bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating cost of illness for kindergarten children with contagious diseases in Germany
Authors: Graichen J
Published: October 2021

Child mortality in Europe steadily declined in the last decades. Children, especially in the kindergarten age, however, still suffer from multiple contagious diseases (CD). This is a burden for children and families and causes high costs for society. While studies examine epidemiology and costs for certain diseases, there is no cost estimation including various CD. Thus, the aim of the study is to estimate costs for kindergarten children with common CD in Germany from a societal perspective. Aggregated results should help design and implement preventive measures. Costs are estimated bottom-up. Direct medical costs are derived from resource costs in the healthcare sector as provided by the German Federal Statistical Office (GFSO), census data and epidemiological data as provided by KIGGS (a representative child health study by the German government). Direct non-medical costs are neglected because they are minor, even though substantial for some families. Indirect costs are calculated using the human capital approach. Work absenteeism days of caregivers are based on statutory health insurance data and weighted with gross income figures from the GFSO. Direct costs are estimated to be 1556 (main driver being hospitalization) and indirect costs 125 Euro per child per year. This sums up to 3817 Mio Euro that are spent yearly due to children in the kindergarten age, infected with common CD. The estimation is conservative not only due to used data but also due to other societal factors that are not translated into monetary terms like costs for parents not joining the workforce because their sick child might need a caregiver, or systematic adverse employment decisions due to more frequent absenteeism from work (especially among care-giving women). The presented estimation shows the magnitude of costs caused by CD among children. Further research is needed to detail the estimation, to quantify factors not yet valued in monetary terms and to estimate costs for other countries.

Key messages

Contagious diseases of kindergarten children not only endanger the wellbeing of children and their families but are also a major cost burden for society. Over 1600 Euro of direct and indirect costs occur yearly per child in the kindergarten age due to common contagious diseases, that could possibly be prevented through adequate measures.
Psychosocial protective factors in promoting healthy lifestyles in children and adolescents
Authors: Ouadine G
Published: October 2021

Introduction

Children and adolescents from socially vulnerable families experience social as well as health-related disadvantages at a very early age. Resilience research increasingly focuses on general psychosocial protective factors and their positive role as an effective health resource. In this research, the influence of some selected protective factors on a healthy lifestyle in the target group of secondary school students is shown.

Methods

Using a method of a cluster analysis, a theory-led lifestyle typology was developed based on the variables ‘physical-sport activity' and ‘media consumption patterns'. Four lifestyle clusters were identified: sports-active frequent media users, sports-active low media users, sports-inactive frequent media users und sports-inactive low media users. The study examined how the resilience factor ‘physical fitness' (measured by the 6 min run) as well as personal, family and social protective factors were manifested in the respective clusters.

Results

In the sporty-active clusters, the proportion of children with good physical fitness was high (47%). In the sporty-inactive clusters, however, this proportion was only about 23%. Approximately 71.5% of the children in sporty-active clusters reported good health and health-promoting behavior, while in sporty-inactive clusters this percentage was 49.2%. Trusting and appreciative parent-child relationship and positive sibling ties were mentioned more frequently in sporty-active clusters than in sporty-inactive clusters.

Discussion

Regular exercise and moderate use of media have a positive effect on protective resilience factors. These can be considered as ‘health-enhancing' lifestyle characteristics in health-related behavior. Personal, family and social protective factors interact with physical activity and are effective health resources: physically active children are more resilient to stressful environmental situations.

Key messages

Regular exercise and moderate use of media have a positive effect on protective resilience factors. Protective resilience factors are ‘health-enhancing' lifestyle characteristics in health-related behavior.
Mental disorders, multimorbidity and labor market marginalization among refugee youths in Sweden
Authors: Chen J , Mittendorfer-Rutz E , Klimek P
Published: October 2021

Background

Little is known about how disease co-occurrences with common mental disorders (CMD) associate with social integration in young refugees. We identify diagnostic groups associated with labor market marginalization (LMM) in refugees and Swedish-born with CMD and determine whether multimorbidity is associated with LMM in young refugees and Swedish-born with CMD.

Methods

This longitudinal registry-based study included adults aged 20-25 years followed from 2011-2016 in Sweden. LMM was defined as > 180 days unemployment or being granted disability pension. A multimorbidity score was derived from a network of disease co-occurrences observed in 2009-2011. Relative risks for LMM in refugees with CMD compared to Swedish-born with CMD in 114 diagnostic groups were calculated. Multivariate logistic regression was applied to estimate the odds of LMM by CMD.

