bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal health in conflict-affected settings: a case study from a frozen conflict zone
Authors: Agopian A , Musheghyan L , Sargsyan Z , Abrahamian D , Dorian A
Published: October 2024

Background

Reproductive, maternal, newborn and child health are negatively impacted in conflict-affected settings, and may be acutely affected in frozen conflicts due to fragile health systems and uncertain geopolitical contexts. To better understand maternal health in a frozen conflict zone, we examined maternal health outcomes in Nagorno-Karabakh during a ceasefire period prior to the forced displacement of the entire population.

Methods

Multistage cluster sampling was used to sample 1023 households in Nagorno-Karabakh during the summer of 2022. From each household, one woman, age 18 to 49, participated in an interviewer-administered survey. Maternal health outcomes were assessed among all married women who had ever given birth. Women with at least one child under 5 years were also asked about their most recent pregnancy.

Results

Among all married women, 85.5% had ever given birth, 19.0% ever had a miscarriage, and 2.8% ever had a stillbirth. Of the 299 women with at least one child under 5, 97.7% received antenatal care, of which 90.4% had at least 4 visits. Over half experienced toxicosis (51.8%), 16.4% high blood pressure, 13.0% anemia, and 6.4% hemorrhage during their most recent pregnancy. The most common delivery complications were uterine scarring (19.7%), breached birth (7.0%), prolonged labor (6.4%) and hemorrhage (5.7%). Age was found to be a significant factor, with the odds of toxicosis (p = 0.039) and breached birth (p = 0.009) decreasing, yet the odds of miscarriage (p = 0.001) and hypertension (p = 0.007) increasing with age.

Conclusions

Almost all women reported adequate antenatal care with birth outcomes comparable to global statistics, demonstrating the ability of Nagorno-Karabakh to provide sufficient maternal healthcare while in a frozen conflict. Fortifying and ensuring access to maternal and reproductive healthcare, particularly antenatal care, is vital for ensuring the health and wellbeing of women and children in conflict-affected settings.

Key messages

• Women in Nagorno-Karabakh received antenatal care and experienced birth outcomes similar to global rates, demonstrating the value of access to reproductive healthcare in conflict-affected settings.

• Future studies should examine the impact of forced displacement on the women of Nagorno-Karabakh to better understand the effect of conflict on reproductive and maternal health.
Generalised and visceral obesity metrics and ankle-brachial systolic blood pressures during pregnancy
Authors: Giannakou K , Fakonti G , Kyprianidou M , Viswambharan H , Kain K
Published: October 2024

Background

Increased body mass index (BMI) (generalised obesity) and waist-to-height ratio (WHtR) (visceral obesity) are associated differently with brachial and ankle blood pressures in the general population. Ankle blood pressures are associated with blood glucose in pregnancy. This study investigates the relationship between BMI and WHtR with the brachial and ankle blood pressures separately during pregnancy.

Methods

Pregnant women were recruited during antenatal visits at an antenatal clinic in Bradford Royal Infirmary, UK, and their BMI, waist circumference, systolic, and diastolic blood pressure were clinically measured by staff in the second trimester. Additionally, blood pressure readings from both arms (left and right brachial arteries) and ankles [dorsalis pedis artery (DP) and posterior tibial artery (PT) on both sides] were obtained using Doppler by research staff.

Results

A total of 179 women participated, with an average BMI of 28.5 Kg/m2 (SD = 4.97) and average WHtR of 0.61 (SD = 0.08). BMI exhibited a positive correlation with all blood pressure measurements (r = 0.165 to 0.419, p < 0.05), while WHtR demonstrated significant correlations only with the right brachial, left PT, systolic and diastolic blood pressures (r: 0.170 to 0.271, p < 0.05). Moreover, BMI significantly associated with all blood pressure measurements in linear regression models, after adjusting for various sociodemographic and other factors, whereas WHtR significantly predicted only right brachial and left PT and some of the other blood pressure measurements.

Conclusions

BMI, and to a lesser extent WHtR, are associated with both brachial and ankle blood pressure measurements during pregnancy. These findings underscore the importance of recognizing the varying impacts of cardiometabolic risk factors for early detection and management of potential complications in pregnancy and the postpartum period.

