bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric properties of the Danish version of the European Health Literacy Survey Questionnaire
Authors: Nielsen M G , Svendsen M T , Sørensen K , Grønborg T K , Torp-Pedersen C , Bøggild H
Published: October 2020

Background

Understanding and utilizing health information has become increasingly demanding whereby people's health literacy becomes important. European Health Literacy Survey Questionnaire (HLS-EU-Q16) measures health literacy (HL). We aimed to study the psychometric properties of the Danish version in the general population and a population with coronary artery disease.

Methods

A national, cross-sectional survey of individuals from the general Danish population and patients with Myocardial Infarction (MI) was conducted. The general population sample consisted of 7,653 individuals. The MI sample of 4,440 individuals had previously been hospitalized with MI. To assess the influence of large sample sizes, we examined five randomly drawn subsamples of 500 from each population. The Rasch analysis was conducted using RUMM-2030 consisting of inspection of unidimensionality, local dependency, Differential item Functioning (DIF), and item fit.

Results

The results are preliminary and analyses still ongoing. The HLS-EU-Q16 did not fit the Rasch model, neither for the total sample, subsamples, the general population sample, nor for the MI sample.

For the MI sample, there were signs of local dependence and item 6 had the largest item misfit. DIF was observed for item 6 and 7 (age and gender). The general population sample also showed signs of local dependence, and item 1 indicated the largest item misfit. DIF was observed for item 1 (age) and item 1, 7, 8, 13 and 16 (gender).

Conclusions

The Danish version of HLS-EU-Q16 did not fit the Rasch model neither in the general population sample nor for the MI sample. Our large population-based study indicated scalability problems of the HLS-EU-Q16. The validation procedure is a step on the path to ensure the use of valid measures of HL in both populations and patient groups to support the raising awareness of HL as a necessary element to ensure equity in our health system and thereby initiating an urgent public health activity.

Key messages

We studied the construct validity of the Danish version of the European Health Literacy Survey Questionnaire HLS-EU-Q16 with a Rasch model. Our large population-based study indicate problems with the psychometric properties of the current Danish version of the HLS-EU-Q16.
Exploring associated factors of subjective health literacy in school-aged children
Authors: Freţian A M , Bollweg T M , Okan O , Pinheiro P , Bauer U
Published: October 2020

Background

Health literacy (HL) has been acknowledged as a critical determinant of health. While HL and its potential determinants have been studied in adults, little research has been conducted with children. Therefore, this study investigates factors associated with children's subjective HL to explore potential entry points for the promotion of HL in childhood.

Methods

Cross-sectional data was collected from 4th-graders at German schools with a self-report questionnaire. Age, sex, family affluence, functional HL, self-efficacy, motivation to learn about health, and perceived parental health orientation were included as potential determinants, while the dependent variable subjective HL was assessed with a newly developed scale. We used hierarchical linear regression to explain variance in HL with different sets of predictors.

Results

n = 907 4th-graders (53.4% female) were surveyed. Subjective HL was high, with 82.2% reporting that it was “rather easy” or “very easy” for them to deal with health-related information. Age, sex, home language, and family affluence together were able to explain 2% of variance in subjective HL. In contrast, 19.3% of variance could be explained by all independent variables together, whereby family affluence, functional HL, self-efficacy, motivation, and perceived parental health orientation were significant predictors (p < .01). Motivation was the most potent predictor (β = .24), followed by parental health orientation (β = .18) and self-efficacy (β = .11).

Conclusions

This study was able to identify potential predictors of HL among children. Our data indicate that the promotion of health-related motivation and self-efficacy, but also of certain parental attitudes might be particularly fruitful in order to support the development of HL early in the life course. However, intervention research will need to provide further evidence on the extent to which these factors can be modified and actually lead to increased HL.

Key messages

This study was able to identify potential predictors of children’s HL which might be used to inform interventions. Further longitudinal research is necessary to verify our findings.
Health literacy level among journalists and general population: a cross-sectional survey
Authors: Savatteri A , Gualano M R , Voglino G , Crocetta R , Lo Moro G , Catozzi D , Bert F , Siliquini R
Published: October 2020

Background

Recent studies have shown that low Health Literacy (HL) negatively influence people's health. In an era of fake news journalists are called to recognize reliable sources in order to provide trustworthy information, especially on health topics. The aim of the study was to evaluate the knowledge of health-related topics among health journalists and how it differs from general population.

Methods

A cross-sectional survey was made by administering an online 28-item questionnaire. The questionnaire was constructed by joining an introductive part assessing socio-demographic characteristics with three tests: Single Item Literacy Screener (SILS), Medical Data Interpretation Test (MDIT) and IMETER, the Italian version of Medical Term Recognition Test (METER).

