bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of smoke-free policies in hospitality venues and the home environment on smoking behaviour and exposure to second-hand smoke: results of two systematic reviews
Authors: da Costa Senior YY , Rozema AD , Kunst AE , Kuipers MAG
Published: October 2022

Background

Smoke-free policies (SFPs) have proven to be effective in protecting people from exposure to second-hand smoke (SHS) and lowering smoking rates. Our aims were to assess the impact of SFPs in hospitality venues (e.g. bars) on smoking behaviour of young people and to assess the impact of SFPs in the home environment on smoking behaviour and exposure to SHS.

Methods

Two reviews were conducted. The first was conducted in June 2020. We searched PubMed, Embase, and Scopus for studies that assessed the association between any form of SFPs in hospitality venues and a measure of smoking behaviour among young people (aged 10-24 years). The second review will be conducted in June 2022. Searches will be conducted in PubMed, Embase, Web of Science, PsycINFO and CENTRAL. We will search for studies that assess the association between any form of SFPs in the home environment (e.g. multi-unit housing) and a measure of smoking behaviour (e.g. initiation) or SHS exposure.

Results

Nine studies (publication years 2005-2016) were included in the first review, of which the majority used a quasi-experimental design. Four studies evaluated SFPs in hospitality venues specifically. Two studies reported that strict, but not weaker, SFPs decrease progression to established smoking. Two other studies provided mixed results. Five studies also included other workplaces, of which three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity. The results of the second review will be presented in detail during the workshop, however an exploration suggests that SFPs in the home environment may prevent smoking and SHS exposure.

Conclusions

Most studies of the first review found that SFPs in hospitality venues are associated with a decrease in smoking behaviour among young people. Their results indicate the need for strict smoke-free legislation without exemptions. The conclusions of the second review will be presented during the workshop.
Associations of pre-existing comorbidities and COVID-19 in-hospital mortality: an unCoVer analyses
Authors: Mertens E , Ademovic E , Majdan M , Soriano JB , Trofor AC , Peñalvo JL
Published: October 2022

Background

Accumulated evidence on risk factors for adverse COVID-19 outcomes revealed that old age and male sex are main associates, next to pre-existing comorbidities, as analysed from scattered single cohorts of hospitalised COVID-19 patients of accessible electronic medical records. Hence, evidence from federated analyses is called for to provide a more comprehensive and robust analyses of risk factors.

Methods

Using the unCoVer network, i.e., a research platform of 29 partners for the expert use of patient data as routinely gathered in real-world healthcare settings, present analyses restricted to available data of four hospitals from Spain, Slovakia, Romania and Bosnia and Herzegovina covering 8,287 hospitalised COVID-19 patients. In-hospital death after COVID-19 diagnosis was examined in relation to common pre-existing comorbidities using virtual pooling of logistic regression models adjusted for age and sex.

Results

Patients were on average 60.1 (± 20.9) years, 50.7% were male, almost half (43.3%) had at least one pre-existing comorbidity (17.4% having obesity, 21.9% hypertension, 18.0% diabetes and 13.7% cardiovascular diseases (CVD)), and 12.6% died during hospitalisation. Patients with comorbidities had a higher risk of mortality that was increasing with the number of comorbidities: from a virtual pooled odds ratio of 1.16 (95%CI: 0.96, 1.40) for one vs none to 1.30 (1.04, 1.64) and 2.14 (1.64, 2.79) for two and three or more comorbidities, respectively. Of the comorbidities, highest risk was seen for CVD (1.68; 1.40, 2.01), followed by hypertension (1.40; 1.19, 1.64) and diabetes (1.27; 1.07, 1.50), and the lowest for obesity (1.13; 0.94, 1.37).

Conclusions

By federated analyses, this study confirmed that the number of comorbidities was a strong risk factor for in-hospital death after COVID-19, in particular CVD. The unCoVer platform pursues using scattered data sources by innovative computational resources and integrated information for enhanced impact.

Key messages
Absence among National Health Service workers during the COVID-19 pandemic in Portugal
Authors: Alves J , Nunes C
Published: October 2022

Background

By March 2020, the first Covid-19 cases were detected in Portugal. While the National Health Service (NHS) faced an increased demand for health care, anecdotal evidence showed that the NHS absenteeism rose. This might be explained by outbreaks in healthcare units, COVID-19 infection due to close contact with patients, self-isolation and quarantines, and family challenges originated by lockdowns. The present work aimed to quantify the absenteeism among NHS workers during the COVID-19 pandemic in Portugal.

Methods

This study used data for the number of NHS workers and absence days (2015-2021), from the Portuguese NHS Transparency Portal and the Strategy and Planning Office. Absenteeism was compared, before and after the pandemic onset, in absolute terms, and as absence rates (number of absent days as a percentage of potential workforce days). Additionally, we performed an interrupted time series analysis, by fitting a Poisson regression model with level change. We controlled for data seasonality using Fourier terms (pairs of sine and cosine functions).