Results

Among 249,245 young adults, 2,841 (1.1%) were granted disability pension and 16,323 (6.5%) individuals experienced unemployment, 20,679 (8.3%) suffered from CMD. Most comorbid diagnostic groups were positively associated with unemployment in young refugees with CMD. Inflammatory bowel disease and acute upper respiratory disease showed the highest relative risks of unemployment for young refugees with CMD, compared to Swedish-born with CMD: RRs 6.4[3.2, 12.8], 4.0[2.6, 6.1], respectively. The multimorbidity score was associated with elevated odds for unemployment and granted disability pension in refugees with/without CMD and Swedish-born with/without CMD (OR range: 1.1-1.8; highest for young refugees without CMD).

Conclusions

Specific diagnostic group had differential risks for unemployment for refugees and Swedish-born. Early culturally sensitive public health measures are warranted to target the detrimental consequences of multimorbidity on LMM in young adults.

Key messages

The importance of diagnostic groups for LMM differs for young refugees and Swedish-born with CMD. Multimorbidity increases the risk for LMM, particularly disability pension.
Discrimination between migrants and non-migrants in depression’s management by General Practitioners
Authors: Duveau C , Wets C , Delaruelle K , Lepièce B , Dauvrin M , Ceuterick M , Demaesschalk S , Bracke P , Lorant V
Published: October 2021

Background

In Europe, migrants have a higher prevalence of depression compared to the native population and, more often, they face unmet medical needs, including less frequent referral to mental health services. According to social psychology, general practitioners (GPs) may undertreat migrants due to unconscious stereotypical bias that could lead to and sustain discrimination in primary health care. The central question in this research is whether patients' migration background influences GPs' attitudes and decisions regarding treatment and referral in mental health.

Methods

In 2021, an experimental design was delivered to GPs with two video vignettes staging a depressed native and a Belgo-Moroccan patient, respectively. The randomly assigned vignette was followed by an online questionnaire regarding treatment and referral decisions. We recruited a national sample of Belgian GPs' (n = 700). T-tests and chi-square were used for analyses.

Results

The preliminary results are based on the first 224 respondents. Overall, there was no significant difference in the management of depression between a Belgian patient and a Belgo-Moroccan patient. Nevertheless, severity of symptoms was rated lower in the Belgo-Moroccan as compared to the Belgo-Moroccan (t = 2.37, p = .019).

Conclusions

In summary, these results indicate that general practitioners seem to treat migrants fairly in comparison with non-migrants. However, underestimation of the severity of the symptoms could lead to a different medical decision. This hypothesis will be investigated in the coming months.

Key messages

These findings may help us to further understand the role of general practitioner behaviour in mental health care discrimination. This research shed light on current management of migrants’ mental health by the primary health care providers in Belgium.
Gender medicine: a cross-sectional survey on knowledge and curriculum among Italian medical students
Authors: Cremona A , Bert F , Pompili E , Boietti E , Rousset S , Franzini Tibaldeo E , Tatti R , Siliquini R
Published: October 2021

Introduction

Gender and sex are important predictors of many attitudes and behaviours that have an impact on health and disease. Gender medicine is then a fundamental approach for better quality of care in Europe. Few information is available on Italian medical students and their knowledge about gender medicine. Our study aimed to investigate knowledge about gender medicine in a sample of Italian medical students in order to identify specific knowledge gaps and improve Medicine degree curricula.

Methods

In 2020, an online cross-sectional survey was conducted on 430 medical students of the University of Turin, Italy. Participants filled out a questionnaire consisting of 29 items concerning the areas of knowledge and attitudes regarding gender medicine. Multivariable logistic regression model was performed to explore potential predictors of knowledge among students.

Results

More than 60% of the students knew the correct definition of gender medicine and around 90% of them knew the difference between sex and gender. In total, 58.16% of female students had a good level of knowledge, significantly more than male students (37,5%; p < 0.001); female students also showed a higher mean score compared to male students (respectively 17.96±2.75 vs 16.59±3.20, p < 0.001). Using a multivariate linear regression model, with level of knowledge about gender medicine used as a continuous variable, we found that being female was the only potential predictor of high consideration of gender medicine in patient management.

Conclusions

The results indicate that students have a good knowledge and high regard for gender medicine. Female students seem more aware of the importance of gender medicine and areas of improvement can be identified. Future European physicians must consider gender medicine in order to encourage a patient-tailored approach and to reduce gender gap still existent in current practice.

Key messages

Gender medicine is a fundamental approach to improve quality of care and to reduce gender gap among European patients. Medical students should be more aware and trained about gender and sex differences during clinical practice in order to encourage a patient-tailored medicine.
Primary Health Care during the COVID-19 pandemic: an analysis based on the HSRM
Authors: Kumpunen S , Webb E , Permanand G , Zheleznyakov E , Edwards N , van Ginneken E , Jakob M
Published: October 2021