Key messages

• BMI & WHtR are associated differently with brachial and ankle blood pressures in pregnancy.

• Further exploration of combined non-invasive measurements like BMI, WHtR, brachial, and ankle blood pressures in early pregnancy for gestational diabetes mellitus and other co-morbidities is needed.
Use of specialist health care among Norwegian-born children with one immigrant parent
Authors: Kjøllesdal M , Helland Y , Sheikh N , Indseth T
Published: October 2024

Background

An increasing number of children grow up with one immigrant and one native born parent. We know little about health in this group. Our aim was to compare the risk of receiving diagnoses of physical health conditions in specialist health care among Norwegian-born children with one immigrant parent compared to Norwegian background children.

Methods

Data from Medical Birth Registry of Norway were linked to data from the Norwegian Patient Registry (diagnoses in specialist health care), and Statistics Norway (parental country of origin, education, and household income). We estimated hazard ratios (HR) with Cox proportional hazard regressions, with Norwegian background children as reference category, adjusted for sex, birth year, parental education, and household income.

Results

Children with an immigrant parent had lower hazards than Norwegian background children of diagnoses of most types of infections, but higher hazards of some, including tuberculosis, and skin infections. They also had higher hazards than Norwegian background children of receiving diagnoses of obesity and other nutritional deficiencies, and skin diseases, but lower hazards for other conditions, including chronic lower respiratory disease, disease of the digestive system, and visual or hearing impairment. The hazards of diagnoses of any neurological condition, sleeping disorders and epilepsy were lower among children with an immigrant mother, but higher among those with an immigrant father. Differences between children with one immigrant parent and Norwegian background could not be explained by differences in parental education or household income.

Conclusions

Children of one immigrant parent do not overall use specialist health care for physical health issues more than other children.

Key messages

• Awareness of diagnoses given most frequently to children of one immigrant parent can help promote timely diagnoses and adequate use of services, which is important for prevention of later illness.

• Barriers to health care use among children of immigrants should be further researched.
Neighborhood environment and falls: a longitudinal Japan gerontological evaluation study
Authors: Matsumoto Y , Hanazato M , Matsuoka Y , Chen Y R , Yoshida H , Matsumoto K , Kondo K
Published: October 2024

Background

Older adults who experience falls are at a high risk of injury and death and require long-term care. Notably, the risk of falls varies among different neighborhood environments. No prior longitudinal studies have examined the association between falls and neighborhood environment at the community level. Identifying such associations will help prevent people falling by improving their neighborhood environment. Herein, we aimed to identify neighborhood environmental factors associated with falls among older adults in Japan.

Methods

We analyzed the data of 27,346 older adults living in 416 communities who participated in the 2010, 2013, and 2016 Japan Gerontological Evaluation Study surveys. The dependent variable was the occurrence of falls in 2016, and the explanatory variables were the mean scores of each of eight community-level neighborhood environment variables, categorized into tertiles (high, middle, and low groups) in 2013. Our model was adjusted for covariates (e.g., sex, age, and socioeconomic status) using the variables from 2010. A multilevel Poisson regression analysis was performed to obtain the relative risk (RR) and 95% confidence interval (CI) between the neighborhood environment and falls. Missing variable values were supplemented by multiple imputations.

Results

Older adults living in neighborhood environments with more parks or foot paths suitable for exercise or walking had a lower risk of falling after 3 years compared to those living in neighborhood environments with fewer parks or foot paths (RR: 0.89; CI: 0.80-0.99). For the variable ‘locations difficult for walking, such as hills or steps’, older adults in the middle group had a lower risk of falling than those in the low group (RR: 0.94; CI: 0.88-0.99).

Conclusions

Parks or foot paths are important environmental improvements that may prevent falls. Having hills or steps in the neighborhood could be beneficial when properly integrated into the environment.

Key messages

• Older adults with access to parks, footpaths, and challenging terrains suitable for exercise and walking, had a lower risk of falling.

