bluuebunny/crossref_metadata_2025 huggingface dataset:
Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood
Authors: Grigorian K , Östberg V , Raninen J , Låftman S B
Published: October 2023

Loneliness and a sense of belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. The dual continuum model has been suggested (Lim et al., 2021) where these two constructs are regarded as independent but related. Four groups of individuals are defined in the model depending on the level of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially searching (high loneliness, high belonging), socially distressed (high loneliness, low belonging), and socially indifferent (low loneliness, low belonging). Swedish cohort data collected among late adolescents (age 17-18 at baseline in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the association between these distinct groups of individuals and psychosomatic complaints. Three psychosomatic complaints were measured: stomach aches, headaches, and sleeping difficulties, and a summary index (range 3-15) was calculated. Linear regression analyses showed that loneliness and a sense of belonging were cross-sectionally associated with psychosomatic complaints (additional adjustment for sociodemographic characteristics barely affected the estimates). The socially fulfilled group reported fewer psychosomatic complaints compared with the other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Furthermore, the socially indifferent group reported fewer psychosomatic complaints than the socially searching group. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, only the socially distressed group showed a significant positive association with subsequent psychosomatic complaints. These findings confirm that the dual continuum model reflects the complexity of social needs and their association with health complaints.

Key messages

• The categorisation of the conjoint relationship of loneliness and belonging helps to reveal more nuanced links between these two constructs and psychosomatic complaints in young people.

• Knowledge of the more nuanced links between loneliness, belonging, and health complaints can be beneficial for developing specific, targeted public health recommendations and interventions for youth.
Covid-19 among migrants, refugees, and internally displaced persons: systematic review and synthesis of the global empirical literature
Authors: Hintermeier M , Pernitez-Agan S , Lopez J , Wickramage K , Gottlieb N , Baroudi M , Rohleder S , Flores S , Mohsenpour A , Bozorgmehr K
Published: October 2023

National pandemic response and preparedness plans aim at mitigating the spread of infectious diseases and protecting public health. Yet, they often fail to consider migrants. Evidence from the pandemic's early phase indicates that migrants are disproportionally affected by the Covid-19 pandemic and its consequences. Yet, synthesized evidence quantifying the magnitude of inequalities in infection risk, consequences of disease, or consequences of public health measures is lacking. We conducted a systematic review of the literature from 12/2019 to 11/2021 to synthesise the empirical evidence in this field. We considered all types of articles and study designs. The synthesis of evidence was divided into qualitative and quantitative analysis. Out of 6961 studies we included 243 to describe the heterogenous research landscape in terms of design, population, country context, and outcomes reported. The qualitative synthesis (n = 44) highlights the complex interplay of social and Covid-19 related factors at macro-, meso- and micro-level, resulting in high exposure, risk of infection, impacts of public health measures, and health impacts for migrants. The meta-analysis of n = 45 quantitative studies shows that migrants have an elevated risk of infection (RR: 2.46 (95%CI: 1.96-3.07)) compared to non-migrants, but a similar risk of hospitalization (RR: 1.05 (95%CI: 0.80-1.37)). Among those hospitalized, migrants have a lower risk of mortality (RR: 0.57 (95%CI: 0.32-1.03)). Yet, population-based excess mortality tends to be higher among migrants compared to non-migrants (RR: 1.30 (95%CI: 0.90-1.89)). Overall, high heterogeneity in reporting and quality of primary studies hampered the comparability of data. The qualitative results highlight the syndemic nature of the crisis, with cascading effects and interactions among socio-economic and health inequalities. They also illustrate the lack of evidence on some migrant categories, e.g., labor migrants, undocumented migrants, and returnees.
Artificial light at night and breast cancer risk: The findings from CECILE study (France)
Authors: Prajapati N , Cordina E , Boileau A , Faure E , Guénel P
Published: October 2023

Background

Environmental exposure to artificial light at night (LAN) has become ubiquitous in modern societies. Experimental and epidemiological studies suggested that LAN exposure disrupts circadian rhythm, inhibits melatonin production, and increases the risk of breast cancer.

Objectives

We aimed to assess the association of exposure to outdoor LAN with breast cancer risk, along with possible effect modifications of this association.

Methods

We used data from a population-based case-control study, including 1185 incident breast cancer cases and 1282 healthy controls enrolled in 2005-2007 from two French departments- Côte d’Or and Ille-et-Vilaine. Data for outdoor LAN exposure was obtained using radiance-calibrated images from Defense Meteorological Satellite Program (DMSP) for 1995-2006. Exposure was assessed for 10 years before inclusion in the study by cross-referencing the DMSP images and the geocoded locations of residences in ArcGIS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the association, adjusting for sociodemographic factors, urbanization, reproductive factors, lifestyle-related factors, night shift work, and air pollution.

