ group with ADHD or conduct symptoms (∼20%), an ‘internalising’ group with depressive, anxiety or peer issues (∼10%), or a group showing many combined mental health symptoms (∼2%). All mental health problem groups had elevated odds across all 7 adverse outcomes in young adulthood. The 5 areas of young adult functioning most related to childhood mental health were: education/economics, subjective wellbeing, mental health, social isolation and substance abuse. Poor educational/economic outcomes were as likely as poor mental health (OR ∼ 2) in individuals with childhood psychopathology. The 3 childhood problem groups showed different risk profiles in young adulthood. For instance, the childhood internalising group had lower odds of substance abuse than all other groups, but had the highest odds of poor physical health by adulthood. Findings point to the need for a wider range of preventative supports for children and adolescents with a history of mental health problems, beyond just mental health support. These include interventions to improve physical health, treat substance abuse, reduce social isolation, and improve adverse educational and economic outcomes.
Risk and protective factors for cannabis use among young people - a population based survey
Authors: O'Dowd T , Power E , Cannon M
Published: October 2023

Background

Cannabis is the most commonly used illicit substance in Ireland and globally, with its use most likely to occur in adolescence when the developing brain is more vulnerable to cannabis-related harm. This study aims to ascertain the prevalence of and determine the risk and protective factors for cannabis use among adolescents in the North East of Ireland.

Methods

This study is a cross-sectional, secondary analysis of the 2021 Planet Youth survey. The population comprised a sample of 4404 adolescents aged 15-16 in Cavan, Monaghan and North Dublin. The outcome of interest was cannabis use in the last 30 days. Independent variables were selected a priori following a literature review. Associations between cannabis use and the independent variables were explored using logistic regression.

Results

The prevalence of current cannabis use among study participants was 7.3%. The odds of cannabis use were higher among current alcohol users (aOR 2.68, CI 1.79-4.02), smokers (aOR 3.17, CI 2.18-4.60), e-cigarette users (aOR 2.72, CI 1.87-3.96), adolescents who did not perceive its use as harmful (aOR 2.24, CI 1.51-3.32), felt their parents were not against cannabis (aOR 3.71, CI 2.43-5.66), had cannabis-using peers (aOR 9.81, CI 5.76-16.71) or felt peer pressure to use cannabis (aOR 1.91, CI 1.09-3.33). Low parental supervision was associated with higher odds of cannabis use. There was no association between gender and cannabis use.

Conclusions

This study identified five risk factors and three protective factors associated with cannabis use which can be targeted by policymakers when designing drug prevention strategies.
An ethics framework for social listening and infodemic management
Authors: Machiri S , Purnat T , Nguyen T , Ho C , Ballalai I , Biller-Andorno N , Germani F , Spitale G , Briand S , Reis A
Published: October 2023

Issue

Successful response to an infodemic requires social listening and integrated analysis to produce infodemic insights by identifying questions, concerns, information voids and circulating narratives including health misinformation. There is currently a wide variation in social listening and infodemic insights generation practices, and a lack of frameworks to be applied on ethical values and standards.

Description of the problem

In the context of infodemic management, infodemic insights are generated based on social listening, health system and data from online and offline sources. Where there is a difference between health guidance and behaviors during an emergency, rapid infodemic insights can help understand the underlying drivers of this divergence. Integrated analysis of this data informs infodemic management strategies generate insights that advise a wide range of public health interventions. Present ethical challenges influence data processing and use.

Results

The World Health Organization (WHO) convened a group of experts to develop an ethical framework for social listening and infodemic management. It will guide health authorities and practitioners in planning and setting up infodemic insights teams and implementing infodemic management activities. To support the deliberation of the WHO expert group, a systematic review has been conducted to understand present ethical concerns and challenges.

Lessons

Infodemic management strategies raise ethical concerns that relate to data control, commercialization, transparency, accountability and implications. Power and power imbalances, human rights, privacy and dignity, trust and respect for cultural practices may arise during data collection, analysis, interpretation, and intervention design. Without proper ethical oversight and guidance, the implementation of infodemic management strategies could harm individuals and communities, erode trust, and undermine the effectiveness of responses to a public health emergency.

Key messages

• Social listening and infodemic management by health authorities require consideration of ethical principles and guidance.

• WHO ethics guidance will help public health authorities establish infodemic management practices, policies and strategies.
Estimating the burden of Long COVID symptom clusters in Ireland
Authors: Igboanugo T , Kabir Z
Published: October 2023

Background

Long COVID is a multi-system illness with the potential for a substantial impact on society, from increased healthcare costs to economic and productivity losses. Long COVID is an umbrella term with no consensus on the definition. Long COVID burden estimations in Ireland are patchy and unavailable. We set out to estimate the burden of Long COVID symptom clusters (LCSCs) in Ireland from March 2020 to February 2022.