Results

A total of 589 valid surveys were obtained. Regarding this sample, 130 participants were journalists, 142 were healthcare workers and 317 belonged to general population. Journalists dealing with health-related topics (p = 0.016) and writing for online newspapers (p = 0.035) were found to have a higher HL, as well as those having a postgraduate qualification compared to colleagues with lower educational qualifications (p = 0.012). Instead, low HL was found among those journalists considering insufficient their economic status (p = 0.031) and among those who had never or only occasionally written about health-related issues (p < 0.001). Among general population HL level was lower for females (p < 0.001), while it was higher for participants with higher educational status (p = 0.038).

Conclusions

These results suggest that education is a key factor for an adequate health literacy. Given the importance, writing about medical and healthcare topics should be prerogative of journalists specifically formed in those fields.

Key messages

An adequate education strongly influences health literacy. It is of great importance to have specialized journalists write about medical and health-related topics.
Universal Design assessment tool to promote well-being and inclusion in healthcare environment
Authors: Mosca E I , Steinfeld E , Capolongo S
Published: October 2020

Background

Universal Design is a design process that enables people of all ability levels by improving human performance, wellness and social participation. The research aims at developing a performance-based assessment tool adopting Universal Design to enhance users' benefits and positive outcomes such as usability, well-being and social inclusion focusing on healthcare environment.

Methods

The evaluation framework resulted by different methodologies: a systematic literature review on existing Universal Design tools; workshops with both users and experts and the analysis of hospital case studies. Multi-criteria analysis is adopted as methodology to develop a hierarchical framework able to compare quantitative and qualitative aspects of the same project. A rating system based on a checklist is used to evaluate performance.

Results

The tool structure is based on a hierarchical framework composed by 3 Categories (Physical/spatial quality; Sensorial/cognitive quality and Social quality); 8 Criteria (Usability, Functionality, Safety and Security, Wayfinding, Understanding, Environmental factors, Well-being and Social Inclusion); 20 Indicators and a plurality of requirements. Since the needs of users (patients, visitors, staff) change in relation to the space setting, the tool assess the quality considering different areas of the hospital: Outdoor Spaces, Entrance, Interior Circulation, Support Spaces (waiting areas, bathrooms, food services), Work Spaces (exam rooms, offices) and Overall Service.

Conclusions

The proposed tool can foster public health supporting the management of healthcare environment in taking decisions on universal usability and multisensory quality perception through a performance-based approach. The tool has been validated in a hospital of the State of New York, focusing on public areas and outpatient department. Further applications in various healthcare facilities of the Italian context are aimed to implement the tool.

Key messages

The assessment tool aims to support designers and healthcare management from the beginning of the design project to ensure public health and inclusive design through a performance-based approach. The tool based on Universal Design allows to evaluate spatial, sensory and social quality considering the relation between hospital areas and users’ needs that influence people’s well-being.
Subsidies for improving diet and population health in Russian Federation
Authors: Mukaneeva D , Kontsevaya A , Myrzamatova A , Khudyakov M , Drapkina O
Published: October 2020

Background

The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). Russia lags behind many countries in the world in per capita consumption of F&V. A growing number of countries have implemented subsidies to address the growing burden of dietary-related diseases. The purpose of the study is to assess the potential social and economic impact on mortality and morbidity due to main NCDs of policy to subsidies F&V in Russia.

Methods

Using a population model of dietary-related diseases and health care costs, we simulated the effect of 10% subsidy on F&V, over the 15 years of the Russian population. We estimated cardiovascular diseases (CVD), diabetes and cancers cases prevented, health-related costs, and incremental cost-effectiveness ratios. Baseline prevalence of the risk factor was derived from the Russian epidemiology survey.

Results

Subsidies aimed at reducing the price of F&V by 10% can lead to an increase in the consumption of F&V by about 14%, and thereby prevent 37 064 deaths, the projected economic effect due to the prevented deaths will amount to 10.7 billion rubles over 15 years. The number of prevented cases of CVD will be 28 881, type 2 diabetes - 580 cases, cancer - 4025 cases. When calculating the economic effect for the analyzed period, the prevented medical costs for CVD will amount to 147.9 million rubles, for cancer - 86.6 million rubles, for type 2 diabetes - 3 million rubles. The implementation of this measure in the Russian population will allow to “save” 221.6 million rubles related to the payment of disability benefits from the main NCDs and 1.2 billion rubles due to the prevented loss of GDP from disability over 15 years. Thus, the cumulative forecasted effect of this measure in the Russia over 15 years will amount to 11.2 billion rubles.

Conclusions

The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health.