Results

From 2015 until March 2020, the average monthly absence rate was of 12.2, rising to 14.4 in the remaining period. This represented an increase of 18% in the absence rate. The interrupted time series showed an increase of 10.8% in the NHS absenteeism after the pandemic onset [Relative risk =1.10; 95% confidence interval (CI) 1.10-1.11; p < 0.01]. When accounting for seasonality in the data, the model showed an increase of 11.0% in the NHS absenteeism [Relative risk =1.11; 95% CI 1.01-1.22; p < 0.05].

Conclusions

These results highlight the excess of absence days among the NHS workers during the COVID-19 pandemic. In future healthcare crises, health professionals should be protected, by assuring a safe workplace and making protective equipment available. Only then will be possible to reduce constraints in healthcare assistance, guarantee the adequate response, and contain the absence costs.

Key messages
Using R programming to inform and improve case notification procedures in a local public health unit
Authors: Ruas H Barrilaro , Capucho R , Ferreira V Melo
Published: October 2022

Issue/Problem

COVID-19 was declared a pandemic in March 2020. Information systems, particularly those related to laboratory testing notification, became extremely important as a mechanism of fast identification of cases. In Portugal, any test performed in a professional setting is of mandatory notification.

For a local public health unit in northern Portugal, much like in other regions worldwide, challenges related to lack of human and material resources were felt over the course of the pandemic.

Description of the problem

In 2021, an intensive surveillance strategy was implemented using up to date notification database analysis through R programming, focusing on simplified data availability for contact tracing team members and accuracy of notifications submitted by laboratories, including verification of individual identifying information.

Results

Some laboratories were identified has having lower data completion rate, which had negative effects on contact tracing timeliness, while others failed to notify tests conducted. Public Health workers warned partners of these failures and worked with them to develop solutions. Interventions included facilitation of access to technologies to notify test results, as well as revision of internal processes to ensure correct patient identification. During the intervention, successful notification rates were increased, and new informal and formal partnerships were developed, leading to faster identification of clusters.

Lessons

Establishing partnerships with stakeholders and developing support systems is beneficial towards epidemiological surveillance efforts. Adequate analysis of notification procedures was an important step towards standardization and correctness of information required for epidemiological surveillance.

Key messages
Covid-19 Vaccination and the issue of insurance status
Authors: Schröpfer D , Fortunato R , Devaud N , Koppensteiner R
Published: October 2022

Issue

It is estimated, that 11000 - 14000 people that live in Zurich do not have health insurance (∼3% of pop.). Covid-19 vaccination in Switzerland required an online registration (‘Vacme') with name, address and health insurance number. Health insurance in Switzerland is only accessible to people with registered residence in the country. This systematically excluded people without right of residence, health insurance or internet access.

Description

To address this issue the health service of the city Zurich organized a vaccination site for the uninsured from 14.06.2021 onward. To achieve this a simplified registration procedure was established, which allowed us to offer Vaccination to everybody, independent of their insurance status. Instead of the health insurance number, on site personal used a dummy number and the address of our site to register those patients. To remove language and technological barriers. In order to lower, the inhibition threshold for people without legal residence the Police department was informed and agreed not to circulate the area of the vaccination site on vaccination days.

Results

Between 14.06.2021 and 19.02.2022, 880 people came for vaccination of which 603 (69%) were clearly identifiable as individuals from non-insured populations. (See Graph)

Lessons

It is therefore critical not to forget these people when organizing public health measures, especially when addressing a pandemic or other infectious diseases (HIV, Hepatitis). A group specific information approach is of paramount importance to reach such subpopulations. Non-insurance is a known barrier for universal access to care.

Acknowledgements: We would like to thank the involved departments of the city Zurich, chief medical officer canton zurich, our collaboration partners and the staff of our vaccination site.

Key messages
Schistosomiasis control in adults: a call for action towards the goal of universal health coverage
Authors: Gruninger S , Rasamoelina T , Rakotoarivelo R , Doumbia C Oumar , Lorenz E , van Dam GJ , Schwarz NG , May J , Rakotozandrindrainy R , Fusco D
Published: October 2022

Background

Schistosomiasis is a high-burden parasitic disease and endemic in tropical climates, such as Madagascar. Recently it is emerging in Europe. Chronic infections lead to disabilities including loss in work productivity. Current control strategies focus on school-aged children, thereby systematically excluding adults. The goal to eliminate the disease as a public health problem is aligned with the Sustainable Development Goals agenda, including Universal Health Coverage (UHC). We aim at assessing the distribution of schistosomiasis among adults in Madagascar, in order to promote more targeted public health initiatives against the disease.

Methods

In a cross-sectional study, 1477 blood samples were collected at three primary health-care centers in Madagascar from 03.21 to 01.22. A semi quantitative PCR assay was used to assess the presence of Schistosoma. Positivity rates with 95% Confidence Intervals (CI) were reported by gender and age groups.

Results

Our study population had a balanced gender distribution with 54.2% [CI: 51.7;56.8] of females and a median age of 37 years (IQR: 24-48). Preliminary results show an overall Schistosome positivity rate of 59.5% [CI: 57.0;62.0]. Positivity was higher in males 62.4% [CI: 58.7;66.1], than in females 57.1% [CI: 53.5;60.5]. Highest positivity was seen in the 18-34 year age group with 66.2% [CI: 62.7;69.6]. Lowest positivity of 46.2% [CI: 39.2;53.2] was observed in adults aged over 55 years.