Methods

Data were obtained from the Health Protection and Surveillance Centre, Ireland. We modelled estimates of the proportion of individuals with Long COVID symptoms based on the Global Burden of Disease Long COVID Study framework. Years Lived with Disability (YLD) due to Long COVID symptom clusters were estimated by age and gender.

Results

An estimated 1.2 million symptomatic SAR-CoV-2 infection was reported in Ireland between March 2020 and February 2022. Overall, 6.3% of individuals who had symptomatic SARS-CoV-2 experienced LCSCs. About 13,657 individuals [females: 6,724 (95% UI: 2,444, 14,439); males: 6,933 (95% UI: 2,594, 14,515)] experienced LCSCs in the first year, and 58,983 in the second year of the pandemic [females: 30,511 (95% UI: 10,377, 69,087); males: 28,472 (95% UI: 9,779, 63,988). YLD attributable to Long COVID was 1,373 (95% UI: 363, 3878) and 4,687 (95% UI: 1,111, 14,575) in the first and second year of the pandemic, respectively. Females experienced a higher Long COVID burden (3,034 YLD) than males (3,026 YLD). Females aged 25-44 years had the highest burden of Long COVID (994 YLD). Long COVID contributed 81.2% (95% UI: 61.4%, 90.2%) of the total YLD [7,464 (95% UI: 2,399, 20,467)] due to COVID-19 within the period.

Conclusions

Long COVID estimates are crucially important for evidence-informed policymaking and developing a model of Long COVID care in Ireland. However, the full impact of Long COVID on population health and the healthcare system will be clearer once a core set of health outcomes is developed internationally.

Key messages

• Post-acute consequences of COVID-19 are the major contributor to the morbidity burden.

• Long COVID estimates are crucially important for evidence-informed policymaking and developing a model of Long COVID care in Ireland.
Adherence to Mask Wearing Policies in OECD and Non-OECD Nations
Authors: McCoy C , Adeyemi O
Published: October 2023

Background

When medical facemasks became a key non-pharmaceutical intervention (NPI) against COVID-19, public health researchers quickly tried to understand why persons did or did not comply with masking policies. Research connected mask adherence to various social characteristics and psychological attitudes. While important, much of this research was performed in the Global North and one might wonder: Are the characteristics of persons who adhere to mask policies the same in industrialising non-OECD nations as in more economically developed OECD nations?

Methods

To examine this question, we used the global COVIDiSTRESS survey and responses from over 15,000 persons in 49 countries to examine the demographics, socioeconomic status (SES), sources of COVID-19 information, and levels of trust of those persons who consistently adhered to mask policies. Using logistic regression analysis, we find important differences between respondents in non-OECD and OECD nations.

Results

We find that identifying as a woman has a significantly stronger impact on mask adherence in OECD nations than in non-OECD nations. In contrast, higher levels of SES (especially higher levels of education) have a stronger impact on mask adherence in non-OECD nations. Furthermore, only in OECD nations is social media use related to a decreased likelihood of adherence and trust in the government's ability to handle COVID related to an increased likelihood of mask adherence.

Conclusions

Our research shows that the characteristics related to adhering to mask policies varies depending on whether one is referring to OECD or non-OECD nations and that research from the Global North cannot not be simply applied to the Global South. Instead, when another global pandemic occurs, mask policies should be developed based on research findings specifically related to that nation and its level of economic development.

Key messages

• We find important differences in mask adherence between persons in non-OECD and OECD nations.

• Research on mask adherence produced in the Global North cannot simply be applied to the Global South.
Exploring flexible methods for national health examination surveys in Germany
Authors: Neuhauser H , Weihrauch T , Maier B , Wolff C , Hey I , Schienkiewitz A , Sarganas G , Gößwald A , Schmich P , Stahlberg S
Published: October 2023

Background

National health examination surveys (HES) are rarely carried out due to high costs and high complexity. We piloted more flexible methods such as self-sampling, self-measurements and household visits conducted by a study-nurse replacing physician examinations in study centers.

Methods

Feasibility of several new methods for the German HES was tested, e.g.: large-scale implementation of unattended self-sampled dried blood spots (DBS) and oral-nasal swabs (ONS) in a countrywide general population panel including a large subsample with migration background (Study 1, n = 15,122); household visits with brief biosampling & examinations (Study 2, n = 470); and unattended blood pressure (BP) self-measurements with mailed devices and video instructions (Study 3, n = 202).

Results

Among participants consenting to participate, Study 1 showed successful postal self-sampling of DBS for SARS-CoV-2 antibody tests in 98% of participants and 97% valid ONS for SARS-CoV-2 PCR tests. Study 2 showed successful standardized measurements of BP (97%), weight/height (99%) and DBS and venous blood sampling with onsite whole blood centrifugation (97%). Temperature requirements for centrifugation, cooled transport and ATC-coded medication assessment (Anatomical Chemical Classification) proved challenging and needed revised methods to avoid data loss. Nested validation studies confirmed use of a multiplex assay for various antibodies with DBS and of HbA1c analysis with uncooled specimen. The strict and time-consuming BP self-measurement-protocol with 12 measurements in Study 3 was followed only by 54% of participants.

