bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain and mental health - separate and joint associations with sickness absence among young employees
Authors: Fagerlund P , Shiri R , Suur-Uski J , Kaartinen S , Rahkonen O , Lallukka T 
Published: October 2022

Abstract

Background
Both pain and mental illness associate with work disability. However, few studies have examined the association of concurrent pain and mental distress with sickness absence (SA). We examined separate and joint associations of chronic pain, multisite pain, and mental distress with total and long-term all-cause SA among young and midlife municipal employees.

Methods
As part of the Young Helsinki Health study, baseline data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥3 months) pain, multisite (≥2 body sites) pain and mental distress (RAND-36 emotional wellbeing subscale below median) were reported by 3911 respondents. Register data on total (&gt;1 day) and long-term ((&gt;11 workdays) SA for the following year were obtained from the employer and the Social Insurance Institute of Finland with respondents’ informed consent. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. The interaction of gender was examined.

Results
Chronic pain, multisite pain, and mental distress were associated with total SA. Chronic multisite pain was associated with long-term SA (rate ratio [RR] 2.51, 95% CI 1.17-5.42), and chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) with long-term SA among those with mental distress. For women, there was a synergistic interaction of multisite pain to the association with total SA (synergy index 1.80, 95% CI 1.27-2.54).

Conclusions
Chronic and multisite pain associate with SA among young and midlife employees. The associations are generally stronger among women and particularly among those with concurrent mental distress. Interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence.

Key messages
• Chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress.
• Interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services.
Work after cancer-sickness absence. Barriers and facilitators from survivors’ perspective
Authors: Ayala A , Serra L , Rodriguez-Arjona D , Benavides FG 
Published: October 2022

Abstract

People who have suffered from cancer find it difficult to return to work after a sickness absence (SA). Previous evidence indicates that people who survive a cancer have a higher risk than general population of leaving the labor market prematurely or being unemployed due to sequelae of both treatment and disease. Our objective is to identify barriers and facilitators associated with the return and permanence in the workplace of salaried workers after a SA due to cancer in Catalonia. The research used a descriptive qualitative approach with socio-constructivist perspective. A theoretical sampling was carried out until saturation. Three discussion groups (7 people/group) were conducted with people who had suffered a SA due to cancer in Catalonia. The sessions were held virtually and were recorded, transcribed verbatim, and analyzed using thematic analysis and mixed coding with Atlas.ti. Most of the people had returned to work after SA or were looking for a job that was suitable for their health status. Among the barriers to reincorporation to their job detected: (1) coping with the same workload they had before the SA, (2) sequelae associated with cancer treatment that affected their ability to work (stress, low ability to concentrate, chronic fatigue, mobility limitations), (3) having jobs with a high physical load, (4) expectations of colleagues and bosses. Among the facilitating factors: (1) sessions with psycho-oncologists, (2) availability of holidays to adapt their return after SA, (3) teleworking, and (4) job adaptation. Regarding proposals to improve this process, the most outstanding were the implementation of policies that allow a gradual return to work adjusted to the people who want to adhere to it and generalize the possibility of doing psycho-oncological therapy. End of SA after cancer is a key moment for people who go through it, they suffer many difficulties during the process that could be prevented with measures such as a gradual return to work.

Key messages
• Workers who suffer a SA due to cancer face difficulties on their return to work.
• Initiatives of adaptation and gradual reincorporation to the workplace could improve return to work process after a SA due to cancer.
Covid-19 impacts on unemployment on the migration-gender intersections in Spain, a multilevel study
Authors: Pedrós Barnils N 
Published: October 2022

Abstract

Background
The covid-19 pandemic has led to several socioeconomic consequences, which ultimately affect individuals’ health status. This study aims to assess and explore the short-term impacts of the pandemic on the labour market in Spain, through the intersectional and multilevel analysis of unemployment rates.

Methods
Cross-sectional study using data from the Spanish Labour Force Survey from the three quarters before and after the outbreak of covid-19 (N = 922,074). Multilevel logistic regressions were used to calculate the odds of being unemployed for the intersectional positions on gender and migration background, nested within 7 educational levels.