Conclusions

Our preliminary results provide evidence of high positivity rates of schistosomiasis among adults in a highly endemic country. Differently from many studies, males seem more affected than females. The youngest age group, representing the more active workforce of a population, shows a higher positivity rate. Our data suggests that, in the logic of UHC and health as a human right, public health strategies for schistosomiasis need to be re-addressed towards a universal coverage of affected individuals.

Key messages
Health status of people with intellectual disabilities: A systematic literature review
Authors: Griebler U , Griebler R , Weber G
Published: October 2022

Background

People with intellectual disabilities (ID) have a right to the highest level of health and to non-discrimination in health care. There are an estimated 89,000 people with ID living in Austria. Little is known about their health status and about their health care. We carried out a systematic review with the aim to provide an overview of comparative studies on the health status and health behaviour of people with and without ID.

Methods

The systematic literature search was conducted in 3 electronic databases for the search period 2008 to March 2020, supplemented by a reference list check and a search of relevant websites. Abstracts and full texts were dually screened, data extraction was performed by one person and checked by a second. Bias risk was assessed by two people using the AXIS tool for cross-sectional studies. Results were summarised narratively.

Results

A total of 73 publications were included. The literature review reveals a very clear picture: people with ID have a shorter life expectancy, are more affected by illness and health problems, are more likely to have health-related limitations in daily living and are more likely to die from potentially preventable causes of death that could be avoided either through preventive measures or by high-quality medical care.

Conclusions

To better assess the health situation of people with ID in Austria, Austria-specific data is needed. Furthermore, systematic initiatives in the areas of prevention, health promotion and health care are necessary. People with ID should therefore be systematically considered in all strategies and processes in the health sector. In terms of health literacy, a stronger information policy towards people with ID and towards their relatives and health care professions would be indicated.

Key messages
Associations between biomass fuel use and child health: a community-based study in Bhaktapur, Nepal
Authors: Schwinger C , Kvestad I , Chandyo RK , Hysing M , Ulak M , Shrestha M , Ranjitkar S , Shrestha L , Strand TA
Published: October 2022

Background

Biomass fuel use for cooking is widespread in low- and middle-income countries. Previous studies have mainly focused on adverse health outcomes in adults or specific diseases. In a cohort among young children living in Bhaktapur, Nepal, we aimed to describe the association between the use of biomass cooking fuels in families with child health using measures of linear growth, cognition and chronic illness.

Methods

Caregivers of 600 marginally stunted children aged 6-11 months were interviewed about their primary source of cooking fuel at enrolment into a randomized controlled trial. Children's body length (n = 572) was measured at age 18-23 months. At the same time, blood samples (n = 497) were taken, and we measured leukocyte telomere length (LTL) as a marker of chronic disease risk. We chose LTL expressed as z-scores as a measure of chronic disease. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and NEPSY-II subtests when the children were 4 years old (n = 531). Associations were estimated in multiple regression models.

Results

About 18% of all families used biomass as primary cooking fuel. Children from families using biomass fuel were on average slightly shorter (mean difference 0.14 Z-scores, 95% CI: 0.28, 0.00), had lower IQ scores (mean difference 2.2 (95% CI: 0.5, 3.9), and shorter LTL (mean difference: 0.09 (95% CI: 0.05 to 0.13) compared to those not using biomass fuel. The observed associations were unaltered after adjusting for relevant confounders.

Conclusions

In children from households in poor, urban neighborhoods in Nepal, biomass fuel use for cooking was associated with health indicators for child growth and cognition as well as longevity and chronic illnesses reflected in shortening of telomeres. As this was an observational study, residual confounding cannot be excluded. Our findings support the ongoing effort to reduce exposure to biomass fuel in low-resource settings.

Key messages
ATHLOS Healthy Ageing Scale score as the predictor of mortality in Poland and the Czech Republic
Authors: Kozela M , Pająk A , Ayuso-Mateo JL , Bobak M , Lu W , Pikhart H , Polak M , Sanchez-Niubo A , Stepaniak U , Haro JM
Published: October 2022

Background

A novel tool to measure healthy ageing was developed by the ATHLOS consortium (Ageing Trajectories of Health-Longitudinal Opportunities and Synergies). ATHLOS Healthy Ageing Scale, constructed using harmonized data from 16 independent ageing cohorts, was designed to contribute to worldwide research on healthy ageing. The aim of the analysis was to assess the relation between ATHLOS Healthy Ageing Scale and all-cause mortality in Central European populations.

Methods

Participants of the Polish and Czech HAPIEE cohorts (baseline age 45-69 years) were followed for 14 years. ATHLOS Healthy Ageing Scale was based on over 40 health indicators related to intrinsic capacity and functional ability. Cox proportional hazards models were used to determine the relationship between the ATHLOS Healthy Ageing Scale scores and all-cause mortality.