The COVID-19 pandemic has had a dramatic impact on workload and responsibilities for those working at primary health care (PHC) level in the European region - much of which has gone unnoticed relative to the focus on hospitals. Based on the PHC-relevant data extracted from the HSRM, we describe PHC models of care and the political and system levers that supported them. Three key themes emerged: (1) varied forms of PHC multidisciplinary collaboration were developed to manage the emergency response - supported by the movement of staff to areas requiring support; (2) vulnerable patients were identified and prioritized for medical outreach within PHC, and were supported through financial incentives and complementary action from centralized and local governments that used much broader definitions of vulnerability; and (3) digital solutions for remote triage, medical advice and treatment enhanced the effectiveness of the PHC response and were facilitated through centralized investment in digital technologies. Based on our analysis, we raise opportunities for the future of PHC, namely that multidisciplinary approaches to PHC service delivery are essential to future infectious and non-infectious outbreaks, and the agility and rapid pace of change that took place among PHC providers should continue. PHC providers lacked visibility during the pandemic and should work together to develop a strong voice in all health systems.
Pathways through rehabilitation for traumatic brain injury: preliminary results from an Irish study
Authors: O'Donnell K , Healy A , Staines A , Corrigan C , Burke T , McGettrick G , Waldron B
Published: October 2021

Background

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, little data exists on the number of TBI survivors or the availability of brain injury rehabilitation services. To address this, we examined nationally representative data to estimate the number of moderate to severe TBI survivors and to learn of their rehabilitation experiences.

Methods

A two-year mixed-methods, observational, cohort study was used to investigate the rehabilitation pathways of moderate to severe TBI survivors (N = 120). Participants were surveyed on two occasions six months apart using a range of standardised instruments (EQ-5D-3L, WHOQOL BREF and EBIQ). Preliminary findings from first surveys are reported.

Results

Fifty percent of participants reported having received some rehabilitation during their initial hospitalization. Following discharge, inpatient rehabilitation was recommended in 55.8% of cases (N = 67); 62.5% (N = 75) in an outpatient setting and 52.1% (N = 62) in a specialised brain injury community-based setting. Rehabilitation was not recommended in 9.2% (N = 11) of cases. Univariant analyses showed statistically significant differences between the experiences of males (N = 87) and females (N = 33) in three main elements; Isolation: males (M), mean 1.88, SD .488, females (F) mean 1.64, SD .476, (p = .015); Communication: M mean 1.85, SD .565, F mean 1.57, SD .469 (p = .012); Cognitive difficulties: M mean 1.81, SD .456, F mean 1.59, SD .426 (p = .020).

Discussion

Referrals to rehabilitation services varied substantially in this cohort of TBI survivors with evidence to suggest that, overall, males experience greater impacts on quality of life than do females. These findings support the need to, a) increase political priority and resource allocation for rehabilitation services for TBI survivors in Ireland and b) further study gender differences in TBI survivor outcome.

Key messages

Survivors of moderate to severe brain injury in Ireland have very divergent, and often inadequate experiences of rehabilitation. There is some evidence that male survivors of moderate to severe traumatic brain injury face more challenges than do female survivors.
Association between obesity and life courses in young adulthood. Results from the KiGGS cohort study
Authors: Rattay P , Schienkiewitz A , Vogelgesang F
Published: October 2021

In the last decades, young adulthood has established as an independent phase of life with important biographical transitions impacting further life course and health. In turn, health in adolescence can also affect the transitions into young adulthood. So far, for Germany there are no analyses on the association between family-related and employment-related biographies and obesity in young adults. The analysis is based on data from the KiGGS cohort study on 3,100 participants aged 23-31 at second follow-up (t2). Using BMI measurements at t0 (2003-2006) and at t2 (2014-2017), obesity groups were formed (no obesity, incidence, remission, persistence). Sequence analysis was used to retrospectively determine family-related and education/employment-related individual trajectories. Differences in life courses between obesity groups were calculated using discrepancy tests. Young adults with incident obesity were more likely to have children or to be a single parent than young adults without obesity at t2. Young adults with obesity at t0 lived longer in the parental home than those without obesity. Young adults with incident or persistent obesity were less likely to attend university and had experienced longer periods of unemployment than those without obesity at t0 and t2. The employment sequences of those without obesity at t2 were not statistically different. Both family and employment biographies were associated with obesity trajectories in young people. However, based on the analysis, it cannot be clarified whether early parenthood led to obesity or early transitions into parenthood led to interruptions in education or employment and subsequently to obesity. The finding that young adults with obesity were less likely to attend university and more likely to be unemployed could be related to disadvantages or discrimination in school, education or work. Obesity in adolescence that did not persist into young adulthood had less adverse effects on education and employment.