Key messages

The insufficient consumption of fruit and vegetable (F&V) is important contributors to main non-communicable diseases (NCDs). The modelling illustrates the potentially large social and economic benefits of subsidies on F&V for improving population health.
Emergency room services for people affected by sexualized and/or intimate partner violence in Berlin
Authors: Tezcan-Güntekin H , Rasch L , Plamp L
Published: October 2020

Background

People affected by intimate partner violence (IPV) and/or sexualized violence (especially women, children and LGBTIQ*) have long-term health consequences (WHO 2016: 6). The WHO Guideline (2013) and the Istanbul Convention (2016) demand systematic and structurally anchored services at the level of care, education, training of health professions and public health research. The aim of this study was to evaluate the service provided at emergency rooms (ERs) in hospitals in Berlin, Germany.

Methods

A questionnaire with quantitative and qualitative questions including dimensions of existing interventions, available resources of trained staff and institutional frameworks was sent to the management of the 37 hospitals with ERs in Berlin. Descriptive-statistical methods were used to analyze the current state of care provided. (Response rate: 76 percent (n = 28))

Results

The care often depends on individual decisions of staff members of the ER: 5 ERs report the existence of a Standard Operating Procedure (SOP) for IPV, 6 for sexualised violence. Awareness of demographic characteristics of diversity varies widely across ERs; no staff specifically trained to serve for the needs of LGBTIQ* is available; 25% offer a gender-specific choice of doctors; 11 ERs co-hospitalize children affected by IPV.

Conclusions

The institutional framework and the awareness of demographic characteristics of diversity in ERs influence the services provided on a regular basis to people affected by IPV and/or sexualized violence. Development of SOP, qualification of health care professionals (HCP) and systematic collection and evaluation of related data are needed in order to implement the WHO guidelines and the provisions of the Istanbul Convention.

Key messages

Public health research regarding the care provided for people affected by IPV or sexualized violence by ERs in Berlin demonstrate the demand for guiding standard procedures and qualification of HCP. The systematic collection and evaluation of relevant data should be implemented in all countries that have signed the Istanbul Convention.
Management of bio-psycho-social frailty to reduce hospital use and improve survival of older adults
Authors: Liotta G , Accarino N , Orlando S , Gentili S , Terracciano E , Scarcella P , Palombi L , Marazzi M C
Published: October 2020

Background

Ageing of population is associated to the increase of care demand. Many health systems are still centered on hospital care, that sometime is not appropriate. The shift from hospital to community care requires a new model of service delivery. Aim of this paper is to assess the impact of a community service based on the assessment of frailty, on mortality and use of hospital care by older adults.

Methods

A cohort made up by 8,592 over-75 subjects (67.1% female, mean age 84.5; SD ± 5.29) has been assessed once a year for bio-psycho-social frailty by the administration of the Short Functional Geriatric Evaluation questionnaire. The enrolled subjects were involved in a Community-based pro-Active Monitoring Program which provides interventions aimed at reducing social isolation. Mortality, use of hospital care and use of residential long-term care have been recorded during the follow up and separate and cumulative incidence rate was measured.

Results

The sample was stratified in Robust (37.5%), Pre-frail (24.0%), Frail, (29.5%) and Very Frail (9.1%) individuals. Mortality, Hospital admission rate and Residential LTC admission rate were higher in the very frails than among the other groups. However, according to social isolation, the integrated subjects at the baseline assessment, showed the highest incidence of negative events: 29.5%, 20.8%, 21.0%, .and 20.8% for integrated, mild isolated, moderate isolated and severely isolated individuals respectively (p < 0.001). The logistic regression analysis, adjusted for age, gender and level of frailty, confirmed the protective role of reducing social isolation among isolated individuals compared with integrated ones (OR: 0.729; CL95% 0.673-0.720).

Conclusions

The assessment of bio-psycho-social frailty could be the starting point for effective intervention at community level, like the program mentioned above. Management of frailty may lead to an improvement of public health outcomes.

Key messages

Intervention dealing with social isolation are able to revert the increase of mortality related to the lack of social resources. Management of frailty may lead to an improvement of public health outcomes.
Educational trends, patterns of employment and selected health indicators among young refugees
Authors: Dunlavy A
Published: October 2020

Background

Although the health and integration of young refugees is a top policy priority within the Nordic region, refugees continue to experience health and social inequalities relative to other immigrants and native-origin majority populations. This project explores how such inequities develop during the formative years among refugees who migrated as children, and how they relate to migration and welfare policies in different Nordic contexts, which vary considerably in terms of their generosity.

Methods

National administrative registers were used to compare key indicators of education, labor market participation, and health among young refugees living Denmark, Finland, Norway, and Sweden. The primary study population consisted of refugee children who were granted residency in the Nordic region as children (0-17 years) between 1986 and 2005, and were followed up through 2015.