• These findings could be applied in urban designs to prevent falls among older adults.
Gastrointestinal infections and ethnicity in the UK: a systematic review and narrative synthesis
Authors: Zahair I , Rose T , Clayton S , Oyebode O , Maden M , Ghosh I , Barr B
Published: October 2024

Background

Gastrointestinal (GI) infections exert a significant public health burden on healthcare services in the United Kingdom (UK). The literature suggests an association between ethnicity and health; however, we do not know the extent of inequalities in GI infection/disease in the UK. This systematic review aimed to identify studies that ascertain differences in the incidence or prevalence of GI infections between UK ethnic groups and explore possible explanations for heterogeneity observed within the literature.

Methods

MEDLINE, CINAHL Plus, Web of Science (Science Social Science Citation Index), and grey literature were searched from 1980 to 21st June 2023 for studies reporting an association between ethnicity and GI infections in UK population samples. Two reviewers independently screened the studies and conducted quality appraisals; data extraction was undertaken by one reviewer and verified by another reviewer. A narrative synthesis was undertaken and a harvest plot supported the textual synthesis to investigate potential sources of heterogeneity in effect estimates by GI pathogen and ethnic group.

Results

The searches identified 10028 studies, of which 16 met the inclusion criteria. 15 out of 47 effect estimates from a total of 16 studies found that GI infection risk was greater in Black and Ethnic Minority Groups, mainly of Asian ethnicity, compared to the majority White population. 13 studies reported a higher risk in ethnic minorities of Asian ethnicity, while one study described a higher risk in the Non-White ethnic group. One single study on STEC reported a higher risk of GI infection in the White population compared to the Non-White population, while another single study on norovirus found no significant difference by ethnic group.

Conclusions

This systematic review demonstrates that ethnic minority groups in the UK have a higher risk of GI infections than the general or White population.

Key messages

• There is a clear need to elucidate further the high incidence of GI infections in UK Indian, Pakistani, and Bangladeshi communities.

• Tackling ethnic inequalities requires a concerted approach and translating evidence into policy.
The shift from inpatient to outpatient settings of a surgical DRG for pediatric patients in Portugal
Authors: Grad D A , Souza J , Lopes F , Pinheiro V , Freitas A , Santos J V
Published: October 2024

Background

The shift of selected surgical procedures from inpatient to outpatient settings has been seen as a solution to improve health care provision. These shifts often occur under pay-for-performance schemes, pay-for-efficiency schemes, or other forms of financial incentives. For this study, we aimed to assess the effect of Decree 132/2009, implemented on February 1, 2009, which increased the relative weights of DRG 60 (“tonsillectomy and/or adenoidectomy, age <18”) performed in outpatient settings, thus acting as a financial incentive.

Methods

We performed a quasi-experimental study and employed interrupted time series (ITS) and controlled interrupted time series (CITS) designs, using monthly pediatric data provided by The Central Administration of the Health System (ACSS), with discharges between January 2006 and February 2012 (having 37 months pre- and post-decree implementation) of inpatient and outpatient episodes for DRG 60 (affected group) and DRG 163 (“hernia procedures age <18”, the selected control group). We used as study outcomes proportions (number of outpatient episodes divided by the sum of outpatient and inpatient episodes) to quantify increases in outpatient episodes and ratios (number of outpatient episodes divided by the number of inpatient episodes) to quantify decreases in inpatient episodes. Fourier terms were included to adjust for seasonality.

Results

We obtained statistically significant results only at the trend level for ratios when using the ITS model (0.01574) and for proportions only when using the CITS model (0.00310), although small non-statistically significant increases were obtained for the employed ITS as well as for the CITS design.

Conclusions

Decree 132/2009, which created financial incentives for the shift from inpatient to outpatient for DRG 60, showed low and non-statistically significant increases using both ITS and CITS models.

Key messages

• We analyzed the impact of Decree 132/2009 on the pediatric surgeries under DRG 60 performed in outpatient settings in Portugal using interrupted time series and control interrupted time series.

• The decree had a small effect at the national level for DRG 60.
Gendered trends in unpaid labour by educational level in Sweden 2004-2022
Authors: Molarius A , Granström F , Ervin J
Published: October 2024

Background

Unpaid labour has recently been recognised as an important yet neglected social determinant of health. Our aim was to investigate the gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30-49 years) from 2004-2022.

Methods

The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30-49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals.

Results

Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. For example, in 2022, 31% of women spent more than 20 hours per week in domestic work compared to 20% of men. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did.