Key messages

Young people’s obesity trajectories were linked to different family/employment biographies. The life courses of young adults with obesity were more often marked by early parenthood and unemployment.
10.K. Workshop: How to upscale in capacity in different aspects of preparedness and response
Authors:   Organised by: RIVM (Netherlands),   Chair persons: Bettie Voordouw (Netherlands), Michael Edelstein (EUPHA-IDC)
Published: October 2021

The magnitude of the COVID-19 pandemic has revealed that the international community was not ready for a public health emergency of this scale. Countries around the world with varying demographic and economic situations struggle to deal with the number of SARS-CoV-2 infections and hospitalisations. There has been a scramble for all types of resources, ranging from personal protective equipment, to testing capacity, to vaccines. During this workshop, we will present scientific research which focuses on how European countries have attempted to deal with these capacity shortages in the period of the first SARS-CoV-2 pandemic wave in European countries as well as the subsequent period. Each presentation will focus on a specific capacity or domain of the COVID-19 pandemic. Yet, they will also all provide information on what went well and what did not go well in the attempt to increase capacity. The objective of the workshop is twofold. Firstly, it is to provide the audience with scientific research which aims to have a better understanding of both the capacity issues which have been identified in the beginning of the COVID-19 pandemic, as well as the (potential) solutions to increase capacity during inter-pandemic times and future pandemics. Secondly, it is to provide the opportunity for audience to discuss about the findings and interact with the authors.

The structure of the workshop will be as follows: The session starts with two thought-provoking statements related to the first two presentations. The audience will be given the opportunity to react to these thoughts using a voting tool and via the chat. This will prime the audience for the upcoming presentations and invite them to participate interactively during the workshop. In the next 15 minutes, the first two presentations will take place. The presenters will end once again with the aforementioned statements. The audience will be given the opportunity to react by asking clarifying questions, respond to, or challenge the statements. After this discussion ends, the same process will take place for the next two presentations.

Key messages

During preparedness, more attention should be paid to the estimated capacity needs during response. The mobilization of existing resource capacity, and of mechanisms to upscale capacity when shortages are likely to occur, require more structured approaches.
Online respondent-driven detection for enhanced contact tracing of COVID-19
Authors: Helms Y
Published: October 2021

Background

Contact tracing (CT) is a core intervention in the global COVID-19 response, but it is a laborious task for the public health professionals (PHPs) who execute CT. In many countries, the workload associated with CT of COVID-19 exceeded available resources for CT. Online respondent-driven detection (RDD) is an innovative method for case finding that can enhance CT efficiency, through active involvement of index cases and contacts in the execution of CT. This can accelerate CT and decrease PHPs' workload. However, it is unclear if and why (not) PHPs want to apply RDD for CT of COVID-19 and what they need to this purpose.

Methods

This mixed methods study is undertaken in the Netherlands and Germany. We developed an interview guide based on the ‘reasoned action approach' to elicit factors that influence PHPs' intention to apply RDD for CT of COVID-19 and their needs. We conducted 17 semi-structured interviews with Dutch PHPs - and will conduct 6-10 interviews with German PHPs involved in CT of COVID-19. Based on the interviews, an online questionnaire is developed to validate the qualitative findings in a larger population of PHPs.

Preliminary results

Dutch PHPs believe that RDD facilitates autonomous participation of index cases and contacts and, conversely, less control of PHPs in CT. PHPs anticipated that this could impact the quality and efficiency of CT, and the delivery of - and compliance with - control measures. Several factors, e.g. the available CT-capacity and the anticipated skills and willingness of index cases and contacts to participate in RDD, influenced PHPs' intention to apply RDD for CT of COVID-19. PHPs expressed a need to retain opportunities to support and guide index cases and contacts in CT and to maintain oversight over the CT-process.

Conclusions

RDD can support PHPs and enhance CT during the ongoing COVID-19 pandemic and future large scale outbreaks of infectious diseases. In order to be properly applied, PHPs' needs should be addressed.
10.L. Workshop: City-level action to promote public health
Authors:   Organised by: Vital Strategies,   Chair persons: Sumi Mehta (USA), Sylviane Ratte (France)
Published: October 2021

With over 50% of the world's population living in cities, urban action on health is a foremost global priority. This workshop will highlight the essential role city governments play in developing and implementing policies and practices to prevent noncommunicable diseases (NCDs) and injuries. Although traditionally perceived as the domain of national governments, actions to protect citizens from risk factors- including air quality, speeding and unsafe road conditions- that cause NCDs and injuries are readily being adopted and implemented by cities. This is due to both the magnitude of the chronic disease and injury burden and the subsequent need for immediate action, and the proximity local governments have to directly changing environments to improve health outcomes. The World Health Organization's (WHO) European Healthy Cities Network has long supported cities in the region in their efforts to put health at the centre of their social, political and economic agendas. This work has been formative in drawing attention to the role of cities. The presentations in this panel will provide specific practice examples of the principles upheld by that network. The workshop will present a diverse set of case studies illuminating city responses to NCDs and injuries, including during the COVID-19 pandemic. By doing so, the discussion will demonstrate the value of what empowered, committed and well-resourced local governments - specifically Health and Transportation Departments - can do to reduce death and disability in urban settings. Showcasing these examples will also provide workshop participants with practical examples of how policy and practice are translated from the global and national to the local level in a variety of geographical settings, and the different ways in which context has been taken into account during implementation. The result will be an exchange of good practices that will hopefully spur other cities and relevant stakeholders to pursue similar interventions in their own municipalities.

