bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequalities in psychological distress before and during the COVID-19 pandemic among UK adults
Authors: Patel K , Robertson E , Kwong ASF , Griffith GJ , Willan K , Green MJ , Patalay P , Porteous D , Katikreddi SV
Published: October 2022

Background

Evidence about how population mental health has evolved from before and over the COVID-19 pandemic remains mixed, with impacts on mental health inequalities being unclear. We investigated changes in mental health and sociodemographic inequalities from before and across the first year of the pandemic.

Methods

Data from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were analysed, estimates pooled, and stratified by age, sex, ethnicity, country and lone household status. Trends in the prevalence of poor mental health were assessed before the pandemic (TP0) and across the pandemic at three time periods (initial lockdown (TP1), easing of restrictions (TP2), and a subsequent lockdown (TP3)).

Results

In total, 49,993 adult participants were analysed across the 11 cohort studies. There was an overall worsening in mental health from pre-pandemic scores across all three pandemic timepoints, (TP1 Standardised Mean Difference: 0.15 (95% CI: 0.06 - 0.25); TP2 SMD: 0.18 (0.09 - 0.27); TP3 SMD: 0.21 (0.10 - 0.32)) with no evidence of improvement during the period of eased lockdown restrictions in summer 2020. Changes from pre-pandemic psychological distress were higher in females during the pandemic (TP3 SMD: 0.23 (0.11 - 0.35)), amongst those with degree-level education (TP3 SMD: 0.26 (0.14 - 0.38)), and adults aged 25-44 years. We did not find evidence of changes in distress differing by ethnicity, lone household status or UK nation.

Conclusions

The substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted and a sustained worsening was observed across the pandemic. Mental health declines have been unequal across the population and these results have implications for policy, including the need for specific investment for support for those most affected to mitigate the effects of the pandemic and measures to reduce inequalities within these specific groups.

Key messages

• A sustained deterioration in mental health was observed from before the start of the COVID-19 pandemic, and did not recover when social restrictions were eased.

• Deterioration in mental health varied by sociodemographic factors, namely age, sex, and education, and highlights a need for improved mental health care provision to minimise widening inequalities.
The changing landscape of food deserts and swamps in Flanders, Belgium
Authors: Smets V , Vandevijvere S
Published: October 2022

Introduction

For decades, people's body weight has been increasing at alarming rates, leading to a worldwide obesity epidemic. One of the main causes of this obesity epidemic is poor diet quality. The food environment has been suspected to be one of the principal drivers of poor diet quality. Older people and families with a poor socioeconomic background can be disproportionately affected.

Methods

This study maps the food environment in Flanders between 2008 and 2020 by using the concepts of food deserts and food swamps. Food deserts have been defined as neighborhoods that lack access to some or all foods that are required for a balanced, nutritionally adequate diet. Food swamps refer to places where there is an abundance of unhealthy food options relative to healthy food options. A spatial analysis using population- and retail density datasets yielded the change in food deserts and swamps between 2008 and 2020.

Results

Food deserts in Flanders are found to be small in area and very localized. While food deserts in areas with the two highest deciles of people older than 65 years increased from 1.3% to 1.6% of total surface area in Flanders between 2008 and 2020, the food deserts in areas with the two lowest deciles of low income families decreased from 4% to 2.4%. Food swamps in Flanders on the other hand, are ubiquitous. In 2020, 42.9% of the residential area examined contained no healthy food retailers and 77.7% of the area can be considered a severe food swamp. Areas with a high number of vulnerable groups are healthier than Flanders as a whole because these areas are mostly found in dense urban centers where the ratio of healthy food retailers to all retailers is higher.

Conclusions

Food deserts are a relatively small problem in Flanders in comparison to the widespread occurrence of food swamps. These food swamps exacerbates the obesity epidemic in Flanders and lead to a shorter health span of the affected individuals and to increased medical costs for society.

Key messages

• The food environment in Flanders is generally unhealthy, making it easy for individuals to buy unhealthy foods.

• Food swamps are a major problem in Flanders, where unhealthy retailers drown out healthy retailers.
Evaluation of the quality of cause of death statistics of the last decades in the European Union
Authors: Cirera L , Ballesta M , Uroz V , Sameron D
Published: October 2022

Introduction

The European Union (EU) do not publish the quality of cause-of-death statistics, when is possible to assess quality by reliability. Quality does not present consolidated indicators. Ill-defined and other inaccurate causes have presented different groupings.

Objective

To assess the quality of official cause-of-death statistics of the European Union by member states from 2006 to 2020.