Results

The overall OR for breast cancer per 1 interquartile range (IQR) increase in LAN exposure (159.9 nW/cm2/sr) was 0.98 (95% CI: 0.81-1.17). Subgroup analyses showed slightly higher ORs in post-menopausal women (OR: 1.15; 95% CI: 0.97-1.37) and a stronger association for HER2-positive breast tumors (OR: 1.55; 95% CI: 1.03-2.31).

Conclusions

We did not find any overall association between outdoor LAN and breast cancer; however, possible associations in certain subgroups were indicated. The strength of this study was the use of calibrated satellite images for exposure assessment and the consideration of a large set of potential confounders. Further large-scale studies using improved exposure assessment methods, including blue light and indoor exposure measurement, are required.

Key messages

• Light pollution is growing as the newest form of environmental pollution in modern society, potentially affecting health.

• More studies are required to explore and ascertain its public health impact.
The development of a social prescribing glossary of terms to facilitate engagement & communication
Authors: Newstead S , Wallace C
Published: October 2023

Background

Social prescribing (SP) offers an alternative and adjunctive form of holistic support for many issues, through engagement in community-based activities. SP has undergone a period of growth and development, accompanied by a diverse and confusing terminology that creates barriers to engagement and communication.

Methods

We used a mixed methods approach to collate the terminology associated with SP: Consultation with the SP workforce, a group concept mapping study (GCM), and a scoping review of UK peer-reviewed literature and Welsh grey literature.

Results

We identified a total of 426 terms, many of which described the same specific elements of SP. Scoping review data was charted from 205 documents: 60% of terms occurred solely in peer-reviewed literature, 20% occurred solely in Welsh grey literature, with an overlap of 10% across both sources. Grey literature contained a higher number of terms per article. Data from the scoping review and GCM study indicated a bias for articles and terminology from England and the healthcare sector that does not necessarily reflect the terminology commonly used by the SP workforce. Preferences for some terms were sector-specific, although many of the terms identified were seemingly used interchangeably with little standardisation across and within specific services.

Conclusions

This research highlights the breadth and diversity of the terminology associated with SP. Results were used to produce an innovative and interactive glossary of terms, in the form of a PDF and a website. Unlike traditional glossaries, it incorporates a description of the terms, shows the connectedness of terms, and identifies alternative terms and preferences for certain terms across sectors. The glossary of terms for SP provides an informative reference tool for the general public, SP workforce and commissioners. It will improve understanding across sectors and professions, and facilitate the standardisation of the language associated with SP.

Key messages

• The language associated with social prescribing is diverse and confusing, creating barriers to engagement and impairing communication with the public, and across sectors and professions.

• The glossary of terms for social prescribing, that resulted from this research, provides an informative reference tool for the general public, social prescribing workforce and commissioners.
Tingbjerg Changing Diabetes: Experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighborhood in Copenhagen, Denmark
Authors: Termansen T , Bloch P , Tørslev M K , Vardinghus-Nielsen H
Published: October 2023

Background

As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study thus contributes with important insights on the role of context and how it contributes complexity in community-based health promotion.

Methods

The study is based on 18 months of ethnographic action research in the local community where the first author participated in the development and implementation of one of TCD's activities, a community restaurant, alongside partner representatives and residents, including participant observations and 9 in-depth interviews with key partner representatives.

Findings

Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners’ navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness.

Conclusions

The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.
Bridging social work and health care: The example of Integrated Diabetes Intervention in Tingbjerg
Authors: Tetens A , Boye M C , Bloch P , Tørslev M K
Published: October 2023

Background

In Denmark, type 2 diabetes (T2D) is on the rise particularly among people in vulnerable positions and of low socioeconomic status. People with T2D often have a complex course of treatment that includes continuous contact with different parts of the healthcare system. For the most vulnerable groups however, navigating diabetes related health services can be challenging and may be a decisive obstacle. Low socioeconomic status is associated with a low degree of participation in screening programmes and low compliance with treatment and rehabilitation. Tackling this problem requires collaborative action across the social and the health sector, a challenge that remains unsolved within the field of diabetes. Thus, coordinated diabetes initiatives are required to ensure that people in vulnerable positions achieve optimal benefits from diabetes treatment and rehabilitation.

Methods

This presentation will introduce Integrated Diabetes Intervention in Tingbjerg (IDIT), a holistic diabetes intervention with the dual aim of a) strengthening the motivation and capacity of residents in vulnerable positions to participate in diabetes-related treatment initiatives and b) strengthening collaboration and partnerships in the field of diabetes between key stakeholders in the municipality, the region, and the civil society. IDIT works across the social and the health sector to bridge the gap between the two and offer coherent and integrated treatment and rehabilitation based on the need of the individual.