Conclusions

Self-sampling and biosampling & examinations in households are feasible options for HES but protocols with high complexity may result in low data completeness.
Step-by-step towards regular health examination surveys in Portugal
Authors: Barreto M , Nunes B , Matias-Dias C
Published: October 2023

The 1st National Health Examination Survey was performed in Portugal in 2015 following the EHES procedures. It consisted of a cross-sectional population-based study representative at regional and national level. Individuals aged 25-74 years, residing in Portugal were selected from the national health users’ registry through multi-stage stratified probabilistic sampling. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. A biobank was created which includes serum, plasma, DNA and whole blood of consenting INSEF participants. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research. The data has provided several indicators for the National Health Programs such as tobacco consumption, prevalence of diabetes, obesity, hypertension and dyslipidaemia for the National Program for Tobacco Prevention and control, National Program of Diabetes and National Program for the Promotion of Healthy Eating. In addition, indicators such as excessive salt consumption were used as a starting point for healthy eating campaigns towards reducing its use. The second National Examination Survey is currently being planned and is expected to be held in 2025 in a consortium with the National Food and Nutrition Survey and with the National Serological Survey. The planning and implementation of a single health survey that associates self-reported information on health status and disease, behavioural health determinants, including a detailed dietary and physical activity component, physical examination, and collection of biological products (blood and urine) would constitute an essential source of knowledge for the monitoring, evaluation of public health interventions, and for population-based epidemiological research.
Quantifying the environmental burden of disease for children and adolescents in Germany
Authors: Plass D , Kienzler S , Tobollik M , Wintermeyer D
Published: October 2023

Introduction

Children and adolescents are more vulnerable to the impacts of environmental risk factors. They are in a sensitive stage of life, where the organ systems are still developing. Already minor interferences can have an effect on their future health. The UKAGEP-project aimed to estimate the Environmental Burden of Disease (EBD) for children and adolescents in Germany.

Methods

We tested the feasibility of applying the EBD-concept, developed by the World Health Organization, for 18 environmental risk factors. Where possible, data from the German Environmental Survey (GerES V) was used as the basis for the analyses. In addition, we performed systematic literature searches to identify adequate exposure-response-relationships.

Results

EBD quantifications were performed for 5 out of 18 environmental risk factors (PM2.5, bisphenol A, environmental noise, second-hand smoke and benzene). For the remaining risk factors, only particular steps of the EBD approach were realized. Taking two exemplary risk factors, about 28 % (170,000) of all obesity cases in the 7-17-year-olds were due to the exposure to bisphenol A and nearly 5 % (1,300) of the disability-adjusted life years for lower respiratory tract infections in 3-17-year-olds were attributable to PM2.5 in 2016.

Conclusions

Even though quantifications were performed for several risk factors, we had to conclude that for the remainder, availability and quality, especially of the exposure-response relationships and health data, were not sufficient to estimate burden of disease. Further, the exposure to some of these risk factors assessed in the GerES-V-study was too low to allow estimating the EBD. This does not mean that the identified concentrations were generally uncritical or that lifelong exposure could not lead to health impairments in the further life course. It only means that potential health outcomes have not occurred yet or the concentrations may lead to subclinical alterations in human body systems.

Key messages

• Environmental risk factors cause considerable burden in children and adolescents.

• Estimating the environmental burden of disease for children and adolescents remains challenging.
Identifying health inequities using a health system performance assessment: findings from Germany
Authors: Achstetter K , Blümel M , Haltaufderheide M , Hengel P , Busse R
Published: October 2023

Background

Reducing health inequities is an important goal of high-performing health systems. Therefore, health inequities need to be assessed systematically, continuously and for all relevant aspects of a health system. The tool “health system performance assessments” (HSPA) aims at monitoring and evaluation the achievement of predefined goals and therefore the overall performance of a national health system. The aim of this study was to identify health inequities using a national HSPA.

Methods

A pilot study for a national HSPA in Germany was conducted between 2020 and 2023. The underlying framework defined the health system goals (e.g., access, quality, population health) and the respective indicators. Equity analyses (e.g., age, gender, socioeconomic factors, geographical region, type of health insurance) were conducted for each indicator to highlight inequities.

Results

Inequities were found for all health system goals. For example, unmet needs (“access”) were higher among people in the lowest income quintiles and in suburban areas. Potentially inadequate medication among the elderly (“quality”) was found more often for women and people 85+ years. The prevalence of infectious diseases (“population health”) was higher among men.

Conclusions

Using a national HSPA to discover health inequities can help identify these in all areas and for all goals of a health system and monitor their development over time. The systematic and continuous assessment within an HSPA is an important prerequisite for identifying and evaluating measures aiming at reducing health inequities.