Results

As many as 9,922 Polish and 8,518 Czech participants had non-missing data on the ATHLOS Healthy Ageing Scale score and mortality (1828 and 1700 deaths, respectively). After adjustment for age, dose-response associations with mortality in both genders and countries were found (HR for lowest vs. highest quintile of the ATHLOS Healthy Ageing Scale: 2.98 and 1.96 in Czech and Polish women and 2.83 and 2.66 in Czech and Polish men, respectively). Only modest attenuation was observed when additionally adjusted for education, economic activity, smoking and self-rated health.

Conclusions

The ATHLOS Healthy Ageing Scale was found to be a good predictor of all-cause mortality in urban populations of Poland and Czechia. This composite indicator seems to be an important contributor to a better assessment of healthy ageing.

Key messages
COVID-19 contact tracing apps in Europe, technological feat or failure?
Authors: Santos A , Rachadell J , Vareda R
Published: October 2022

Background

In the context of infectious disease control (IDC), public health services (PHS) have been under great pressure during the COVID-19 pandemic, especially with the burden of contact tracing. Most European Union countries have developed contact tracing apps for smartphones (CTA) with the goal of aiding PHS in IDC. CTAs generally use proximity data from mobile devices to determine a user's risk of exposure to SARS-CoV-2, thus providing testing and isolation recommendations. This review aimed to study the acceptance and adoption of CTAs in Europe.

Methods

5 European countries were selected: Germany, Spain, France, Ireland, Italy. A literature review was carried out and official sources of information from each country were consulted in order to compare the adoption of each national CTA. Criterias included number of downloads, rating in the app stores, costo of development, proportion of positive tests registered. Potential factors influencing population adherence to CTAs were also investigated.

Results

In proportion to their population, the number of downloads varied significantly in each country (18 % in Spain, 67% in France, 75% in Ireland). Except for Spain, all countries integrated additional functions into the CTA to increase its uptake, such as access to the vaccination certificate. App stores ratings ranged from 3.0 (Spain) to 3.9 (France and Ireland). The proportion of tests added in the apps varied significantly (1% in Italy and Spain, 4% in Ireland, 10% in France and 17% in Germany). Concerns that lead to the non-use of CTAs were related to data protection, smartphone battery drainage and app bugs.

Conclusions

CTAs as a way to identify contacts from a positive case had a low impact in the analyzed countries, with low population adherence being an important factor. Adding more features within the apps, minimizing bugs, and increasing public confidence in data privacy seem essential to increase uptake in the future.

Key messages
The impact on ambient air pollution and asthma-related admissions of COVID-19 transport restrictions
Authors: Kelly C , Kenny P , O'Dwyer M , Quintyne KI
Published: October 2022

Exposure to air pollution is a known risk factor for asthma exacerbations, emergency attendances and hospitalisations. In Europe, the main source of air pollution is the transport industry, and so the COVID-19 transport restrictions provided an opportunity to examine if reduction in traffic had a demonstrable impact on ambient air quality and asthma-related admissions. Routinely collected data was used to conduct a retrospective population cohort study. The Environmental Protection Agency provided daily nitrogen dioxide (NO2) and particulate matter (PM) concentrations for Dublin, and all asthma-related admissions were collected from the Hospital In-Patient Enquiry system. The two years prior to the pandemic were compared with the period of transport restrictions (from March 2020). During the period of restrictions, there was a significant reduction in the mean number of daily asthma admissions (2.8 v 4.5 admissions p < 0.001). There was also a significant decrease in mean daily concentrations in two pollutants: NO2 (16.7 v 24.0µg/m3 p < 0.001) and PM2.5 (7.8 v 8.9µg/m3 p = 0.002). Only NO2 had a statistically significant correlation with asthma admissions (r = 0.132 p < 0.001). Transport restrictions introduced to mitigate against COVID-19 led to improvements in air quality, as seen by the reductions in pollutant concentrations. Previously described associations between pollutants and asthma, would suggest that these improvements in air quality contributed to the reduction in asthma admissions. Whereas the primary source of NO2 is transport emissions, PM is made up of particles from multiple sources, which likely explains the lack of correlation between asthma admissions and PM. Public Health need to advocate for transport policies which can improve air quality, and as a result, public health.

Key messages
Environmental Health Literacy: an index to study its relations with pro-environmental behaviors
Authors: Carducci A , Fiore M , Lorini C , Federigi I , Verani M , Ferrante M , Bonaccorsi G
Published: October 2022

The citizen’ awareness about environmental health risks has been identified as an important determinant of citizens’ choices for the adoption of pro-environmental behaviors, but for its study simple measures to be applied in population studies are still lacking. The Environmental Health Literacy (EHL), is a recent sub-cathegory of health literacy, including functional, critical and interactive dimensions, that can be applied in surveys on environmental health risk perception and behaviors. The aim of our study was to elaborate and validate an EHL Index (ELHI) using data from a large multicenter survey carried out among 4778 students of different disciplines in 15 Italian Universities, with a self-administered anonymous questionnaire investigating risk perceptions, attitudes and behaviors towards environmental health risks and including a simple Functional Health Literacy test (FHL). From the original questionnaire of 56 items three sets of questions were selected to represent the three dimensions of health literacy (Functional, Critical or Interactive) and their outcomes were compared with the answers about FHL test and pro-environmental behaviors. The Principal Component Analysis was used to select the most representative questions that were then grouped in the EHLI. The index was significantly associated with both FHL test and behaviors questions. The ROC curve indicated a satisfying accuracy and was used to identify the best cut-off for ELHI. In conclusion the constructed ELHI can be considered reliable and useful for further population surveys in similar target people to plan communication interventions about environmental health risks and their prevention through individual choices.