Conclusions

As gender differences in unpaid labour/domestic work persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities.

Key messages

• Amongst Swedish adults aged 30-49 years, the gender gap in unpaid labour has declined during the last two decades, but this is only due to women reducing their domestic work time.

• For men, prevalence of high domestic work time was consistently greater among those with higher educational levels, whereas no difference was observed among women.
The impact of garbage codes on the quality of death coding in Belgrade in 2010, 2015, and 2020
Authors: Šantrić Milićević M , Rosić N , Stamenković Ž , Todorović J , Branković B , Stevanović A , Tamburkovski G , Miltenović S , Janković-Mladenović S , Wengler A
Published: October 2024

Background

Accurate data on the causes of death (CoDs) is the foundation for analyzing the health situation and developing health policy in various countries. The percentage of garbage codes (GCs) indicates the quality of the CoDs data. Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Improved Surveillance), we evaluated the impact of the four levels of GCs on the quality of mortality data of Belgrade.

Methods

In a retrospective study, we examined the underlying CoDs of Belgrade residents by age and sex and the change in GCs’ share in the CoDs in 2010, 2015, and 2020. We used anonymous individual mortality data and population age and sex annual data from the electronic databases of the City Institute of Public Health of Belgrade, as well as the list of GS levels 1-4 from the 2019 Global Burden of Disease Study.

Results

Over the observed years, the percentage of all GCs in underlying CoDs was approximately 20%. The GCs with profound policy implications level 1 accounted for 52% of all GCs in 2020, higher than those recorded in previous years - 46.3% in 2010 and 45.1% in 2015. The total number of GCs per 100,000 inhabitants in Belgrade was the highest in 2020, with a rate of 325.2/100,000 (males: 374.4, females: 301.3). This rate has increased by about one-third since 2010 (both sexes: 245.4, males: 269.2, females: 221.1) and by about two-fifths since 2015 (both sexes: 235.8, males: 262.7, females: 211.8).

Conclusions

This research has revealed a significant decline in the quality of data related to the causes of death in Belgrade. One-fifth of the recorded causes of death are inaccurate or unreliable. The study highlights the importance of maintaining strict protocols for data collection, analysis, and management to ensure the accuracy and reliability of CoDs data in developing effective public health policies.

Key messages

• The rate of total garbage codes per 100,000 inhabitants of Belgrade has increased by about two-fifths since 2015.

• Failure in quality, accuracy, and reliability of causes of death can lead to suboptimal health policymaking.
The burden of sepsis in Italy: an analysis of treatable mortality trends
Authors: Guarducci G , Golinelli D , Sanna A , Fabbri G , Nante N
Published: October 2024

Background

The burden of sepsis, a life-threatening condition triggered by the body’s extreme response to infection, remains a critical global healthcare concern. Sepsis-related deaths often result from delayed recognition, insufficient treatment, or gaps in healthcare delivery. The study aims to analyze treatable mortality for sepsis in Italy and its regions.

Methods

A retrospective study was conducted on data of treatable mortality for sepsis in Italy and its regions. According to joint OECD/Eurostat list, we included sepsis deaths with the ICD-10 codes A40 (excl. A40.3 [sepsis due to Streptococcus pneumoniae]) and A41 (excl. A41.3 [sepsis due to Hemophilus influenzae]) from 2006 to 2019. Through data on the resident population two-year age-standardized rates by region were calculated.

Results

From 2006/7 to 2018/9 an overall increase was observed in Italy, from 1.6 to 2.2 age-standardized mortality rates with a maximum peak in 2014/5 (+46.7%). This trend was confirmed for Lombardy (+47.8%), Veneto (+48.8%), Emilia-Romagna (+49.3%), Tuscany (52.0%), Marche (+58.4%%), Abruzzo (39.4%), Molise (26.7%), Apulia (+57.0%), Sicily (+57.2%), and Sardinia (+46.8%). Aosta Valley (+72,5%) had a maximum peak in 2010/1, while Piedmont (+42.5%), Autonomous Province (A.P.) of Bolzano (+27.8%), A.P. of Trento (+45.0%), Friuli-Venezia Giulia (+23.3%) in 2012/3, Calabria (+46.4%) in 2016/7 and lastly Campania (+52.9%) and Basilicata (+73.0%) in 2018/9. Liguria (+49.8%), Latium (47.2%) and Umbria (49.3%) showed two maximum values, one in the 2012/3 and the other in the 2014/5.