Findings

Based on findings from one year's intervention period (still ongoing), this presentation will discuss the potentials and challenges associated with integrating social work and health care for populations in vulnerable positions. Thus, it showcases how a Supersetting approach to diabetes care may provide sustainable solutions to tackle low compliance with treatment and rehabilitation among people in vulnerable positions
Effect of a health service integration on health care use of patients with alcohol disorders
Authors: Laatikainen T , Lamidi M-L , Wikström K
Published: October 2023

Background

In North Karelia, Finland an integration of all levels of health and social services was carried out in 2017. One of the usual targets in the service integration is to increase the performance of the service system especially in the care of patients with high use of services. The aim of this study was to assess the impact of the performed integration on the use of health services among patients with alcohol use disorders (AUD).

Methods

Data on all health care contacts of patients with AUD (n = 4344) covering both primary and specialized care was obtained from the electronic patient records for years 2016 to 2020. Patients having AUD were identified using AUD related ICD-10 diagnosis codes that were either set permanent for the patients or recorded at health care contacts. Information on the type of the contact (appointments and remote contacts), reason of contacts (ICD-10 code) and the professional providing the service (physician, nurse or other health professional) was collected.

Results

The proportion of patients with any yearly contact to health services was about 90% and did not change after the integration. The proportion of those having alcohol related contacts declined in the whole patient population, but not among the cohort having AUD related diagnosis already in 2016. Appointments decreased and remote contacts increased, but this was not associated with the year of the integration. Especially remote contacts to nurses in outpatient services increased remarkably during the two last years of the study.

Conclusions

Integration had very little effect on service use of AUD patients. It seemed that the overall trend with increasing remote contacts and decreasing appointments in the health services explain the observed changes. The decline of alcohol related contacts in the whole patient cohort can be explained by the identification of patients with less complicated and advanced diseases as the recording of diagnosis codes has improved.

Key messages

• Organizational integration of health and social services had very little impact on the service use of patients with alcohol use disorders.

• There is a need of better functional integration.
Complex vaccination strategies prevent the emergence of vaccine resistance
Authors: Rella S A , Kulikova Y A , Minnegalieva A R , Kondrashov F A
Published: October 2023

Background

Vaccination is among the most effective tools to control infectious diseases. However, the evolution of vaccine resistance, exemplified by vaccine-resistance in SARS-CoV-2, Influenza or Hepatitis B, remains a concern. As an attempt at containing antigenic evolution, multi-epitope vaccines were proposed, but displayed varying success. Rapidly evolving pathogens call for alternative vaccination procedures.

Methods

We model complex vaccination strategies against a pathogen with multiple epitopes, by diversification of available vaccine targets across the vaccinated population. Our analytical model incorporates within-host evolution in response to vaccination (in form of an evolutionary Wright Fisher model) as well as between-host pathogenic spread (in form of a stochastic transmission model). The model allows analyzing how the combined effects of different life history properties of a pathogen affect the evolution of novel resistant variants.

Results

Vaccine resistance in highly infectious pathogens was prevented by the full-vaccine, one targeting all available epitopes, but only when the rate of pathogen evolution was low. Strikingly, a bet-hedging strategy of random administration of vaccines targeting different epitopes was the most effective in preventing vaccine resistance in pathogens with low rate of infection and high rate of evolution.

Conclusions

Complex vaccination strategies utilizing a diversified vaccine portfolio may be preferable to the currently used single-vaccine approaches for long-term control of disease outbreaks. Depending on the rate of evolution and the transmissibility of a pathogen, an optimal vaccine portfolio may greatly reduce the risk of newly evolving variants. Given the biological feasibility and our knowledge about the life history of a pathogen, we recommend stronger consideration of diversification in vaccine design.

Key messages

• Diversification of vaccine targets reduces the pathogens propensity to evolve vaccine resistance.

• Fast evolving pathogens are best contained by random administration of diverse multi-epitope vaccines.
Prevalence of healthcare-associated infections and antibiotic use in Sicilian hospitals in 2022
Authors: Barchitta M , Maugeri A , Campisi E , La Mastra C , La Rosa M C , Manoli M , Favara G , Magnano San Lio R , Agodi A
Published: October 2023

Introduction

Point prevalence surveys (PPSs) of healthcare-associated infections (HAIs) and antibiotic use are crucial to monitor trends over years at regional level, especially in countries with decentralized healthcare systems. Here, we reported the results of the fourth PPS conducted in Sicilian acute care hospitals (Italy) in 2022.

