bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of outpatient healthcare services before and after the onset of unemployment
Authors: Rinne H , Blomgren J
Published: October 2023

Background

The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services.

Methods

Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for propensity score matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls.

Results

The use of healthcare services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational healthcare services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of healthcare services.

Conclusions

When access to occupational healthcare services ceases, other healthcare services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status.

Key messages

• The overall use of outpatient healthcare services decreases significantly after job loss in Finland because of a decrease in the use of occupational healthcare services.

• Adequate and easily accessible healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status or other socio-demographic factors.
Quality improvement in multi-professional primary health care units: Lessons learned from Austria
Authors: Radl-Karimi C , Petschk K , Siebenhofer A , Spary-Kainz U , Posch N , Paier-Abuzahra M
Published: October 2023

Issue/problem

In 2017, Austria started the establishment of multi-professional primary health care units (PCUs) to better meet patients’ and healthcare professionals’ needs including a focus on health promotion, health literacy and patients with chronic diseases. Currently, Austria has 40 operational PCUs. In the province of Styria, the quality of care in PCUs is monitored through quality indicators (QI) in annual surveys. The patient questionnaire includes items on patient satisfaction, shared decision-making, and self-management. The PCU team questionnaire covers organizational routines and working satisfaction.

Description of the problem

Only few improvement initiatives were launched in response to the QI surveys, especially for low-performing QI. In addition, the concept of quality indicators seemed difficult for the teams to understand. As a result, from 2021 on, the surveys are being conducted every other year. In the intervening years, PCU teams get the opportunity to discuss and reflect on the previous yeaŕs results in facilitated workshops.

Results

We held workshops in the ten PCUs in Styria from October 2022 to February 2023. In the workshops, the teams identified six strengths (e.g. providing a wide range of services) and six weaknesses (e.g. appointment coordination) of the PCUs with corresponding actions for improvement (e.g. managing the patient flow).

Lessons

Combining the QI surveys with workshops lead to practical actions for quality improvement as well as a better understanding of the relevance of quality indicators among PCU teams and funders. Workshops provided the teams with a dedicated space for reflecting on organizational processes, which they may not have the opportunity to do amidst their heavy workload and still adjusting to PCU structures.

Key messages

• Engaging the PCU teams in the quality improvement process ensures that the resulting actions are more relevant to their needs and priorities.

• Our quality indicators as well as the identified actions for quality improvement are highly transferable to other primary care settings and countries.
Nothing about us without us - community perspectives
Authors: Sarma N
Published: October 2023

The fourth workshop contribution will represent the important perspective of self-organisation and NGOs. A debate on discrimination-sensitive communication can only and exclusively take place if the people who are being talked about have a say - people with experiences of racism and other forms of discrimination. The focus herein should be on partnership and participation rather than paternalism. It is therefore important to talk about self-organisation, self-advocacy and empowerment - and how language, concepts and categories can be sensitively developed with the participation of all those concerned.
The City of Cork Food Policy Council – Inter-agency collaboration towards a fairer, healthier, more secure and sustainable local food system
Authors: Harrington J
Published: October 2023

Food has long played a significant part in Cork's identity and Cork regards itself as ‘the food capital of Ireland’. In contrast Cork city has areas of severe social disadvantage and, in line with other parts of the country, there are rising levels of diet-related ill-health and where up to one in eight households experiences food poverty (Kenny and Sage, 2019). To date, Cork City does not have an Urban Food Strategy. The Cork Food Policy Council is a partnership between representatives of the community, food retail, farming, fishing, restaurant/catering, education, environmental and health sectors and local authorities. It was established in 2012 to work towards the achievement of a fairer, healthier, more secure and sustainable food system within the City and throughout the region. As a multidisciplinary group that works closely with the Cork Healthy City initiative, it has pioneered innovative approaches to bring food systems thinking into the city, working at both local and policy levels. This recognises the position and value of food within the fabric of city life, and for its multifunctional benefits to health, community, infrastructure and spatial thinking. The presentation will focus on the interagency nature of this group and how a greater understanding and collaboration among local policy drivers has led to innovative actions in the city and the groundwork towards co-creating a food strategy for the City.
The role of the perceived food environment on the eating behavior of people with lower socioeconomic positions in municipal settings
Authors: Inac Y , D’Hooghe S , De Ridder K
Published: October 2023