Methods

Cases and population were from the WHO repertory. We selected causes in EU27 countries by up to fourth code-character of ICD10 -on the EuroStat website were not available-. Case counts were grouped into ill- defined, unspecific, less specific (the latter two, in inaccurate), and judicial (inaccurate external causes) categories, based on literature and expertise. We calculated age-adjusted rates to the Standard European Population by country, sex, period (2006-, 2011- and 2016-2020), and quality category. We tested the Comparative Mortality Ratio (CMR) of each country to the European Union median by a Bayesian approach, at 5% statistical significance. We plotted the rates proportion of each quality category in its all causes.

Results

We included 25 countries. Some did not report all years. Six countries showed >19% for ill-defined causes and 3 member states had <5% in both sex and last period. In inaccurate, for the same time period and sex, average pointed 10% with a range of 3-19%. In the same period, CMR exceeded significantly the EU median in 19 and 18 countries for women and men, respectively; and exceeded in unspecific causes in 12 countries for women and men.

Discussion

Literature showed that incorrect causes of death were random distributed. Probably major causes were biased and underestimated.

Conclusions

Quality of cause of death is a useful indicator of mortality statistics reliability. Quality indicators targeted national gaps across EU. We need a new EU task force on statistics of causes of death in accordance with the XXI century.

Key messages

• Quality indicators of causes of death statistics targeted national gaps across the European Union.

• The statistics of death causes underestimated the main causes of death in the European Union.
Community-based health professionals in face of crisis – a practice example from Bremen, Germany
Authors: Gansefort D , Altgeld T , Tempel N , Wächter M , Sterner J , Lettau I , Focke L
Published: October 2022

At the end of 2020, a district-based analysis of Covid-19-infection rates in Bremen uncovered differences between socially deprived and “better off” areas. The first analysis conducted on a district level in Germany revealed a social gradient in the Covid-19-affectedness with deprived areas having above-average incidences. These areas are characterized by poor living conditions, high migrant population, low education and health literacy levels, language barriers and precarious job situations. Bremen's Health Senator acted on this challenge early on, initiated and financed the deployment of community-based health professionals (CHP) in disadvantaged areas to tackle the rising Covid-19-rates while reducing social inequalities and promoting health literacy. The CHPs’ work is coordinated by the Association for Health & Academy for Social Medicine Lower-Saxony. The 14 CHP are multilingual, with a background in health professions, social work and public health. They cooperate with local partners in 18 disadvantaged districts in Bremen and Bremerhaven. In 2021, work focused on outreach work, low-threshold provision of multilingual information (e.g., on regulations, vaccination) and the support of local vaccination campaigns. Bremen currently has the highest vaccination coverage in Germany (87,5% of population with primary series, national average: 76,2%; 07/2022).

Since 2022, CHPs’ work has shifted to health promotion activities aimed at mitigating the effects of the pandemic, e.g., physical inactivity, mental stress. Bremen was the first German city to pilot a large-scale implementation of CHP in socially disadvantaged areas. Due to their continuous presence, CHP quickly became people of trust and are integrated into local structures. Their work has received huge attention both in professional contexts and public media. The low-threshold outreach-work and close cooperation with local partners has high potential to address other health challenges in disadvantaged communities.

Key messages
Implementation of Case Management in emergency departments: the view of the involved staff
Authors: Schmutz E , Graells M , Moullin J , Kasztura M , Chastonay O , Allen M Canepa , Hugli O , Daeppen JB , Grazioli V , Bodenmann P
Published: October 2022

Introduction

Frequent users of emergency departments (FUED; ≥ 5 ED visits in the previous 12 months) often present with somatic, psychological and substance use problems. Providing a Case Management (CM) intervention may reduce their number ED visits and improve their quality of life. However, there is limited knowledge about the implementation process of CM.

Methods

This study aimed to introduce CM into the EDs in the French-speaking part of Switzerland and to identify the facilitators, barriers and needs encountered in this process. Semi-structured interviews were conducted with ED involved staff. An inductive content analysis was conducted.

Results

Among 13 invited hospitals, 8 implemented CM (62%); 23 ED staff were sampled from all participating ED: 17 nurses (74%), 5 physicians (22%) and 1 healthcare manager (4%). The average age was 48,48 years (SD = 8,64) and 74% were female. Four main facilitators emerged from the analysis: 1) Direct hierarchy support and flexibility (e.g. time management, supplemental paid hours); 2) Exchange with colleagues (e.g. debriefing, support); 3) Supervision by the research team (training and toolkit consisting of a binder and USB stick containing the study presentation and implementation procedures); and 4) Motivation (pleasure to work on an innovative project, benefit for patients and caregivers). Lack of resources was an unanimously mentioned barrier (e. g., time to identify and contact FUED medical and social support). Finally, participants identified the following needs to enable CM implementation: official and protected time for the project, a dedicated room for CM, at least two team members involved in the project since its initiation with complementary skills (e.g.: somatic, psychiatric and social).