Key messages
Effect of socio-economic deprivation on refugee health: a natural experiment study in Germany
Authors: Biddle L , Bozorgmehr K
Published: October 2022

Background

Characteristics of the place of residence have been proposed as a key determinant of physical and mental health, but so far, little experimental evidence exists. The quasi-random dispersal of refugees in Germany serves as a natural experiment to study the causal relationship between socio-economic deprivation and health as well as the impact of the social context on this relationship.

Methods

Refugees subject to dispersal policy (n = 1723) were selected from the nation-wide German IAB-SOEP-BAMF Panel from 2016 to 2018. The effect of German Index of Socioeconomic Deprivation quintiles (Q1-Q5) on change between baseline (t0) and follow-up (t1) in mental (mcs) and physical (pcs) health component scales of SF-12 were analysed using multi-level linear regression. Social context variables were included in a mediation analysis.

Results

Across quintiles, mental health improves (Δmcs=0.5) and physical health declines (Δpcs=-0.8) between t0 and t1. Fully adjusted models show a negative, dose-responsive relationship between deprivation and physical health, which is statistically significant for Q4 (coef. Q4vsQ1: -1.84, 95%CI: -3.50;-0.17). Models for mental health show an improvement in Q5 (coef. Q5vsQ1: 6.00, 95%CI: 1.70;10.31). Social context variables have no effect on physical health but slightly diminish the effect on mental health (coef. Q5vsQ1: 4.78, 95%CI: 0.65;8.90).

Conclusions

The quasi-random dispersal of refugees in Germany acts as a natural experiment to disentangle selection effects from the relationship between deprivation and health. Results suggest a negative effect of deprivation on physical health and a potential positive effect on mental health which can be partially explained by the social context. Limitations are the small sample sizes in deprived quintiles and short follow-up periods. This analysis can act as a magnifying glass for similar effects among other population groups, but causal paths need to be investigated further.

Key messages
Elevated risk of depression and anxiety disorder by „high strain“ occupations: a systematic review
Authors: Seidler A , Freiberg A , Drössler S , Hussenoeder FS , Conrad I , Riedel-Heller S , Starke K Romero , Schubert M
Published: October 2022

Background

Poor working conditions might lead to mental illness.

Methods

We performed a systematic review with meta-analyses as an update of a review published in 2013. We registered the study protocol with PROSPERO (registration number: CRD42020170032) and searched for epidemiological studies in MEDLINE, PsycINFO, and Embase. Two reviewers carried out independently all review steps including title-abstract screening, full-text screening, risk-of-bias assessment and data extraction. Discordances were solved by consensus. We determined the certainty of evidence using the GRADE-approach.

Results

Ten cohort studies with acceptable study quality examined the relationship between high job strain and the incidence of depression. In the “classic” demand-control-model, ‘high strain’ (combination of high demands and low control) is compared with ‘low strain’ (combination of low demands and high job control). For high strain, the risk of depression was elevated by 73%, the pooled effect estimate for the risk of depression was 1.73 (95% CI 1.32-2.27. In a dichotomous analysis (without dividing job strain into the four dimensions mentioned above), there was a doubled risk of depression with high job strain (pooled effect estimate=1.99, 95% CI 1.68-2.35). We found comparable risk estimates for men and women. The GRADE assessment revealed a high certainty of evidence of the association between job strain and depression. We also found a considerably increased risk of anxiety disorder among individuals prone to high job strain.

Conclusions

This systematic review finds a clear association between high job strain (high demands in combination with low control) and depression as well as anxiety disorders.

Acknowledgment: This study was financially supported by SUVA (Schweizerische Unfallversicherungsanstalt).

Key messages
Trajectories of part-time work and sickness absence among shift working healthcare employees
Authors: Ropponen A , Ervasti J , Härmä M
Published: October 2022

Background

Healthcare systems are facing major challenges due to population ageing, increased need for care, and economic challenges combined with staff shortage. The existing need for longer work careers combined with increasing turnover rates in healthcare highlights the need to understand working hours in association with work capacity and sustainable work careers. We aimed to investigate the concurrent changes in part-time work and sickness absence (SA) among healthcare employees without any SA spell >14 days at baseline.