Food environments are an important determinant of diet and play a crucial role in the development of obesity and overweight. People with lower socioeconomic position (LSEP) often have an unhealthier diet. Perceived characteristics of the food environment have a critical and distinct role in influencing diet, since they take people's experiences and reality into account. Therefore, the aim of this study was to explore the role of the perceived food environment on the eating behavior of people with LSEP in two municipalities in Belgium, and to identify potential actions which can be taken by these municipalities to promote a healthy diet. 23 people with LSEP were recruited through purposeful convenience sampling until data saturation was achieved. The photovoice and photo-elicitation method were used to capture respondents’ perception of their food environment and to identify potential actions, both individually (n = 16) and in group (n = 7), that play a role in a diet. All data was transcribed and analyzed thematically using NVIVO 20.0. Multiple local actions to improve a healthy diet were identified during the interviews and focus groups. Respondents identified affordable and accessible cooking classes, opening a social restaurant/store and including affordable healthy recipes in the municipal newspaper as potential actions. Actions such as making at-home delivery of healthy groceries financially accessible to everyone and to distribute vouchers instead of food parcels at food banks also came forward. Furthermore, respondents cited a lack of information about where healthy food was available as a barrier and identified a central overview of affordable and healthy food and communal field visits to local food producers such as farmers as potential actions. These results show that people with LSEP identified a wide variety of actions related to the food environment that local governments and related stakeholders can take to promote healthy eating.

Speakers/Panelists

Ingrid Stegeman

EuroHealthNet, Brussels, Belgium
Negative experiences on social media and mental health among adolescents. The “LifeOnSoMe”-Study
Authors: Skogen J C , Andersen AIO , Finserås T R , Ranganath P , Brunborg G S , Hjetland G J
Published: October 2023

Background

Cyberbullying has been widely studied and is associated with poor mental health outcomes in adolescents. However, adolescents frequently also experience a range of other negative experiences, such as name-calling, exclusion, and unwanted attention or contact from others. Few previous studies have investigated how adolescents’ mental health is affected by these more common and relatively less severe types of negative experiences on social media (SOME). The aim of the present study was to assess the associations between mental health outcomes and two aspects of negative experiences on SOME; unwanted attention and negative acts and exclusion.

Methods

This study is based on a survey conducted in 2020/21 consisting of 3,253 Norwegian adolescents (mean age 17 years; 56% female). Eight statements about negative experiences on SOME were asked and combined into two composite measures: “Unwanted attention from others” and “Negative acts and exclusion”. Dependent variables in regression models were symptoms of anxiety, symptoms of depression, and quality of life. Covariates included age, gender, subjective socioeconomic status, and amount of SOME-use.

Results

Both “negative acts and exclusion” and “unwanted attention from others” on SOME were consistently positively associated with self-reported symptoms of depression and anxiety, and negatively associated with mental well-being in both crude and adjusted analysis.

Conclusions

The results indicate a potential important relationship between experiencing negative events on SOME, even presumably less severe events, and worse mental health and well-being. Future research should investigate the potential causal relationship between negative experiences on SOME and mental health, as well as exploring potential precipitating and intermediating factors.

Key messages

• The findings from this study indicate that commonly reported negative experiences on social media is associated with poor mental health and well-being among adolescents.

• The present study highlight the need to also focus on less severe but commonly occuring negative experiences on social media.
Challenges and Benefits of Social Media Influencers for Adolescent Health – A Scoping Review
Authors: Gell S , Engel E , Heiss R , Karsay K
Published: October 2023

Background

Social media has become the primary source of entertainment, information, and news for adolescents. Influencers play a key role in this new information environment as content providers, with a large number of followers. While they can motivate and inform young people about health topics, they may also share questionable information driven by commercial interests. This scoping review aims to synthesize existing literature on the benefits and challenges influencers represent for adolescents’ health.