Results

Overall, refugees in Denmark and Finland had the poorest primary and secondary educational outcomes, even when country of origin and age of arrival were considered. In all countries, the gap in secondary educational attainment between refugees and the native-born majority population was of a much greater magnitude than the corresponding achievement gaps in higher education.

Refugees in Denmark had the lowest proportion of labor market participation and the highest proportion of NEET (not in employment or education) at age 30 relative to refugees in the other Nordic countries; yet this difference was greatly diminished when secondary educational attainment was considered. Results also showed higher rates of early retirement pension receipt at age 30 among refugees in Denmark than those observed among refugees in other Nordic contexts.

Conclusions

Policies that facilitate introduction into the educational system and secondary education attainment among refugees should be given greater priority in order to promote labor market integration and health in young adulthood.
13.C. Workshop: Epistemic and ethical innovations in public health research
Authors:   Organised by: Universidad Autónoma de Barcelona (Spain),   Chair persons: Angel Puyol - Spain
Published: October 2020

About 90% of the biomedical data accessible to researchers was created in the last two years. These data have a very meaningful impact both in creating public policies on health, as well as public health research. This certainly implies complex technical problems on how to store, analyse and distribute data, but it also brings relevant epistemological issues. In this workshop we will present some of such problems and discuss how epistemic innovation is key in order to tackle ethical issues related to the use of big data in public health research. Databases implied in public health research are so huge that they rise relevant questions about how scientific method is applied, such as what counts as evidence of a hypothesis when data can not be directly apprehended by humans, how to distinguish correlation from causation, or in which cases the provider of a database can be considered co-author of a research paper. To consider such issues nowadays, current protocols do not hold, and we need innovation in methodological and epistemic procedures. At the same time, due to the fact that a relevant deal of such biomedical data is linked to individual people, and how medical data can be used to predict and transform human behavior, there are ethical questions difficult to solve as they imply new challenges. Some of them are related to communication issues, so patients and citizens understand these new ethical problems that didn't arise before the development of big data; others relate to the way in which public health researchers can and can't store, analyse and distribute information, and some others relate to the limits on which technologies are ethically, safe and which ones bring erosion of basic human rights. The four contributions in the workshop analyse these questions in some detail. During the workshop we will present a coherent understanding on what is epistemic innovation, some logical tools necessary for its development, and then we will discuss several cases on how epistemic innovation applies to different aspects of public health research, also commenting its relevance when tackling ethical problems that may arise.

Key messages

The workshop deepens the ethical and epistemological innovations involved in public health policies and research, specially related to big data. The workshop analyses novel aspects of public health ethics
Abductive reasoning on humans/AI interactions in medical contexts
Authors: Sans A
Published: October 2020

The proposal of this talk is to explain alternatives to obtain ethical reasoning in the humans/AI interactions in medical (especially public health) contexts. One of the ethical problems in AI is the alignment mechanisms between human values and machines automatisms. This research is based on obtaining a system capable to infer from rational human activity in a certain behavior, so it can be captured how a human moves and the way that human beings learn and teach ethical values. One way is mimetic alignment, which are values imitation processes based trough big data preferences analysis, linguistic expressions, etc. However, this approximation commits two mistakes. First, preferences are confused with values, and then the second problem is that naturalistic fallacy is committed. From this point of view, naturalistic fallacy occurs if the research is focused on alignment meaning instead of value one, and the subsequent answer is preference analysis based. Therefore, prescriptions are derivate from descriptions. The chain of reasoning that leads us to commit this fallacy begins with the confusion that values and preferences are equivalent. An alternative proposal is anchored values alignment, which is based on anchoring normative values processes of a machine that has a behavior to interact. Through abductive reasoning, this way of thinking tries to capture the idea that a value is not in any set of things, instead it is some action guiding. The relevance of abduction is its temptative value to project beyond descriptive reasoning as statically one, which it is currently used in works on medical diagnosis precisely for the characteristics that clinical eye needs.
Urban Health as a Complex System
Authors: Damiani G , Sapienza M
Published: October 2020