Conclusions

Our study suggests that successful CM implementation is a complex process that, in addition to motivated ED staff, requires significant dedicated resources, such as protected time and a devoted support team.

Key messages
Improving population health in Germany – lessons of a pilot study to assess health system performance
Authors: Achstetter K , Blümel M , Hengel P , Schwarzbach V , Busse R
Published: October 2022

Background

Improving the population health, both its level and equity, is a major goal of health systems. Health System Performance Assessment (HSPA) is a tool to evaluate the performance of different health system dimensions, e.g., population health, access, efficiency. For the first time, a systematic HSPA was piloted for Germany including the dimension population health.

Methods

The conceptual framework for the German HSPA pilot has been developed in a previous feasibility study. The selection of indicators was based on established indicators used in other HSPA initiatives. Another inclusion criterium was data availability. The ten indicators to measure population health cover e.g., maternal and neonatal health, amenable mortality, infectious diseases, and cancer screening. The indicators are evaluated in terms of their trend over time (2000-2020), in international comparison (e.g., Austria, Denmark, France), and by various equity criteria (e.g., age, gender, region).

Results

Overall, Germany's health system performs moderately regarding population health, especially when compared to selected European countries. While Germany performs very well in terms of incidence rates of infectious diseases, amenable mortality is an area with need for improvements. However, trends over time show improvements of the population health in Germany.

Conclusions

Measuring population health in Germany using ten predefined indicators reveals areas for improvement. Furthermore, subgroup analyses indicate inequities. These results should be considered in further efforts aiming at the improvement of population health in Germany.

Key messages
Introducing Community Houses in Italy: a scoping review of the international literature
Authors: Cerri A , Arcaro P , Veneziano E , Panà A , Mete R , Maurici M , De Vito C , Damiani G
Published: October 2022

Background

The SARS-CoV-2 pandemic put under pressure all the world's health systems, to the point that it was a severe threat to their stability. At the same time, this scenario confirmed the importance of primary health care to guarantee effective care for patients who suffer from complex and chronic diseases. From these considerations and in the light of the funding provided by the European Union for enhancing the health care system in Italy, our working group has decided to analyse various organisational models of Primary Health Care founded around the world to set up innovative Primary care community Centers in Italy, called Community Houses.

Methods

A scoping review of the international literature was conducted on Pubmed, searching for primary care models based on integration and co-location of services. Each organisational model was then evaluated using different levels of multidimensional integration inspired by the taxonomy work of P. P. Valentijn, such as clinical, professional, organisational, system, functional and normative integration levels.

Results

The search produced 2053 results, initially screened by title and abstract and, subsequently, by full-text, finally obtaining 116 articles. When a model is characterised by integrating services with external stakeholders, it also presents more integration levels than the others. In particular, these models are, on average, about 20% more likely to have an organisational, functional and normative integration in the model. Moreover, by stratifying for population complexity, we can find an increase in integration levels for populations suffering from chronic diseases with a higher degree of complexity, such as diabetes or cancer.

Conclusions

From these preliminary results, we can conclude that it is necessary to prefer primary care models with more integration levels to deliver better healthcare for people with complex or chronic diseases, improving the performance of the Health Care System, especially in Italy.

Key messages
Evaluating the pandemic’s impact on surgical site infections after abdominal surgery in Italy
Authors: Elhadidy HSMA , Paladini G , Ugliono E , Cornio AR , Bordino V , Vicentini C , Zotti CM
Published: October 2022

Background

The COVID-19 pandemic led to important disruptions in surgical activity. The aim of this study was to evaluate the impact of COVID-19 on abdominal surgery outcomes in the region of Piedmont, in northern Italy.

Methods

Data were gathered from 42 hospitals participating in the regional surveillance network from 2018 to 2020. SSI, overall mortality and case fatality rates (CFR) were calculated, comparing 2020 to mean 2018-19 data. Chi-squared tests were used to assess both the differences among the proportion of urgent and oncological procedures (based on ICD-9-CM codes) and rates between the two periods. Subgroup analyses on 2020 data were carried out comparing urgent vs. elective and oncological vs. non-oncological procedures using chi-squared tests. Analyses were performed using SPSS v. 28.0.1.0.

Results

5407 procedures were recorded in 2018-19; 310 SSIs and 120 deaths were observed. The mean proportions of urgent and oncological operations were, respectively, 21.90% and 43.24%. In 2020, 1057 procedures were recorded, along with 44 SSIs and 29 deaths. 34.44% of procedures were urgent and 39.74% oncological. The mean 2018-2019 SSI rate was 5.73%, with an overall mortality of 2.22% and a CFR of 7.42%. The SSI rate in 2020 was 4.16%, with an overall mortality of 2.74% and a CFR of 9.09%. The proportion of urgent procedures significantly differed between the two periods (p < 0.001), as did the proportion of oncological procedures and SSI rates (both p = 0.05). Considering 2020, significant differences were found comparing overall mortality between urgent vs. elective procedures (4.95% vs. 1.59%, p = 0.002) and comparing SSI rates between oncological vs. non-oncological patients (3.57% vs. 2.20%, p = 0.02).