Methods

Annual working hour and SA data from 23 hospital districts and cities in Finland for 2008-2019 (172 922 employees with at least one work shift in any year). The sample was restricted to 20274 employees with ≤31 work shifts/year in 3 consequent years during the follow-up and without any SA spell >14 days at baseline in 2008. Part-time work/year (yes/no), SA months/year, and nightwork/year (% of nightwork of all shifts) as time varying covariate were used in the group-based trajectory models examining the concurrent changes. Models for age groups (in 2008 and categorized into < 25 years of age, ≥25 and <40 years, ≥40 and <55 years, and >55 years) will be considered later.

Results

A five-trajectory solution identified groups for “stable full-time work without SA” (56.8%), “increasing part-time work and stable very low SA” (13.5%), “slight increase both in part-time work and SA” (16.5%), “steep increase in part-time work and reversed low U-shape in SA months” (5.0%), and “stable part-time work and low SA” (8.2%) across 2009-2019.

Conclusions

These initial findings indicate that while most employees work full-time without SA, those who transfer from working full-time to part-time during follow-up from 2009 to 2019 seem to have low SA. Thus, part-time work may promote work capacity, and accompanied by part-time work disability benefits, offer a tool for employers to support sustainable working life and to keep older employees at work.

Key messages
Risk of first musculoskeletal disorder in Danish occupational fishermen – a register-based study
Authors: Remmen LN , Christiansen DH , Herttua K , Berg-Beckhoff G
Published: October 2022

Background

Occupational fishery increase risk of musculoskeletal disorders due to a combination of heavy workloads and strenuous settings. Scarce and inconsistent knowledge exists on work-related risk factors despite high prevalence is evident. The aim was to determine work-related risk factors for the first diagnosis of musculoskeletal disorders in Danish occupational fishermen.

Methods

This study was a register-based cohort study. We extracted data the from Nationwide Danish registers on work affiliation and health data for all persons registered as occupational fishermen between 1994 and 2017. Job titles were retrieved from the Danish Occupational Cohort with eXposure (DOC*X). Time-to-event analysis using cox regression with age as timescale was applied.

Results

Among 15.739 fishermen, forty percent (n = 6.218 cases) experienced first musculoskeletal disorder during 82.2 million person-years of follow-up. Adjusted gender-stratified analysis showed that male fishermen, who worked less than 5 years and more than 15 years had the highest significant risks of MSD (HR 2.40 (95%CI: 2.06, 2.80), HR: 2.40 (95%CI: 1.76, 2.35)) respectively, compared to working more than 20 years. In males, more years in workforce, a captain education and working part time significantly protected against first MSD, while shifting trades above three times increased risk. Women had estimates with greater uncertainties due to their small numbers in the industry.

Conclusions

A high incidence of musculoskeletal disorders was found in Danish occupational fishermen between 1994-2017. Findings suggest a bimodal relationship between occupational fishermen seniority level and their risk of musculoskeletal disorder, where highest risk was seen at five years in trade, afterwards from lower estimate slowly increasing with accumulating years until highest occupational seniority, compared to more than twenty years in trade. Continued development actions of preventive measures are suggested.

Key messages
The causal effect of switching from precarious to standard employment on mortality in Sweden
Authors: Matilla-Santander N , Matthews AA , Gunn V , Muntaner C , Kreshpaj B , Wegman DH , Jonsson J , Bodin T , Consortium PPWR
Published: October 2022

Background

Precarious employment (PE) is a well-known social determinant of health and health inequalities, yet the effect of PE on mortality has not been explored sufficiently and high-quality longitudinal studies are lacking. When studying this effect, several methodological factors must be considered, one of them being the immortal time bias or prevalent user bias. A framework that helps us overcome these biases is the target trial. Therefore, the aim of this study is to estimate the causal effect of switching from precarious to standard employment (SE) on the 12-year risk of all-cause mortality among precariously employed workers aged 20-55 in Sweden.

Methods

We emulated the target trial as a series of 11 target trials (starting at any year between 2005 and 2016), such that each individual may participate in multiple trials using Swedish register data (N = 251274). We classified individuals as: a) workers that at baseline (start) move from PE to SE and then followed while in SE or b) continuation of PE over follow-up. All-cause mortality was measured from 2006 to 2017. We pooled data for all 11 emulated trials and used pooled logistic regression to estimate intention-to-treat effects via hazard ratios and standardized survival curves.

Results

The following results are preliminary. Individuals that continued on PE were 185,480 and those that initiated SE were 65,794. Over the 12-year follow-up, 1553 individuals died. The estimated observational analogue of the intention-to-treat 12-year survival difference for all cause-mortality between workers that continued on PE and those that initiated SE was of -0.2%, and the HR:0.82, 95%CI:0.72-0.94.

Conclusions

The following conclusions are preliminary. According to our results, we find indication that shifting from PE to SE decreased the risk of death. Our study highlights the crucial role of decent employment conditions for health.

Key messages
Fed up: a qualitative investigation on the influencing factors of food insecurity in the Azores
Authors: Freiheit R , Leão T
Published: October 2022

Background

In 2019, over 1 billion people experienced food insecurity. In the Azores, a 9-island archipelago in the Atlantic Ocean, 13.4% of its population perceived food insecurity, the highest regional rate in Portugal (10.1%). These geographical limitations paired with high unemployment and low education rates, may challenge their access to nutritious food. It is still unclear how these (and other) contextual factors may affect access and availability to food in this remote area, and how they interact with individual determinants.