Methods

The PPS was conducted according to the 6.1 version of the European Centre for Disease Prevention and Control protocol. Each ward carried out a single-day surveillance, including all patients admitted to the ward before or at 8 a.m. and not discharged at the time of the survey. The definition of an active HAI relied on the presence of signs and symptoms, the day of onset of symptoms in relation to hospital admission, and the possible presence of an invasive device before infection.

Results

We used data from 4496 patients from 52 acute care hospitals in Sicily (Italy), with a mean age of 60.7 years (50.9% females). Patients exposed to medical devices were 13.1% for central venous catheter, 37.6% for indwelling urinary catheter, and 4.0% for mechanically assisted ventilation. Antibiotic treatment was given to 48.6% of patients. Overall, our survey found 8.3% patients with at least one active HAI on the survey day. Of a total of 369 HAIs for which information was available, the most commonly reported types were pneumonia (22.2%), urinary tract infections (20.1%), and surgical site infections (10.3%).

Conclusions

Approximately one in 12 patients has a HAI on a given day in Sicilian hospitals. This estimate is higher than that obtained through the previous Sicilian PPS conducted in 2018 (8.3% vs. 5.1%). By contrast, the proportion of patients who received at least one antimicrobial agent was lower than in 2018 (48.6% vs. 53.7%). Nevertheless, the high prevalence of HAIs observed underlines the need for maximising infection, prevention and control strategies and antibiotic stewardship programs against HAIs and antimicrobial resistance.

Key messages

• The prevalence of HAIs in Sicilian hospitals is higher than previous years.

• There is the need for actions against HAIs and antimicrobial use at regional, national, and global levels.
Which Patients gain more from short-term planned hospitalization?
Authors: Guarducci G , Panichella F , Gurnari J , Moirano F , Gentile A M , Nante N
Published: October 2023

Background

The measurement of health-related quality of life (HRQoL) has become one of the most important components in the evaluation of healthcare outcomes. The EQ-5D-5L is an econometric tool to transform HRQoL into Quality Adjusted Life Year (QALY). The study aims to measure the health gain, expressed in QALY, provided by an Italian clinic.

Methods

A retrospective study was conducted on 137 geriatric patients admitted, for short-term planned rehabilitation hospitalization, from March 2018 to March 2020. Patients completed the EQ-5D-5L questionnaire at both admission and discharge. We calculated QALY from the difference between EQ-5D-5L at discharge and admission, assuming that health gains (discounted at the rate of 3.5%) accumulate up to one year after discharge. A risk adjustment has been done through the Cumulative Illness Rating Scale (CIRS). We stratified our sample by gender, age, BMI and clinical severity. Descriptive (median and interquartile range) and statistical (Mann-Whitney and Dunn's Test) analysis was carried out using STATA.

Results

In our sample (62.8% female) the median age was 82[15] years old. The median length of stay was 16[17] days. Patients gained 0.14[0.19] QALY: this was greater (p < 0.05) for female (0,15[0,14]) than males (0,12[0,14]). According to age groups, patients >75 years old had a lower QALY (0.12[0.26]) than both patients ≤65 years (0.16[0.15]) and those between 65 and 75 years (0.15[0.12]), while patients younger than 65 years had a higher QALY gain than the other two groups (p > 0.05). The obese class I (0.31[0.46]) gained more QALY than the other BMI classes (p < 0,05), except that obese class II. Patients with a Severity Index of CIRS higher than the median of our sample had a greater health gain (0.18[0.20] vs. 0.12[0.20]) (p > 0.05).

Conclusions

The EQ-5D-5L allowed us to quantify the ‘health gain’ obtained by patients through its transformation into QALY. The best results were obtained in female and obese class I patients.

Key messages

• The outcome assessment is essential when performing healthcare.

• The QALY allows us to assess quantitative and qualitative life expectancy's increases provided by healthcare.
A Comparative Study on the Efficiency of Health Care Systems in OECD Countries Against COVID-19
Authors: Baek S J , Jeong H S , Heo M H , Choi J A , Noh J W
Published: October 2023

Background

COVID-19 has resulted in more than 670 million confirmed cases and more than 6.8 million deaths worldwide as of March 2023. This pandemic situation has put a significant strain on health care systems in each country, and the crises experienced by the USA, Britain and Italy have shown that even developed countries’ systems can collapse. This this study aims to measure and evaluate the performance of OECD countries’ health care systems against COVID-19 in terms of relative efficiency.