Conclusions

We observed an overall increase in age-standardized mortality rates throughout Italy, with a peak in 2014/5. This trend was resumed in ten regions, while three regions showed multiple peaks, indicating fluctuations in mortality rates. These findings underline the importance of targeted health interventions and policy initiatives to address region-specific health challenges.

Key messages

• Regional disparities in mortality rates highlight the necessity for customized health interventions and policy measures between Italian regions.

• Recognizing fluctuating mortality trends in specific regions is crucial to effectively address various health challenges.
Fast lane for decision making: The PHIRI Rapid Exchange Forum
Authors: Habl C , Weiss J
Published: October 2024

Issue & Problem

The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice.

Lessons

Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute GÖG had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum).

Key messages

• The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges.

• Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.
Development of health care expenditures in Finland up to 2040
Authors: Reinikainen J , Pihlava M , Härkänen T , Honkatukia J
Published: October 2024

Background

Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments.

Methods

We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures.

Results

The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively.

Conclusions

Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system.

Key messages

• Notable increases are expected in health care expenditures up to 2040.

• Impacts of demographic changes varies markedly between health care sectors.
Viral pathogen surveillance in wastewater using metagenomic approaches: obstacles and prospects
Authors: Seabra S G , Santos A F , Nunes M , Manjate F , Silva A , Crespo T , Pimentel V , Libin P , Abecasis A B , Parreira R
Published: October 2024

Background

Wastewater monitoring offers an important tool for pathogen detection and tracking within large populations at a minimized cost and labor. Untargeted metagenomic approaches for the detection and sequencing of viruses still face limitations. In this study we tested the application of the sequence-independent single-primer amplification (SISPA) protocol in conjunction with nanopore sequencing to the study of viromes in wastewater samples.

Methods

Influent wastewater was collected from four Wastewater Treatment Plants located in the Lisbon region and Alentejo, Portugal in 2019 and 2023. Samples were processed with different methods including filtration, flocculation, Nanotraps or absorvent tampons. We applied the SISPA protocol, that includes a random amplification step, followed by nanopore sequencing on flow cells R9.4.1. We used the CZ ID (https://czid.org) pipeline for metagenomic analysis and taxonomic reporting.

Results

A large heterogeneity was found between samples in sequencing output (ranging from 17 thousand to 12 million reads) and the proportion of sequence reads classified as viral (ranging from 0.06% to 4% per sample). Viral taxa with higher number of reads were Picornavirales, dsDNA and ssDNA phages, Mimiviridae and Circoviridae. Known viral pathogens included Rotavirus A, Orthopoxvirus, Human betaherpesvirus and Avian orthoavulavirus.

Conclusions

Metagenomic studies of environmental samples generally exhibit a low proportion of viral reads, even after viral enrichment. A substantial sequencing effort is thus required to achieve a comprehensive virome characterization. As alternative, a more targeted approach, e.g. to target families of viruses of interest, may be considered. Funding: Fundação para a Ciência e Tecnologia (FCT): GHTM - UID/04413/2020; LA-REAL - LA/P/0117/2020; https://doi.org/10.54499/CEECINST/00102/2018/CP1567/CT0040 to SGS. Research council of the Vrije Universiteit Brussel (OZR-VUB): OZR3863BOF to PL.

Key messages

• Enrichment for viruses in metagenomic approaches remain challenging in very complex samples as are influent wastewaters.

• Virome characterization still necessitates high sequencing efforts but may be used as a complementary environmental survey tool integrated with more targeted approaches.
Emergency department frequent users in the paediatric population: a retrospective analysis in Rome
Authors: Vinci A , Barbara A , Chierchini P , Maurici M , Damiani G , De Vito C
Published: October 2024

Background

Recent studies have reported the increasing utilisation of the Emergency Departments (EDs) for non-urgent attendances by people aged <18 years. The aim of this study is to describe the characteristic of the paediatric frequent user (FU) population, highlighting the differences between FUs and non-FUs, and to identify factors linked to appropriate ED attendance, comparing the level of variability attributed to the geographical and family physician components.

