bluuebunny/crossref_metadata_2025 huggingface dataset:
Pleasure-inclusive sex education, sexual agency and sexual wellbeing in youth: A scoping review
Authors: van Ditzhuijzen J , Overeem A
Published: October 2024

Background

A recent review study showed that pleasure-inclusive sex education can contribute to reducing sexual health risks such as unwanted pregnancy and STIs (Zaneva et al., 2022). Pleasure-inclusive sex education could also contribute to other measures of sexual wellbeing. In this study, we review the literature on associations between pleasure-incorporating sex education and sexual agency (including related concepts such as autonomy) and sexual wellbeing (part 1), and between sexual agency and sexual wellbeing (part 2).

Methods

We searched in 5 scientific databases using a wide scope of variables related to pleasure inclusive sex education, sexual agency, and various outcomes of sexual wellbeing, focusing on the last 2 decades. Forty-six articles were selected.

Results

In part 1 of the review we found that all studies reported associations between pleasure-based sex education and sexual agency or sexual wellbeing, but the literature is characterized by limitations and did not permit conclusions about the role of an added benefit of the pleasure component. In part 2 of the review study, we found positive associations between sexual agency (and related variables) and sexual wellbeing (including decreased levels of (re-)victimization).

Conclusions

Sexual agency may be related to increased sexual wellbeing, but it is still largely unclear whether pleasure-inclusive sex education can significantly contribute to this. There is a great need for high quality research, using innovative evaluation designs, taking into account the role of other important sources of sex education and other contextual factors.

Key messages

• A lot of work has been done, but the evidence that pleasure in sex ed ‘works’ for sexual wellbeing, is limited and indirect.

• Great need for high quality research using novel and more realistic evaluation approaches.
Acculturation and self-management abilities of well-being among older Moroccans in the Netherlands
Authors: Hussein H , Cramm J M , Nieboer A P
Published: October 2024

Background

Migration involves a variety of stressors. Their accumulation over time may negatively impact migrants’ well-being. The extent that older migrants can integrate into a host society may determine their readiness to adopt behaviors such as self-management of well-being. Research regarding this relation among older Moroccans, one of the largest migrant groups in the Netherlands, has not been examined. This study aimed to investigate the relationship between acculturation and self-management abilities of well-being among older Moroccans and to examine differences in subgroups.

Methods

This cross-sectional study included 290 older Moroccans (≥ 65) living in Rotterdam, the Netherlands. Linear regression was applied to explore associations between acculturation (attachment to Moroccan and Dutch cultures) and self-management abilities of well-being. Independent samples t-tests were used to test differences between subgroups.

Results

Older Moroccans who received low education were found to be less attached to the Dutch culture [3.24 (0.72) vs. 3.54 (0.73); p = 0.016]. They were also poorer self-managers of their well-being [2.60 (0.59) vs. 2.86 (0.58); p = 0.012], along with those with multi-morbidity [2.55 (0.60) vs. 2.77 (0.54); p = 0.006] and those lacking comprehension of Dutch [2.46 (0.56) vs. 2.69 (0.59); p = 0.011]. Self-management abilities of well-being had a negative association with multi-morbidity (β = −0.18, p = 0.007) and lack of Dutch comprehension (β = −0.16, p = 0.031), and a positive association with attachment to Moroccan (β = 0.17, p = 0.012) and Dutch (β = 0.18, p = 0.010) cultures.

Conclusions

Findings indicate that attachment to Moroccan and Dutch cultures is beneficial for older Moroccans’ self-management of well-being. Efforts need to support older migrants’ integration for them to adequately function and feel at home. Interventions promoting integration and self-management need to consider the characteristics of older migrant populations

Key messages

• Attachment to origin and host cultures benefits older migrants’ self-management of well-being. The cultural context of older migrants needs to be considered when promoting values of self-management.

• Differences in acculturation and self-management of well-being existed between older migrant subgroups. Interventions promoting these values should account for the diversity that exists among migrants.
Institutional Discrimination in Health Security Policies against Immigrants in South Korea
Authors: Kweon S , Baek M , Choi Y , Kim J
Published: October 2024

Background

South Korea is poised to become Asia’s first mult-iethnic society with over 5% of its population, totaling more than 2.5 million, being immigrants. This demographic shift presents significant public health challenges linked to widespread, and even intensifying, institutional discrimination in healthcare services.

Methods

This study reviews discriminatory practices across ten essential health security programs, including National Health Insurance (NHI) system, disability assistance, occupational health services, maternal and child care services, national immunization program, health screening program, and assistance for catastrophic medical expenses. Government data and personal narratives were also reviewed to identify the discriminatory elements that can have significant consequences, including increased disease prevalence, higher incidence of occupational injuries, and broader socio-economic instability among migrants.

Results

Discriminatory elements were found in most programs, with the exception of emergency medical services. These programs commonly provide fewer benefits or impose stricter eligibility criteria for migrants compared to nationals. In particular, the Korean NHI system demands migrants to pay higher premiums and more rigorous maintenance requirements.