Methods

This study uses DEA to measure and compare the relative efficiency of national health care systems in response to COVID-19. We calculate technical, pure technical, scale, and super efficiency ranks based on the CCR, BCC, and Super-SBM models. The input variables are COVID-19-related health expenses, ICUs, facilities and equipment, and the number of examiners, and the output variable is the excess mortality rate due to COVID-19 of 2020, one year.

Results

According to the CCR model, two of the 20 analyzed countries, including Denmark and Iceland, are 100% efficient, and the remaining 18 countries are relatively inefficient. The average of technological efficiency is 0.26. According to the BCC model, a total of 10 countries are 100% efficient. The average of pure technical efficiency is 0.71. As a result of measuring the efficiency of scale, Denmark and Iceland are 100% efficient, and the remaining 18 countries are relatively inefficient. The average scale efficiency is 0.28. The super-efficiency ranking was followed by Denmark, Iceland, Korea and, etc.

Conclusions

When the analysis results were classified by health security system again, efficiency was high in the order of NHS, NHI, and SHI. When classified by financing sources and service provider, it was confirmed that tax-type countries were more efficient than insurance-type countries, and public supply-oriented countries were more efficient than private supply-oriented countries.

Key messages

• The efficiency of health care system of OECD countries against COVID-19 was measured, and the causes of performance were explored in terms of the structure of the system.

• Through this, we intend to derive policy implications that can maintain the sustainability of the health care system in the face of health security crises such as the pandemic.
Effectiveness of the ‘Know what you eat’ nutrition education program for Dutch secondary schools
Authors: Hoefnagels F A , Battjes-Fries MCE
Published: October 2023

Background

School-based nutrition education programs have increasingly been used to teach children about healthy and sustainable nutrition, but there are less recognized programs available for secondary education. In this study we studied the effectiveness of the digital ‘Know what you eat’ program from the Netherlands Nutrition Centre among students (12-15y) on behavioral determinants and self-reported behaviors related to healthy, safe, and sustainable eating behavior.

Methods

Within a quasi-experimental research design, students in the first or second grade of 7 intervention schools and 11 control schools received a digital questionnaire during the pretest and posttest measurement. The questionnaire included questions on knowledge, self-efficacy, attitude, subjective norm, intention, and behavior related to healthy, safe, and sustainable eating behavior.

Results

The pre- and post-questionnaire was filled out by 364 students in the intervention and 247 in the control group. Linear multilevel regression analyses show a higher significant increase in self-efficacy, attitude, intention to drink water (all three p < 0.01), and a significant decrease in sugary drinks, snacks and meat consumption (all p < 0.05) in the intervention group than the control group. Additionally, students in both the intervention and control groups scored higher on knowledge during the post-test than the pre-test (both p < 0.05), but the intervention group was not significantly higher than the control group (p = 0.14). No significant effects were found for subjective norm, intention, and fruit, vegetable, and whole grain bread consumption.

Conclusions

The results of this study showed effects of the ‘Know what you eat’ program on self-efficacy and attitude towards healthy, sustainable, and safe eating behavior, intention to drink more water, and several healthy eating behaviors of secondary school students. Further research is needed to determine the sustainability of these results in the long term.

Key messages

• The ‘Know what you eat’ program is effective on self-efficacy, attitude and certain eating behaviors related to healthy, sustainable, and safe eating behavior of students (12-15y).

• Nutrition education programs in secondary schools appears promising for promoting students food literacy.
Loneliness in emerging adulthood: A qualitative study using cultural probes and interviews
Authors: Nielsen B K , Nielsen L A , Lasgaard M
Published: October 2023

Background

Prolonged loneliness in emerging adults is a public health concern associated with poor mental health such as symptoms of depression and anxiety that may have negative implications for health and well-being in later life. This study aimed to explore how prolonged loneliness is experienced and coped with by emerging adults in their everyday life.

Methods

The study is a thematic analysis of qualitative data consisting of cultural probes and in-depth interviews. 21 emerging adults (mean age 21.3) completed cultural probes consisting of open and evocative activities for them to delve into in their own time thereby contributing to depicting their story about loneliness in everyday life. After completion of the probes, participants were interviewed using a semi-structured interview-guide.

Results

Through thematic analysis of the cultural probe material and interview data we identified three main themes: ‘the many faces of loneliness’ (subthemes: social exclusion and bullying, life interrupted, disconnected in a connected world), ‘internal struggles: the interplay between low self-esteem, intrusive thoughts, and mental health’ (subthemes: trapped in self-doubt, labelled and lonely), and ‘the duality of coping strategies’ (subthemes: reconnecting with others, distracting activities).