Conclusions

During the pandemic, patients undergoing surgical procedures significantly differed, reflecting public health decisions. Even though these differences did not reach statistical significance, overall mortality and CFR increased in 2020.

Key messages
Attitudes towards vaccination are associated with vaccination behaviour among university students
Authors: Trümmler J , Heumann E , Helmer SM , Stock C , Busse H , Heinrichs K , Negash S , Horn J , Niephaus Y , Pischke CR
Published: October 2022

Introduction

Vaccination behaviour is influenced by various determinants. Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of complications compared to the general population in Germany. However, little is known about other COVID-19-related determinants for the population of German university students. This study aimed to investigate determinants of vaccination behaviour among German university students.

Methods

The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities at the end of 2021 via an online survey (n = 7.267). Multiple logistic regressions were calculated to examine associations of vaccination behaviour (not vaccinated vs. fully vaccinated) and attitudes towards vaccination (5Cs: confidence in the safety of the vaccine, complacency - not perceiving diseases as high risk, constraints - structural and psychological barriers, calculation - engagement in information seeking, collective responsibility - willingness to protect others), health literacy in a pandemic (CHL-P), and additional determinants.

Results

All 5Cs were associated with the vaccination status ‘fully vaccinated’, except for complacency. Regarding CHL-P, we found that students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had a higher odds for being vaccinated (OR = 3.02; 95% CI: 2.26-4.04). Regarding additional determinants, the analysis revealed that students who had been previously infected had in all regressions a lower odds for being vaccinated compared to students with no previous infection.

Conclusions

Due to the strong association of the attitudes towards vaccination and vaccination behaviour among university students, we recommend that the different components of the 5Cs should be considered in future COVID-19 vaccination campaigns in the university context.

Key messages
The timeliness of COVID-19 testing and tracing in eight public health regions in the Netherlands
Authors: Bosdriesz JR , den Boogert EM , Dukers-Muijrers NHTM , Götz HM , Goverse IE , Leenstra T , Raven SFH , van Dijken SKS , Wevers K , Matser AA
Published: October 2022

Background

Testing and Contact Tracing (TCT) was a core strategy in the fight against the spread of SARS-CoV-2. However, little is known about the real-world effectiveness of TCT for COVID-19. Because time is an important conditional factor, we aim to study timeliness of TCT in the Netherlands, and its determinants.

Methods

We used routine COVID-19 TCT registry data from all individuals who tested positive for SARS-CoV-2 at 8 Dutch regional public health services from 1-6-2020 to 28-2-2021 (N = 338,066). We calculated median time intervals of TCT stages. Factors associated with the time between test result and completion of TCT, categorised as ≤ 3 days and >3 days, were assessed using logistic regression adjusting for region, testing site, and laboratory. Potential determinants were: gender, age, country of birth, number of close contacts, working in health-care or education, TCT manpower, and the Oxford Covid-19 Government Response Tracker (OxCGRT).

Results

The median time from symptom onset to TCT completion was 6 days (IQR:3-10). Median times between TCT stages were 1 day (IQR:0-3) for symptom onset to test request, 1 day, (IQR:0-1) for test request to sample collection, 1 day, (IQR:1-1) for sample collection to test result, and 2 days (IQR:1-5) for test result to TCT completion. In 31.7% of tests, time between test result and TCT completion was >3 days. This delay was associated with being older (65+), whereas being younger (0-14), a higher OxCGRT, scaling down TCT, and a higher number of TCT employees were associated with a shorter interval.

Conclusions

Over fifty percent of interval times from symptom onset to TCT completion exceeded the median SARS-CoV-2 incubation period of 5 days. There seems to be little room for improvement on the side of the index case, but there are some implications for logistics such as increasing TCT manpower, and better integration of digital systems.

Key messages
Increasing role of Public Health Rapid Response Teams in infectious disease outbreaks
Authors: Tweed S , Stewart DE , Hornsey E , Graham W
Published: October 2022

Background

Following the Ebola crisis (2013-2016), the WHO, Global Health Security Agenda and other international actors advocated for the development of Public Health Rapid Response Teams (RRTs) to strengthen outbreak response. Despite significant investment, evidence on the uptake, composition and effectiveness of such teams remains lacking.