Key messages

• A national health system performance assessment is useful for identifying and monitoring health inequities on a system level.

• Health inequities (e.g., regarding age, gender, geographic region) were found for every goal of the German health care system.
Improving the quality of translation for patients with language barriers
Authors: Patel M , Fernyhough C , Loo Y , Hillier M , James H
Published: October 2023

Background

Patients with language barriers have worse health outcomes. To promote equitable care, efforts must be made to ensure effective communication with patients, specifically by using professional impartial translation services.

Aims

To build upon previous cycles to promote the use of professional impartial translation.

Methods

A multi-centre quality improvement project in the Acute Medicine Departments of Bart's Health Trust Hospitals in East London. Patients with language barriers were identified; methods of translation were analysed; and interventions to improve access to professional translation were introduced. Professional impartial translation was defined as use of either a member of staff or interpreter.

Results

The first three cycles were completed at the Royal London Hospital. Interventions included the dissemination of information to staff members and also the provision of Bengali interpreters on the ward. This improved the number of patients receiving professional impartial translation from 5% to 20%. Further cycles at Newham Hospitals were then undertaken. The initial intervention included the provision of a portable language line device providing 24hour access to professional translation via telephone or video. Despite this, <20% of patient received professional impartial translation, with >50% still receiving translation via a family member instead. Following departmental teaching sessions on the project, this improved significantly with 35.7% having in person and 33.3% having telephone professional translation.

Lessons

Translation is commonly provided by family members who are often seen as natural advocates for patients; however they may lack impartiality and may be selective in their translation. Impartial professional translation is essential in delivering equitable care. Improved access to translation services alone was not enough, with significant increases in impartial professional translation only being seen after education on its benefits.

Key messages

• Education of staff and easy access to translation services improve their use.

• However, further research is needed to identify why family members are still chosen over professional services.
European training program for competence enhancement in management of health regions
Authors: Behrens Y , Amort F M , Kollányi Z , Romaniuk P , Horváth G , Ferrandiz Roberto R , Todorovska N , Cassens M
Published: October 2023

Background

Health regions aim to increase equal opportunities in health care through the networking of regional actors. In the Erasmus+ founded project Com.HeNet, a European training for the management of health regions was developed. The contents were defined through interviews with European health experts (n = 33). The Com.HeNet training was developed in international interdisciplinary teams with a great transfer potential to other sectors.

Objectives

The objective of the Com.HeNet training is to impart European competences in the development, management, and evaluation of health regions. The training is designed for 5 ECTS (EQF level 6) and consists of 6 teaching modules (Blended Learning). The question arises: Do EU blended learning modules for the management of health regions offer the potential for competence enhancement for successful management in the health sector?

Results

Through an Erasmus+ grant, a total of 23 students and health care practitioners from seven EU countries were able to evaluate the Com.HeNet Training. In a qualitative survey, the training was evaluated for quality, quantity, and professional relevance. 19 (n = 23) respondents stated a high to very high increase in their knowledge regarding the online course on theoretical introduction. 21 (n = 22) respondents perceive, inter alia, the teaching of ‘Health and society - theoretical background’ as helpful to very helpful for their professional future.

Conclusions

The blended learning format of the Com.HeNet training has the potential to useful enhance competences in European health management. The modules have been successfully piloted and will now be transferred into practice.

Key messages

• A European establishment of health regions and the associated training requires cooperation between the national level and the European Union.

• Interdisciplinary competencies can be taught in European blended learning trainings.
A Pilot Study on the Prevalence of Peripheral Arterial Disease in Kigali, Rwanda
Authors: Denison Martin K , Dockery D , Harelimana J , Ahishakiye E , Licht A , Nuenzweig S , Allu S , Cunningham R , Ingabire E , Izere J
Published: October 2023

Background

Peripheral arterial disease (PAD) has significant morbidity including limb loss. The prevalence of PAD in low- and middle-income countries ranges from 3-25% though the global burden is accepted to be near 6%. The objective of this pilot study was to estimate the prevalence of PAD and associated risk factors in Kigali, Rwanda.

Methods

This is a multicenter, mixed-methods, cross-sectional study conducted at three health facilities in Kigali, Rwanda. Patients older than 40 years old presenting for non-emergent reasons at the clinics were eligible for participation in the study. An ankle-brachial index (ABI) was measured using the Unetixs Revo 1100/8 MHz probe for PAD screening. An ABI </=0.9 was the value diagnostic for PAD, and >1.3 was used for an inconclusive ABI. A self-reported survey was collected to determine demographics and medical history, including smoking status and medication use.