The 17 Sustainable Development Goals (SDGs) are a complex system comprising 169 targets and about 230 indicators. Urban Health could be considered a complex system since it deals with 15 out of 17 SDGs, excluding the two related to life below water and life on land. According to the World Health Organization, to achieve the SDGs, countries have committed to organize Urban Health initiatives to improve the social, economic, and physical environments promoting health and sustainability globally. Cities will become more inclusive, safer and more sustainable, which are important driving forces to implement the development equation. To set up a framework to point out that Urban Health is a complex system oriented to the achievement of the SDGs. It has been conducted an extensive literature review on databases (PubMed, Embase, Web of Science and Scopus) using keywords in 3 strings combined with Boolean operators: SDGs and Urban Health, Urban Health as Complex System and Urban Health, Environmental Health and Public Health as Complex Systems. In addition, a grey literature review has been carried out. Out of 1005 publications, 21 were eventually included: 14 publications relate to the interdependent relationships between SDGs and Urban Health, with regard to the association between Urban Health and complex system, 3 publication studied the effects and implications of such correlation, 4 focused on Environmental Health and Public Health in relation with the complex system. The selected publications suggested methodologies aimed at setting up an urban health framework to achieve SDGs. There is an initial orientation focused on the study of Urban Health problems aimed at achieving SDGs from the perspective of complex systems. We highlight the need to conduct further studies on a more detailed framework in order to address this type of approach.
Mapping of education of health professionals in health promotion; a European survey
Authors: Patja K , Bonello M , Dorottya A , Orhan R , Huis int'Veld T , Soethout M
Published: October 2020

Health behaviours comprise over half of risk of Non-communicable Diseases. Lifestyle interventions need collaborative approaches in healthcare; this makes health professionalś knowledge and skills in advocating lifestyle interventions crucial. However less is known about educational programs of professionals in Europe about health promotion. So, a project commissioned by Consumers, Health, Agriculture and Food Executive Agency (Chafea) in years 2018-2020 was carried out in all EU countries.

Over 15 professions were included in this study. Information was obtained from national education providers, European associations of health professionals and national authorities. Study questions included: 1) how are health professionals being trained in health promotion in the EU? 2) what competencies professions require? 3) what methods are used? 4) what are the good practices? A three-stage data collection and analyses were carried out in order to answer these questions: a) desk research b) on-line survey for education content, methods and practices c) good practices assessment.

Final report is to be concluded and published in April 2020, but first indications show that a) there are guidelines of competencies in health promotion in different levels of education (graduate, post-graduate and continuous professional development) b) good practices were found in all health professions b) all health professions provide description of health promotion competencies, c) traditional teaching methods (lectures and assignments) are most often used and d) there is a need for of digital health coaching and health economics practices.

There is a need for capacity building and joint development in the European countries. Willingness to create European network of faculties, education regulators and professional associations is obvious and all parties acknowledge the need for support developing good practices and improving professional competencies in health promotion.

Key messages

There was a need for mapping of educational programs of professionals in Europe about health promotion. There is a need for capacity building and joint development in the European countries.
Feasibility of HCV micro-elimination: HCV test and treatment in two harm reduction services in Milan
Authors: Mazzilli S , Sebastiani T , Casigliani V , Cocca G , Stemat A , Nicola C , Selva P , Catani C , Tavosci L , Ranieri R
Published: October 2020

Background

Most of Harm Reduction Service (HRS) users represent a crucial high-risk population for blood borne infections, including HCV. With the advent of new direct antiviral agents (DAAs), HCV micro-elimination in this setting has become feasible. We evaluated HCV treatment cascade in two HRSs located in Milan.

Methods

We collected data on demographics, substance abuse history, HIV prevalence, HCV prevalence, testing and treatment on all register HRS users on 1 January 2019. Data collection was closed on 1 January 2020.

Results

A total of 881 HRS users (732M,149F) were included (median age: 45). The majority was addicted to heroin 67.5% (595), 24.1%(212) to cocaine, 5.3%(47) to THC and 3.1%(27) to other substances. The 28.0%(247/881) reported current or prior judiciary problems, 168/881(19.1%) were under psychiatric treatment. HCV serological screening (HCVAb) was performed for 587/881(66.7%), 113/881(12.8%) were in process, 2/881(0.2%) refused, 179/881(20.3%) were not HRS user anymore. 364/587(62%) resulted HCVAb positive, of whom 288(79.1%) were tested for HCV RNA. Among them 123/324(37.9%) were positive, 165/324(50.9%) were negative. Among HCVAb positive, 116/364(31.9%) were tested for HIV and 92(79.3%) resulted HIV positive. Among HCV RNA positive 92/123(74.8%) were initiated on DAAs treatment. Compliance to treatment was high; one treatment failure was registered. Individuals tested for HCV and HCVAb positive people had an average age significantly higher than the individuals not tested and HCVAb negative people (p < 0.001). Heroin user had a higher likelihood of being tested both for HCVAb and for HCV RNA and of being positive to the HCVAb test (p < 0.001).

Conclusions

Our study demonstrate that it is feasible to achieve good efficacy and compliance for HCV treatment among people who use drugs when decentralising treatment to HRS. To achieve the viral hepatitis elimination agenda goals, HRS-based model of treatment provision needs to be implemented at larger scale.