Key messages

City-level action can effectively address leading risk factors to health. Exchanging learnings from city experiences can lead to replication and adaptation in other cities.
Competences in Health Network Management (Com.HeNet)
Authors: Behrens Y , Cassens C
Published: October 2021

Background

Health regions are geographically defined clusters that serve to coordinate health and social care for the population. For this purpose, networks are formed consisting of actors from the health care sector and its environment. These networks exist in various stages in a few European countries, e.g. in Germany and Austria. In order to improve health care in Europe, the Com.HeNet project aims to provide training in the management of health regions with a European standard.

Com.HeNet: The Erasmus+ project Competences in Health Network Management aims to develop curriculum modules for the training of regional health network managers. The modules should correspond to the European standard. By completing the modules, health professionals should be able to implement and manage a health network at regional level. The required competences for the management of health regions were collected in the international consortium in six European countries and transferred into a European core competence profile. This serves as a basis for the development of the teaching modules. In addition, the requirements for a data system are identified and described.

Presentation

The presentation Competences in Health Network Management introduces the project Com.HeNet. The structure and process of the project will be explained. Potentials for further European developments will be discussed. The presentation also serves as an introduction to the subsequent lectures.

Main message

European health care management curricula have the potential to improve European health care.
Impacts of local area public sector spending and food purchasing in England: a panel study
Authors: Jenkins RH , Mason KE , Vamos EP , Taylor-Robinson D , Laverty AA
Published: October 2021

Background

The UK adopted austerity policies in 2010, leading to reduced public sector spending. Reductions in local authority (LA) highways and transport expenditure may affect food access, and decreases in LA housing service expenditure may reduce financial resources for many. Impacts of these changes on food purchasing have not yet been investigated.

Methods

We used publicly available data for 324 English LAs between 2008-15. Highways and transport service expenditure and housing service expenditure were the exposures, log transformed to account for diminishing returns. Food purchasing outcomes were fresh fruit and vegetables; foods high in fat, salt, and sugars (HFSS); and takeaways, as a proportion of total food and drink purchases. We used fixed effects linear regression models adjusting for local socio-demographics with robust standard errors. We stratified by Index of Multiple Deprivation and rural/urban area status.

Results

A 10% reduction in highways and transport expenditure was associated with a 0.005 (p = 0.002) percentage point decrease in fruit and vegetable purchases and a 0.006 (p = 0.010) percentage point increase in takeaway purchases, both as a proportion of total food and drink purchasing. Both results were only statistically significant in urban areas when stratified by rural/urban area status. A 10% decrease in housing expenditure was associated with a 0.006 percentage point decrease in HFSS purchasing as a proportion of total food and drink expenditure (p = 0.001).

Conclusions

This is the first time that impacts of reductions in public sector spending on food purchasing have been investigated. Our research highlights that these changes may affect diets of the whole population in addition to existing evidence around impacts on foodbank use. Reductions in public spending may impact food purchasing, suggesting that austerity policies may have impacts on diets and health. Further research at the individual level is needed.

Key messages

To our knowledge, our research is the first time impacts of reductions in public sector spending on food purchases have been investigated. Reductions in local authority highways and transport and housing service expenditure may lead to decreased fruit and vegetables and unhealthy food purchases and increased takeaway purchases.
Healthcare system delay and utilization in tuberculosis patients in Portuguese high-incidence region
Authors: Vales L , Soares P , Nunes C , Lopes S
Published: October 2021

Background

In Portugal, the Tâmega e Sousa region (TeS) has a high incidence of tuberculosis (TB) [27.4 and 43.8 per 100.000 inhabitants in sub-regions Baixo Tâmega (BxT) and Vale do Sousa Sul (VSS), 2017]. Delay in TB diagnosis leads to increased transmission, which may lead to more people infected. This study aimed to describe healthcare system delay among TB patients and healthcare utilization from symptoms onset to diagnosis in TeS.

Methods

We analysed pulmonary TB cases notified in BxT and VSS in 2014-7 in the national surveillance system (SVIG-TB). Concomitantly, we analysed healthcare utilisation from patients in a retrospective study (URBAN-TB) about TB delays in 2019-20. We characterised demographics of patients from each data source and comorbidities from SVIG-TB. We calculated median overall delay until diagnosis (days); and healthcare delay overall and by patient characteristics, for each sub-region. Delay was calculated only when relevant dates were recorded. Healthcare utilisation from symptoms onset to diagnosis was described using the frequency of each first contact provider and the average number of visits until diagnosis.