Methods

The review followed the PRISMA-ScR approach, with predetermined databases, inclusion and exclusion criteria, and a search string developed. The review produced 1699 items, and after duplicate removal, title, abstract, and full-text screening, 51 articles were included. Along the topic of adolescents’ health and social media influencers, prevalent benefits and challenges were synthesized from the 51 articles.

Results

Identified challenges (n = 41) revolved around regulating influencer marketing, adapting laws to social media environments, enforcing existing laws, and strengthening social media literacy among adolescents and professionals. Benefits (n = 21) included tailoring health campaigns to social media environments and target groups with influencers and using the authenticity and trustworthiness of influencers to increase range and engagement with health information.

Conclusions

Most challenges focus on regulation and policy efforts rather than harnessing the advantages of influencers for health campaigns on social media. Health professionals need to expand and adapt their skills and content to cater to these new information environments.

Key messages

• Introducing and enforcing policies to regulate influencers and to increase media literacy among adolescents and professionals pose major challenges.

• Influencers are capable of providing authentic and trustworthy channels, as well as expertise, for social media health campaigns.
A Smoking Prevention Intervention in an Online Community Game: Results from a Pilot Trial
Authors: Le Roux E , Martin P
Published: October 2023

Background

Innovative methods for smoking prevention interventions need to be investigated to increase attractiveness, access hard-to-reach populations, and increase effectiveness. We studied the feasibility and immediate effects of an intervention to reinforce norms and behaviors of young people related to antismoking, integrated into a popular online community game.

Methods

A pilot randomized controlled trial was conducted through the HABBO online community. The intervention group was exposed to repeated discussion sessions with small groups of peer players and two facilitators once a week for 1 month (four sessions), inside the game. The control group had access to antismoking information websites. Process indicators (attractiveness, participation) and immediate outcomes (norms and intentions with regard to smoking) were assessed by questionnaire.

Results

One hundred sixteen players were invited to participate in the intervention; 10 did not meet eligibility criteria, 30 were allocated to the intervention group, and 76 to the control group. Median age was 23. Twenty-four percent were not in education, employment, or training. A median of eight players attended each session and the median number of exchange chats by session was 399; 70% of chat time was occupied by the players. Twenty players attended all four sessions. Immediate norms, representations, and intentions were evaluated in 39 players and showed small differences between groups.

Conclusions

Delivering and evaluating a smoking prevention intervention in an online game is feasible. In the targeted online community game, the intervention was attractive and allowed the delivery of innovative interventions to audiences with diverse social profiles. Long-term effects, sustainability, and evaluation methodology are discussed.

Key messages

• Entertainment video games (which have no initial interest in health issues) can be used as a field of intervention in public health.

• Innovative contexts for delivering public health actions make it possible to reach audiences that more traditional interventions would not reach and open up prospects for reducing social inequalities.
The use of health care databases for surveillance of congenital anomalies: A EUROlinkCAT study
Authors: Loane M , Garne E , Morris J K , Bakker M K
Published: October 2023

Background

Although health care databases were not designed for research or surveillance, they are increasingly used by researchers to investigate the epidemiology of congenital anomalies (CAs). Identifying specific CAs that can be accurately identified in hospital databases and those that are poorly recorded will enable surveillance of CAs. We evaluated the accuracy and the quality of the coding of CAs in hospital databases compared to EUROCAT data.

Methods

The EUROlinkCAT project linked data from eleven EUROCAT registries I eight countries to electronic hospital databases. The coding of specific CAs in hospital databases was compared to the codes in the EUROCAT registries (gold standard). For birth years 2010-2014 all linked live birth CA cases and all children identified in the hospital databases with a CA code were analysed. Registries calculated sensitivity and Positive Predictive Value (PPV) for 17 selected CAs. Pooled estimates for sensitivity and PPV were then calculated for each anomaly using random effects meta-analyses.

Results

Most registries linked more than 85% of their cases to hospital data. Gastroschisis, cleft lip with or without cleft palate and Down syndrome were recorded in hospital databases with high accuracy (sensitivity and PPV >85%). Hypoplastic left heart syndrome, spina bifida, Hirschsprung's disease, omphalocele and cleft palate showed high sensitivity (>85%), but low or heterogeneous PPV, indicating that hospital data were complete but may contain false positives. The remaining anomaly subgroups showed low or heterogeneous sensitivity and PPV, indicating that the information in the hospital database was incomplete and of variable validity.