Results
Before (pre) and after (post) the covid-19 outbreak, women had higher odds (ORnw-pre=1.974; p-value&lt;0.001; ORmw-pre=2.202; p-value&lt;0.001) of being unemployed than men (ORmm-pre= 0.887; p-value&lt;0.001). However, the pandemic affected women's employment unequally. Migrant women experienced an increase in the risk of being unemployed 6 times larger than native women (48.67% (ORmw-post=2.688; p-value&lt;0.001) v 8.78% (ORnw-post=2.062; p-value&lt;0.001)). Moreover, in the post-covid 19 scenario, individual characteristics of migrant women (ORmw-post=2.688; p-value&lt;0.001) played a larger role in the risk of being unemployed than their educational level (MOR=2.537).

Conclusions
Migrant women are disproportionately bearing the short-term economic consequences of the pandemic by means of higher unemployment rates, underpinning experiences of racism and gender discrimination. Increasingly attention needs to be placed on discriminated groups in society. Targeted protective policies that foster labour market integration and increase social protection are needed to mitigate and decrease existing economic, social, and health inequalities.

Key messages
• Migrant women have disproportionately carried the economic impact of the covid-19 pandemic in Spain. Targeted protective policies are needed to mitigate existing socioeconomic and health inequalities.
• Migrant women’s gender and migration background play a greater role than their education in the risk of being unemployed, underpinning experiences of racism and gender discrimination.
Digital health literacy and health behaviors of eighth and ninth graders from Germany
Authors: Dadaczynski K , Rathmann K , Schricker J , Bilz L , Sudeck G , Fischer S , Janiczek O , Quilling E 
Published: October 2022

Abstract

Background
Due to the high availability and use of digital media, health-related information is increasingly shifting into the digital space. While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior.

Methods
A cross-sectional study of 490 secondary school students (grades eight and nine) from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, soft drinks, and weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS.

Results
Across all items, the percentage of adolescents reporting difficulties in acquiring and dealing with digital health information ranges from 15.3 % to 37.5 %. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showing a limited digital HL. Adolescents with moderate and low digital HL report higher levels of low physical activity, non-daily fruit and daily soft drink consumption. Depending on the health behavior, different relationship patterns can be observed for the dimensions of digital HL.

Conclusions
The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions.
Health workforce needs of small medical specialties: findings from rheumatology in Germany
Authors: Kuhlmann E , Hoeper K , Witte T , Ernst D , Dopfer-Jablonka A 
Published: October 2022

Abstract

Background
Small medical specialties may be more vulnerable to workforce shortage and the COVID-19 pandemic and this may directly impact in the provision of care for chronically-ill patients. This study aims to explore health workforce development and new needs, using rheumatology in Germany as a case study.

Methods
An explorative multi-methods approach was applied, combining health labour market assessment of rheumatology physicians (public statistics 2000-2019) and a questionnaire-based online survey conducted in early 2021 (n = 101 respondents; rheumatology physicians and residents). Main selected topics: work hours, workload, mental health issues, discrimination and sexual harassment experiences, impact of COVID-19. Descriptive statistical analysis was performed and qualitative content analysis for free-text information.

Results
Health labour market analysis showed that the numbers of rheumatologists increased markedly between 2000 and 2019 in the groups aged +50 years, but only 9% in younger groups under 50 years; since 2010 the group 40-50 years showed decreases. In 2019, the absolute number of rheumatologists working in healthcare after retirement-age exceeded those aged 40 and under. Survey data revealed a strong mismatch between actual and desired work hours for women and men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress with major stressors being digitalisation and increased demand for communication and patient education.

Conclusions
Decreasing health workforce capacities in German rheumatology combine with negative perceptions of work and workplace conditions, threatening both retention and service delivery.

Key messages
• Small medical specialties, like rheumatology, face severe shortage that threaten healthcare for chronically-ill patients and need greater attention.
• COVID-19 has reinforced rheumatologists’ workload and stressors, thus worsing mental health and retention.
Mixed-methods study to assess an intervention for healthier lifestyles in primary healthcare
Authors: Bytyci Katanolli A , Merten S , Kwiatkowski M , Obas K , Gerold J , Zahorka M , Jerliu N , Ramadani Q , Fota N 
Published: October 2022

Abstract

Background
Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate lifestyle behaviour change. This study assesses the uptake of counselling and the impact on health behaviours and participants’ stages of health behaviour change as well as describes experiences and perceived benefits of motivational counselling.