Results

A total of 861 participants were included in this study with an overall PAD positivity rate of 3.14%. Additionally, 166 patients (19.3%) had inconclusive ABIs. Patients who screened positive for PAD were significantly more likely to be older (63 vs 56, p = 0.009), of lower wealth indexes (p = 0.016), and were more likely to be current or former smokers (13 (48.1%) vs 217 (32.5%), p = 0.041) (Table 1). Patients with inconclusive ABIs were significantly more likely to be male (70 (42%) vs 140 (21%), p = <0.001), more likely to have chronic kidney disease (4 (2.4%) vs 2 (0.3%), p = 0.016), and more likely to be positive for human immunodeficiency virus (HIV) (44 (27%) vs 127 (19%), p = 0.041). There were also lower rates of DM and HTN in the inconclusive group but no differences in the diagnostic group.

Conclusions

Our results revealed that the prevalence of PAD in Kigali, Rwanda, was similar to ranges quoted in the literature at 3.14%. Results hint that traditional risk factors such as DM and HTN may be less common amongst people with PAD in Rwanda.

Key messages

• The prevalence of peripheral artery disease (PAD) in Rwanda is similar to estimates in other LMICs.

• Traditional risk factors such as diabetes and hypertension may play smaller roles in the etiology of peripheral artery disease (PAD) in Rwanda.
Environmental determinants of body mass index trajectories: results from a longitudinal Swedish study
Authors: Rebouillat P , Gefenaite G , Mattisson K , Östergren P-O , Nilsson P M , Björk J
Published: October 2023

Exposure to natural environments is thought to benefit mental and physical health. A better understanding of the interplay between the individual and the environment in relation to public health is imperative in light of the joint biodiversity, climate, and health crises. This study aimed to 1) identify Body Mass Index (BMI) trajectories in the Scania Public Health Cohort (SPHC), 2) characterise trajectories in terms of sociodemographics, lifestyle, health and living environments and 3) study the associations between BMI trajectories and green qualities of the environment. The SPHC was established in southern Sweden (Scania) in 2000. Participants (n = 13581 at baseline, 18-80 years old) responded to 4 surveys (2000-2016) including questions on sociodemographics, lifestyle and health. Residential coordinates were linked to the Scania Outdoor Environment Database (ScOut) comprising perceived sensory dimensions. “Diverse”, “serene” and “natural” dimensions were summed up to obtain the Scania Green Score. Sex-specific BMI trajectories, identified using group-based trajectory modeling, were compared using multinomial regression, adjusted for main confounders. Five trajectories were identified with similar shapes in men and women. Stable-normal (1) and stable-overweight (2) trajectories exhibited slow linear BMI increase. Fluctuating-overweight (3) and fluctuating-obesity (4) trajectories showed BMI increase followed by decrease, starting from overweight or obesity. The increasing-obesity (5) trajectory showed a persistent increase towards obesity. Trajectories were associated with socioeconomic and lifestyle factors. The highest proportions of university education and lowest proportions of sedentary lifestyle were found in the stable trajectories (1-2). Economic strain was highest in (5). Preliminary analyses showed no clear associations between Scania Green Score at baseline and trajectory membership. BMI trajectories were associated with socioeconomic and lifestyle factors.

Key messages

• BMI trajectories were associated with socioeconomic and lifestyle factors.

• Identifying environmental risk factors is of importance for both public health and urban planning.
Correlates of HIV infection among HIV-exposed infants in low-income settlements Nairobi, Kenya
Authors: Kiilu E M , Kikuvi G M , Karanja S M , Wanzala P
Published: October 2023

Background

Prevention-of-mother-to-child-transmission of HIV services provide timely catchpoints for universal test-and-treat strategies, improving health outcomes among HIV-exposed infants. We explored factors influencing vertical transmission of HIV among HIV-exposed infants in Nairobi County, Kenya.

Methods

A longitudinal study design was adopted and cohort of 166 mother-infant pairs were followed-up over 12 months. The study was conducted in three public healthcare facilities. Simple random sampling was used to select participants. Fisher's exact test was used to test for associations while Poisson regression analyzed data at the multivariable level. The study was powered at 0.08 (P < 0.05 at 95% CI). Correlates were assessed at 6 weeks, 6 and 12 months. All ethical approvals were obtained. The outcome measure was infant HIV status over a 12-month follow-up period.

Results

Infant HIV incidence rate over 12-months was 9 cases per 100 person-years (CI:5.465, 16.290). Maternal non-disclosure of HIV status to partner(s) presented a higher risk of infant HIV positivity relative to mothers who had disclosed their status i.e., at 6 months (relative risk 5.22 CI:1.40, 19.45) and 12 months (relative risk 4.54 CI: 1.62, 12.73). Mothers unaware of their partners’ HIV status had a higher risk of infant HIV positivity relative to mothers who knew their partners’ HIV status i.e., 6 weeks (relative risk 5.3 CI:1.10, 27.98), 6 months (relative risk 4.51 CI:1.13, 17.96) and 12 months (relative risk 5.14 CI:1.66, 16.07). Underweight mothers had a higher risk of infant HIV positivity relative to mothers with a normal body mass index i.e., relative risk 5.82 CI:2.0, 16.89 at 12 months/endpoint.