Conclusions

The findings emphasize the need for urgent reforms to equalize health insurance costs, simplify eligibility criteria for migrants, and broaden the scope of benefits to encompass all residency statuses. Implementing these changes will enhance public health infrastructure, improve occupational safety, and foster better integration of the diverse population, ultimately promoting social cohesion and a fairer health system for all.

Key messages

• A number of discriminatory elements against migrants have been identified in South Korea’s social security policies that can exacerbate health disparities.

• Reforms are needed to expand benefits and relax eligibility criteria for migrants in key healthcare policies, including the National Health Insurance system.
Health-related quality of life among refugees from Nagorno Karabagh resided in Kotayk, Armenia
Authors: Giloyan A , Harutyunyan T , Petrosyan V
Published: October 2024

Background

In September 2023, more than 100,000 ethnic Armenians were displaced from Nagorno Karabakh (NK). This study assessed the health-related quality of life (HRQoL) and associated factors among NK refugees who settled in Kotayk province of Armenia.

Methods

We surveyed 197 refugees using a structured interviewer-administered questionnaire, which collected information about socio-demographics, chronic diseases, smoking status, HRQoL, utilization of healthcare services, living conditions and food access. The SF-36 Health Survey assessed HRQoL. Ophthalmic examination was conducted. Eyeglasses and medications were provided at no cost to those requiring them.

Results

The participants’ mean age was 64.8 years and 59.4% were retired. The most commonly reported chronic diseases were bone/joint diseases (67.5%), hypertension (55.3%) and heart diseases (24.9%). Around 48.7% of participants experienced sleeping disorders often/ very often. The mean total SF-36 score was 57.42±23.12; the mean physical (PHC) and mental health component (MHC) scores were 63.57±26.28 and 59.37±20.04, respectively. Only 28% of the participants utilized healthcare services after displacement. Most participants had consistent access to an adequate food supply. In the adjusted analysis age (B/PHC=-0.94, p < 0.001; B/MHC=-0.61, p < 0.001), sleeping disorder (B/PHC=-21.86, p = 0.011; B/MHC=-17.44, p = 0.001), use of medical service (B/PHC=-8.63, p = 0.022; B/MHC=-6.95; p = 0.015) and having more than one chronic disease (B/PHC=-17.35, p < 0.001; B/MHC=-10.90, p = 0.001) were associated with both PHC and MHC.

Conclusions

This study marks the first assessment of HRQoL among NK refugees. Governmental support and interventions targeting individuals with ophthalmic, sleeping, and chronic diseases might be beneficial. Follow-up assessments should track changes in both physical and mental health scores in this population, as they may fluctuate over time in response to displacement challenges.

Key messages

• Age, sleeping disorder, use of medical service, and the number of chronic diseases were significantly associated with decreased PHC and MHC of HRQoL

• Interventions targeting individuals with restricted access to healthcare services, as well as those affected by eye diseases and chronic health issues might be beneficial.
Towards integration of care in Portugal: Expansion of a new management model for the NHS
Authors: Fronteira I
Published: October 2024

Introduction

In 1999, the first Local Health Unit (LHU) was created in the Northern region of Portugal to improve management, share resources and integrate care. The LHU integrated a National Health Service (NHS) hospital and primary healthcare (PHC) services located within the same geographic area and became responsible for public health activities and the provision of care. Over the next few years, 7 LHUs were created, the last one in 2012. In 2024, the government expanded this model to the entire territory, creating 39 LHUs. This research analyses the objectives, characteristics and expected outcomes of the scale-up of LHUs.

Methods

This study utilised a mixed methods approach based on the 6 Ps - Problem, People (policy stakeholders), Process (policy development), Price tag (Resource allocation), Paper (policies, laws, regulations), Programmes (policy implementation); and the political, social and economic setting of the Policy Circle Framework.

Findings

A 2015 assessment revealed that LHUs did not differ from non-LHUs in terms of access, waiting times, clinical excellency, patient safety or patient centeredness. The degree of integration of care in LHUs seemed lower compared with non-LHUs. However, there was no systematic evaluation of the creation of the first LHU. Despite this, the government announced the intention to expand LHUs to the entire national territory, which culminated with the creation of 39 LHUs in 2024 to deliver integrated care, with an emphasis on the proximity and continuity of health services and promotion.

Conclusions

Despite the existing knowledge gap on the impacts of LHUs in health outcomes and management efficiency, LHUs can provide opportunities to advance integrated and patient-centred care and develop strategies for managing scarce resources, including the health workforce. Nevertheless, the integration of hospitals and PHC can threaten the centrality of primary health care both in terms of delivery of care and resource allocation.
Comparison of hospital treatments of the Roma settlements’ inhabitants in Slovenia
Authors: Krajnc Nikolic T , Ranfl M , Rostohar K
Published: October 2024

Background

Roma ethnic minority in Slovenia was recognized as a vulnerable group with worse health indicators and significantly shorter life expectancy. The vast majority of Roma population in Slovenia have health insurance. We were investigating the use of hospital services in Roma population according to their age and comparing it with the rest of the population.