Conclusions

The study provides a deeper understanding of the lived experiences of prolonged loneliness among emerging adults and offers insights into the reasons underlying loneliness. Moreover, the findings can contribute to developing interventions aimed at reducing loneliness in emerging adults. The rich data from the cultural probes were subsequently used to create a traveling exhibition, which facilitates dialogue on loneliness.

Key messages

• Prolonged loneliness in emerging adults is a public health concern associated with poor mental health, which may have negative implications for health and well-being in later life.

• Insights on coping strategies and loneliness experiences of emerging adults in the study can help inform interventions aimed at reducing loneliness.
Experiences of catch-up vaccination among adult migrants in the UK: An in-depth interview study
Authors: Deal A , Crawshaw A F , Salloum M , Hayward S E , Carter J , Mounier-Jack S , Majeed A , Hargreaves S
Published: October 2023

WHO's Immunization Agenda 2030 emphasises equitable access to vaccination across the life course, including migrants who may have missed childhood vaccinations due to disrupted healthcare systems or differing vaccination schedules. Uptake of adult catch-up vaccination is thought to be poor in the UK, but limited evidence exists to explain this. In-depth semi-structured interviews were carried out across two studies with different adult migrant populations on views and experiences around vaccination. Study 1 recruited those resident <10 years in the UK from a range of backgrounds (remote interviews, 09/2020-01/2022, REC2020.0058) and Study 2 (in-person, 01/2022-03/2022, REC2021.0128) engaged Congolese and Angolan migrants. Interviews were conducted in English, Lingala or French and were audio-recorded, transcribed, and analysed through qualitative content analysis in NVivo 12. 71 participants were interviewed (mean age 43.6 [SD:12.4], 69% female, mean 9.5 [SD:7] yrs in UK). Most reported having never been offered or asked about vaccination history in the UK. Participants more often reported being offered seasonal or selective vaccinations (flu [n = 20], travel-related [n = 8], pregnancy-related [pertussis, n = 7]) compared to catch-up vaccines (MMR (n = 3), DTP (n = 3)) in the UK. Generally, participants were not aware of catch-up vaccination but viewed it mostly positively. Concerns included side effects, barriers to attending primary care facilities, and vaccination fatigue. Trust was an important factor in vaccination decisions, and participants expressed varying levels of trust towards healthcare professionals’ recommendations and the NHS. There is a need to increase opportunities for catch-up vaccination in primary care by incentivisation of catch-up vaccination and education of healthcare professionals. Low trust and concerns around safety exist in some migrant groups, for which tailored information campaigns or community-led interventions could be developed.

Key messages

• There is a need to increase opportunities for catch-up vaccination in primary care.

• Low trust and concerns around safety exist in some migrant groups, for which tailored information campaigns or community-led interventions could be developed.
10.C. Round table: EU Global Health Strategy: Mapping European support for improving health and health systems globally
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Matthias Wismar (European Observatory)
Published: October 2023

In November 2022, the European Commission unveiled its new Global Health Strategy. Featuring three cross-cutting priorities, the Strategy calls for the mobilisation of a “wide number of policies to work on a global health agenda” (1). The Strategy also highlights the importance of establishing a “permanent mapping of key measures and financing efforts of the EU and its Member States to better understand what actions are taking place and to allow for tying means to the strategy's priorities”(1).

The EU's ongoing actions are already delivering more for health systems globally than one would expect - and it has many policy tools and support instruments which affect Global Health. These instruments vary greatly in their intent and design, with some targeted at strengthening health systems and promoting health and wellbeing, while others contribute to these objectives more indirectly by generating spillover effects. The European Observatory's upcoming policy brief ‘European support for improving health and care systems globally’ aims to unpack the key EU instruments available in policy areas including:

• Trade in goods and services

• Public investment and fiscal instruments

• Official development assistance and humanitarian aid

• Solidarity, voice, and multilateralism

• Research and training partnerships

This roundtable will delve into the main priorities of the Strategy and reflect on upcoming plans for its realisation. Engaging with the audience, the panel will explore the need for transparency, alignment, and coordination of the existing instruments across the different policy areas. It will also discuss opportunities for collaboration between the European level and the EU Member States. This facilitated roundtable discussion will explore how resources such as the Policy Brief can serve as a steppingstone to map and make sense of the diverse range of EU actions relevant for Global Health, in order to maximise synergies, transparency and policy consistency for successful coordination and implementation of the Strategy.

(1) EU Global Health Strategy - Better Health for All in a Changing World. Commission Communication COM(2022) 675, https://health.ec.europa.eu/publications/eu-global-health-strategy-better-health-all-changing-world_en

Key messages

• The EU already has more policy instruments with an impact on Global Health than one would expect.

• Delivering on the priorities of the new EU Global Health Strategy will require taking stock of ongoing EU actions and forging meaningful synergies for cross-sectoral collaboration.