Results

Included 139 patients from BxT and 206 from VSS (83% male, 53% aged 40-59y, and 17% with silicosis). Global delays were 48 and 75 days (n = 57/132; BxT and VSS). Healthcare delays were 7 and 8 days (n = 76/180; BxT and VSS). In both ACES, healthcare delays were longer for patients aged 60-79y, with COPD and aged 0-19y. Healthcare utilisation analysis included 38 patients (89% male; 55% aged 40-59y; n = 17/21). Primary care (n = 15; 39%) and emergency department (ED) (n = 9; 24%) were frequent points of first contact. The average number of visits until diagnosis was higher for patients from ED (3.9) and lower for patients from TB specialised units (1.3).

Conclusions

Our results suggest that in TeS it is important to avoid ED as a point of first contact of TB patients and to facilitate the diagnosis in young, older and COPD patients.

Key messages

Emergency department is a relevant point of first contact and may be included in efforts to reduce tuberculosis delay. Policies to reduce tuberculosis delay may target younger, older and COPD patients.
Employment gaps of foreign-born women in Finland: an intercategorical intersectionality approach
Authors: Yuksel H , Rask S , Lilja E , Velázquez RG , Kuusio H
Published: October 2021

Background

Previous studies have shown that foreign-born women have multiple disadvantages in the Finnish labor market leading to an employment gap between foreign-born women, foreign born men and the general population. The employment gap negatively affects the lives of many women and their children (e.g. poverty), contributing to disparities in health and wellbeing, as well as underutilization and waste of human capital in the society.

Methods

Using data from the cross-sectional survey on well-being among foreign born population (FinMonik), conducted in Finland 2018, we compared employment outcomes and the prevalence of different barriers to working life across studied population groups, aged 25-64, representing different ethnic backgrounds, genders and education levels. We employed an intercategorical intersectionality approach that uses categories to make visible which differences carry significance and how multiple simultaneous disadvantages intersect to produce inequities in full- and part-time employment outcomes. Analysis weights were applied in the analyses.

Results

Labor market outcomes showed wide variation across genders, ethnic backgrounds and education levels both within and between studied groups. Highly educated Estonian women had the highest rate of full-time employment 73% (95% CI [59.3, 83.1]), while highly educated women from African countries (excl. North Africa) and North Africa and Middle East lagged behind all migrant groups, with full-time employment around 42% and 34 % (95% CI [23.3, 63] and [20.6, 50.2], respectively). Low educated Estonians had the highest full-time employment rate, 69% (95% CI [61.5, 75.8]), exceeding that of general population, 55% (95% CI [53.2, 56.5]).

Conclusions

The results suggest that intersectionality of ethnicity, gender and education level have impacts on labor market participation. The most marginalized groups are disproportionately affected by inequities and exclusionary practices in the Finnish labor market.

Key messages

Distinct employment gaps between population groups demonstrate how multiply disadvantaged groups face multiple barriers in working life. To improve health equity, solutions are needed to remove structural barriers to employment that unfairly disadvantage certain groups of people.
European burden of cancer in 2020 attributable to alcohol use
Authors: Rumgay H , Shield K , Charvat H , Ferrari P , Lemmens V , Rehm J , Soerjomataram I
Published: October 2021

Background

Alcohol use can increase the risk of at least seven different cancer types. We present regional and national estimates of alcohol-attributable cancer burden in 2020 to inform alcohol policy and cancer control in Europe.

Methods

In this population-based study, we calculated population attributable fractions (PAFs) using relative risk estimates and alcohol use prevalence by age, sex, and country. Assuming a 10-year latency period between alcohol consumption and cancer occurrence, we used alcohol consumption prevalence from 2010 and GLOBOCAN 2020 data to estimate new cancer cases attributable to alcohol consumption. We also calculated the contribution of moderate (<20 g alcohol per day), risky (20 to 60 g per day), and heavy (>60 g per day) drinking to the total alcohol-attributable cancer burden.

Results

Within Europe, an estimated 181,000, or 4%, of all new cases of cancer in 2020 were attributable to alcohol consumption. Males represented two thirds (68%) of the total alcohol-attributable cancer cases in Europe. The cancer sites which contributed the most alcohol-attributable cases were cancers of the colorectum (59,000 cases), breast (38,500 cases), and oral cavity (22,000 cases). Among women in the European regions, the burden of alcohol-attributable cancers was highest in Western Europe and Northern Europe; among men, the burden was highest in Central and Eastern Europe. Heavy drinking contributed most to the burden of alcohol-attributable cancers in Europe (52% of alcohol-attributable cases), and risky and moderate drinking contributed 37% and 11%, respectively.

Conclusions

Our findings highlight the need for effective policies to increase awareness of the link between alcohol use and cancer and decrease overall alcohol consumption to reduce this preventable burden of cancer in Europe.