Methods

We determined the inhabitants of Roma settlements from the Slovenian register on residents. The data on hospital treatments used were from Slovenian national register on hospital treatments for the period 2018 to 2022. We compared different ratios according to certain hospital treatments within age categories of patients and co-pared those two groups. The frequency statistics, ANOVA and comparison of column proportion tests were used (p-value<0.005, 95% CI).

Results

Inhabitants of Roma settlements were more often treating in hospitals that rest of population. If comparing the frequency of hospital treatments between age groups only in Roma population, the percentage of hospital treatments steeply declines with age as well as the number of persons in age groups. The highest percentages and numbers of services are in the youngest age group of 0-15 years, and the lowest in the oldest group (75+). Therefore, significantly higher ratios of hospital treatments were detected in younger then in older age groups.

Conclusions

Roma children and youngsters (0-15 years old) had the highest rate of hospital treatments and it declined with the age. It was consistent with age pyramid of Roma as young population as well as emphasized care for children in culture. The steady decline rate of hospital treatments with age could be explain with delayed seeking of health care services in adult age and higher premature mortality that leads to smaller adult population. Additional and in-depth research is necessary to explain the root causes of higher premature mortality and use of primary and preventive health services.

Key messages

• Higher use of hospital treatments was caused by higher morbidity. It is necessary to explore the leading causes of hospital treatments and premature mortality.

• It is necessary to explore the use of primary health care service, preventive service and level of health literacy of inhabitants of Roma settlements.
Conversation circles – an inventive way to talk about and address migratory related mental health
Authors: Al-Adhami M , Wångdahl J , Tomsfelt C , Carlzén K , Svensson P
Published: October 2024

Refugees in European countries face psychological stressors stemming from pre-, peri- and post-migration experiences. In Sweden, a mental health promotion program for newly settled refugees “Ways Forward - After the escape”, was tried out to mitigate the consequences of negative migratory experiences. The program included training of course leaders and implementation of conversation circles for participants, i.e., short in-depth courses for smaller groups led by a trained leader. The objective of the program was to equip civic communicators working within the Introduction program for refugees with the necessary skills to lead conversation circles on mental health in cities in the south of Sweden. During 2020-2023, 43 course leaders were trained and 55 refugees participated in conversation circles. The course leader training included 50 hours of training on themes of the program “Ways Forward”; health and well-being, loss and identity, grief and forgiveness, reconciliation and acceptance, stress and stress management, trauma and trauma-conscious care. The conversation circles for participants were given in 3-hour modules x 10 occasions.

1. How did the course leaser perceive the utility of the training for their work with the target group? 2. In what ways has the intervention assisted the participants in navigating their mental and well-being in Sweden? The results showed that course leaders acquired new knowledge and practical skills and tools to lead reflective conversations about mental health related to migration. Participants reported a higher awareness of mental health issues, less stigma, trying out new coping techniques and increased motivation to seek help. Short training courses for civic communicators on migratory mental health increased knowledge and gave new skills and tools to lead conversation circles. Newly settled refugees reported higher awareness, new tools and less stigma to talk about mental health following participation in conversation circles.

Key messages

• Short training courses on mental health related to migration increased knowledge and gave new skills and tools to lead conversation circles.

• Newly settled refugees reported higher awareness, new tools and less stigma to talk about mental health following participation in conversation circles.
Experiences of discrimination in Finnish healthcare services
Authors: Klemettilä K-L , García Velázquez R , Skogberg N , Castaneda A E , Eid M , Kuusio H
Published: October 2024

Background

It has been found that foreign-born people report more discrimination than the general population. This study examines experiences of discrimination in Finnish healthcare, with a focus on individuals with a foreign background.

Methods

Two nationally representative cross-sectional data sets were used: MoniSuomi (n = 7838; response rate 44.1%) and Healthy Finland Surveys (n = 28154; response rate 46.3%). The outcome variable, experiences of discrimination, was predicted by means of stepwise logistic regression models covering (1) socioeconomic factors, (2) factors related to healthcare service need and use, and (3) migration-related factors.

Results

In healthcare services, migrants experienced discrimination more than twice as frequently as the general population (8.9% versus 3.6%, 95% CI = 8.0-9.8, 3.2-4.1). According to regression models, relevant factors were insufficient income, being female, studying as the main occupation and poor mental and physical health. Foreign background was not independently associated with discrimination. However, higher educational attainment, chronic disease, and use of occupational healthcare services increased the likelihood of experiencing discrimination only among those of foreign background and showed the opposite trend for the general population. All migration-related factors increased the risk of discrimination.

Conclusions

The findings underline the need for training on explaining the service system, overcoming language barriers, and working with forced migrants. The occupational healthcare workforce would particularly benefit from these interventions. The results inform the development of professionals’ training.

Key messages

• Migrants experience higher levels of discrimination in healthcare compared to the general population. Multiple factors explain this difference.

