Health Status Research Articles

Happiness and all-cause mortality: the HAPIEE study

Abstract Background The evidence on the association between happiness and mortality is mixed. Similarly, the role of covariates in this association is not clear. Almost no evidence on the topic comes from the Central and Eastern Europe (CEE). This analysis aims to evaluate such association in longitudinal data from three CEE countries, and to investigate the role of other variables in this association. Methods The analysis is based on data from 18,362 men and women from the longitudinal Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study conducted in the Czech Republic, Lithuania and Poland who were 45-70 years old at the start of the study. Happiness was based on 4-points Likert scale answers ‘Very happy’, ‘Quite happy’, ‘Not very happy’, and ‘Not at all happy’ to the question ‘Taking all things together, would you say you are ...’. All-cause mortality was obtained from local or national mortality registers. Cox proportional hazards regression was used to estimate the hazard ratios (HRs). Results 2,718 deaths have been observed during the 11 years of follow-up. The mortality rates were 13.0, 14.1 and 20.7/1000 person years in very happy, quite happy and unhappy groups. After adjustment for country and age the HR comparing very happy and unhappy was 0.53 (95%CI: 0.43-0.67) in men and 0.66 (0.48-0.91) in women. This association was reduced after adjusting for socioeconomic characteristics, health behaviours and conventional risk factors (HR 0.78 in men and 0.84 in women); and was further reduced after controlling for health conditions at baseline. No strong evidence for country interaction was identified although the association was slightly stronger in Polish men than in other two countries. Conclusions Happiness has been shown to predict all-cause mortality in these three countries from CEE although it may be (at least partly) explained by established risk factors and underlying health conditions. This work was supported by the NPO SYRI (LX22NPO5101). #NGEU Key messages • Happiness is shown to predict all-cause mortality in this CEE population. • The association seems stronger in men than in women.

Different approaches to regulate digital health applications in seven European countries

Abstract Background Demographic ageing, shortages in health workforce and increased use of digital tools in daily life kindle decision makers’ interest to utilize digital health applications (DHA). While there are several reviews that provide an overview across remuneration frameworks, no synthesis between additional regulatory aspects and frequency of remuneration approval has been conducted. Methods European countries with either strong status in digital health in general or regulation for health apps in particular were chosen for analysis (BE, DK, DE, EE, EN, FR, NL). Country specific information was collected from scientific and grey literature, legal and stakeholder webpages. Semi-structured interviews were conducted with country experts via video call or e-mail and analyzed using Mayring’s structured, qualitative content analysis. Preliminary results We find three approaches concerning DHT-definitions: For BE, DE, FR, specific regulations define national remuneration requirements. EN and NL define only minimum requirements while decentralized payors make financing decisions. DK and EE fit DHTs into existing financing schemes. Among countries with a national financing framework, DE achieved the largest number of approvals, followed by FR, while BE has not yet issued a (lasting) financing approval. Evaluation requirements focus on clinical and economic outcomes, largely ignoring non-clinical improvements for patients. Conclusions The German regulation stands out with a peculiar definition that might help clarify evaluation criteria, increase the number of financing approvals but also empower patients while reducing the role of health workforce in their application. BE and NL regulations necessitate involvement of health workers, thus addressing structurally different applications. Key messages • Drawing lessons for DHT regulations across countries needs to address differences in national definitions and evaluation criteria. • A standardization system for DHT may help to speed utilization of effective tools and clarify evaluation requirements.

Are health inequalities decreasing in Sweden?

Abstract Background The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed. Methods All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years. Results Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to > 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to > 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time. Conclusions The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect. Key messages • Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64. • A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.