Methods

Qualitative review of published and grey literature including from governmental and multilateral agencies, with semi-structured interviews of key informants. Thematic content analysis was completed and evidence synthesised to inform future policy recommendations.

Results

RRTs have been adopted globally providing surge capacity in outbreak settings. RRTs typically include microbiologists and field epidemiologists but can be more efficacious when broadly multidisciplinary with the inclusion of social scientists, risk communicators and infection prevention and control professionals. The organisation of RRTs must be responsive to district and national contexts so existing systems are not undermined, with regional collaboration beneficial where skill gaps exist. Literature and interviewees agreed that RRTs should not be uniformly defined by narrow technical capabilities, but rather regional standards and evaluation of deployments used to assess operational readiness.

Conclusions

Public Health RRTs should be multiprofessional in nature and evaluated against regional standards to be effective. Future research should seek to assess the experience of countries before and after RRT implementation including detailed economic assessment.

Key messages
Geospatial characteristics of medical workforce and infrastructure to combat COVID-19 in Kazakhstan
Authors: Glushkova N , Semenova Y , Jobalayeva B , Davletov K , Sarría-Santamera A
Published: October 2022

Background

After cessation of initial quarantine in Kazakhstan, the COVID-19 outbreak peaked in July 2020, imposing dramatic stress on the country's healthcare system. This study was focused on calculation of updated epidemiological characteristics, on evaluation of available medical workforce and infrastructure and the impact of workforce density on infected and dead individuals via ArcGIS platform.

Methods

The national and local incidence rate (IR), mortality (M) and case-fatality rates (CFR) were calculated along with the population-weighted densities of beds, physicians, general practitioners, resuscitators, nurses and healthcare budget. Associations between the density of different health workers, infected and dead individuals were investigated using Poisson regression. Finally, we constructed vector maps of country regions clustered by IR and CFR to depict the density of beds and those health workers that were significantly associated with infection and death rates.

Results

There is much heterogeneity between the country regions in terms of CFR (range from 0.28 to 2.57) and IR (range from 1.62 to 12.04), while density of beds was characterized by a relatively greater stability (range from 3.47 to 6.66) and so did density of physicians (range from 0.79 to 2.76) and density of nurses (range from 5.73 to 8.26). Densities of beds, physicians, general practitioners, resuscitators, and nurses have been linked significantly with infection and death rates.

Conclusions

As COVID-19 epidemic is still far from ending, findings of this study could be of interest for policy makers to formulate an appropriate action plan in the view of possible repeated outbreaks.

Key messages
Health equity of displaced Syrians in Lebanon
Authors: Khalifeh R , D'Hoore W , Dauvrin M , Saliba C
Published: October 2022

Lebanese government data indicates that the country hosts 1.5 million displaced Syrians (DS). Providing care for DS is a challenge, especially when barriers and discrimination issues arise in accessing the Lebanese health system. This study therefore aimed to understand the causes of biases, their mechanisms, their forms and their consequences on access and quality of care for DS in Lebanon. A qualitative study using in-depth semi-structured interviews was utilized. In 2021, 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16). Six group interviews were conducted with DS (n = 22) in different Lebanese healthcare facilities. The recruitment of participants was based on reasoned and targeted sampling. The interviews were recorded and transcribed for later narrative content analysis. Thematic analysis was performed to identify common themes in participants’ experiences of DS in accessing Lebanese healthcare. The results showed a barrier of access to care related to transportation and financial issues. Discrimination emerged as an underlying mechanism that drives health inequity. Several factors contributed to the presence of biases in the Lebanese healthcare system. Healthcare services provided to the Syrian population may not be the best due to inequity to access the health system attributable to the discriminatory behavior of healthcare providers. The underlying causes of discrimination are due to the fragility of the Lebanese healthcare system facing a humanitarian crisis with a collapsed infrastructure torn by previous wars and current socio-political and financial problems. Global initiatives can provide the help needed for the equitable provision of health services by providing the resources necessary to address this problem. The findings of this study highlight the changes that should be performed at the micro (cultural skills) and macro (equitable distribution of resources) levels to grant quality of healthcare services for DS.