Key messages

Decentralising HCV test and treatment to harm reduction services is an effective strategy to achieve HCV micro-elimination among people who use drugs. Young people and people who are addicted to other substance than heroin resulted more difficult to link to HCV care through the harm reduction services. They require tailored intervention.
Cultural mediators are needed to fulfill Right to health for all
Authors: Magnusson M , Jama I-Z
Published: October 2020

The Right to health framework supports available, accessible and acceptable health care of high quality for all (AAAQ). Health of migrants often worsen in the new country. AAAQ may be hindered by poverty, discrimination, health cares' shortcomings and misunderstandings, respectively. Advocating for marginalised groups' Right to health include action. Interventions based on shared influence, participation and control need to be launched. Cultural mediators (CM), i.e. persons that are knowledgeable in both cultures and with networks in migrant groups help overcome lingual problems, lack of trust and uneven power relations. This resource needs to be further examined.

How can a CM strengthen AAAQ in a public health setting? Women with Somalian origin living in an underserved neighborhood in Sweden contacted the Public Health Unit of a local hospital, asking for support for a health focused group-activity. Weight loss after delivery was a primary concern. Women gathered monthly 2018-19. The objective was to support healthy life style habits drawing on issues raised by the women. The intervention was conducted by group talks, led by the CM and a public health planner. Methods were based on Social Cognitive Theory focusing on self-efficacy.

The CM recruited women, helped them to find the venue, encouraged them to trust the public health planner and broadened perspectives to include female genital mutilation, children's food, how to seek care and workforce issues. Trust developed over time. 70 women participated. Reported gains were raised awareness of ones' rights, increased self-efficacy in relation to food, physical activity and how to support children to a healthy life style. Support for a healthy lifestyle was made more available, accessible and acceptable by the cooperation with the CM, as was the quality of the support.

A CM bridges distances regarding spoken language, trust and cultural understanding. S/he puts forward perspectives and needs from the group in question

Key messages

The Right to health framework highlights areas that need to be in focus when advocating for health equity. Health care workers in settings with many migrants should strive to include cultural mediators in planning, execution and evaluation of interventions.
Prevalence and associated factors of gaming disorder among pre-clinical students in a medical school
Authors: Aktuna A , Hassoy H , Durmaz S , Durgun K , Sarbat O , Ergin I , Koybaşi E
Published: October 2020

Background

The aim of this study is to determine the prevalence of gaming disorder and associated factors among pre-clinical students in a medical school.

Methods

This cross-sectional study was carried out in 2019 at Ege University Faculty of Medicine. The research population consisted of 1162 pre-clinical medical students. Gaming disorder which is dependent variable was evaluated with “Game Addiction Scale”. Gamers who played games in the last 6 months were categorized in four groups as addicted, problem, engaged and normal. Independent variables are; socioeconomic characteristics, mental health status, habits, use of technology and gamer preferences. Multinominal regression analysis was used with the reference category as 'normal'.

Results

The response rate was 88.6% (n = 1030). 72.9% of all participants were gamers. 69.1% of gamers were men and the average age was 20.4±1.19. The prevalence of engaged, problem and addicted gamers in all participants was 8.3%, 12.6% and 2.6%; in the gamers, it was 11.3%, 17.3% and 3.6% respectively. The multivariate analysis showed that male sex was associated with being engaged (OR = 2.63, 95%CI [1.38, 5.01]), being problem (OR = 2.42, 95%CI [1.25, 4.69]), being addicted (OR = 5.95, 95% CI [1.30, 27.30]). Attention deficit and hyperactivity disorder (ADHD) was associated with being engaged (OR = 2.37, 95%CI [1.31, 4.27]), being problem (OR = 2.62, 95%CI [1.44, 4.79]), being addicted (OR = 4.42, 95%CI [1.85, 10.60]). Preferring online multiplayer games was associated with being engaged (OR = 2.03, 95%CI [1.12, 3.70]), being problem (OR = 2.18, 95%CI [1.18, 4.02]), being addicted (OR = 5.35, 95% CI [1.21, 23.66]).

Conclusions

One in every four students has a gaming disorder risk. Gamers who are male, have ADHD and prefer online multiplayer games have increased risk. There is a need for prospective studies that will evaluate the gaming disorder and its social determinants among medical students. Students should be directed to recreational activities.