Parental leave benefit levels and postpartum maternal mental health: a Swedish cohort study

Abstract Background While generous parental leave benefits are protective for postpartum maternal mental health, not all mothers qualify for these benefits due to strong work requirements. Sweden offers paid parental leave to all residents, but the benefit level depends on their salary and labour market attachment. Objectives To evaluate the association between parental leave benefit levels and maternal mental health in the postpartum period. Methods Using total population register data, we studied 210 800 first-time mothers, aged 18-52 years, who gave birth to a live singleton offspring in Sweden between January 1, 2007 and December 31, 2011. We performed multivariable logistic regression to compare odds of mental health outcomes from different levels of severity (prescribed anti-depressants or anxiolytics, specialist outpatient care and hospitalisation) between mothers receiving higher-level benefits (i.e., qualified for earnings-related benefits) and those with basic benefits (i.e., a low flat-rate level). We also performed decomposition analyses using the Karlson-Holm-Breen method, and subgroup analyses by region of birth. Results Mothers receiving basic benefits had increased odds of prescribed antidepressants or anxiolytics (OR 1.44 95% CI 1.37-1.51), specialist outpatient care (OR 2.27 95% CI 2.13-2.44), and hospitalisations (OR 2.47 95% CI 2.97) compared with mothers receiving higher-level benefits. Increased odds remained after adjustment for pre-existing mental health. After further adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR 1.13, 95%CI 1.02-1.24) and hospitalisation (OR 1.34, 95%CI 1.03-1.76). Conclusions Mothers with basic benefits are more likely to experience moderate-to-severe mental disorders compared to mothers with higher-level benefits, independent of pre-existing mental health, income and employment status. Key messages • Labour market attachment prior to childbirth affects parental leave benefit levels and plays an important role in determining mental health outcomes in the postpartum period. • The work requirements for more generous parental leave benefits may prevent mothers from benefiting from the protective mental health advantages of parental leave.

Association between life's essential 8 score and 5-year all-cause and cardiovascular mortality in people with prediabetes: based on a cohort study

Abstract Background The Life's Essential 8 (LE8) score, which evaluates cardiovascular health (CVH) status, is linked to premature mortality in individuals with diabetes. However, the relationship between LE8 score and the risk of all-cause and cardiovascular mortality in individuals with prediabetes remains unclearly. Purpose This study aims to investigate the association between LE8 score and both all-cause and cardiovascular mortality among prediabetic patients within the United States population. Methods Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016. We selected prediabetic patients with blood glucose levels between normal and type 2 diabetes range from this database. The CVH status of these patients was categorized into low group (0-49), medium group (50-79), and high group (80-100) based on the LE8 score, which was assessed on a scale of 0 to 100. We constructed a multivariable Cox proportional hazards model to explore the relationship between LE8 score and mortality, and used restricted cubic spline curves to assess their non-linear correlation. Additionally, we conducted stratified analyses by age, gender, BMI, comorbid hypertension, and ASCVD in different populations to investigate the association between LE8 score and mortality. Results This study enrolled a total of 4,912 individuals with prediabetes (577 with low LE8 scores, 3,549 with medium LE8 scores, and 786 with high LE8 scores). Compared to the other groups, prediabetic patients with high LE8 scores exhibited younger age, lower BMI levels, a smaller proportion of Non-Hispanic Black individuals, higher education levels, and fewer clinical comorbidities. After adjusting for covariates using Cox proportional regression risk models, we observed that a low LE8 score was significantly associated with an increased rate of cardiovascular mortality (HR 4.13; 95% CI = 1.16-14.72) and all-cause mortality (HR 3.42; 95% CI = 1.73-6.74) in prediabetic patients. Restricted cubic splines demonstrated a linear trend between high LE8 scores and decreased risks of all-cause and cardiovascular mortality (P>0.05). Stratified analysis indicated that compared to the group with high LE8 scores, the group with low LE8 scores had a significantly higher risk of death within subgroups defined by age (≥65), gender, BMI<30, presence of hypertension, and absence of ASCVD. Conclusions In the American population, as the LE8 score increases, the risk of all-cause and cardiovascular mortality decreases for individuals with prediabetes over a 5-year period. Maintaining an ideal LE8 score will provide long-term benefits for individuals with prediabetes.Cox proportional regression modelRestricted cubic spline curves