• Healthcare professionals require training to better inform patients about the service system, to improve communication and to address the situation of forced migrants.
Child COVID-19 rates and migrant status: A quantitative study in the Lisbon area (Mar 2020-Jun 2022)
Authors: Banha Alves I , Becker Loesch R , Neto Conceição M , Carmezim Pereira S , Carlos Silva A , Oliveira Martins M R
Published: October 2024

Introduction

According to OECD data, immigrant children were over-represented among COVID-19 cases compared to non-immigrant children. However, evidence is missing on whether their migrant status is associated with testing positive for COVID-19. Therefore, we aimed to estimate COVID-19 positivity rates among children residing in five municipalities of the Lisbon metropolitan area, Portugal, and to analyze migrant status as a determinant of health.

Methods

We conducted a prospective cross-sequential cohort study with 989 children born in 2015, 2018, and 2020 (48.5% non-immigrants; 51.5% immigrants). Sociodemographic data were collected through interview-based questionnaires, and the child’s birth weight and gestational age were obtained from the primary health center’s information system (SClinico). COVID-19 test results (conducted between March 2020 and June 2022) were obtained from the national surveillance system (SINAVE Lab) and categorized into two primary outcomes: ever positive for COVID-19 (yes/no) and positivity frequency for COVID-19 (count). Robust and standard Poisson regressions were used to estimate the association between primary outcomes and demographic, socioeconomic, and clinical variables. We estimate relative risks (RR) and prevalence ratios (PR) with 95% confidence intervals.

Results

The positivity rate is lower for immigrant children (12% vs 17%). Compared with non-immigrant, and adjusting for other factors, immigrant children are 52% less likely to be ever positive for COVID-19 (PR = 0.482; IC 95%: 0.392-0.594), and the estimated number of positive tests is 54% lower (RR = 0.456; IC 95%: 0.362-0.574).

Conclusions

Being an immigrant is a protective factor against testing positive for COVID-19, aligning with the well-known immigrant paradox. These results underscore the need for further research into the immunological profiles of this population and are crucial for guiding strategies to manage emerging public health crises.

Key messages

• Immigrant children living in the Lisbon metropolitan area may have a protective factor against testing positive for COVID-19, consistent with the well-known immigrant paradox.

• Understanding COVID-19 positivity rates and associated factors in children is crucial for guiding effective strategies to manage and mitigate emerging public health crises.
Meaning-making of mental health among reception center clients in Finland
Authors: Mankinen K , Nordberg C , Skogberg N
Published: October 2024

Introduction

Asylum seekers and refugees face significant challenges, including high rates of mental health issues, as they navigate unfamiliar societal systems and norms. However, little is known about their subjective experiences of mental health and the mental health support in everyday social encounters. This study aims to explore the meaning-making of mental health and the experiences of receiving mental health support among clients of Finnish reception centers (FRCs).

Methods

Semi-structured individual in-person interviews were conducted with 11 reception center clients from various locations in Finland, with an interpreter present in four interviews. Interviews lasted approximately 60-90 minutes. Thematic analysis was employed to identify recurring themes and subthemes.

Results

Preliminary findings indicate a diversity in the meaning-making of mental health among participants. While some discussed mental health in terms of stress, others approached the topic analytically, while some avoided it altogether. Participants highlighted the importance of access to external resources, such as schools, language courses, and employment, for enhancing overall well-being. Trust in FRC staff emerged as a crucial factor in seeking and receiving assistance for mental health concerns. Additionally, participants exhibited resilience, suggesting benefits of empowering them during this challenging period.

Conclusions

Adopting a holistic approach to mental health care within FRCs is imperative. Understanding how clients construct meaning around mental health is particularly relevant for training FRC staff, who serve as primary points of contact for asylum seekers and refugees in Finland. Moreover, amplifying the voices of reception center clients can contribute to improving services and enhancing the health and well-being of this population in Finland.

Key messages

• It is necessary to adopt a holistic approach to mental health care within reception centers, one that addresses broader social determinants of mental health.

• Trust in the staff of Finnish reception centers is a critical factor in facilitating the seeking and receiving of assistance for mental health concerns among asylum seekers and refugees.
Long COVID Prevalence and Factors Among ethnically Diverse UK Healthcare Workers
Authors: Al-Oraibi A , Martin CAA , Woolf K , Bryant L , Nellums L B , Tarrant C , Khunti K , Pareek M
Published: October 2024

Background

Long COVID (LC), characterised by persistent symptoms post-acute COVID-19 infection, presents a growing public health concern. Data on prevalence among healthcare workers (HCWs) are lacking. Our study aimed to establish the proportion of UK HCWs with symptoms lasting beyond five weeks and identify factors associated with LC in a diverse cohort.

Methods

We conducted a cross-sectional analysis from December 2020 to March 2021. The main outcome was LC in relation to self-reported ethnicity. Univariable and multivariable logistic regression identified associations. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated with 95% confidence intervals (95%CIs). The multivariate analysis adjusted for demographic information, job role, household factors, health status, and existing long-term conditions. Missing data were imputed via chained equations.