Key messages

An estimated 181,000 cancers in Europe in 2020 were attributable to alcohol use. Effective policies are needed to increase awareness of the link between alcohol and cancer and decrease alcohol use in Europe.
Online-based intervention on LGBTI+ health promotion in Brazil: development and preliminary impacts
Authors: Signorelli M , Polidoro M , Canavese D
Published: October 2021

Background

Brazil reports public healthcare gaps concerning lesbian, gay, bisexual, transgender, and intersex (LGBTI+) people. Massive Open Online Courses (MOOCs) are online-based teaching interventions, however their use is still scarce in Brazil. We aim to describe the development and to analyze preliminary impacts of the first online-based intervention through MOOCs for LGBTI+ health promotion in Brazil.

Methods

We adopted mixed qualitative and quantitative approaches, based on participatory-action research: 1) to design the content and format of the MOOC, we conducted 10 focus groups during 2018 and 2019 with key stakeholders in three different Brazilian State capitals, identifying needs and challenges and linking it with guidelines of the National Policy for Comprehensive Health of LGBTI+ people; 2) based on step 1, we developed the MOOC, producing reading content, video-classes and multimedia; 3) we quantitatively analyzed, through a survey, its impact and reach after six months.

Results

The results showed that: a) focus groups were essentials to inform the priorities to design a tailored MOOC; b) the MOOC had 30 hours of autonomous learning activities divided into two modules, with problem-based evaluation; c) the first ten-month of the course had a total of 5,000 people enrolled with a completion rate of approximately 30%; d) 1,700 successfully completed the course; e) 582 participants joined the survey post-course evaluation and for 370 (63.6%) of them, this was the first training activity on LGBTI+ health.

Conclusions

Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. The MOOC format was successful and reliable in enabling the teaching-learning process.

Key messages

Participatory action research was able to inform the content of the first MOOC for LGBTI+ health in Brazil. The MOCC had high interest, and for the majority of concluding participants it was the first activity and formal education about LGBTI+ health.
Secondary cancer prevention among the youth: research status and policy recommendations for the EU
Authors: Mayer A , Kosir U , Feliu Josna A , Stojanovska M , Mehmetbeyli L , van Egmond S , Miotto E , Rotberga L , Margaryan Y , Chierigo F
Published: October 2021

Background

In early 2021, Europe's Beating Cancer Plan was announced on World Cancer Day. While the European Commission's plan does not include a focus on secondary cancers prevention, the secondary cancers are the sixth most common group of malignanciesThe review aims to 1) synthesize the existing approaches and interventions for cancer prevention in young cancer patients and survivors, 2) deliver evidence-based recommendations for how to best adapt the existing cancer prevention guidelines for young cancer survivors including children, adolescents or young adults (AYA).

Methods

Four major databases (PubMed, Web of Science and PsycINFO, PsycNET) were screened for relevant literature on cancer prevention in childhood and AYA cancer patients and survivors using a combination of terms.

Results

The search yielded 2,712 unique articles from which 32 met the inclusion criteria. Few existing studies focus on AYA or directly address cancer prevention in young survivors. More emphasis is needed on other preventative measures beyond healthy diet and physical exercise.

Conclusions

This review revealed a gap in the translational research in cancer prevention for young people with cancer. The findings emphasize that childhood and AYA cancer patients and survivors need not be overlooked. A pan-European research framework for prevention of second primary cancer among young people is recommended to gain knowledge on how to best adapt the measures against second primary cancers in youth.

Key messages

Developing targeted cancer prevention measures in young cancer survivors may lower the burden of second primary cancers as well as attenuate the fear of recurrence, one of the most prevalent worries. A pan-European research framework for prevention of second primary cancer among young people is recommended to gain knowledge on how to best adapt the measures against second primary cancers in youth.
Trust the directives and physical distancing during three COVID-19 lockdowns in Israel
Authors: Shibli H , Palkin D , Aharonson-Daniel L , Daoud N
Published: October 2021

The emergence of the COVID-19 virus highlighted the importance of public trust in official directives during a pandemic. As part of the measures taken to reduce the spread of the coronavirus, people were asked to maintain physical distancing. Compliance with physical distancing influenced by trust levels which are generally lower in minority groups. The current study aimed to explore the trust level and compliance with the physical distancing relationship among Arab minority and Jewish populations during three lockdowns during the COVID -19 outbreak in Israel. Three cross-sectional online surveys were conducted among a convenience sample of Jews and Arabs adults (≥18 years old) citizens of Israel following the first (April to June 2020), second (October to November 2020), and third lockdown (January to February 2021). The surveys collected demographic data, compliance with physical distancing, and trust level in official sources. In total, 613 (N = 281 Arab, N = 281 Jewish) participants completed the first online survey, 542 (N = 223 Arab, N = 319 Jewish) completed the second survey, and 98 (N = 38 Arab, N = 60 Jewish) completed the third survey. In the three surveys, both populations, Arabs and Jews, reported higher levels of trust in health professionals than in politicians. The level of trust and keeping physical distancing during the three lockdowns were significantly lower among Arab compared to the Jewish participants. However, the association between trust and social distancing was significant only in the first lockdown (OR = 2.02, 95% CI 1.37-2.97) but not in the second and third lockdowns. Trust in official directives is an important determinant of citizens' compliance with physical distancing guidelines during a pandemic. Minority groups have lower trust levels and face more challenges for keeping physical distancing. This should be brought to the policymakers' attention to increase trust and physical distancing among them.