Conclusions

Electronic health care databases cannot replace CA registries, although they can be used as an additional ascertainment source for CA registries. CA registries are still the most appropriate data source to study the epidemiology of CAs.

Key messages

• European hospital databases can accurately record a limited number of anomalies that are visible at birth, diagnosed prenatally and/or require hospitalisation or surgery in the first year of life.

• Additional data sources are needed to capture all children with CAs as hospital databases have limited information or codes to identify pregnancies that result in termination for fetal anomaly.
Exploring the gender gap in end-of-life care: ethical considerations for dementia patients
Authors: Yakov G , Halevi Hochwald I
Published: October 2023

Background

Dementia is a common, terminal disease that significantly reduces the quality of life. Home hospice services face ethical challenges when caring for patients in the final stages of the disease. While gender differences are known to exist in various aspects of care, limited research has explored gender variation in end-of-life care perceptions. This study aims to explore how home hospice staff consider gender, particularly regarding ethical issues.

Methods

The study used a phenomenological qualitative approach, conducting semi-structured interviews with 30 multi-professional home hospice staff members caring for dementia patients.

Findings

Caregivers tend to ignore gender when caring for elderly patients at the end of their lives. This non-gender-related approach is evident in their attitudes towards ethical issues, such as respecting patients, considering their welfare and dealing with communication difficulties. However, disregarding gender when caring for dementia patients within the home hospice framework raises questions regarding the dying person's perception of human dignity, their wishes, and their overall welfare.

Conclusions

Given that gender is a crucial component of a person's identity, the staff's non-gender-related approach towards end-of-life care reflects the non-gender-related social construction of the elderly. This raises concerns about the quality of care provided to end-of-life patients. To ensure that patients’ dignity is preserved in the final stages of their lives, it is necessary to provide training for caregiving staff on the importance of considering gender in end-of-life palliative care.

Key messages

• Home hospice staff tend to ignore gender when caring for dementia patients. Neglecting gender raises ethical concerns and questions about patient dignity and welfare.

• Considering gender in end-of-life palliative care is crucial to ensure high-quality care for patients with dementia in the final stages of their lives.
The health literacy toolbox for schools: An intervention to promote (digital) health literacy
Authors: Schulenkorf T , Okan O
Published: October 2023

Background

Children and youth increasingly seek for health information on the Internet and Social Media, requiring to link media, digital and health literacy to equip them with the skills to distinguish reliable and trustworthy information from disinformation. Preferably, health literacy learning is addressed in schools, but to date there are no programs to address this subject in German schools. This study sought out to develop a classroom-based toolbox to promote health literacy in, e.g., media and digital education classes or subjects such as biology, physical activity, social sciences.

Method

A review on curricular, school requirements, and health literacy interventions was conducted. Findings informed the participatory development of a health literacy toolbox with teaching and learning units for students (7-8th grade) and teachers. The toolbox was tested in three schools, comments were received by teachers and students, supporting the adjustment of the toolbox.

Results

The toolbox is based on the school curriculum for media and digital education of secondary schools, addressing adolescent students in grades 7 and 8 in German secondary schools. It includes learning units to increase competencies regarding health information seeking, understanding of information, and critically analysing health claims and messages. Alongside exercises on critical thinking while navigating online Internet and media sources, the toolbox provides topical learning units, linking health literacy with, e.g., COVID-19, vaccination, healthy eating, substance use, media use, commercial determinants, and mis- and disinformation.