Conclusions

Maternal non-disclosure of HIV status and unawareness of their partners’ HIV status increased the risk of infant HIV vertical transmission. Recommendation: Healthcare provider assisted disclosure should be enforced to remove barriers brought about by HIV status non-disclosure.

Key messages

• Strategies to improve healthcare provider assisted disclosure of HIV status should be enforced to increase partner support, consequently reducing barriers associated with HIV status non-disclosure.

• Nutritional support should be offered to all mothers living with HIV during the pregnancy and the breastfeeding period, to reduce the risk of vertical transmission of HIV to their infants.
Cluster analysis of maternal socioeconomic and non-modifiable factors with birth & placental outcomes
Authors: Teo S , Murrin C , Mehegan J , Douglass A , Segurado R , Kelleher C , Phillips C , Hébert J
Published: October 2023

Background

Maternal social disadvantage adversely affects both maternal and offspring health outcomes. This study aimed to explore clustering of socioeconomic and non-modifiable factors in mothers and their association with birth and placental outcomes, which are under-researched in this context.

Methods

This analysis of the Lifeways Cross-Generational Cohort includes 250 mother-child pairs. Self-completed general health and food frequency questionnaires in early pregnancy provided information on diet, lifestyle, socioeconomic status (SES) and non-modifiable factors. Parity, untrimmed placental weight (PW) and birthweight (BW) were abstracted from hospital records, and the BW:PW ratio was generated. TwoStep cluster analysis clustered mothers based on age, parity, marital status, net household income, private healthcare insurance, homeowner status, and tertiary education. Differences between clusters were assessed using one-way ANOVA and chi-square tests.

Results

A three-cluster solution was found to be optimal with a modest average silhouette coefficient of 0.3. Clusters were classified as “Married Homeowners” (n = 140, 37.1%), “Highest Income” (n = 58, 23.2%) and “Renters” (n = 52, 20.8%) based on predictor importance. Renters were younger, more likely to smoke, have a medical card (an indicator of social disadvantage) and have poorer dietary quality and dietary inflammatory status (as indicated by lower Healthy Eating Index (HEI-2015) and higher energy-adjusted Dietary Inflammatory Index (E-DII) scores) compared to other clusters (all p < 0.01). Offspring of Renters were more likely to have lower BW (-259.26g, p < 0.01) and shorter birth length (-1.31cm, p < 0.01) and head circumference (-0.59cm, p = 0.02) compared to offspring of Married Homeowners.

Conclusions

Results suggest associations of SES (particularly housing status) with birth, but not placental, outcomes and less favourable lifestyle factors, which may have multi-behavioural and multi-sectoral policy implications.

Key messages

• Associations between low SES, adverse lifestyle behaviours and birth outcomes highlight the importance of a multi-sectoral public health strategy.

• Placental outcomes should be examined in further studies.
Selected outcomes from the study The Youth and Parents Risk Factor Behavior Survey in Bratislava
Authors: Babjakova J , Vondrova D , Wimmerova S , Mayer-Vargova K , Weitzman M , Argalasova L
Published: October 2023

Background

The cross-sectional study of behavioural risk factors in adolescents and adults in Slovakia comes from a bilateral American-Slovak project aimed to evaluate the impact of selected behavioural, psychological, and socioeconomic factors on the health of adolescents/young adults and their parents/caregivers.

Methods

The questionnaires for students and parents were developed according to the studies designed by CDC and adapted to national specificities. A total of 2,384 questionnaires were distributed to a sample of students aged 15-19 years from eight secondary schools and to their caregivers (798 + 1,586). The survey was anonymous and voluntary, approved by the Ethical Committee of the Faculty of Medicine Comenius University and University Hospital in Bratislava.

Results

The study found a high prevalence of behavioural risk factors among adolescents, including smoking (19.9 %), alcohol consumption (39.7 %), substance abuse (27.3%), and suicidal thoughts (41%), particularly at a younger age. The excessive use of IT was also found, mainly over the weekend. The study revealed a significantly lower age of first alcohol consumption and first sexual intercourse among adolescents than among their parents. Additionally, the study confirmed a significant relationship between maternal and child smoking (p = 0.043; OR = 1.84 95% CI 1.02-3.34), while the proportion of children who drank at least once in the last month increased significantly with the intensity of the father's drinking (p = 0.013). Similarly, statistically significant relationship was found between children's and mothers’ drug use (p = 0.008; OR = 2.77 95% CI 1.28-5.99).

Conclusions

The study identified various forms of risky behaviour among adolescents and highlighted the significant influence of parents’ risky behaviour on their children. Parents/caregivers serve as primary role models for their children, and their behaviour significantly impacts adolescent development. Supported by KEGA 015UK-4/2022

Key messages

• The study assessed behavioural risk factors in adolescents, revealing high prevalence of smoking, substance abuse, suicidal thoughts.