Key messages
Evaluation of interventions for essential newborn care practices at home-based delivery in India
Authors: Moon J , Usmanova G , van der Schans J , Noh JW , Biesma R
Published: October 2022

India has the largest share of neonatal mortality, accounting for 21.7 per 1,000 in 2019, while the global goal is at least 12 per 1,000 by 2030. More than 20% of deliveries still occur at home in India for various reasons. Several national interventions were designed to ensure essential practices even at home by engaging skilled birth attendants (SBAs), antenatal care (ANC), and community health workers (CHWs). This study evaluates the effectiveness of these interventions on essential newborn care practices (EP); clean cord care, thermal care, and breastfeeding. Using data from the 2015-2016 India Demographic and Health Survey (n = 9,273), this study employs structural equation modeling to confirm the relationship between SBA, ANC, CHWs` counseling, and EP, including indirect effects of ANC and CHWs and moderating effects of women's empowerment. The results show that SBA and ANC have significant direct effects (standardised coefficient=0.105 and 0.056, respectively) on EP, and ANC and CHWs have significant indirect effects (0.015 and 0.004) in the well-fitted model (CFI=0.938, TLI=0.920, RMSEA (upper 90% CI)=0.028 (0.029), SRMR=0.044). The empowerment-related factors which had a significant positive moderating effect on the paths from SBA to EP and from ANC to EP are decision-making power (0.007, 0.003), allowed mobility (0.002, 0.001), and education (0.009, 0.004). More than 90% of EP variance is not associated with the factors in this model (standardised coefficient=0.958). SBA demonstrated the most considerable effectiveness for EP, while ANCs and CHW indirectly impacted EP. Improving women's empowerment can be an effective strategy to enhance EP. Previous literature said that the other factors explaining EP could be quality of care, other interventions for a safe birth, and cultural characteristics. Policymakers are recommended to consider comprehensive factors to address barriers to safe home birth and design CHW's intervention to persuade SBA.

Key messages
Disability risks in past populations: Sweden from the 1800s until 1959
Authors: Vikström L , Junkka J , Lundevaller E Häggström
Published: October 2022

Background

While diseases in contemporary and past populations are thoroughly studied, the knowledge about disability and the risks of getting it is poor. Like diseases, disabilities increase with growing age affecting primarily elderly groups. Whether this notion holds historically and for other groups at risk for disability and differences over time is not known. This study estimates the disability risks in Swedish populations c. 1800-1959 by age, sex and disability type (sensory, physical, mental).

Methods

We use data on two historical populations in the 1800s (N = 36,500; 550 with disability) and 1900-1959 (N = 194,500; 4,700 with disability) drawn from digitized parish registers reporting socio-economic and demographic characteristics over lifetime and on disabilities. Cox proportional regressions estimate disability risks across time by group (age, sex, disability type).

Results

Our preliminary results based on unadjusted estimates from 1900-1959 suggest that the disability risks doubled or more. In the 1950s, women had 2.6 times higher risk than 50 years before, while it was 2.0 for men. The major rise started in the 1930s (Men 1.51; Women: 1.67), and grew in the 1940s (Men 1.80; Women: 2.14). Next, we will assess these risks by group and in the 1800s.

Conclusions

From 1900-1959, Swedish populations experienced consistently higher disability risks, which doubled for men and almost tripled for women. These risks increased while improvements in public health and economic growth would subsequently make Sweden internationally known as a modern welfare state. That health improvements did not reduce the disability risks but the reverse, was possibly due to higher recognition or labeling of disabilities.

Key messages
Medical studentś needs for an integration of climate change into the medical curriculum
Authors: Rybol L , Amelung D , Nieder J , Hachad H , Depoux A , Sauerborn R , Herrmann A
Published: October 2022

Background

The impacts of climate change (CC) on health comprise increased human morbidity and mortality. Consequently, physicians need to be systematically trained to address CC in their professional life. Due to lacking research on educational needs of medical students, we developed a survey instrument to assess studentś attitudinal and knowledge-based needs for the integration of CC into medical curricula and their readiness to learn.

Methods

Our survey was administered online to 788 students at the Medical Faculty of Heidelberg University between 06/2021 and 02/2022. Data analyses included descriptive statistics, reliability analyses as well as regression modeling with regard to readiness to learn.

Results

214 students participated in the survey, 170 fully completed datasets were included in the analysis. A majority of students (72.35%) (strongly) agreed that doctors carry a responsibility to address CC in their work setting, while only 4.71% (strongly) agreed, that their current medical training had imparted them with enough skill to do so. Students showed both considerable knowledge and interest in the area of CC, its health impacts, vulnerabilities and clinical adaptation (70.09% correct answers). Knowledge gaps were identified in the areas of health co-benefits and sustainable healthcare (55.53% and 16.71% of correct answers). 79.42% of students want to learn about CC through the integration into existing mandatory courses.

Conclusions

Results encourage the integration of CC topics with a focus on knowledge and professional role development into existing mandatory courses of the medical curriculum. Specifically, they also pinpoint health impacts and adaptation as greatest areas of interest for students and at health co-benefits and sustainable healthcare as areas with least prior knowledge.