Key messages

One in every four medical students has a gaming disorder risk. Gamers who are male, have attention deficit and hyperactivity disorder and prefer online multiplayer games have increased risk. There is a need for prospective studies that will evaluate the gaming disorder and its social determinants among medical students. Students should be directed to recreational activities.
Impacts of international labor migration on the mental health and well-being of left-behind children
Authors: Antia K , Boucsein J , Deckert A , Dambach P , Racaite J , Surkiene G , Jaenisch T , Horstick O , Winkler V
Published: October 2020

Background

Labor migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families with the particularly vulnerable groups of left-behind children (LBC). These families, where family members of migrant workers are 'left-behind' are becoming common practice in many developing countries. In this systematic literature review, we aimed to investigate the impacts of parental labor migration on the mental health and well-being of their LBC.

Methods

Following the PRISMA guidelines, we performed a systematic literature search in English using PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar for studies, investigating mental health and well-being among LBC who live in transnational families. Case-reports, qualitative studies as well as opinion papers were excluded. We summarized the evidence and additionally compared quantitative results.

Results

25 studies were selected for the final analysis. We found that mental health and well-being outcomes of LBC differ across regions and sometimes even within regions. Only studies conducted in South America and South Asia observed purely negative effects. Overall, LBC show abnormal SDQ (Strengths and Difficulties Questionnaire) scores and report higher levels of depression and loneliness, than children who do not live in transnational families. Evidence suggests that gender of migrant parent, culture and other transnational family characteristics such as family arrangement, the role of the mother and the role of the father contribute to the well-being and psychological health of LBC.

Conclusions

International migration of parents has more negative than positive effects (e.g. through remittances) on the mental health and well-being of LBC. However, the effects strongly depend on family arrangements and care giving practices in migrants' sending countries.

Key messages

Further research utilizing longitudinal data is needed to better explore the complex and long-term effects of parental migration on LBC. Multidimensional family characteristics are crucial and should be better explored when examining the impacts of migratory separation on left-behind children.
The number of years lost in 30-year work life spans of people with type 1 and type 2 diabetes
Authors: Nexø M A , Pedersen J , Andersen I , Cleal B , Bjørner J B
Published: October 2020

Background

Although diabetes is among the most common causes of lifelong disability, no studies have yet outlined work disability from a life course perspective. This study estimated the number of years people with type 1 and type 2 diabetes lost in a work life span compared to people without diabetes

Methods

Individuals aged 18-65 years, diagnosed with type 1 (n = 33,188) or type 2 diabetes (n = 81,930) were identified from national registers from the entire Danish population and age and gender matched with controls without diabetes (n = 663,656), for period 2000-2017. WLE in years were estimated as time in employment from age 35 to 65. We used a life table approach with multi-state Cox proportional hazard modelling (95% Confidence Intervals: CI). Age was the underlying time-axis. Inverse probability weights accounted for differences between populations. Analyses were performed separately for sex, educational status, and types of diabetes in 5-year age intervals.

Results

Individuals with type 1 diabetes and type 2 diabetes had significantly shorter WLE compared to people without diabetes in the 30-year span. Type 1 diabetes: WLE ranged from 8 years shorter among women with short education [-8.0; CI:-11/-5.0] to 4 years shorter [-4.4; CI:-6.6/-2.3] with high education; WLE in men ranged from -6.4 [CI:-8.7/-4.0] with short education to -3.0 [CI:-4.5/-1.5] with high education. Type 2 diabetes: WLE ranged from -6.5 [CI: -8.9/-4.0] in women with short education to -2.9 [CI: -4.5/-1.3] with high education. WLE in men ranged from -7.0 [CI: -9.4/-4.5] with short education to -3.7 [CI: -5.4/-2.0] with high education.

Conclusions

The substantial number of years lost in a work life span for individuals with type 1 or type 2 diabetes, highlight need for new strategies that prevent work disability, particularly for individuals with short education.

Key messages

Individuals with type 1 diabetes and type 2 diabetes had between 9 and 3 years shorter work life expectancies compared to people without diabetes in a 30-year span. The work life spans are substantial shorter for individuals with type 1 or type 2 diabetes with short educations.
Evidence-based reporting, methods and content of allergy-specific digital training programs
Authors: Lander J , Drixler K , Dierks M L , Bitzer E M
Published: October 2020

Background

The World Allergy Organization frames allergies as a “major global public health issue”, due to the consistently high prevalence of, e.g., allergic rhinitis (up to 30%). Digital training programs (DTPs) may help fostering self-management and provide allergy-specific information, given, for instance, their good accessibility. We aimed to assess an exploratory sample of allergy-specific, interactive and feedback-oriented DTPs towards the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information.

Methods

We searched for DTPs via scientific databases and online sources and developed a checklist from established scientific guidelines for digital health information. The checklist contained 44 items covering 11 domains related to content (e.g. evidence-base), structure (e.g. trainer qualification) and impact (e.g. user perspective).