Results

From 11,513 HCWs, 2,331 (20.2%) reported COVID-19, with 525 (22.5%) experiencing LC. 80.0% of those reporting LC were female, compared to 74.3% without LC were female. Participants with LC (median age 46 [IQR 36-54)]) were slightly older than those without LC (median age 41 [IQR 31-52]). In multivariable analyses of those who reported having had COVID-19, HCWs in nursing/midwifery roles (aOR 1.76, 95% CI 1.26-2.46, p = 0.001) and allied health professions (aOR 1.42, 95% CI 1.05-1.93, p = 0.023) had higher odds of reporting LC compared to those in medical roles. Significant associations were also found with self-reported depression, anxiety, and asthma. There was no significant association between ethnicity and experiencing LC.

Conclusions

In this large ethnically diverse cohort study, there is a substantial burden of LC among UK HCWs. Further research and collaborative efforts are urgently needed to address these factors effectively, develop targeted public health interventions, and understand the temporal and longitudinal dynamics of the condition.

Key messages

• One in five UK healthcare workers reported long COVID, indicating critical needs for targeted public health interventions.

• Our study highlights urgent public health responses to address long COVID among healthcare professionals.
From crisis to chronic: a comparative analysis of Long COVID impact in Italy and the United States
Authors: Nurchis M C , Heidar Alizadeh A , Garlasco J , Mhmoued Abdo Elhadidy H Safwat , Raspolini G M , Gianino M M , Damiani G
Published: October 2024

Background

The aftermath of COVID-19 is bringing about socio-economic consequences, such as diminished quality of life (QoL), decreased productivity, and considerable healthcare expenditures. Despite the emerging acknowledgment of a clinical syndrome following COVID-19 disease, known as Long COVID (LC), notable research gaps persist. This study aims to assess the epidemiological and economic impact of LC in both Italy and the United States (US).

Methods

This ecological analysis comprises epidemiologic and economic data from 2020 to January 2023, regarding working-age individuals (18-64 years). An Italy/US incidence rate ratio (eIRR) was estimated to compute LC cases in each country. The product between the value of a year spent in good health, individual Quality-Adjusted Life Year (QALY) loss, and LC cases yielded total lost QoL. Temporary productivity loss (TPL) was calculated through the Human Capital Approach. All estimates were deemed significant at a p-value less than 0.05.

Results

Up to date, the eIRR was 0.78 [0.43 - 0.91] implying 22% fewer LC cases in Italy with respect to the US. Total LC cases were 11 [8.7 - 13.5] and 1.8 [0.9 - 2.1] million in the US and Italy, respectively. The relative QALYs loss was 1.5 [0.8 - 3.1] and 0.2 [0.1 - 0.9] million. Reduced QoL cost roughly $189 [164 - 214] billion in the US and €6 [1 - 11] billion in Italy. TPL amounted to $37 [21 - 57] billion in the US and €2.8 [1.2 - 7.4] billion in Italy. Americans aged 30-39 years showed the largest income loss (26.6%), while in Italy it occurred in the age group 50-64 years (38%).

Conclusions

LC places a substantial burden in Italy and the US, impacting both the productivity of the working-age population and influencing the younger generation, who constitute the future workforce. Our study underpins the necessity for comprehensive health policies, programs, and interventions alongside effective tertiary prevention strategies to tackle the challenges posed by LC.

Key messages

• According to this analysis, both countries show significant productivity and quality-adjusted life years loss due to LC among working age individuals.

• Steering the formulation of evidence-based sounding health policies to address LC burden, among working age individuals, both in Italy and in the US.
Health Impacts of Disasters and Social Indicators: An Ecological Study
Authors: Özden M , Paksoy Erbaydar N
Published: October 2024

The objective of this study is to investigate the correlation between certain social indicators and the mortality and morbidity in disasters recorded in the EM-DAT database within countries in the last decade. The correlation between the mortality and morbidity in disasters recorded in the EM-DAT database between March 1, 2014-2024 and the most recent data on Human Development Index (HDI), Gender Inequality Index (GII), Gini Coefficient (GC), Government Health Expenditure as a share of GDP (GHE/GDP) and Corruption Perception Index (CPI) were analyzed. During the period of the study, disasters from a total of 207 countries/regions were recorded in the database. The median (IQR) values of countries in disasters were found to be 35.1 (67.5) for death per million and 76.3 (783.0) for injury per million. The most frequent types of disasters, the most frequent cause of mortality and the most frequent cause of injury in each country were found to be floods, extreme temperatures, and epidemics, respectively. While there was no significant difference between the social indicators analyzed and the total number of deaths, there was a negative correlation between the number of injuries and the HDI, CPI, GHE/GDP values of the countries, and a positive correlation between the GC and GII values (for all tests, Spearman correlation test, p < 0.001). The correlation coefficient was interpreted as ‘weak’ in all other pairwise analyses except for the GHE/GDP value (moderate). Countries with social indicators closer to the positive threshold have been found to have less injuries in disasters. The possible reason for the insignificant correlation with the mortality is thought to be the difficulties in detecting mortality, especially in ‘extreme temperatures’, and the fact that it is mostly recorded in countries where social indicators are relatively more advanced. More research is needed to investigate the relationality between social indicators and disaster harms.