Methods
Study participants (n = 907) were recruited from 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study. For the quantitative study, data on lifestyle behaviours, use of counselling, and stages for behavioural change were used. For the qualitative study, in-depth interviews were conducted with 26 cohort participants who had undergone motivational counselling.

Results
Motivational counselling was received by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours remain high even in persons who underwent counselling (of whom 13% are smokers; 86% are physically inactive; 93% with inadequate fruit and vegetable consumption; 61% are obese). According to the qualitative study results, the participants that received counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation.

Conclusions
More tailored and additional primary healthcare approaches in accordance with patients’ views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change.

Key messages
• The following tailored approaches are suggested: a) strengthened referral mechanism b) specialized services for smoking cessation; c) delivery of group physical activity sessions.
• More tailored and additional primary health care approaches in accordance with patients’ views need to be considered for the motivational counselling intervention.
5.N. Workshop: Children first: do health systems pay enough attention to their youngest constituents?
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Ewout Van Ginneken (Germany), Dimitra Panteli (Belgium)
Published: October 2022

Abstract

This workshop aims to bring together a range of insights on how health systems have dealt with child health and health care, highlighting both successes and challenges. For children, access to health care is vital. It impacts their physical and emotional health and wellbeing and largely determines whether they can reach their full potential as adults, which is also important to their families and society at large. Consequently, it comes as no surprise that he 1989 UN Convention on the Rights of the Child, which was ratified by all European countries, guarantees a fundamental right to healthcare for all children. However, various national governments do not fully comply with the Convention, and evidence exists that children may not always enjoy the necessary access to meet their needs. In 2021, Doctors of the World (DoW) concluded that there are urgent questions about the welfare and health of vulnerable children across Europe, based on the increase in children seeking healthcare from DoW clinics instead of the national health system. This concerning trend is not captured well enough in available statistics. What is more, the COVID-19 pandemic and the Ukrainian refugee crisis raise additional concerns as to how health systems will deal with the observed increases in related paediatric sequelae and mental health needs. The aims of this workshop are therefore to stimulate discussion around better understanding children's access to health care and how it relates to health system performance, and provide impetus for new initiatives that can improve health care for children. The workshop will take a hybrid format, kicking off with three short presentations followed by a round table discussion and engagement with the audience. The presentations will cover the regulatory framework for children's access to health care in European countries; identified bottlenecks of health system performance specific to child services from a range of countries around the world; and the impact of COVID-19 on hospital care for children based on the example of one European country.

Key messages
• Ensuring children’s access to health care is now more important than ever; a lot more can and should be done at all levels.
• More and better data about children’s health and health care access is necessary to enable effective policies; collecting it should become a health system priority.
Gender and occupational differences in post-terrorist mental health outcomes among emergency responders with and without crisis intervention
Authors: Wesemann U , Mahnke M , Polk S , Bühler A , Willmund G 
Published: October 2022

Abstract

Introduction
After the Berlin terrorist attack at Breitscheidplatz, the gender-specific evaluation of emergency responders (ER) revealed higher perceived levels of paranoid ideation among females. The occupation-specific evaluation revealed higher hostility among police officers and a lower quality of life among firefighters. The aim of this study was to examine the outcome of crisis intervention (CI) provided for ER deployed to this terrorist attack.

Methods
In total, N = 55 ER were included (n = 37 with and n = 18 w/o CI). Stress, quality of life, post-traumatic stress disorder, and current psychological stress were assessed 4 months after the attack.

Results
ER with and w/o CI were compared. Participants with CI showed lower quality of life in psychological health (t(53)=2.01, p=.050) and higher depressive symptomatology (t(44) = 2.51, p=.016). Females with CI showed lower quality of life in social relationships (t(12)=2.46, p=.030), whereas males showed more posttraumatic stress symptoms (t(39)= .32, p=.026). Emergency responders from NGOs with CI had higher phobic anxiety (t(9.2)=2.72, p=.023). Emergency medical technicians with CI showed more somatic (t(7.5)=2.52, p=.037) and depressive (t(8)=2.30, p=.050) symptoms.