Shifting focus - the need to prioritise an inclusive public health approach to trauma

Abstract Since 2017, the Welsh government has prioritised the development of a Public Health Approach to understanding the impact of Adverse Childhood Experiences. Taking the work of Bellis et al, and the population level research to understand the prevalence of ACEs, and associated risks (Bellis etc al, 2015), the ACE Hub Wales was established to coordinate a multi-agency, cross sector approach to preventing, tackling and mitigating the impact of adversity in childhood. The Hub developed its approach to advocate for more public awareness of the life course risks to health if the right support was not accessed or available to children, such as poor mental health and chronic conditions such as type 2 diabetes and heart disease in adulthood. From 2021 there has been a dramatic shift to attempting to understand the experiences, and unmet needs, of children and people who have come to Wales to seek sanctuary, migrant women who have no recourse to public funds, and people experiencing racism and discrimination. In 2021, the ACE Hub Wales co-produced a Wales national trauma-informed practice framework including a set of principles placing inclusion at the heart of the approach in Wales; shining a light on the need to have a cultural, intergenerational and gender-based understanding of adversity and trauma which links directly to, informs and supports the government’s ambitions to be a nation of sanctuary and to be anti racist by 2030. To continue to ignore the experiences of adversity and trauma by people of colour, and Gypsy, Roma and Traveller people; is to perpetuate the health inequity experienced in healthcare, and justice systems. Wales has committed to developing wisdom, not just knowledge, that means that a public health approach is inclusive of all of our communities in Wales. Key messages • The experiences of racialised ad minoritised communities from population studies of adversity and trauma is traumatizing. • Understanding the life course impact of adversity and trauma must include the experiences of racism and discrimination to be inclusive and trauma-informed.

Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review

Abstract Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

Individual level risk factors associated with episodes of heat as recorded within primary care records: a time-stratified case-cross over study

Abstract Background A key recommended action outlined in Heat-Health Action Plans is to identify individuals at risk and deploy targeted interventions, however this is not routinely undertaken. A major contributing factor is a lack of understanding of individual-level risk factors to support an evidence-based approach to targeted prevention. Aim To use electronic health data to identify individual level characteristics associated with increased risk of mortality during heatwaves in England. Methods A time-stratified case-crossover analysis was undertaken of individual-level clinical and socio-environmental (SE) risk factors. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days, with analysis stratified by potential risk modifying factors. Results Heat mortality risk was modified by a large range of chronic conditions, with cardio-respiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. Prescribed medications also increased odds of death during heatwaves. Heat mortality risk was modified by a range of SE determinants of health investigated, with ORs increasing with age; OR differences by sex, ethnicity and living arrangement; an increasing trend in ORs by alcohol intake and body mass index, excluding the obese-3 group. Results suggest the least deprived have the lowest OR and the most deprived have the highest. Conclusions This study has important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies. The results also provide important evidence on the role of disadvantage in driving the inequitable distribution of climate impacts, and the need for better socio-economic data sets linked to health records. The findings highlight the importance of incorporating an assessment of individual SE circumstances when prioritising patients at highest risk during heat events.

Precarious employment expectancy by history of mental-health-related sickness absence in Finland

Abstract Background Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence. Methods We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history). Results Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%. Conclusions Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability. Key messages • People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market. • Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.