Key messages

• Disasters are critical mediators between social determinants and health. Addressing and reducing inequalities should remain on the public health agenda to prevent disasters and protect health.

• Analysis of disasters shows that ‘extreme temperatures’, which cause the most deaths in some countries, are barely detected in developing countries. Disaster recording systems need to be strengthened.
Non-medical use of tranquilizers and sedatives by 15-16-year-old adolescents in Estonia, 2003–2019
Authors: Veskimäe L , Vorobjov S , Pärna K
Published: October 2024

Background

Non-medical use of prescription drugs has become a global concern in recent decades. This study aimed to explore trends in non-medical tranquilizers and sedatives use (NTSU) among adolescents in Estonia from 2003 to 2019.

Methods

Utilizing data from the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 2003-2019, study included 15-16-year-old Estonian schoolchildren (n = 11,328; 48.6% boys). Cochran-Armitage test was employed to assess changes in NTSU trends, with statistical significance set at p < 0.05. Prevalence rates and 95% CIs used as outcome measures.

Results

From 2003 to 2019, the lifetime prevalence of NTSU significantly increased for both genders, with girls consistently showing higher rates. Among boys, NTSU rose from 5.0% (95% CI 3.8-6.5) to 11.3% (95% CI 9.6-13.3), particularly among those reporting NTSU 1-2 times, from 3.0% (95% CI 2.1-4.2) to 8.2% (95% CI 6.7-9.9), p < 0.001. Similarly, for girls, NTSU rose from 12.6% (95% CI 10.7-14.7) to 17.5% (95% CI 15.4-19.7), p < 0.001. There was an increase among girls reporting NTSU 1-2 times from 7.5% (95% CI 6.0-9.2) to 10.6% (95% CI 9.0-12.4), p < 0.001, and those reporting NTSU three or more times, from 5.1% (95% CI 3.9-6.6) to 6.9% (95% CI 5.6-8.4), p = 0.017. Among boys reporting medical tranquilizers and sedatives use (MTSU), NTSU rose from 21.1% (95% CI 13.9 to 30.0) in 2003 to 41.4% (95% CI 32.3 to 50.9) in 2019, p = 0.006. However, there was no statistically significant change in NTSU among girls reporting MTSU, remaining at 44.1% (95% CI 36.0 to 52.4) in 2019, p = 0.951.

Conclusions

Study reveals a significant increase in lifetime NTSU from 2003 to 2019, with girls consistently showing higher prevalence. Targeted interventions are needed to address adolescent non-medical prescription drug use, particularly among girls. Moreover, substantial NTSU among those reporting MTSU highlights the need to monitor and address non-medical usage in this subgroup.

Key messages

• Estonian adolescent non-medical tranquilizers and sedatives use surged from 2003 to 2019, particularly among girls, highlighting the need for targeted interventions.

• The high prevalence of non-medical tranquilizer and sedative use among those reporting medical tranquilizer and sedative use underscores the necessity for vigilant monitoring.
Characteristics of web-based and paper-based respondents in The Danish Capital Region Health Survey
Authors: Grønkjær M S , Eliasen M H , Elsborg P , Andreasen A H
Published: October 2024

Background and aim

This study aims to investigate the potential impact of adopting web-only surveys on the representativeness of survey participants by examining the sociodemographic characteristics of participants in the Danish Capital Region Health Survey (DCRHS) who respond online versus those who respond using a paper-based questionnaire.

Methods

The study utilizes data from the DCRHS including participants invited by a mixed-mode approach and given the choice to respond to a web-based or paper-based questionnaire in 2021 (N = 53,874) and 2017 (N = 51,902). Information on age and sex was obtained from national registers.

Results

The proportion of paper respondents decreased significantly from 18% in 2017 to 16% in 2021. In both years, women had higher odds of responding on paper compared with men (OR = 1.20; 95% CI: 1.16-1.24). In 2017, the highest prevalence of paper respondents was observed among participants aged ≥80 (29%) and 16-24 years (21%). In 2021, the highest prevalence was likewise observed among participants aged ≥80 (28%) but with the second highest among the 65-79 years age group (17%). The decrease in paper responses from 2017 to 2021 varied across age groups, with a greater decrease among younger participants than among older participants.

Conclusions

This study highlights the potential risk of excluding a significant proportion of elderly citizens from large population surveys if the web-based response option is the only option provided. Elderly individuals are less likely than younger individuals to switch to digital responses, emphasizing the importance of considering alternative modes of data collection to ensure representativeness in survey samples.

Key messages

• The use of web-only surveys has increased; however, we risk excluding a significant proportion of elderly citizens from large population surveys if only the web-based response option is provided.