Key messages
Results of a Qualitative Study on Disaster Nursing in a Coastal Region of Lower Saxony/Germany
Authors: Koppelin F , Palm D , Illiger K
Published: October 2022

The increase in heavy rainfall in recent years shows the need to consider disaster preparedness also for persons in need of assistance and care who are cared for at home or in old people's and nursing homes. Evacuation concepts in the event of a heavy rainfall event lasting several days with simultaneous power failure are hardly available for the vulnerable group so far. As part of the LifeGRID project funded by the Federal Ministry of Education and Research, the question is being investigated as to what regional challenges and requirements arise in the event of flooding and a prolonged power blackout in the Wesermarsch district. In addition, the question will be addressed as to how the current care situation of patients referred to electricity presents itself in such a situation. Within the framework of a qualitative design, expert interviews were conducted with care service managers in winter 2022. The four guided interviews were transcribed and their content analysed. In coping with the assumed catastrophic events, the interviewees see problem areas in the organisation, communication, form of care and target group, in addition to the regional characteristics. It became clear that there are not only unanswered questions regarding responsibilities in the event of a crisis, but also that the diversity of forms of care (e.g. private households) poses a particular challenge. The interviewees do not see any viable alternatives to secure communication in the event of a power failure and also see that respiratory patients, for example, have a special need for care (e.g. due to the limited battery life of the respiratory equipment). The results also show that the nursing experts have different views on how they should prepare for such a scenario. These range from passivity to proactivity. A clear need for action becomes visible for cooperation and networking of the relevant actors, promotion of disaster literacy as well as the necessity to adapt the training curricula.

Key messages
Understanding addiction in e-cigarette users – the EVAPE project
Authors: Lohner V , Schneider S , Andreas M , Szafran D , Grundinger N , Vollstädt-Klein S , Fong GT , McNeill A , Mons U
Published: October 2022

Background

Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid. However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood. Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use.

Methods

This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using e-cigarettes daily or weekly for at least four months. Perceived addiction to e-cigarettes was categorised as very vs. not/somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive. Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength. We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking.

Results

17.8% of participants reported feeling very addicted to e-cigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)). All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness.

Conclusions

Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures. Understanding the addictive potential of e-cigarettes is the cornerstone for developing new strategies for prevention and treatment, and ultimately understanding their role from a public health perspective.

Key messages
Interaction between APOE ɛ4 genotype and education on mild cognitive impairment
Authors: Frank M , Hensel J , Baak L , Dragano N , Weimar C , Jokisch M , Schmidt B
Published: October 2022

Introduction

Studies have identified the apolipoprotein E (APOE) ɛ4 genotype to be a genetic risk factor for mild cognitive impairment (MCI) with environmental factors, such as education, modifying this genetic effect. The aim of this study was to investigate possible interaction of APOE ɛ4 status and educational attainment on MCI.

Methods

Information on education, MCI and APOE status was available for 3,829 participants from the Heinz Nixdorf Recall study. Logistic regression models were fitted to estimate sex- and age-adjusted odds ratios (OR) and 95% confidence intervals (95%-CI) for education (<14 years vs. ≥14 years of education), APOE status (carrier vs. noncarrier) and the interaction between APOExeducation on multiplicative scale with MCI. To consider interaction on additive scale, the relative excess risk due to interaction (RERI) was calculated. The effect of APOE on MCI was additionally stratified by educational groups.

Results

A higher chance of MCI was observed for reporting <14 years of education (OR: 1.37 [95%-CI: 1.11, 1.69]) and having a positive APOE ɛ4 status (OR: 1.27 [95%-CI: 1.04, 1.55]). Stratified analysis showed a stronger genetic effect of APOE ɛ4 status on MCI in participants with low education (OR: 1.42 [95%-CI: 1.12, 1.79)], compared to participants with higher education (OR: 1.00 [95%-CI: 0.67, 1.45)]. An indication for positive interaction between education and APOE ɛ4 status on MCI was found on additive scale (RERI: 0.52 [95%-CI: 0.01, 1.03]), no interaction on the multiplicative scale was observed.

Conclusions

Results gave indication for positive interaction on the additive scale of APOE ɛ4 status and education, showing stronger genetic effects on MCI in groups of low education. Socioeconomically disadvantaged environments and health behaviors related to low educational attainment may be responsible for an altered APOE ɛ4 expression. Higher educated groups seem to be better equipped to reduce their genetic susceptibility for MCI.

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Time period effects in work disability due to common mental disorders among young employees
Authors: Amin M , Mittendorfer-Rutz E , Björkenstam E , Virtanen M , Helgesson M , Gustafsson N , Rahman S
Published: October 2022

Background

Previous research on period effects in risk for work disability due to common mental disorders across employment sectors and occupational classes in young employees is lacking. Temporal changes in the healthcare system or social insurance policies or other structural/organisational changes could contribute to such time period effects. We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to their employment sector (private/public) and occupational class (non-manual/manual).