Key messages

Understanding the relationship between trust and compliance and its potential consequences during a pandemic warrant particular attention in the present context of a global pandemic. It is of utmost importance to identify the unique characteristics of sub-populations and minority populations in which there may be additional factors affecting compliance.
SARS-CoV-2 in a long-term care facility: lessons learnt and importance of repeated mass testing
Authors: Kelly C , O'Connell E
Published: October 2021

The COVID-19 pandemic has had a devastating impact on long-term care facilities worldwide. Reflecting on public health management of COVID-19 outbreaks in these settings is crucial to identify lessons learnt and improve outbreak control strategies for the future. A confirmed case of COVID-19 in a private nursing home facility was notified to the Department of Public Health West on December 30th 2020. Immediate actions included case investigation, contact tracing, implementation of infection prevention and control (IPC) measures and mass testing of all residents and staff. On December 31st 2 more confirmed cases were notified. A multidisciplinary outbreak control team was convened. Testing of SARS-CoV-2 samples was via reverse transcription polymerase chain reaction. IPC site visits were made. Seven further mass testing rounds were completed at 5-7-day intervals. Data collation and descriptive analyses were performed using Microsoft Excel. There were 56 laboratory-confirmed COVID-19 cases associated with the outbreak (28 residents, 28 staff). Overall attack rate was 52.8% (66.7% for residents, 44.0% for staff). Over half of all cases (51.7%) were detected from the first and second mass testing rounds (positivity rates 34.2% and 27.8% respectively) in the first week of the outbreak. Mean age of resident cases was 81.5 years. The majority (96.4%) were symptomatic (diarrhoea 64.3%, fever 57.1% and anorexia 25%). Hospitalisation and case fatality rates for residents were 21.4% and 41.4% respectively. Mean age of staff cases was 35.5 years. One-quarter were asymptomatic, with no hospitalisations or deaths. The outbreak was declared over on February 16th 2021. Residents of long-term care facilities are extremely vulnerable to COVID-19. Mass testing is a critically important outbreak control strategy which can facilitate rapid case finding and contact tracing in these settings, minimising the potential for further spread of infection and harm to residents and staff.

Key messages

Residents of long-term care facilities are extremely vulnerable to COVID-19, and may present with atypical clinical symptoms and signs of this disease. A low threshold for testing is required. Mass testing is a crucial COVID-19 outbreak control strategy in long-term care facilities to enable rapid case finding and contact tracing, minimising the potential for further spread of infection.
The effect of COVID-19 epidemic on the incidence of community-acquired pneumonia in the elderly
Authors: Lastrucci V , Bonaccorsi G , Forni S , D'Arienzo S , Bachini L , Paoli S , Lorini C , Gemmi F
Published: October 2021

Background

Since the outbreak of COVID-19 has raged, large-scale measures for prevent disease transmission have been implemented worldwide. If effectively implemented, these measures may have led to a reduction of the spread of other respiratory infectious diseases at community level. The aim of the present study was to evaluate the indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in the elderly during the first epidemic wave of COVID-19 in Tuscany, Italy.

Methods

A population based study was carried out on data from the Tuscany healthcare system. Hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumptions of antibacterials for CAP in people aged 65 years and older were considered as outcome measures. Percentage changes in the outcome measures were calculated considering corresponding periods of the 2020 and 2017-19. 95% confidence intervals and the statistical significance of the percentage changes were calculated using the Poisson model.

Results

A total of 3,346 new CAP hospitalizations occurred in people aged 65 years and older in the whole study time-frame. Significant reductions in the weekly hospitalization rates for CAP were observed starting from the week in which the national containment measures were imposed, this negative deviation continued even after the lift of the national lock-down until the end of the first wave of COVID-19 in July (maximum weekly decrease of 46%). All the antibacterial classes for CAP showed a significant decrease in their outpatient consumptions during the COVID-19 epidemic period.

Conclusions

The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in the elderly during the first wave of COVID-19 pandemic. Furthermore, findings suggests that individual prevention measures that remained mandatory after the lift of the national lock-down also had a relevant role in the reducing CAP incidence.

Key messages

The potential benefits of pandemic containment measures can extend beyond the prevention of COVID-19 to include the reduction of the burden of respiratory infectious diseases Taking into account the indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic.