bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of mental health-related healthcare use in employment and benefits use after unemployment
Authors: Salonen L , Leinonen T , Solovieva S 
Published: October 2024

Abstract

Background
Mental health problems are common among unemployed job-seekers and they further hinder successful re-employment. Previous studies investigating the role of mental health problems on labour market participation after unemployment have largely focused on a single outcome. However, many have subsequent unemployment or receive different types of benefits. To understand these complex pathways a more comprehensive approach is needed. In this study, we examine how mental health-related healthcare use among the unemployed affects their employment and benefit use trajectories.

Methods
We use a 90% population sample of individuals who were residing in Finland at the end of 2010, who were 25-59 years old and unemployed between 2014-2016 (n = 596,323). We use multistate trajectory models to analyse their employment and benefits use development three years after the onset of unemployment. We will further use multinominal regression analysis to investigate how mental health-based healthcare use is associated with these trajectories and how this association varies between different sociodemographic groups.

Results
Around half of the unemployed job-seekers received some type of benefit after the onset of unemployment. Almost 25 % received sickness allowance (especially women), a little less social assistance (especially young and low educated), or unemployment benefits (especially men), and around 10 % received disability pension (especially among those with healthcare visits due to mental disorders). Next, we will conduct a trajectory analysis to get a more comprehensive picture of the employment and benefits trajectories.

Conclusions
Unemployment is followed by complex employment and benefits trajectories which further differ by sociodemographic groups and mental health-related healthcare use. Knowledge on the factors influencing these trajectories will help direct employment-promoting interventions towards different groups of unemployed.

Key messages
• Many unemployed job-seekers receive some type of social or sickness benefit after unemployment.
• The employment and benefits trajectories after unemployment differ between those who had mental health-related healthcare use and those who did not, and further by sociodemographic factors.
Maternal pre-gestational and gestational diabetes and risk of offspring epilepsy: A cohort study
Authors: Hossin M Z , Persson M , Bjørk M H , Stephansson O , Razaz N 
Published: October 2024

Abstract

Background
Despite growing evidence linking maternal diabetes to impaired brain physiology and neurodevelopment in offspring, evidence on its effect on epilepsy remains scarce. This study aims to determine if intrauterine exposure to maternal pre-existing and gestational diabetes mellitus is associated with risk of offspring epilepsy.

Methods
We studied &gt;2.3 million singletons live-born in Sweden between 1998 and 2021, with final follow up until October 31, 2023. The Swedish Medical Birth Register was linked to the National Patient Register to identify gestational diabetes (GDM), maternal pre-gestational type 1 (T1DM) and type 2 diabetes (T2DM), and offspring epilepsy. The incidence of epilepsy, comparing offspring of mothers with versus without diabetes, was calculated as hazard ratios (HR), adjusting for maternal education, smoking, body mass index, hypertension, epilepsy and other important confounders. Paternal T1DM and T2DM were additionally analysed as negative control exposures to assess genetic confounding.

Results
Of the 2,335,245 offspring analysed (48.9% female), 13,883 (0.6%) were exposed to maternal T1DM, 4477 (0.2%) to T2DM, and 37,253 (1.6%) to GDM. During a median follow up of 13 years (range 0-26 years), 18,732 offspring were diagnosed with epilepsy. Maternal T1DM (HR 1.27, 95% confidence intervals [CI] 1.08-1.49) and T2DM (HR 1.34, 95% CI 1.00-1.49) were associated with higher hazards of epilepsy in offspring, compared with no exposure to maternal diabetes. Preterm birth and birth-asphyxia jointly mediated 63% and 39% of these associations, respectively. No association was found between maternal GDM and epilepsy. Paternal T1DM and T2DM did not show association with epilepsy.

Conclusions
In this nationwide population-based cohort study, children of mothers with T1DM or T2DM showed an elevated risk of epilepsy. The results from paternal comparison and mediation analyses suggest a key role of the intrauterine environment in the aetiology of epilepsy.

Key messages
• Maternal pre-existing T1DM and T2DM might be risk factors for epilepsy in offspring and are likely to influence the risk through the intrauterine environment independent of genetic mechanisms.
• In the context of a globally rising prevalence of diabetes in women who get pregnant, it is crucial that the diabetes is well-regulated and birth complications associated with diabetes are prevented.
Housing tenure and acute lower respiratory tract infection admissions in two Scottish birth cohorts
Authors: Hart C , Hardelid P , De Stavola B , Hajna S , Cunningham S , Taylor J , Cruz J 
Published: October 2024

Abstract

Introduction
Early-life acute lower respiratory tract infections (LRTI) have been associated with increased morbidity and mortality. Despite young children spending much of their time at home, the contribution of home ownership status, on LRTI hospital admissions is unknown.

Objectives
To estimate the association between housing tenure and the odds of LRTI hospitalization in children &lt;2 years in two birth cohorts.

Methods
De-identified Scottish birth records were linked to maternal Census data (2001 and 2011) and to hospital admission data to construct two birth cohorts (Cohort 1 (C1), born 2000-2002; Cohort 2 (C2), 2010-2012). Using logistic regression we estimated the association of housing tenure (owned, social rented, private rented, rent-free) with the odds of LRTI hospital admission, before and after adjustment for maternal age, residential area, and maternal qualification level.

Results
Over the 2-year follow-up, there were 14,833 LRTI admissions in 12,527 children (10,832 children had 1 LRTI admission and 1,695 &gt;1 LRTI admission). 75.6 % of all LRTI admissions were due to bronchiolitis. In C1 and C2, 4.0% and 5.3% children, respectively, had one or more LRTI admission. Compared to children living in owned housing, the odds of LRTI admission were higher in children living in social rented housing (C1: Odds ratio=1.40, 95% confidence interval: 1.31-1.49; C2: 1.23, 1.16-1.31), private rented (C1:1.24, 1.11,1.39; C2: 1.14, 1.06-1.21), and rent-free housing (C1: 1.53, 1.35,1.74; C2: 1.04, 0.80-1.36) after confounder adjustment.

Conclusions
We found an association between non-owned housing and higher odds of LRTI admission which was more marked in C1 than in C2. Further research is warranted to unpick the mechanisms underlying the association between housing tenure and LRTI admission. Interventions to prevent LRTI admissions could usefully target children living in non-owned housing.

Key messages
• This study demonstrates the value of administrative and health data linkage in improving our understanding of how socio-environmental factors might impact children’s respiratory health.
• Children living in social and private rented housing (compared to owned housing) have a higher risk of LRTI hospital admission and could benefit the most from LRTI-lowering interventions.
11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments
Authors:   Organised by: EUPHA-SGMH,   Chair persons: Richard Bränström (EUPHA-SGMH), Arjan van der Star (EUPHA-SGMH)
Published: October 2024

Abstract

Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health.

Key messages
• Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals.
• Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.
Real-time exposure to negative news media and suicidal ideation intensity among LGBTQ young adults in a high-stigma US state
Authors: Clark K A , Kellerman J K , Argiros A P , Phillips K L , Park E C , Cyperski M , Pachankis J E , Kleiman E 
Published: October 2024

Abstract

Background
With a recent surge in anti-LGBTQ policies and associated news/media coverage worldwide, there is a crucial need to study the role of LGBTQ negative news/media on proximal risk for suicide among LGBTQ youth, especially in high-stigma contexts.

Methods
Using a smartphone-based protocol, participants responded to brief self-report surveys 3x per day for 28 consecutive days. LGBTQ young adults (ages 18-24 years old) residing in Tennessee with recent suicidal ideation were recruited. At each assessment, participants reported real-time exposure to negative news/media, whether the news/media was related to LGBTQ topics, expectations of anti-LGBTQ rejection, and current intensity of passive suicidal ideation, active suicidal ideation, and self-harm ideation. Statistical analyses employed multilevel path analyses with restricted maximum likelihood estimation.

Results
31 participants completed 2189 assessments (90.5% median compliance). Within-person effects showed that real-time exposure to LGBTQ - but not general - negative news/media was positively associated with suicidal ideation intensity. Significant indirect effects were present from exposure to LGBTQ negative news/media to higher suicidal ideation intensity through expectations of rejection. Mediation through expectations of rejection accounted for 25% and 39% of the total effect for active and passive suicidal ideation, respectively.

Conclusions
Findings have important public health implications related to media reporting, policy, and clinical intervention. Interventions targeting media organizations should promote responsible reporting practices and increase awareness of the potential suicidogenic impact of negative LGBTQ news coverage. This study joins numerous others in documenting the potential mental health harms of policies that restrict LGBTQ visibility and rights. Mental health professionals play a vital role in promoting coping in the face of exposure to LGBTQ negative news/media content.
Multilevel Sexual Minority Stigma-Based Experiences and Mental Health Among U.S. Sexual Minority Adults: A Socio-Ecological Longitudinal Moderated Mediation Analysis
Authors: van der Star A , Bos H 
Published: October 2024

Abstract

Background
The current study aimed to longitudinally examine whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes among sexual minority adults, and as a function of two moderators: structural climate and generation.

Methods
Data from 600 sexual minorities across three generations (i.e., ages 18-25, 34-42, 48-55) who completed all three waves of the 2016-2019 Generations Study were merged with census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent and dependent variable combination through two parallel mediators, with both moderators included on each independent-mediator variable pathway.

Results
Greater identity concealment partially explained the effects of perceived external stigma on greater psychological distress and suicidal ideation, but most strongly among older generations. Other mediation was not supported. Reversed sensitivity analyses revealed how identity concealment’s positive effect on suicidal ideation may be suppressed through lower adulthood victimization and, only among younger generations in higher stigma climates, how it’s positive effects on psychological distress and suicidal ideation may be suppressed through lower everyday discrimination.

Conclusions
Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of interpersonal stigma on distress and suicidal ideation. While the longitudinal findings provide some support for the cross-level effects of sexual minority stigma on mental health outcomes, further advanced time-lagged examinations are warranted.
The mental health impacts of othering LGBTQ+ in Rwanda and Kenya: a mixed methods exploration
Authors: Stojanovski K , Otukpa E , Igonya E K , Twahirwa L G 
Published: October 2024

Abstract

Background
Globally lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons experience stigma across at multiple socioecological levels with health-harming impacts. The objectives of this study were to quantify and explore how stigma shapes mental health among LGBTQ+ persons living in Rwanda and Kenya.

Methods
Respondent-driven sampling was used in this mixed methods study of LGBTQ+ persons. In Rwanda, we surveyed 499 and conducted focus groups with 59 persons. In Kenya, we surveyed 1,573 persons, conducted focus groups with 40 persons, and conducted 113 individual interviews. We used thematic analysis for the qualitative data to examine how LGBTQ+ discuss what shapes their mental health.

Results
The average depression score was 6.3, which is categorized as mild depression. Additionally, 36% (n = 744) scored as mild, 14% (n = 289) as moderate, 5% (n = 110) as moderately severe, and 2.5% as severe (n = 52). Average scores were the same in Kenya and Rwanda. In regression models, as compared to cisgender males, cisgender females’ depression scores were 2.1 points higher (95% CI 1.5, 2.8), trans male scores were 1.6 points higher (95% CI 0.7, 2.5), trans female scores were 1.9 points higher (95% CI 1.1, 2.7), and gender non-conforming scores were 1.7 points higher (95% CI 1.0, 2.4). As compared to transgender people, lesbian & gay participants had depression scores that were 0.93 points lower and bisexual 1.3 points lower (p &lt; 0.000). In adjusted regression models, we found that for every one-unit increase in discrimination, depression scores increased by 0.44 (95% 0.36, 0.52). Qualitatively, stigma was described as a prominent factor in negatively impacting mental health.

Conclusions
LGBTQ+ people in Rwanda and Kenya experience elevated mental health issues that arise from discrimination due to their stigmatized identity.
The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018–2023
Authors: Schulmann K , Bruen C , Parker S , Siersbaek R , Burke S 
Published: October 2024

Abstract

Background
This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation.

Methods
This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis.

Results
The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors.

Conclusions
Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed
Sleep health across the life cycle: an unmet and neglected public health priority
Authors: Stranges Saverio 
Published: October 2024

Abstract
The presentation will set the stage on the central role of sleep health across the life cycle. Despite the large body of evidence on the importance of poor sleep behaviors as a modifiable risk factor for several adverse health outcomes, sleep health is still an unmet and neglected issue in public health policy, especially in the European context. Sleep problems are widespread and potentially affect everyone, from childhood to adult age. In addition, sleep health disparities represent a major source of health inequities across marginalized and high-risk population subgroups, such us people from low socio-economic status, women, refugees and immigrants, shift workers, people living with physical and mental illness. There is an urgent need to promote evidence-based health promotion and public health policy to enhance sleep health both in the general population and high-risk subgroups.
Cancer prevention over the life course
Authors: Chiolero Arnaud 
Published: October 2024

Abstract
Within a life course epidemiology framework, the etiology and prevention of cancer are informed at different ages from a social, behavioral, and biological perspective (1). Due to population aging, the burden of cancer increases and calls for new cancer prevention and screening strategies. In this introduction, we will discuss the issues of cancer screening among older adults and inequalities in screening uptake, and how vulnerable population preventive strategies can reduce these health inequities.
Monitoring inequities using routine administrative data: a case study of cancer screening in Ontario, Canada
Authors: Stranges Saverio 
Published: October 2024

Abstract
Routine cancer screening is a critical primary care service to reduce cancer morbidity and mortality, through early detection, diagnosis, and treatment. We evaluated longitudinal changes in socioeconomic inequities in cancer screening in Ontario, Canada, by using linked provincial health administrative databases including 15.9 million records eligible for cancer screening. The rate of colorectal cancer screening increased between 2011 and 2020 (54% to 62%) with a reduction in the indices of inequity (slope index, SII: from 0.36 to 0.33; relative index of inequity, RII: from 0.69 to 0.54). However, the rate of cervical cancer screening decreased (from 76% to 68%), particularly in deprived areas (RII increasing from 0.47 to 0.54). Access to cancer screening is a challenge in deprived areas. Understanding the socio-economic determinants in access to screening across the life course can help develop tailored interventions to increase health equity.