Methods

A retrospective cohort study was carried out of the ED attendances in 2022 in the 8 EDs of the Local Health Authority Roma 1 geographical area, in Rome. The cohort was enrolled from the regional Healthcare Emergency Information System. Records included information on number of attendance, age and gender, usage of emergency medical service (EMS), triage code, appropriateness of attendance. Multivariable nested logistic regression was performed to identify the characteristics of FU and non-FU attendances and the predictors for appropriateness of attendances.

Results

In 2022, the total number of children with at least 1 ED attendance is 24.824 and a total of 35.691 attendances were recorded. The regression analysis highlights that the appropriateness of attendances is associated to the female gender (OR male: 0.84), age <1 year (OR: 2.06), the usage of EMS (OR: 2.00), high triage code and being a FU (OR FU: 1.53). The family physician group have a greater influence of District group but lower influence of single patient characteristics group to determine the appropriateness of paediatric ED attendances (MOR District: 1.73; MOR PCP: 1.84; MOR single patient characteristics: 2.75).

Conclusions

Frequent use of the ED is partially associated with an inappropriate use of EDs, mostly due to the specific patients’ characteristics. It is therefore necessary to adopt strategies to improve the appropriate use of health service resources in order to provide quality health solutions to real health needs.

Key messages

• This is the first study that defines an ED paediatric FU profile in Italy.

• It compares the level of variability attributed to the geographical component and family physician components.
Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy
Authors: Van Der Zanden B , Nemer L
Published: October 2024

Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity.

Key messages

• The EPHF framework as an innovative tool to strengthen public health in border regions.

• Take the geographical living space of citizens in a border region into account to achieve health equity.
Past trends and future projections of psychological distress among general population in Finland
Authors: Parikka S , Holm M , Suvisaari J , Lahti J , Reinikainen J , Tolonen H , Lundqvist A
Published: October 2024

Introduction

The aim was to examine past and future trends of psychological distress in Finland from 2013 to 2040.

Methods

Six representative cross-sectional surveys from the years 2013, 2014, 2015, 2018, 2020, and 2022 (N = 172,547, aged 20+ y) were used. Multiple imputation was used in projecting psychological distress (MHI-5, with cut-off value ≤60). As the COVID-19 pandemic had a strong effect on psychological distress which persisted after the pandemic, projections were made with and without data from the years 2020 and 2022.

Results

The prevalence of psychological distress was slightly declining during the period 2013-2018 for both men and women, ending up around 18% for men and 19% for women. When including the years 2020 and 2022, however, trends showed a steep increase in the prevalence of psychological distress during 2018-2022. Among 20-39-year-olds, the prevalence of psychological distress increased 9.8%-points over the four-year period. Similarly, among 40-54-year-olds, an 8.2%-points increase was observed. In older age groups (55-64, 65-74 and 75 years and older) psychological distress first increased from 2018 to 2020 but then plateaued especially among the oldest. Projections based on the observed past trends during the period 2013-2018 showed a steady decline in psychological distress, the prevalence of psychological distress ending up around 11% for men and around 15% for women in 2040. When including the years 2020 and 2022, however, the projections suggested an increase in psychological distress in the general population and the prevalence of psychological distress is projected to end up around 37 % for both men and women in 2030.

Conclusions

The prevalence of psychological distress has increased substantially in the 2020s particularly in young adults. Mental health needs to be given a priority in all policies in order to change the future projections.

Key messages

• The upward trend of psychological distress did not reverse or plateau after COVID-19 pandemic in Finland.

• Increased efforts to protect and promote mental health in all policies seem indicated especially among young adults.
Systematic review of burden&quality of life in caregivers of children with schizophrenia (SyREN)
Authors: Caminiti M , Giesen C , Grieco V , Failla G , Traglia F , Zannoner A , Silva Pires P , Gallinoro V , Mosconi C , de la Torre-Perez L
Published: October 2024

Background

Schizophrenia is a chronic, disabling disorder that affects 23.6 million people worldwide, with patients often needing extensive assistance and care. Main caregivers are frequently family members who may present a reduced quality of life (QoL) due to the high-level burden of care. Literature mostly focuses on the burden caused by other mental disorders or by schizophrenia in both the adult and child population. We aim to assess the burden and QoL in caregivers of children and adolescents with schizophrenia.