Conclusions
This study provides evidence for differences in the mental health burden for ER with and w/o CI, in general and for subgroups of gender and occupation. There is no conclusive explanation for why ER with CI score worse on certain measures. It is possible that CI had a harmful influence due to the reinforcement of negative emotions in some parts of measures like the Critical Incident Stress Debriefing (CISD). While it is known that ERs are vulnerable to develop mental problems, and appropriate and timely help is recommended, it is important to critical evaluate the methods used and to take also into account the identified gender and occupational differences. Further research is needed to better understand the interaction of risk factors.
How much of the unemployment effect on mental health is due to income? Mediation analysis in UK data
Authors: Thomson RM , Kopasker D , Leyland A , Pearce A , Katikireddi SV 
Published: October 2022

Abstract

Background
Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.

Methods
We studied adults 25-64y from nine waves of the representative UK Household Longitudinal Study (n = 45,497/obs=202,297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as a General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using inverse probability of treatment weights to estimate odds ratios (OR) and absolute differences for the effects of unemployment on CMD as measured in the same sweep, before (TE) and after (CDE) blocking the income pathway. The percentage mediated by income was 100*(TE-CDE)/TE, with standard errors calculated via bootstrapping. Multiple imputation addressed missingness.

Results
The TE of unemployment on short-term CMD risk was OR: 1.66 (95% CI 1.57-1.76), with 7.09% (6.21-7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46-1.66) and 6.08% (5.13-7.03). Income mediated 14.22% (8.04-20.40) of the TE. Percentage mediation was higher for job losses (15.10% [6.81-23.39]) than job gains (8.77% [0.36-17.19]). Mediation by income was lowest for those aged 25-40y (7.99% [-2.57, 18.51]) and those in poverty (2.63% [-2.22, 7.49]).

Conclusions
In the UK, a high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for those who are younger or already living in poverty. Population attributable fractions suggested 16.5% of CMD burden was due to unemployment, with 13.9% directly attributable to job loss rather than resultant income changes. Further research is needed across different European countries to determine how different welfare regimes might moderate these effects, and to investigate longer-term effects.

Key messages
• Unemployment has a clear detrimental effect on MH in the short-term.
• Only a small proportion of this effect appears to be mediated by income.
A novel plot for the early alert of epidemic growth using regional targets: the doubling plot
Authors: Carinci F , Veltro G , Rocchi L , Mipatrini D , Mantoan D , Siccardi G 
Published: October 2022

Abstract

Background
During the pandemic, restrictions set by the Italian Government were primarily based on the regional level of key parameters including hospitalization and incidence rates. We aimed to build a specific plot to monitor trends and trigger early alerts, with daily updates publicly available on a National Portal.

Methods
A multidisciplinary team conceived and implemented a new composite plot, developing ad hoc R scripts on top of a specialised database, built in collaboration with the Ministry of Health. We calculated the doubling time Td as log(2)/log(1+r/100), where r is the daily change of target parameters and Td ranges between (0,+-infinity), and not determined for constant or missing values. We calculated Td daily, as either doubling (growth) or halving (decrease) time. To visualize trends, we assembled two different types of graphs: a bivariate plot showing the path of each point (Td, target parameter) over time, and a line plot of Td over time. The Y axis was inverted for doubling times, as lower Td indicate higher alert in this case. The two graphs were arranged in lines, using cutoffs for excessive high values for doubling times and low values for halving times. A third line was included to display trends of the target parameter over time.

Results
The plot was successfully realized and published on the Portal for all regions in February 2021 (https://www.agenas.gov.it/covid19/web/index.php?r=english%2Fdoubling&q=ITA&t=0). Since July 2021, we used the doubling plot to monitor the three main parameters adopted to set restrictions for Covid-19: a) occupancy rates in intensive care; b) occupancy rates in medical wards; c) weekly incidence rates. The plot highlighted growth trends and early alerts, particularly in the initial phases of growth.

Conclusions
The doubling plot can provide useful information to trigger early responses for pandemic control in decentralised governance. R code is available open source from AGENAS for free use.

Key messages
• The doubling plot was conceived and implemented on a National Portal to trigger early alerts of Covid-19 progression in Italian Regions and Autonomous Provinces.
• The plot could be rapidly adapted to legislative parameters and can be useful in different situations to monitor epidemic growth and support public health policies.