Methods

Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on the 31-Dec-2004, 2009 and 2014 (n = 573,516, 665,138 and 600,889 individuals in cohort 2004, 2009 and 2014, respectively) were followed for four years. Crude and multivariate-adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (CIs) were estimated regarding the risk of LTSA and DP due to CMDs using Cox regression analyses.

Results

In cohort 2004, public sector employees had a higher relative risk for LTSA due to CMDs than private sector employees (aHR, (95%CI): 1.24, 1.16-1.34 and 1.18, 1.11-1.26 among non-manual and manual workers). These associations were similar in the later cohorts. Compared to cohort 2004, the rate of DP due to CMDs was considerably lower in the later cohorts leading to uncertainties in the risk estimates limiting the comparability for time period effects regarding the risk of DP due to CMDs across employment sectors and occupational classes.

Conclusions

Stricter regulation changes regarding the receipt of DP in Sweden, rather than other time period events, may have differentially affected the risk of work disability among young non-manual and manual employees working in the private and public sectors.

Key messages
Estimating the magnitude of surveillance bias in COVID-19
Authors: Tancredi S , Cullati S , Chiolero A
Published: October 2022

Background

Most European countries implemented COVID-19 surveillance systems based notably on the number of diagnosed infections. Using this number as an indicator of epidemic severity is however problematic since it is influenced by testing modality. Indeed, differences in the frequency of infections are partly due to differences in detection rates rather than to changes in the risk of infection, leading to a “surveillance bias”. Our goal was to estimate the magnitude of this bias in one region of Switzerland, using population-based seroprevalence as the best marker of epidemic severity.

Methods

We used data from serosurveys carried out on random samples of the adult population after the 1st (Jul-Oct 2020) and the 2nd wave of the pandemic (Nov 2020-Feb 2021), before the start of the vaccination campaign. To assess the scale of surveillance bias, we assessed the burden of COVID-19 between 2 waves comparing seroprevalence with the number of diagnosed cases (positive PCR or antigen tests).

Results

Out of 867 participants (46% men), 8% (IC 95%:4%-12%) and 19% (IC:15%-23%) had anti-SARS-CoV-2 IgG after the 1st and 2nd wave respectively, that is, a 11% increase between waves. The cumulative number of SARS-CoV-2 diagnosed cases was 2'355 after the 1st wave and 23'321 after the 2nd, that is, an increase of 20'966 cases between waves. Based on the number of diagnosed cases, the epidemic severity of the 2nd wave was 8-9 times higher compared with the 1st wave (20'966 vs 2'355 cases). Based on seroprevalence estimates, epidemic severity of the 2nd wave was less than 1.5 times higher compared to the 1st wave (11% vs 8%).

Conclusions

Due to changes in testing modalities, the number of cases is problematic to assess the burden of COVID-19 in different phases of the pandemic. Accounting for surveillance bias is necessary for accurate public health surveillance.

Key messages
Motivations and strategies underlying the adoption of the front-of-pack labelling scheme Nutri-Score
Authors: Sarda B , Fialon M , Ducrot P , Serry AJ , Galan P , Kesse-Guyot E , Hercberg S , Touvier M , Julia C
Published: October 2022

Front-of-pack nutrition labellings (FoPL) have gained traction in the European Union as tools to tackle the burden of nutrition-related chronic diseases. Multiple FoPL have been implemented by both governments and private actors. Under the European food labelling regulation, any FoPL is optional to display, although the legal framework is being revised for a harmonized FoPL to emerge. Since the implementation of the Nutri-Score in France in 2017, little data is available to understand the motivations and strategies underlying the adoption of the FoPL from a food business’ perspective. A cross-sectional study was conducted in March 2021 on food businesses having adopted the Nutri-Score in France through an online questionnaire. In total, 121 businesses completed the questionnaire, representing 32% of companies adopting the scheme and covering a variety of company types. Engaged businesses had a rather healthier portfolio of products according to the Nutri-Score (on average, 69% of engaged products were A or B and 12% were D or E), with disparities between retailers and national brands. Businesses mostly reported their engagement was motivated by a will to be transparent (76%) and to simplify nutritional information (67%) but still 19% reported that they engaged following external pressures. External pressures were more likely to play a role in the engagement if the company engaged in 2020 compared to those engaged before 2018 (P = 0.032), if the company was larger (P = 0.044) and if the scope of engagement included D or E products (poorer nutritional quality) (P = 0.033). Our study showed that the Nutri-Score, as an optional measure, is mainly used by businesses, especially national brands, as a tool to promote rather healthier products, while companies with products of lower nutritional quality are more likely to engage following external pressure. This highlights the relevance of enforcing a mandatory FoPL system, in line with the Farm to Fork strategy.

Key messages