• Elderly individuals are less likely to switch to digital responses, emphasizing the importance of considering alternative modes of data collection to ensure representativeness in survey samples.
4.F. Scientific session: Progress in assessing climate change risks to health and implementation in UK and Europe
Authors:   Organised by: NIHR Health Protection Research Unit in Environmental Change and Health (UK), EUPHA-ENV,   Chair persons: Marija Jevtic (EUPHA-ENV), Grace Turner (UK)
Published: October 2024

Climate change poses one of the greatest threats to health security. Climate change is increasing the frequency and intensity of environmental health threats like flooding and heatwaves and is creating conditions which heighten the risks from infectious diseases. Whilst everyone will be at some risk from adverse health impacts from climate change, the impacts will vary at individual level and the most disadvantaged both here in the UK and around the world will be disproportionately affected. Many of the anticipated adverse health impacts of climate change in the UK are still avoidable through mitigation and adaptation and that there are other benefits to health to be gained, therefore rapid action is critical to avoid the most severe potential scenarios. The Health Protection Research Unit in Environmental Change and Health, funded by the National Institute of Health Research, provides multi-disciplinary research to support decision-making relating to the impacts and responses to environmental changes that affect human health and well-being in the UK and beyond. In this workshop we present the results of recent research on the progress in assessing climate change risk factors on health in the UK and review the evidence on implementation of mitigation and adaptation measures in Europe. The workshop aims to support evidence translation for climate action that prioritises health protection and equity. The workshop will include presentations on reviewing risk assessment methods for quantifying health impacts across Europe as well as analysing the effects of fuel poverty on cold-related mortality. We present results from an analysis of primary care data to identify individual level characteristics associated with increased risk of mortality during heatwaves. Furthermore, we review national food-based dietary guidelines across Europe and South America to determine how environmental sustainability is being integrated to benefit health. The workshop will comprise 4 -5 oral presentations and we will then open the floor to have a wider facilitated discussion about what are the evidence needs for UK and European policy to further address climate risks to health.

Key messages

• The progress in assessment and understanding of risks from climate change on health is improving.

• The health risks we face from climate change will not be distributed equally across the UK and Europe.
Hand grip strength in older and very old people: Results of the study Gesundheit 65+
Authors: Fuchs J , Gaertner B
Published: October 2024

Background

Functional capacity decreases with increasing age. Hand grip strength (HGS) is considered as an objective general measure of health and a parameter of muscle strength, a component of functional capacity and is part of the evaluation of frailty. HGS is important for many everyday functions, such as holding heavy objects or supporting oneself to prevent a fall. Low HGS is associated with a higher mortality risk. In our study we describe HGS in people aged 66 to 101 years in Germany and identify groups with low HGS.

Methods

Gesundheit 65+ is a longitudinal epidemiologic study of the health status of persons 65 years and older in Germany by the Robert Koch Institute. In 2022/23, one year after baseline, isometric HGS was measured during the examination part of the study using a hand-held dynamometer (Smedley, Scandidact, Denmark, 100 kg). Two values were recorded for each hand. Maximum HGS from all attempts was used for analyses. Weighted prevalence estimates and 95% confidence interval (CI) for grip strength are reported by sex, age-group, height, self-rated health, chronic conditions, and difficulties in activities of daily living (ADL).

Results

HGS was measured in 1,457 persons aged 66 to 101 (48% women). Mean maximum HGS was 28.8 kg (CI 28.4-29.3). HGS was significantly related to sex (men: 35.4 kg, CI 34.8-36.0, women 21.8 kg, CI 21.4-22.2) and age (66-79: 31.0 kg, CI 30.1-31.9, 80+: 23.9 kg, CI 23.0-24.7). In both sexes, shorter persons and persons with bad self-rated health, chronic conditions or difficulties in ADL showed lower HGS than their reference group.

Conclusions

HGS was reduced in very old people, people with support needs, and people with poor health or chronic diseases, identifying these people as important risk groups for preventive measures. These should aim to improve not only endurance but also strength in older and very old people. In the long term, this could also maintain independence and reduce serious injuries from falls.

Key messages

• We found sex and age-related differences in hand grip strength in older people in Germany.

• Based on the results, planning of prevention and intervention could be enhanced.
Significant pre-post effects on a patient-reported outcome measure in inpatient rehabilitation
Authors: Marquardt M , Utsch M , Zembic A , Basedow F , Garuffi G , Tobler S
Published: October 2024

Background

We conducted a pilot study for the Swiss National Association for Quality Development in Hospitals and Clinics (ANQ) in the inpatient rehabilitation setting. The aim was to assess the suitability of a generic health-related quality of life patient-reported outcome measure (PROM) as an outcome quality indicator for public reporting across all rehabilitation domains on a national level.

Methods

In a multi-stage expert-based selection process, the PROMIS Global Health 10 was selected for piloting. We collected data from 29 rehabilitation clinics from April to December 2023. Mean T-scores and effect sizes were analysed across different rehabilitation domains. Patients’ need for assistance in completing the questionnaire was also assessed.