Methods

We conducted a Systematic Review of articles published between 2013 and 2023 on MEDLINE, Scopus, Web of Science, APA PsycARTICLES, CINAHL. We included studies in which a validated instrument was used to measure the burden of caregiving and QoL for adult caregivers of children and adolescent schizophrenic patients. The results were reported following the PRISMA guidelines.

Results

We identified 1388 studies. We removed 610 duplicates. After screening 788 studies on title and abstract and 52 for full-text, we included one cross-sectional study in China based on the STROBE Checklist. Significant correlations between burden of care and schizophrenia severity, children’s age, period of care, education, sex, residence, and income were reported. Additionally, we screened 7 qualitative studies. Social stigma and struggle were the most frequently reported feelings, and financial burden was the most common external factor associated with a worse quality of life.

Conclusions

This review revealed a significant research gap in this field. This lack of focused research underscores the urgent need for targeted investigations into the experiences of caregivers of children and adolescents with schizophrenia. Addressing these knowledge gaps will improve support systems and interventions tailored to the unique needs of this population, such as disease-specific advisory, mental health services, social and financial support, and self-help groups.

Key messages

• We identified a research gap for burden and quality of life in informal caregivers of children with schizophrenia. Education, sex and income of caregivers relate to the burden of care.

• Further research is needed to develop strategies to improve support systems and interventions tailored to the unique needs of this population.
Physical activity and sedentarism among non-binary gender identified university students
Authors: García-Lorenzo E , Visos-Varela I , Pintos-Rodríguez S , Salgado-Barreira A , Corral-Varela M , Figueiras-Guzmán A , Caamaño-Isorna F , Rico-Díaz J
Published: October 2024

Background

Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential.

Methods

Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS).

Results

Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend >6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%).

Conclusions

In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus.

Key messages

• Non-binary gender identified students are less physically active and more sedentary than their peers.

• Once they commit to physical activity recommendations, there are no differences among their performance.
Organizational well-being in a healthcare facility in Tuscany
Authors: Viti F , Rencinai A , Lazzeri G , Nante N
Published: October 2024

Introduction

Organizational climate assessment provides crucial insights into work life across sectors. While corporate culture evolves gradually, the organizational climate promptly reflects employees’ mood, motivation, enthusiasm, and perception of the work environment. This study aims to analyze the organizational well-being in a healthcare facility in southeast Tuscany to reveal both successful areas and critical issues within the organization.

Methods

Data on gender, age, tenure, qualification, and contract type were collected anonymously. Organizational climate was assessed using a Likert scale (1-10), covering workplace safety, stress, fairness, discrimination, career development, relationships, belonging, and other perceptions. STATA was used to conduct this analysis.

Results

Twenty-nine participants included 55.3% male, averaging 45.3 years. Thirty-one percent had less than 5 years of tenure, with only 14% in managerial roles. Workplace safety perception varied: 58% moderately safe, 20% unsafe, and 20% highly insecure. Bullying was reported by 14.3%, while 17.6% found compensation fully appropriate. Merit and career opportunities were unrelated for 65.5%, and 48.2% found their role aligned with their profile. Fifty-five percent felt part of a team, and 27.5% perceived good integration. Company rules were clear for 93%, but 34.5% considered changing companies, while 55.1% were satisfied. External user perception was positive at 58.5%.

Conclusions

The analysis identified positive aspects and areas for improvement in workplace well-being. Safety and fairness in job allocation were well-received, with room for improvement, mostly in promotion transparency. Colleague relationships were positive, emphasizing the importance of transparent communication and employee engagement in building trust and participation. These findings can guide the development of targeted interventions to enhance organizational well-being, fostering employee satisfaction and efficiency.

Key messages

• The evaluation of organizational climate in this healthcare facility revealed a variety of employee perceptions, highlighting strengths and areas for improvement in workplace well-being.