Methods

Data collection was conducted in early 2022 with 13, in-depth, 1:1 semi-structured interviews regarding topics of food consumption and supply in the Azores. Non-probability sampling was used, with use of purposive and snowball sampling. We included key-stakeholders currently living in the islands or working in a role related to the islands (i.e., in healthcare, supply chain, agriculture, etc.). We performed a thematic analysis with an inductive-deductive iterative analysis.

Results

Participants identified several challenges related to access and availability of food. Vegetables, fruit and fish can be scarce and are subject to seasonal variation. There are clear regional disparities in access to food, with more isolated islands having less variety, quality and quantity of healthy foods available. Its topography and weather limit agricultural practices and transportation, but education, culture, and policies subsidizing the production of meat and dairy were also identified as important barriers to local production of fruits and vegetables.

Conclusions

Food insecurity is a public health concern in this outermost EU region. If topography and geography limit the production and access of nutritious foods, economic and agricultural policies are a leading theme of concern to highlight. The solution for food insecurity thus demands an interdisciplinary dialogue to better adjust future policies in the Azores and in similar regions.

Key messages
Healthcare accessibility since and during Covid-19 pandemic among older individuals in Europe
Authors: Mikelsone M , Reine I
Published: October 2022

Ensuring access to healthcare is critical to prevent illnesses and maintain health and functional abilities for older individuals. The Covid-19 pandemic is a major global public health threat that challenges healthcare availability and accessibility. The objective of the study was to compare healthcare accessibility for older individuals since and during Covid-19 pandemic. The study was based on a sample of individuals from wave 8 Covid-19 add-on and wave 9 Covid-19-add-on of the Survey of Health, Ageing and Retirement in Europe (SHARE) in the period from 2020 till 2021. The sample size was 44043 respondents from 26 European countries. Descriptive statistics, Chi-square and McNemar test was performed. Overall, in 2021 there is a statistically significant decrease in proportion of respondents who forwent medical treatment (from 12% to 8%, in Latvia from 14,6% to 7%), postponed medical appointment due to Covid-19 (from 27% to 13%, in Latvia from 14,6% to 3,2%) and to whom appointment was denied by healthcare facility due to Covid-19 (from 5,3% to 4,5%, in Latvia from 6.9% to 3,3%) (p < 0.001). More often forwent medical appointment in 2021 was reported from females as well as respondents younger than 75 years, with good or very good self-rated health status and with less or no limitations due to health. Forwent medical treatment was reported more often from respondents with diabetes and hypertension. Results indicate that remote consultations are used more often than in 2020 (number of remote consultations varied between 1 and more than 100) and more often were reported by younger respondents (50-74 years). No significant association was found in self-rated health changes since and during Covid-19 pandemic for respondents who reported healthcare accessibility issues. As those issues were reported also by individuals with poor or fair self-rated health status and serious health conditions it can lead to a more rapid decline in health and functional abilities in the future.

Key messages
Professionals’ roles in the hospital discharge of older adults in 3 Nordic cities: a vignette study
Authors: Liljas AEM , Pulkki J , Jensen NK , Burström B , Keskimäki I , Andersen I , Jämsen E , Agerholm J
Published: October 2022

Background

The hospital discharge process of older adults in need of both medical and social care post hospitalisation requires extensive care coordination. Cooperation and continuity between involved care providers are essential, however, existing care systems including the Nordic care systems, are poorly designed to provide health and social care to patients with complex health and social care needs which increases the risk of certain groups not receiving optimal care.

Aim and methods

This study aims to examine and compare what roles, responsibility and actions nurses take in the hospital discharge process of older adults with complex care needs in three Nordic cities: Copenhagen (Denmark), Stockholm (Sweden) and Tampere (Finland). A vignette study consisting of three fictive cases was conducted face-to-face with nurses in Copenhagen (n = 11), Stockholm (n = 16) and Tampere (n = 8). Participants were identified through the researchers’ networks and snowball sampling. The vignettes represent older patients with age-related medical conditions of which one also has cognitive loss and one looks after their partner with dementia. The cases further include differences in the home help received by their children, physical obstacles in their homes and unwillingness of becoming a burden to the system. A thematic approach is used for the data analysis.

Results and conclusions

Preliminary results suggest that the informants’ roles and engagement in the coordination and collaboration may differ both within and between the systems studied, and that they take responsibility beyond their job roles particularly if the patient has no close relatives. The study is of public health importance as it identifies gaps in how the care is organised in the three welfare states targeted. It also sheds light on the complexities of providing universal care in ageing societies where a growing proportion of older adults have both medical and social care needs.

Key messages
Hustle: Experiences of making work ‘work’ for non-standard and precariously employed workers in NYC
Authors: Cuervo I , Ahonen EQ , Vignola EF , Davis L , Baron S
Published: October 2022

Background

Precarious and non-standard employment (NSE) has negative implications for workers’ health. As part of a six-country comparative mixed methods case study, this research explores US-based workers’ experiences in NSE and its influences on their health and well-being in a context of weak labor regulations and social welfare programs.