Results

15 DTPs covered an average of 37% of the items (score 33/88). Items relating to intervention (58%), content (49%), and data safety (60%) were frequently considered, as opposed to user safety (10%), qualification of staff (10%), effectiveness (16%), and user perspective (45%). In 13 of 15 DTPs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% scored on use of scientific research, 53% on regular information update, and 33% on provision of references.

Conclusions

Allergy-specific DTPs conform only partly to established criteria for evidence-based (digital) health information and education. The named methodological and content-wise shortcomings pose considerable obstacles for users. While there have been related, general criticisms earlier, this study provides empirical evidence via the example of allergy-specific DTPs.

Key messages

For DTPs to add value, service providers and health information experts need to cooperate much closer to reduce the 'reporting vs. requirements' gap. Cooperation is also needed to agree essential methodological and content-wise features of DTPs and similar services.
Health disparities by neighborhood socioeconomic status and the role of spatial spillovers
Authors: Dekker L H , Rijnks R H , Mierau J O
Published: October 2020

Background

The contextual determinants of population health disparities across neighborhoods with similar socioeconomic characteristics are not well understood. We aimed to estimate subjective and objective population health measures within and between neighborhoods with similar socioeconomic status (NSES) scores, and the (in)direct potential of a spillover effect of NSES of adjacent neighborhoods.

Methods

Based on whole-population neighborhood data we determined the percentage of inhabitants with good/very good self-assessed health (SAH) and with at least one chronic disease (CD) in 11,521 neighborhoods with on average 1,470 inhabitants. Neighborhoods were classified by the quintile of a composite NSES score. Spatial lag of X models was applied by including neighborhood cross-sectional units on population density, the percentage of inhabitants aged 65 and over, and the NSES of adjacent neighborhoods by constructing a spatial weights matrix.

Results

Substantial population health disparities in SAH and CD both between neighborhoods with different and similar NSES scores were observed, with the largest SAH variance in the lowest NSES group. These differences were only partially explained by neighborhood characteristics. Neighborhoods adjacent to higher SES neighborhoods showed a higher SAH and a lower prevalence of CD, adjusted for other explanatory variables. When NSES in the first decile would be increased to the NSES of the quintile median, the direct effect on SAH would increase by 5.6% in the lowest NSES group. Spillovers would lead to an additional increase of 1.7% in all NSES groups.

Conclusions

Population health differs substantially among neighborhoods with similar socioeconomic characteristics, which can partially be explained by a socioeconomic spillover effect. The mechanisms behind these spillovers need further study, but may already provide interesting leads to policy design aimed at improving population health outcomes of deprived neighborhoods.

Key messages

Neighborhood population health is partially affected by a SES spillover effect. This study provides interesting leads to policy design aimed at improving health outcomes of deprived neighborhoods.
Malnutrition and Socio-economic Factors in HIV Infected and Uninfected Under 5 Children in Zambia
Authors: Ng'andu M N , Moonga G M , Banda J B
Published: October 2020

Malnutrition contributes to more than one third of all child deaths, although hardly listed as the direct cause. In sub-Saharan Africa, malnutrition accounts for about 2% of deaths and 3% of Disability adjusted life years (DALYs) among under-5 children. In Zambia, 35% of under-5 children are stunted, 4% wasted, 12% underweight and 5% overweight. Malnutrition and HIV interact in complex ways that increase vulnerability to and worsen each condition therefore we sought to determine factors associated with malnutrition among under 5 children in Zambia.

Using Stata version 14.2, we extracted and analysed sample data of 159 children aged 0-59 months from the 2016 ZAMPHIA population-based survey, that used a two-stage cluster sampling design. We used Generalised Linear Models to measure socio-economic factors associated with malnutrition. P-value of less than 0.05 was set as level of statistical significance.

Factors associated with malnutrition included gender, child's HIV status and wealth index which showed an association with stunting, wasting and being underweight. The 16 (10%) under-5 children living with HIV were significantly more affected by stunting (38% vs 33%), wasting (19% vs 11%) and underweight prevalence (38% vs 10%) than the remaining 143 who were HIV negative. Our sample prevalence was similar to national stunting (33% vs 35%) and underweight prevalence (13% vs 12%) but had three times higher wasting prevalence (12% vs 4%).

A high prevalence of malnutrition was found in HIV positive compared to negative under 5 children, wealth index showing an association with malnutrition. Eliminating malnutrition is key to attaining SDG 3 which is to end preventable deaths of newborns and children under 5 years of age.

Key messages

All types of malnutrition had a higher prevalence in HIV infected than uninfected under five children in Zambia. Wealth index is a socio-economic factor that is associated to all types of malnutrition in under-five children in Zambia.