Speakers/Panelists

Scott Greer

University of Michigan, Ann Arbor, USA

Nicole Mauer

European Observatory on Health Systems and Policies, Brussels, Belgium

Elena Petelos

EUPHA-HTA, EUPHA-GH
Burden of T1DM and T2DM among adolescents in Western Europe, 1990-2019: results from the GBD 2019
Authors: Armocida B , Monasta L , Sawyer S , Bustreo F , Onder G , Castelpietra G , Pricci F , Giacomozzi C , Perel P , Beran D
Published: October 2023

Background

Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are major causes of global morbidity and mortality. As little is known about the burden of DM in adolescents in Western Europe (WE), we aimed to explore the epidemiology of T1DM and T2DM among 10-24-year-olds, including temporal trends.

Methods

Estimates were retrieved from the Global Burden of Diseases study 2019 (GBD 2019). We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for incidence, prevalence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries.

Results

In 2019, prevalence and YLDs estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM incidence rates per 100,000 population were 3.5 times higher than T1DM. T2DM showed a greater increase in prevalence and YLDs than T1DM in the 30-year observation period in all WE countries. The highest prevalence rate of T1DM was in Finland (542.7 [402.9-681.0]), while the United Kingdom had the highest prevalence for T2DM (751.0 [501.2-1063.3]). Prevalence increased with age, while only minor differences were observed between sexes. In 2019, HBMI accounted for 28.8 (12.6-54.9) of the attributable YLD rates for T2DM in age group 20-24 years in WE.

Conclusions

The findings show the substantial burden posed by DM among adolescents in WE. The study can help inform the development and implementation of appropriate infrastructure and healthcare frameworks for adolescent-centred diabetes care. It highlights the need for transition services, and adolescent-oriented education programs, as well as investments in data systems to improve the availability and quality of data for T1DM and T2DM in 10-24-year-olds. Finally, it can be used to guide policymakers towards prevention of obesity and broader policy actions on the social and commercial determinants of health across the life course.

Key messages

• Adolescent-oriented health system responses on transition services, data collection systems, education, and complications’ prevention are needed to achieve targets for NCDs within the 2030 UN SDGs.

• T2DM should not only be considered as an adult-onset disease, implying a paradigm shift for paediatric DM services and a strengthening of interventions on social and commercial determinants of health.
Disease burden in Norway in 2050: A forecasting analysis based on the Global Burden of Disease (GBD) Study
Authors: Knudsen A K , Sulo G , Klitkou S T , Vollset S E
Published: October 2023

Life expectancy in Norway has increased steadily in the past 50 years, in line with decreases in important causes and risk factors for premature mortality. However, due to the aging of the population, it is expected that a higher number will live with chronic diseases in the future. This will have implications for the planning of health services and public health work. The aim of this analysis was to forecast the disease burden in Norway up to 2050. The analyses were based on data on life expectancy and disease burden by 21 disease groups from the Global Burden of Disease Study 2019 (GBD 2019). The population was forecasted to get estimates on future size, age-composition and life expectancy up to 2050. Independent drivers of population health, in terms of sociodemographic factors and a selection of risk factors and preventive measures (e.g. vaccines) were included in the forecasting of general and cause-specific mortality. Non-fatal health loss was forecasted based on incidence/mortality ratios, or previous trends in disease development for causes not associated with mortality. Results are presented as rates, and compared with observed rates from the period 1990 to 2019. Both life expectancy and the proportion of elderly in Norway is forecasted to increase towards 2050. The decreasing trend in mortality and disease burden rates observed from 1990 to 2019 is, however, forecasted to turn, with a forecasted increase starting from 2020 and onward. Mortality due to cancers, neurological diseases and chronic respiratory diseases were forecasted to increase, while cardiovascular diseases were forecasted to contribute with decreased mortality in 2050. The non-fatal disease burden was forecasted to remain relatively stable. Aging of the population is the most important driver of future disease burden. Forecasting of disease burden by cause- and age-groups provides important background knowledge for planning of future health services and targeted health promotion.
10.G. Workshop: Investigating risk and protective factors for youth mental health using population-based datasets
Authors:   Organised by: Royal College of Surgeons in Ireland,   Chair persons: Mary Cannon (Ireland), David Cotter (Ireland)
Published: October 2023

Mental health problems are increasing among young people both in Ireland and worldwide and the causes of this increase are not known. This workshop will focus on large population based datasets which provide recent and comprehensive information on the mental health of young people, including the Growing Up in Ireland study, the Planet Youth study and the ALSPAC cohort. We will present recent data on prevalence of mental health disorders among adolescents and we will present data on possible risk factors and protective factors for mental health problems in youth. We will focus on the possible role played by the COVID pandemic in this observed increase. We will also present data relating to substance use including cannabis use and diet . We will explore trajectories of psychopathology between childhood and adolescence and incidence and persistence of psychotic experiences in youth. This workshop will be a chance to bring together researchers and clinicians working in this important area to discuss the issue of youth mental health which will have importance not just for Ireland but for other countries worldwide.