Vaccine conspiracy beliefs are the main determinant of adult vaccine hesitancy

Abstract Background Many factors influence the level of vaccine hesitancy. The COVID-19 pandemic demonstrated that conspiracy beliefs are an important element of overwhelming misinformation. The main aim of the study was to assess the relationship between vaccine hesitancy (VH) and vaccine conspiracy beliefs (VCB) in Polish society. Methods The analysis was conducted using data from an online survey of 2189 Internet users conducted in November 2021. Uni- (ULRM) and multivariable linear regression (MLRM) models were developed for vaccine hesitancy as a dependent variable. The independent variables included VCB score (VCBS), health (HL) and e-health literacy (eHL), Internet (IU) and social media use (SMU), political views (PV), and sociodemographic variables. Results The VCBS, eHL, HL, age, income, vocational and marital status, place of residence, PV, IU, and SMU were significant predictors of VH in ULRMs. A significant relationship with VH was maintained in MLRM for all independent variables enlisted earlier, apart from age, income, and vocational status. Respondents with higher VCBS were more likely to have higher VH (B, 95%CI: 0.38, 0.37-0.40). Those with undetermined HL had higher VH than persons with sufficient HL (B, 95%CI: 0.13, 0.06-0.20). A higher level of eHL predicted a lower level of VH (B, 95%CI: -0.01, -0.012 - -0.03). Lower IU and higher SMU were associated with higher VH (B, 95%CI: 0.16, 0.02-0.30, and 0.10, 0.03-0.17, respectively). Supporters of far right-wing party showed higher HV than supporters of the governmental party (B, 95%CI: 0.16, 0.07-0.27). Finally, singles showed higher HV than married (B, 95%CI: 0.07, 0.01-0.13), and residents of small cities had higher HV than residents of rural areas (B, 95%CI: 0.08, 0.004-0.15). Conclusions The vaccine conspiracy beliefs play a major role in the development of VH. The interventions aimed at the change of antivaccination attitudes should address the problem of widespread conspiracy beliefs. Key messages • Conspiracy beliefs are an important determinant of attitudes toward vaccination. • The development of adequate digital health literacy may be a protective factor against vaccine hesitancy.

The determinants of oral health in Turkish elderly: an analysis of Turkey Health Survey (THS) 2022

Abstract Background Oral health is an integral part of health and wellbeing; however, the use of dental care by the elderly is lower compared to other services. Considering the relationship between oral health and chronic diseases, along with healthcare use patterns, evaluating oral health in the elderly is crucial. This study aims to assess the oral health status and individual, socioeconomic and healthcare related factors in people aged 65 and over in Turkey. Methods This cross-sectional study was based on THS 2022 micro dataset. Participants aged 65 and over constituted the population of this study, with 3144 participants included. Data analysis was performed using SPSS 28.0 and included descriptive statistics, Pearson’s chi-square and logistic regression. Results The mean age of participants was 72.57 with 54% being women.Self-reported poor oral health was noted in 25.8%, and 75.2% did not receive dental care in the past year. Individual factors such as older age, obesity, and multimorbidity, as well as social factors like female gender, being single, and language barrier, were associated with worse oral health. Education and social support were also associated with oral health. Among economic factors, employment showed a significant association. Concerning healthcare-related factors, not using oral care in the past year, unmet dental care needs due to financial constraints, appointments, and transportation were associated with worse oral health. Logistic regression revealed significant associations between oral health and age, multimorbidity, gender, language, education, social support, employment, dental care use, unmet dental care needs due to financial constraints and transportation. Conclusions Addressing barriers and risk factors is needed to improve oral health among Turkey’s elderly. Efforts should focus on enhancing access to dental care and addressing socioeconomic determinants of oral health. Key messages • Identifying and addressing barriers and individual, socioeconomic and health-care related risk factors associated with poor oral health among the elderly in Turkey is important. • It is needed to prioritize efforts aimed at enhancing access to oral care for the elderly in Turkey by both improving physical access and addressing social determinants to ensure better oral health.