Conclusions

This is the first health literacy toolbox of its kind. Embedding it into the mandatory media and digital education curriculum, and addressing both students and teachers, will ensure the uptake of the programme in schools. Both the toolbox and the methodology of its development can serve as a blueprint for other countries to develop their own interventions.
Investigation of an unusual cluster of illness among staff at a wildlife rescue centre
Authors: Purcell B , Harvey Vince L , McManus O , Crook P , Letts A , Murphy A , Kane U , Sheehan S
Published: October 2023

When two previously fit and well staff from a wildlife rescue centre were hospitalised in early September 2018 with severe pneumonia and meningitis symptoms, the Health Protection Team began an investigation. Possible diagnoses included influenza and legionella, although it was not flu season, and initial testing proved negative. There were reports of other staff illness over the preceding weeks. The centre had accepted a wide range species over the Summer, including high numbers of gulls and pigeons, and an outbreak of psittacosis was suspected; the patients responded rapidly to doxycycline. An incident management team was rapidly convened to investigate and determine control measures. A testing algorithm was developed: including for Influenza A&B, Urine legionella & pneumococcal antigen; reference laboratory serology testing and real-time PCR for Chlamydia.psittaci; and pan-corona viruses. Case finding was conducted by telephone interviews and a select-survey of all 55 staff gained 46 responses. A series of site visits examined working practices at the site. Avian and environmental sampling was undertaken. A total of 22 staff met the agreed case definition for psittacosis, five of whom were later confirmed. Clinical features ranged from mild to severe. The onset dates of illness ranged from July to September. There was no evidence of person-to-person transmission. Analysis did not show a clear correlation between PPE use and illness. Clinical, microbiological, environmental, veterinary, and epidemiological evidence indicated zoonotic transmission of psittacosis. Variable compliance with PPE, hygiene when handling birds, and disinfection had likely contributed via aerosolization of dust. This was likely exacerbated by very high bird stocks and unusually warm weather conditions. Comprehensive recommendations were made to reduce the chances of future outbreaks, which are generalisable to other countries.

Key messages

• This was one of the largest clusters of human psittacosis described in a workplace in England.

• Biosecurity in animal rescue centres is crucial to limit the chance of psittacosis and other zoonoses.
Living Arrangements and the Speed of Chronic Disease Accumulation among Older Migrants and Natives
Authors: Jang S Y , Myrskylä M , van Lenthe F J , Loi S , Oksuzyan A
Published: October 2023

Background

Immigrants may experience a faster health decline than natives due to the deleterious impact of migration-related experiences on healthy ageing. Support from living arrangements where family members reside together is known to provide a buffering effect for such health deterioration. This study examines the role of living arrangements in the health of immigrants versus natives, focusing on the rate of chronic disease accumulation to portray the healthy ageing processes.

Methods

We use data from the Survey of Health, Ageing and Retirement in Europe (SHARE). First, we employ ordinary least square regression models with clustered standard errors in the pooled sample to determine the average number of chronic diseases by migration background. Then, we run immigrant status- and living arrangement-stratified analyses to illustrate the age-related profiles of chronic disease accumulation in immigrants versus natives.

Results

According to our results, living with a spouse or family has a buffering effect on chronic health deterioration for natives, which disappears among immigrants. This beneficial effect is especially prevalent for native men, explaining the immigrant-native gap in the average number of chronic diseases - observed only in a couple or family households among men. Further, chronic diseases accumulate at different rates with age between immigrants and natives based on their living arrangements. Immigrant men living with a family have a slower chronic disease accumulation than native men, while among women, the accumulation speed is faster in immigrants than in natives.

Conclusions

Our results indicate that living with a spouse or a family member provides a different amount of protection by the migration background, leading to different healthy ageing processes between immigrants and natives. Therefore, public policies should monitor the health of the ageing migrant population not only as a whole but also by living arrangements.

Key messages

• Types of living arrangements are associated with age-related profiles of chronic disease accumulation.

• Living with a spouse or a family member provides a different amount of protection by the immigration background, leading to different healthy ageing processes between immigrants and natives.
Health and sustainability impacts of scenarios of replacement of beef by pulses in two EU countries
Authors: Monteiro Pires S , Fieis de Melo J , Vieira ACL , Gomez Redondo H , Assunção R , Cozzi E , Biasini B , Menozzi D
Published: October 2023

Background

High consumption of red meat is an important cause of burden of disease and environmental degradation globally. To motivate changes in food consumption and production, policymakers need evidence on the overall impact of such changes on the health of citizens, and on all aspects of sustainability: environment, socioeconomics, and culture.