• Parental/caregiver behaviour was found to significantly impact adolescent development.
Neonatal jaundice detection in low-income Mexican settings: is there scope for mHealth innovation?
Authors: Jiménez-Díaz G , Keitsch M , Marcuzzi A , Gierman L , Elizarrarás-Rivas J , Aune A , Infanti J J
Published: October 2023

Introduction

Neonatal jaundice (NNJ) is a common and usually harmless condition, but undetected severe cases can cause brain damage and disabilities in thousands of babies each year. Low- and middle-income countries often lack accurate methods for detection and rely primarily on visual assessment (VA), resulting in a higher incidence of consequences. Norwegian researchers developed an easy-to-use and affordable smartphone app (Picterus) to detect NNJ that has shown higher accuracy than VA in Norwegian and Mexican neonates. We evaluated the feasibility of implementing Picterus in low-income settings in Mexico to improve outcomes for affected newborns.

Methods

Qualitative methods, including 1 focus group, 15 semi structured interviews, and 4 observations, were used in urban and rural health facilities in Oaxaca, Mexico, with medical doctors, nurses, and health authorities as participants.

Results

Four themes were identified through thematic analysis guided by the Consolidated Framework for Implementation Research: (1) the current process to detect NNJ, (2) participants’ needs to improve it, (3) feasibility of implementing Picterus in the health system, and (4) users’ expectations from the app. The findings indicate deficiencies in the current process of NNJ detection and a desire among participants for a more accurate tool. Picterus was perceived as an easy-to-use and useful tool compatible with the work routine; however, barriers to adoption were identified, primarily related to internet deficiencies and costs.

Conclusions

Picterus has the potential to improve NNJ detection but contextual barriers must be addressed for a successful implementation in the setting. Additionally, there is scope to optimize VA to strengthen NNJ detection.

Key messages

• Prevalence of severe consequences of NNJ is higher in LMIC compared to high-income ones reflecting an unjust but preventable health inequity with significant health, social and economic costs.

• Picterus offers a reliable and accessible tool to bridge the gap in NNJ detection, potentially improving outcomes for affected newborns in all settings.
The role of labor market inequalities in the gender gap in depression risk among older US adults
Authors: Gueltzow M , Bijlsma M J , van Lenthe F J , Myrskylä M
Published: October 2023

Background

We aim to investigate to what extent gender inequality at the labor market explains higher depression risk for women than men among older US adults.

Methods

We analyze data for 35,699 US adults aged 50-70 years that participated in the Health and Retirement Study. We calculate the gender gap as the difference in the prevalence of elevated depression symptoms ( > = 3, 8-item Center for Epidemiological Studies Depression Scale) between women and men. We employ a dynamic causal decomposition and simulate the life course of a synthetic cohort from ages 50 to 80 with the longitudinal g-formula. We introduce four nested interventions and assign women the same probabilities of being in a labor force category, occupation class, current income, and prior income as men conditional on women's health and family status until age 70.

Findings

The gender gap in depression risk is 2.9 percentage points at age 50 which increases to 7.6 per 100 at age 70. Giving women the same employment, occupation, and income opportunities as men decreases the gap on average over ages 50-71 by 1.2%-points (95%CI: -3 to 0.5), 1.2%-points (95%CI: -3 to 0.5), and 1.3%-points (95%CI: -3.2 to 0.3), respectively and 1.6%-points (95%CI: -3.5 to 0), or approximately one third, if we additionally intervene on prior income. The impact of the simulated intervention is particularly large for Hispanics and low-educated groups.

Interpretation

Policies that equalize labor market opportunities may reduce depression risk in older women and contribute up to one-third to the gender gap in depression risk.

Key messages

• We disentangle the complex relationship between gender, labor market and mental health in older US adults in an innovative life course approach with the help of hypothetical interventions.

• Equalizing opportunities at the labor market reduces the gender depression gap most in groups with the largest gender depression gap, i.e. Hispanics and low educated groups.
Social support and emotional wellbeing among women living with bacterial vaginosis in new york city
Authors: Sun Y , Landers S , Ashmore M , Pathela P , Crawley A , Davis A
Published: October 2023

Background

Bacterial Vaginosis (BV) is a common pathological vaginal condition in women and is disproportionately higher among Black (33%) and Hispanic women (31%) than among non-Hispanic White (23%) or Asian women (11%). BV can have highly distressing impacts on women, yet the role of social support has received limited attention. This paper aimed to explore women's experiences of social support for BV.

Methods

We conducted semi-structured interviews with women (n = 41) aged 18 years or older and who had a BV diagnosis in the past year. Interviews examined women's infection history and symptoms, BV management approaches, the impact of BV on women's lives, and BV clinical care experiences. Qualitative data were analyzed with an a priori coding framework based on key domains, followed by open-coding to uncover emergent themes.