Quality of Life and Symptoms of Hospitalized Hematological Cancer Patients

Patients with hematological malignancies undergo intensive treatment and prolonged hospitalization, thus having a variety of physical and psychosocial symptoms and worse quality of life (QOL). This study aimed to assess the QOL and investigate the symptoms of hospitalized hematological cancer patients. A cross-sectional study was conducted in the hematology clinics and day units of two general hospitals of Heraklion, Crete. Adult patients with hematological malignancy and an adequate understanding of the Greek language participated. A demographic questionnaire, the European Organization for Research and Treatment for Cancer quality assessment questionnaire (EORTC QLQ-C30), and the MD Anderson Symptom Inventory (MDASI) were used. The sample consisted of 120 patients—42.5% were women, with a mean age of 65.6 years. The mean time from diagnosis was 33 months. The global health status of QoL had an average value of 47.1. The highest levels of QOL were found in the subscale of cognitive function (72.8) and the lowest in the role function (46.1). For the EORTC QLQ-C30 symptoms scale, the lowest score was found in nausea-vomiting (11.0) and the highest in fatigue (59.1). In the MDASI, in part I (core symptoms), higher levels but also medium intensities were reported at fatigue (78.3%, mean 3.5), drowsiness (65.0, mean 3.3), and distress (65.8%, mean 2.8). In part II, enjoyment of life (85.8%, mean 5.1) had the highest, and relation with other people (67.5%, mean 3.7) had the lowest scores. The increase in the severity of the core symptoms (part I) was related to females (rho = 0.193, p <0.05) and comorbidities (rho = 0.220, p < 0.05). It was also associated with a significant decrease in all functional domains and increased fatigue (rho = 0.571, p < 0.05) in the EORTC QLQ-C30 questionnaire. The increased global health status was related to males (rho = −0.185, p < 0.05) and physical functioning with younger age (rho = −0.331, p < 0.05), higher education (rho = 0.239, p < 0.05), fewer months from diagnosis (rho = −0.199, p < 0.05), and low comorbidity (rho = −0.209, p < 0.05). Finally, multiple linear regression analysis revealed that the total average symptom score of the MDASI was the most significant factor influencing the global health status of the EORTC QLQ-C30 (β = −4.91, p < 0.001). The increased global health status of the EORTC QLQ C30 was not significantly related (p > 0.05) to the social characteristics of the patients, such as education or employment, which requires further validation. The QoL of hematological cancer patients significantly decreases during treatments due to a considerable number of symptoms that must be taken into consideration for high-quality, individualized care.

Does import trade liberalization worsen residents’ health? Evidence from China

Health is important to human capital and national sustainable development. Based on the latest Chinese Family Panel Studies (CFPS), this paper uses the IVprobit model to test the impact of import trade liberalization on residents’ health from the micro-individual perspective and further explores its mechanism. The results indicate that import trade liberalization brings hidden health costs, and that the negative effects on the health of people in eastern China or rural areas, people with a low education background, people under 60 years of age, and women are more significant. In areas with more serious environmental pollution, the health deterioration effect of expanding imports is more obvious. Increasing green coverage and optimizing the quality of public services can effectively alleviate this negative impact. Import trade liberalization does not affect residents’ health through income gap, therefore when carrying out import trade liberalization the government should pay greater attention to the health status of the specified groups, adopt various means to improve the ecological and living environments, reduce pollution emissions, optimize the supply of public services, and ultimately improve residents’ overall health level.

Factors Influencing Health Literacy among South Korean Adults: A Nationwide Study

Abstract Background Health literacy is crucial for health knowledge, behaviors, and outcomes, but research on health literacy has been limited to specific populations and settings in South Korea. This study aimed to identify factors influencing health literacy in a nationally representative sample of South Korean adults to inform public policies. Methods This cross-sectional study utilized data from the 2020 Korea Health Panel survey (10,262 adults aged 18-84 years). Sociodemographic factors (age, gender, education level, monthly household income, employment status, marital status, household characteristics, and region) and health (subjective health status, presence of chronic diseases, depression, and health insurance status) factors were examined. Health literacy was assessed using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Linear regression analysis was performed to identify factors associated with health literacy. Results The mean health literacy score was 9.1 (SD 1.60), with significant differences across age groups (p < 0.001). Linear regression analysis (adjusted R2=0.287, F = 322.83, P < 0.001) revealed that higher age, female gender, lower education, lower household income, being single, living outside a metropolitan area, having chronic diseases, lower subjective health, depression, and being uninsured or receiving medical aid were significantly associated with lower health literacy (all p < 0.001). Conclusions This study identified several socio-economic and health-related factors significantly associated with health literacy among South Korean adults. The findings suggest that older individuals, who may require more time to understand and use health information, are particularly vulnerable to low health literacy. These results provide valuable insights for developing targeted interventions and public health policies aimed at promoting health literacy and successful aging in the context of a rapidly aging society. Key messages • Various socio-economic and health-related factors significantly influence health literacy among South Korean adults. • Older individuals are particularly vulnerable to low health literacy, which has implications for successful aging in a rapidly aging society.