Methods

Using three different approaches, we compared the impact of four scenarios of replacement of beef consumption with pulses (a well-established plant protein source) in two EU countries, Portugal and Denmark. First, health impacts were quantified in disability-adjusted life years (DALY); second, sustainability impact was measured using various social, economic and environmental indicators. Finally, we used MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique), an interactive, iterative, multicriteria decision analysis approach, to create a quantitative value model.

Results

We estimated positive health impacts for all substitution scenarios in the two populations. Positive impacts were larger for Denmark and ranged from 5,9 DALYs (25% substitution of beef by pulses in Portugal) to 39,7 DALYs averted/100,000 people (100% substitution, Denmark). The two countries had positive economic impacts, but beef production was more resilient than pulses. Environmental and social impacts of beef production were consistently higher than pulses. The MCDA model included a set of 15 criteria within the four dimensions of analysis to assess the overall value of implementing each scenario.

Conclusions

Individually, each approach allowed us to compare health, sustainability and integrated impacts of different options for food substitutions relevant to the sustainability agenda. Together, they allowed us to create a platform for discussing the co-benefits of dietary changes in different contexts. Expanding this work to other dietary changes and countries will support further development of public health policies.

Key messages

• Different possible scenarios of substitution of beef consumption by pulses, an alternative plant-based protein source, will lead to overall positive health and sustainability impacts.

• Quantitative measurements of the integrated health, environmental and socioeconomic impacts of dietary transitions will support development of public health policies towards sustainable diets.
Non-adherence to COVID-19 containment behaviours: results from an all-Ireland telephone survey
Authors: Darker C , O'Connell N , Graham C , O'Connor C , Zgaga L , Burke E , Mather L , Nicolson G , Barry J , Scally G
Published: October 2023

Background

COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines.

Methods

A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health.

Results

3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9).

Conclusions

Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.

Key messages

• non-adherers have different demographic/psychological covariates public health messages should be tailored to the specific behaviour/populations of interest, rather than generic messaging.

• both behaviours (hand washing & social distancing) share some predictive variables, including male gender, perceptions of response cost, social norms and self-efficacy.
Experiences of elderly people living alone during the COVID-19 pandemic: Phenomenological research
Authors: Ilgaz A , Sert E , Gozum S , Oncel S
Published: October 2023

Background

One of the groups most affected by the COVID-19 pandemic, with a high mortality and morbidity rate, is the elderly. Among these, one of the most affected groups is the elderly living alone. No study has been found in the literature that questions the experiences of the elderly living alone in this process in detail. It is aimed to explore the experiences of elderly individuals living alone during the COVID-19 pandemic, and to address this process and the problems they experience with all aspects in terms of health.

Methods

In qualitative research, a phenomenological approach was adopted, and this study was conducted with 14 elderly people living alone. Individual in-depth face-to-face interviews were conducted. A semi-structured interview form was used in the interviews. Content analysis was used in the analysis of the data. Kappa analysis was performed to determine the internal consistency of the responses from the experts. Cohen's kappa coefficient was 0.95, which means a perfect fit.

Results

The mean age of the individuals was 76.14±7.04 and 71.4% of the participants were women. The main themes identified were a) the effects of pandemic restrictions, b) the view of the elderly on pandemic rules, c) physical, d) mental and e) social health problems, f) coping strategies of the elderly, g) support received in problem solving, h) and solution suggestions from the elderly.

Conclusions

Pandemic restrictions in elderly individuals living alone have caused disruption of health checks and changes in daily life. The elderly experienced physical, mental and social health problems during the pandemic and developed coping strategies to combat the process. The experiences of the elderly and their suggestions should be taken into account in being prepared for any crisis that may affect the whole society, especially the elderly living alone.

Key messages

• The elderly living alone experienced physical, mental and social health problems during the pandemic period.