Results

The majority of participants were Non-Hispanic Black/African American (63.4%). Nearly a quarter (22.0%) of participants identified as lesbian or bisexual or reported having sex with a woman in the past year. Most women with BV expressed feelings of shame. Many women noted a lack of social support, particularly from sexual partners, which might lead to relationship mistrust and blame for the infection. Sexual partners’ inadequate knowledge of BV resulted in women's reluctance to discuss their diagnosis and avoidance of sexual activities. Supportive partners or friends helped women recognize BV infection and seek treatment earlier, provided emotional support and reduced feelings of isolation. In addition, women reported receiving greater support and care from sexual health clinics than from other healthcare settings.

Conclusions

The study highlights the importance of social support in women's experiences of BV. Findings imply that enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women's emotional well-being and overall BV experiences.

Key messages

• The study highlights the importance of social support in women’s experiences of BV.

• Enhancing sexual partners’ understanding of BV, fostering open-dialogues among women, and promoting empathetic healthcare systems can potentially improve women’s overall BV experiences.
Associations between problematic use of ICTs, depression, psychosocial, and behavioral factors
Authors: Méndez-López F , Dominguez-Gárcía M , León-Herrera S , Mártinez-Pecharroman M , Samper-Pardo M , Aguilar-Latorre A
Published: October 2023

Background

Depression is a significant and growing health problem that has a significant impact on psychosocial functioning and quality of life. The onset and the severity of mental health problems have been related to various biological, psychosocial, and behavioral variables.

Purpose

The purpose of this study is to explore the association among the severity of depression, problematic information and communications technology (ICT) use, and some related personal factors with health behavior among adults. It also analyzes the moderating role of personal factors in the relationship between the problematic use of ICT and depression.

Patients and methods

Descriptive, bivariate, multivariate, and moderation analyzes of data from 391 participants of 35-74 years old in primary healthcare centers located in Aragón, in northern Spain were performed between July 2021 and July 2022. The primary outcome was the severity of depressive symptoms as continuous variable (PHQ-9).

Results

Low sense of coherence (β = - 0.058; p = 0.043), low self-esteem (β = −0.171; p=0.002), and low self-efficacy (β = −0.122; p= 0.001), are predictors of having more severe depressive symptoms. The negative relationship between problematic ICT use and higher depression was stronger in participants with lower self-efficacy (b = 0.1805, p = 0.080).

Conclusions

The problematic use of ICT and personal factors are related to depressive symptomatology. The interrelationship between problematic ICT use, personal factors, and depression needs to be further explored. The development of prevention and communication strategies by the authorities, which consider the psychosocial factors of adults and promote knowledge of the disease, will increase the adoption of protective health behavior.

Key messages

• The abusive use of information and communication technologies occurs at all ages and in very different cultural contexts, being a growing health problem.

• Knowing the psychosocial risk factors that predispose to this problematic use of ICTs should be key to preventive identification and early care measures among people at risk and their families.
Time series analysis on tuberculosis cases in Kazakhstan from 2014 to 2025
Authors: Yerdessov S , Arupzhanov I , Aimyshev T , Makhammajanov Z , Kadyrov S , Kashkynbayev A , Gaipov A
Published: October 2023

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. The seasonal autoregressive integrated moving average (SARIMA) model is widely used for forecasting infectious disease incidence, including TB. However, there is a lack of comprehensive research on TB epidemiology and predictions for the future in Kazakhstan. Therefore, this study adopted a time series analysis of 72 monthly observations of reported TB cases in Kazakhstan from 2014-2019. The study used monthly health data from 2014-2019 for TB cases obtained from large-scale administrative records. The methodology involved using the Augmented Dickey-Fuller test for determining stationarity, ACF and PACF for identifying model parameters, and AIC/BIC for selecting the best SARIMA model, which was evaluated based on R2 score, MAE, and MAPE. The modeling dataset comprised monthly TB notification rates from 2014 to 2018, while the forecasting dataset comprised data from 2019. The findings suggest that the SARIMA model demonstrated some efficacy in predicting TB notification rates, although there remains scope for enhancing its precision. The time series was stationary after the first difference (ADF test: t-value of -3.25, P < 0.001) and not a white noise (P < 0.01). Based on ACF and PACF graphs, a SARIMA (0,1,0) (0,1,0)12 model was deemed to be the most appropriate forecasting model, with an R2 score of 0.43, MAE of 89.73 and MAPE of 0.08. To develop effective forecasting models for TB incidence, this study examined monthly TB cases in Kazakhstan from 2014 to 2019 and analyzed the seasonal patterns of TB occurrence. It is important to note that these results are preliminary and necessitate additional validation. Future studies will include correlation analyses between TB cases and meteorological data, using more recent data for TB cases, and evaluating various TB incidence forecasting models.

Key messages

• A SARIMA model developed for TB in Kazakhstan showed decreasing trend using time series analysis.

• Evidence-based strategies for TB prevention & control, and importance of monitoring & forecasting TB incidence highlighted in this study.