Key messages

• An increase in mental health problems among young people has been observed over recent years but the causes for this increase are not known.

• There is an urgent need to identify risk and protective factors for mental health problems among youth and how these are changing over time.
The concept of personal responsibility in Bulgarian health and social legislation
Authors: Yankulovska S
Published: October 2023

Background

In the context of scarce health care resources, national policies and legislation increasingly advocate patients’ personal responsibility for their ill health. This report aims at studying the concept of personal responsibility as a basis for resources prioritisation in Bulgarian health and social legislation.

Methods

Official normative documents were subjected to content and comparative analysis.

Results

Indirect personal responsibility can be found in the Bulgarian Health Act, Art.94 stating the duty of the patient to take care of his own health. Further, in the liver transplant algorithm of the Recipient Selection Ordinance, it is possible to distinguish a hidden criterion of patient's responsibility. One possible interpretation of Article 12 of the Code of Professional Ethics of Physicians in Bulgaria is the right of a physician to refuse medical care on the grounds of lack of trust due to patient's non-compliance with prescriptions. The latter correlates with the idea of prospective responsibility. Direct personal retrospective responsibility is imputed in the Health Insurance Act, Art. 111, where persons who themselves have damaged their health or in a state of alcoholic intoxication or drug abuse have damaged the health of others, must reimburse the costs of the NHIF. We also find clearly defined personal responsibility in the Social Security Code, Art. 46, according to which monetary compensation for temporary incapacity is not paid to insured persons who intentionally damage their health. There is no official data on the applicability of these legal norms.

Conclusions

Although in a less categorical form and not in relation to access to specific planned treatments, the idea of the personal responsibility is embodied in the Bulgarian legislation. It is necessary to accumulate further data on the applicability of these norms, as well as to study the views of patients, users of social services, professionals and general public.

Key messages

• Personal responsibility is gradually entering Bulgarian legislation as an official criterion for the allocation of social and health resources.

• It is necessary to accumulate further data on the applicability of the prescribed legal norms, as well as to study the views of patients, users of social services, professionals and general public.
Why is care use declining? Changes in residential long-term care between 1999 and 2018 in Finland
Authors: Korhonen K , Moustgaard H , Murphy M , Martikainen P
Published: October 2023

Background

Residential long-term care (LTC) coverage has declined in many countries over the past decade. However, it is unclear to what extent the decline is attributable to a smaller proportion of older people entering or shorter time spent in LTC, and if the change has been similar across sociodemographic groups. This study analysed changes in life expectancy in LTC at age 65, the proportion ever entering, and years spent in LTC among those who entered, and quantified the contributions of changing rates of admission, mortality and exit to the change in life expectancy in LTC.

Methods

We analysed linked population register data that covered all Finnish residents aged 65+ between 1999 and 2018 (n = 2,016,987) on dates of entries to and exits from LTC, dates of death, and sociodemographic characteristics. We estimated transition rates between home, LTC and death, and calculated multistate life tables by sex, marital status and education across four periods 1999-2003, 2004-2008, 2009-2013 and 2014-2018.

Results

Life expectancy in LTC increased from 0.75 to 0.89 years among men and from 1.61 to 1.83 years among women between 1999-2003 and 2003-2008. The increase was mainly attributable to declining rates of exit from LTC, and thereby longer time spent in LTC for those who entered. Life expectancy in LTC started declining in 2009-2013 and reached 0.80 years among men and 1.51 years among women in 2014-2018. The decline mainly related to an increasing death rate in LTC. In all periods, declining mortality in the community contributed to an increase in life expectancy in LTC, but this was offset by steady declines in admission rates. Life expectancy in LTC changed similarly across marital status and education groups.

Conclusions

Recent declines in LTC use - driven by lower rates of entry and higher mortality in LTC when entered - imply that across sociodemographic strata it is has become more difficult to find LTC placement and older people enter LTC in ever worse health.

Key messages

• Overall LTC use increased in early 2000s despite declining admission rates. The increase was mainly due to declining exit rate from LTC indicating longer time spent in LTC for those who entered.

• The recent shortening of life expectancy in LTC derives from entering LTC at a later stage and closer to death, indicating greater level of disability and worse health at the time of entry.