• Enhancing transparency and communication regarding merit-based promotions within the organization is necessary to foster employee trust and engagement.
30-month work participation trajectories of employees returning to work with common mental disorders
Authors: Sikora A , Almansa Ortiz J , Arends I , Wegewitz U , Bültmann U
Published: October 2024

Background

Promoting a sustainable return to work (RTW) and work participation (WP) for employees with common mental disorders (CMDs) is a crucial challenge for mental healthcare, organisations, and society at large. To date, work-related factors have only very rarely been examined within RTW trajectory studies. The present study aims to examine 30-month WP trajectories and associated individual, health- and work-related factors of employees on sickness absence due to CMDs in Germany.

Methods

In a prospective cohort study with N = 259 participants, five measurements were conducted at baseline (during the last week of inpatient treatment), and 6, 12, 18 and 30 months later. WP was defined as the proportion of weeks being present at work between two measurement points (self-reported). WP trajectories over 30 months were estimated with Latent Class Growth Analysis (LCGA), and were described according to associated individual, health- and work-related factors.

Results

We extracted four trajectory classes: Class 1 ‘slowly increasing WP’ (19.6%) with a slow but constantly increasing WP over time, and finally reaching nearly 60% of WP; Class 2 ‘high maintaining WP’ (30.3%) with a maintaining high WP of over 80% after RTW until 30 months; Class 3 ‘highest maintaining WP’ (34.7%) with the highest maintaining WP throughout follow-up and reaching nearly 100% WP after RTW; and Class 4 ‘decreasing WP’ (15.4%) with a positive development of WP until 12 months, reaching of about 90% WP, but then decreasing below 60% WP until 30 months. Participants with persistent high WP (Classes 2 and 3, 65.0%) reported better individual-, health- and work-related characteristics at baseline, and more realized work accommodations during RTW.

Conclusions

For the majority of the employees, returning to work resulted in sustainable WP during the 30 months study period. However, about one third of the employees should be given more attention in their complete RTW process from treatment to workplace support.

Key messages

• Sustainable work participation after returning to work with common mental disorders is a long and complex journey.

• Employees with a better individual, health- and work-related situation at baseline seem to be more likely to achieve a sustainable work participation.
Are migrant workers at greater risk of workplace deaths? A systematic review and meta-analysis
Authors: Lau K , Aldridge R , Norredam M , Mkoma G F , Kugan M , Lin RCY , Kiss L , Zimmerman C , Hargreaves S
Published: October 2024

Background

Globally, 170 million individuals migrate for work. Yet, evidence on their mortality risk remains unclear. Our aim was to synthesize global evidence on migrant worker mortality risk compared to local workers and to identify the multiple intersecting social determinants of mortality.

Methods

We conducted a systematic review of peer-reviewed literature which reported on mortality outcome of migrant workers. Studies published between 1 Jan 2000 to 17 Jan 2023 in English were searched in MEDLINE, Embase, PsycINFO, and Ovid Global Health. Meta-analysis using random effects model was used to calculate pooled estimates and narrative synthesis was used to develop a data-driven framework on intersectional social determinants.

Results

Out of 11,495 identified records, 44 were included, of which 11 were pooled in meta-analyses. The combined migrant worker death count was 44,338, with data from 16 countries, including migrants from agriculture, construction, and service industries. Compared to local workers, migrant workers had a higher risk of fatal occupational injury (pooled RR = 1.71, 95%CI: 1.22-2.38, I² = 99.4%), and a lower risk of all-cause mortality (pooled RR = 0.94, 95%CI: 0.88-0.99, I² = 90.7%). Key social determinants associated with increased mortality risk were either migration-related (e.g. lower language proficiency, undocumented status) or labour-related (e.g. precarious employment, labour migration policies) interacting over migrant workers’ life course.

Conclusions

As the largest evidence synthesis to date, these findings indicate that migrant workers have higher fatal occupational injury rates than local workers, indicating the need for tailored protections for migrant workers. These data confirm that the all-cause mortality advantage observed in migrant populations applies to the working population. Future interventions should be designed to address both migration- and labour-related determinants of migrant worker health.

Key messages

• Migrant workers have a higher risk of workplace fatality despite being generally healthier than local workers, explained by structural determinants such as precarious employment.

• Future interventions must address migration- and labour-related social determinants of health at structural levels, such as extending labour protection laws to migrant workers.