Methods

To understand US policy context, we analyzed country-level labor regulatory and social protection frameworks using 2019 Organization for Economic Cooperation and Development data. To understand workers’ experiences, we conducted in-depth interviews with NSE workers in various occupations in New York City (N = 40) between January and May 2021. We recruited and screened eligibility via Facebook advertisements and an online questionnaire, respectively. We used deductive and inductive thematic analysis for interview data.

Results

With heavy reliance on market competition in the US, minimal state regulation and flexible labor markets create less secure employment along with limited government-funded social supports. Workers’ experiences center on the Hustle, i.e., figuring out how to make NSE work for them and their families. They lack healthcare coverage and have low expectations of other supportive employment and social protections (e.g., paid leave). While NSE payoffs (e.g., perceived flexibility) were common for most, almost all experience NSE tradeoffs (e.g., job insecurity and instability) that create stress and overwork, negatively implicating overall health and well-being. These impacts differ by access to resources associated with social location (e.g., immigration status). COVID-19 exacerbated these experiences.

Discussion

Low expectations of supportive policies of US workers in NSE are linked to the individualized hustle, as they attempt to counter NSE tradeoffs often relying on family to fill those gaps. Over-reliance on privatization for social supports such as healthcare coverage can be detrimental to workers’ health.

Key messages
Sickness absence due to common mental disorders among precarious and non-precarious workers
Authors: Hernando-Rodriguez J , Matilla-Santander N , Almroth M , Kreshpaj B , Gunn V , Muntaner C , Bodin T
Published: October 2022

Background

Mental health disorders have become one of the leading diagnoses causing sickness absence. Previous studies have examined the impact of single employment characteristics or working conditions on sickness absence. However, few studies have investigated the effect of a multidimensional construct of precarious employment on sickness absence. Therefore, this study aims to describe sickness absence due to common mental disorders (CMD) as a proxy for access to social security benefits among precarious and non-precarious workers with mental health problems.

Methods

Cohort register-based study of the total Swedish population aged 27 to 61 years residing in Sweden in 2016 and having mental health problems defined as being prescribed Selective Serotonin Reuptake Inhibitors (SSRI) in 2017 (N = 19,691). Individuals were classified as precariously employed or not based on a precarious employment score measured multidimensionally in 2016 (i.e., employment insecurity, income inadequacy, and lack of social protection). The outcome was the incidence of the first sickness absence episode due to CMD co-occurring with SSRI treatment in 2017. Logistic regression models will be performed.

Results

The following results are preliminary. Precariously employed treated with SSRI were 8,68% in 2017. The distribution of a first sickness absence episode due to common mental disorders was similar in precarious and non-precarious workers (12.35% and 12.42%, respectively). Individuals directly employed (12.20%), with multiple jobs holding (14.62%), and low-medium income levels (14%) had higher sickness absence incidence due to common mental disorders. There were slight differences by gender.

Conclusions

In these preliminary results, no differences were found between precarious and non-precarious workers with mental health problems in the distribution of sickness absence due to CMD. Further analysis will be conducted to investigate whether precarious employment is associated with sickness absences.

Key messages
Cardiovascular risk in young healthcare workers: results from a cross-sectional study
Authors: Imeshtari V , Imeshtari A , La Torre G
Published: October 2022

Background

Cardiovascular diseases represent the main cause of mortality worldwide. While cardiovascular risk (CVR) has decreased in grown adults and elderly in the last years due to innovative therapies and prevention, it seems to be rising among young adults. The aim of our study was to map the 10-year CVR in healthcare workers (HCWs) at the teaching hospital Policlinico Umberto I of Rome and identify possible determinants in order to design and implement preventive strategies.

Methods

A cross-sectional study was carried out between January 2019 and July 2020. 525 HCWs aged 20-40 years were recruited. All participants underwent, after informed consent, medical history collection, physical examination and blood tests. CVR was measured using Framingham Risk Score (FRS) and CUORE score (CVR score developed by the Italian National Institute of Health). Univariate, bivariate and multivariate analysis were performed.

Results

CVR evaluated with FRS correlated positively with age (β = 0.104, p < 0.001), being a shift worker (β = 0.06, p = 0.037), and negatively with female gender (β= -0.757, p < 0.001). No differences were found between being a doctor or a nurse. CVR evaluated with CUORE score correlated positively with age (β = 0.698, p < 0.001), and negatively with female gender (β= -0.332, p < 0.001) and being a doctor (β= -0.220, p < 0.001). Inferential analysis showed low correlation between FRS and CUORE Score (R2=0.340).

Conclusions

Our study demonstrates that females have a lower CVR among HCWs. On the contrary, 15% of male HCWs show a CVR above the average. FRS and CUORE score indicate that advancing age determines an increase in CVR. There is a low correlation between the scores used, in fact CUORE score underestimates the CVR of shift workers while it is known that this particular category is at higher risk.

Key messages