Results

A dataset of 2261 cases yielded a cleaned sample of 2083, with 1217 complete cases. Mean T-scores for physical health (PHS) and mental health (MHS) significantly differed (p < 0.001) at admission and discharge across all rehabilitation domains. The largest effects were observed in PHS for pulmonary (38.9(7.3); 46.0(7.6); dz = 0.95) and cardiologic rehabilitation (41.7(7.4); 47.9(7.2); dz = 0.85), and in MHS for internal medicine (44.1(6.9); 49.1(5.6); dz = 0.80) and psychosomatic rehabilitation (36.0(7.2); 45.2(8.2); dz = 1.19), while the smallest effects were noted in PHS for paraplegia (36.3(7.2); 39.8(7.2); dz = 0.50) and in MHS for the musculoskeletal rehabilitation domain (46.2(7.9); 48.7(7.4); dz = 0.33). Of all complete cases, 40.5% needed assistance in filling in the PROM and support needs were distributed unequally across rehabilitation domains, ranging from 10.0% in psychosomatic to 70.3% in geriatric rehabilitation.

Conclusions

The study presents a nuanced understanding of HRQOL across various rehabilitation domains, with notable effects observed across all domains, alongside significant assistance needs.

Key messages

• PROMIS-GH10 shows significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation, with notable effects observed across all domains.

• Observable barriers in implementation are evident due to substantial assistance requirements.
Monthly Tracking of Infant Mortality in Portugal: Post-COVID Trends
Authors: Nogueira P , Elias C , Camarinha C , de-Araújo-Nobre M , Bacelar-Nicolau L , Furtado C , Oliveira M M , Costa A S
Published: October 2024

Background

The Infant Mortality Rate (IMR) is a fundamental health indicator that reflects the overall well-being of populations. Recognizing the need for more timely data to inform public health strategies, the authors have presented a novel method for monitoring IMR monthly instead of traditional annual reporting. Our work aims to increase further the robustness of a novel method for monitoring IMR monthly.

Methods

This new approach leverages the Portuguese E-Death Certification System (SICO) and Statistics Portugal (2016-2024) data. It provides the most recent insights into IMR trends in Portugal, highlighting the post-pandemic period. This method allows for the analysis of cumulative deaths under one year of age against live births over the previous 12 months, offering a more responsive metric to guide interventions.

Results

The updated analysis reveals a continued pattern influenced by the dynamic public health landscape of the COVID-19 pandemic, including the phasing out of restrictions and the end of mandatory mask usage. The pandemic has significantly impacted IMR trends, with Portugal experiencing a decline in IMR during the stringent phases, reaching historically low levels. This trend slightly reversed following the lifting of restrictions, underscoring the urgent need for understanding the complex interplay between public health policies and infant mortality. In the post-pandemic period, the IMR increased until October 2023, showing a later (up to February 2024) global decreasing trend within the range of 2.5 and 2.9 deaths per 1000 live births.

Conclusions

Recent updates confirm the effectiveness of real-time IMR monitoring as a vital tool for policymakers and health professionals. Portugal’s experience underscores the importance of real-time health indicators in managing public health crises. It stresses the need for further research to understand factors affecting IMR and to continue reducing infant mortality.

Key messages

• COVID-19 restrictions correlated with a historical low in Portugal’s IMR, showcasing the impact of stringent public health measures.

• Post-lockdown, the rise in IMR after the phasing out COVID-19 restrictions and later stabilization underscores the challenges and the necessity for dynamic health policies.
Health behaviour and well-being in the Faroe Islands prior to and during the first COVID-19 lockdown
Authors: Honnudóttir V , Veyhe A S , Mohr M , Mohr M , Strøm M
Published: October 2024

Detrimental effects on health and well-being were reported during the COVID-19-induced lockdown periods in several countries, but these associations have not been studied in small-scale island societies. This study aimed to examine the lockdown period’s impact on health behaviour, social media use and measures of well-being in the Faroe Islands. We used cross-sectional data from two extensive population-based surveys of public health conducted in November 2019, the pre-COVID survey (n = 2906), and 4-6 weeks into the first national lockdown, the lockdown survey (n = 1204). A larger proportion of participants in the lockdown vs. pre-COVID survey people reported high physical activity levels (42.1 vs 30.7% p < 0.001), while nutritional habits were rated worse and social media usage increased. Furthermore, the proportion displaying excellent/very good self-rated health was larger in the lockdown vs. pre-COVID survey (68.1 vs 62.0% p < 0.001), and the same pattern was observed for reporting good quality of life (85.7 vs 82.7% p < 0.05). These associations remained statistically significant in a logistic regression model after adjusting for characteristics for which varying impact of the pandemic has been shown. Indicators of health behaviour showed that larger proportions of participants kept active during the lockdown vs pre-COVID survey, and these differences were statistically significant for physical, mental, and spiritual activities (p < 0.001). On the other hand, similar stress levels in the pre-COVID/lockdown periods were observed, but stratified analysis showed that participants with a high-stress level displayed better self-rated health in the lockdown period compared to the pre-COVID period (p = 0.001).

Conclusions

Findings indicate that self-reported health and quality of life improved during the early phase of the COVID lockdown, and individuals reported higher activity levels associated with good mental health during the COVID-19-induced lockdown period.

Key messages

• Physical activity improved, but dietary habits worsened during initial COVID-19 lockdown in the Faroe Islands.

• Measures of wellbeing and quality of life improved during initial COVID-19 lockdown in the Faroe Islands, while there was no overall difference regarding stress levels.