• During the pandemic period, the elderly are affected in many ways such as economically, socially, etc. In this process, they developed coping strategies and gave suggestions for the next crises.
Integration of prison health care into national disease surveillance and health informatic systems: opportunities and challenges for Europe and beyond
Authors: O'Moore E
Published: October 2023

Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a ‘black hole’ for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic&clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes.
Sociodemographic disparities in burden of osteoporosis among Swedish adult and elderly population
Authors: Gao M , Scott K , Falkstedt D , Mishra G , Grünberger I
Published: October 2023

Background

Osteoporosis is a common skeletal disease. Previous research has been primarily based on non-prospective designs, and rarely included male and/or migrant populations. We investigated the associations of sociodemographic characteristics with risk of osteoporosis in a Swedish nationwide cohort.

Methods

This register-based prospective study included 1,900,279 males and 1,961,619 females born in 1920-1960, followed for osteoporosis from age 50 until December 31, 2012. Multivariable Cox regression was used to estimate the associations with sociodemographic characteristics and was stratified by gender and co-occurrence of fractures.

Results

12,906 males and 84,621 females aged 50-92 years received a diagnosis of osteoporosis. Incidence rates increased sharply from age 70. At all ages, women on average had 5 times higher rates of receiving first osteoporosis diagnosis than men. Region of birth and education were associated with incidence of osteoporosis in a gender-specific pattern. Compared to Swedish-born women, incidence of osteoporosis without fracture was elevated among female migrants from the former Soviet states (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.51-1.73) and the Middle East (HR, 1.62; 95% CI, 1.48-1.78), but lower among those from other Nordic countries (HR, 0.94; 95% CI, 0.91-0.97). Compared to Swedish-born men, a higher incidence was observed for male migrants from North America (HR, 2.03; 95% CI, 1.47-2.81). When fracture was accounted for, Swedish-born individuals showed higher incidence compared to migrants from other European countries except Nordic. For all osteoporosis subtypes, higher education was associated with increased incidence in women but not in men.

Conclusions

Incidence of osteoporosis varies with age, sex, country of origin, length of stay, and educational level. Sociodemographic disparities in osteoporosis need to be considered by healthcare sectors for targeted interventions to reduce future fracture rate.

Key messages

• This study demonstrates a large burden of osteoporosis in the Swedish adult and elderly population.

• Sizeable sociodemographic disparities in osteoporosis exist even within a country with universal healthcare.
Digital public health in Germany
Authors: Maass L
Published: October 2023

The German healthcare system is complex, with different levels of government and stakeholders involved. Therefore, implementing a consistent and cohesive digitalisation strategy nationwide is challenging. Unsurprisingly the system seems to operate according to the mantra: “From the cradle to the grave: forms, forms”. It is still one of the most paper-based healthcare systems in Europe. Until 2021, there were no electronic health records. Electronic prescriptions are delayed until 2024. The systems structures appear stuck and inflexible. The COVID-19 pandemic displayed the weaknesses of the German healthcare system: A lack of digital infrastructure, limited access to teleconsultations and telemedicine, healthcare professionals lacking training in digital health tools, etc. However, instead of giving up, there was a push from the industry and legislators toward applying more digital tools in the healthcare routine. Germany was among the first countries to develop one of the safest contract tracing apps worldwide (Corona-Warn-App). It further lifted its restrictions on telemedical consultations and was the first country to introduce medical and care apps on prescription (DiGA and DiPA). Additionally, the first national health portal was introduced in 2020 to provide the general population with information on health- and disease-related topics and an overview of currently implemented and planned digital health services. Now, it is discussed setting up a national Health Data Lab to empower public health research through secondary data based on health insurance claims data. Nevertheless, the question remains where the German legislative sees the role of health promotion and primary prevention. While public health associations push for recognising these crucial aspects of public health, all national projects currently focus on diagnostics and treatment. The question remains if and when Germany will realise the potential of digital public health in primary health promotion.
Prenatal counseling and maternal health behavior: The case of Ramadan fasting during pregnancy
Authors: Witte P , Van Ewijk R , Pradella F
Published: October 2023

Background

Ramadan during pregnancy has been found to be associated with various adverse health effects in the offspring, which are largely attributed to maternal intermittent fasting. At the same time, many pregnant Muslims decide to fast during Ramadan. With a growing Muslim population in Europe, Ramadan fasting during pregnancy may become an even more prominent issue in the future. Since pregnant women regularly exchange with healthcare professionals, it is pivotal to evaluate the role of prenatal consultation on Ramadan for the maternal fasting decision.

Methods

This study uses survey data on pregnant Muslims from Mainz, Germany (N = 326). Data on fasting during pregnancy, consultation with healthcare professionals on fasting during pregnancy, as well as a rich set of socio-economic background characteristics were collected. We estimate the effect of prenatal consultation on the number of days fasted using a log-normal hurdle model. To test whether our controlled estimates might be biased by unobservable confounders, we use the Oster (2019) method.

Results

The share of women who fasted at least one day was 36.5% (mean: 17 fasted days). Among these women, receiving prenatal consultation on fasting during pregnancy reduced the number of fasted days by 10.8 days (95% CI: -19.03, -2.56). Results from the Oster method show that this result is not biased by unobservable confounders.

Conclusions

This study shows that prenatal consultation on Ramadan fasting reduces the number of fasted days among pregnant Muslims who intend to fast during pregnancy. These findings imply that prenatal caregivers should be encouraged to discuss Ramadan fasting with their Muslim patients. Further research is needed to develop guidelines for prenatal advice on Ramadan during pregnancy in a framework of shared decision-making.

Key messages

• Controlled effect estimates show that potentially harmful maternal Ramadan fasting behavior during pregnancy can be mitigated by prenatal caregivers.

• This study demonstrates a novel way to exploit real-world data in the absence of randomization by quantitatively assessing the impact of unobservable confounders.
Predictors of lower response to COVID19 vaccine in people living with HIV. A 6-month follow-up study
Authors: Amoruso I , Fonzo M , Geppini R , Miccolis L , Serpentino M , Leoni D , Cattelan A , Baldo V , Baldovin T
Published: October 2023

Clinical trials demonstrated efficacy and safety of COVID-19 vaccines, although enrolment of immunocompromised individuals, including people living with HIV (PLWH), has been limited. Although cellular immunity is not negligible, recent evidence suggests a strong correlation between neutralising antibody titre and overall protection against infection. Our study aimed to identify potential predictors of lower response to vaccine in PLWH. We conducted a prospective study at the Padua University Teaching Hospital, Italy. Participants were vaccinated with a BNT162b2 2-dose schedule in early 2021. Non-naïve to SARS-CoV-2 were excluded. Anti-S titres were assessed using AdviseDx SARS-CoV-2 IgG II quantitative CMIA assay at 30, 90 and 180 days after completion of vaccination. Non-response was defined as < 50 AU/mL and lower response as the lowest quartile. Information on age, sex, BMI, comorbidities, CD4 count, CD4/CD8, viral load was collected. The association between predictors and lower response was assessed using logistic and linear regression. We enrolled 180 individuals (15 excluded). Mean age 54.0±11.2 years; 17% females; 23% showed CD4 count <500 (none <200), while 18.2% CD4/CD8 <0.5. All responded to vaccine at any follow-up time. Lower response was associated with dyslipidaemias (AOR 4.75; 95%CI: 1.39-16.20; 30 days) and diabetes (AOR 7.11; 95%CI: 1.10-46.10; 90 days), while 1-unit increase in BMI was associated with reduced risk (AOR 0.78; 95%CI 0.64-0.95; 90 days). No correlation was found between anti-S titre and CD4 count (β -0.057; p 0.52), CD4/CD8 (β 0.050; p 0.57) nor viral load (β -0.001; p 0.99). Response to vaccine is good and sustained in well controlled PLWH. Dyslipidaemias and diabetes are associated with a non-concerning lower response. Increased BMI as protective factor may reflect the effect of good nutritional status. Using CD4 count, CD4/CD8 or viral load does not appear to help predict vaccine response in well controlled HIV.

Key messages

• Well controlled People Living With HIV (PLWH) respond well to BNT162b2 vaccine, and neutralising antibody titres are maintained for up to 6 months after primary vaccination.

• PLWH with dyslipidaemias and diabetes have lower antibody persistence, although always above the threshold. Good nutritional status may contribute to longer antibody persistence.