Inferring diagnoses from prescription data: a machine-learning approach

Abstract Estimating disease prevalence is a fundamental while challenging public-health goal: in the absence of solid diagnostic data, it typically requires expensive and time intensive studies. Analyzing existing medical records is an alternative, complementary approach. In particular, prescription records offer a glimpse into the health status of populations, prescribing patterns, and operational dynamics. We asked whether these could be used to infer diagnostics and, therefore, estimate disease prevalence. We used the Portuguese electronic medical prescriptions dataset (ADD NUMBERS) and trained a machine learning model that captures the probability that specific drugs are prescribed for the same or related medical conditions. We 1) constructed a manually-curated dataset of diseases and associated medications; 2) used this dataset to train embeddings models; 3) tested these models against human-classified data; 4) used the trained/tested model to uncover comorbidities associated with a) antibiotic prescription (to validate the model), and b) the impact of COVID-19 in prescription patterns of chronic-diseases. The model was able to accurately identify drugs used for targeting ten specific diseases, with few false positives and false negatives. Our analysis showed that the COVID-19 pandemic had almost no effect on the number of prescriptions for some chronic diseases (such as diabetes and depression), but, importantly, had a strong impact on the number of new diagnoses, with new users of diabetes medication in 2019 dropping by more than 16.8% in 2020. Medical prescriptions offer a promising tool to quickly assess disease prevalence, underdiagnosis, and allow a broad overview of the medical status of the population, especially in the face of health emergencies that strongly pressure the medical system. Key messages • We propose a new approach to infer diagnostics from prescription data with several promising applications. • We propose a new approach to infer diagnostics from prescription data with several promising applications.

Factors Associated With Health-Promoting Behaviors Among South Korean Adults: A Cross-Sectional Study.

To examine the association between positive psychological capital, social support, illness attitudes toward COVID-19, and health-promoting behaviors in Korean adults. An online cross-sectional study. The participants were 820 South Korean adults aged 19-64, recruited through quota sampling. The sample was census-matched in terms of age and gender based on the Korean Population Census. The participants completed measures assessing psychological capital, social support, illness attitude toward COVID-19, and health-promoting behaviors. The t-test, one-way analysis of variance, Pearson's correlation, and multiple stepwise regression analysis were used to analyze the data. Participants who were religious, perceived themselves as physically healthy, had negative illness attitudes, had high positive psychological capital, and received high social support were more likely to engage in health-promoting behaviors. These variables explained 44.5% of the participants' health-promoting behaviors. This study is the first to examine illness attitudes toward COVID-19 and health-promoting behaviors among South Korean adults during the COVID-19 pandemic. The results can pave the way for effective public health intervention strategies that consider religiosity, physical health status, illness attitude, and social support, to promote healthy living during future public health crises.

The data layer: the importance of sources critical appraisal

Abstract One of the main purposes of public health institute is to tracking the health status of its citizens and understanding its evolution over time. Given the absence of a singular, comprehensive data source, we developed a framework to select databases specific to each disease and outcome of interest. This process includes a thorough evaluation of the operational case definitions, as well as the strengths and weaknesses of each database, with a particular focus on their sensitivity and specificity. These qualities are appraised following a dedicated scoring form into different categories (i.e., high, medium, low). The selection criteria for data sources hinge on several key questions: Is the database exhaustive or merely a sample? Does the case definition rely on direct medical diagnoses or proxies? Does the source capture all cases? Is the data collected at regional or national level? Are there mechanisms for yearly or periodic updates? To establish the most accurate national prevalence estimates for each outcome, we often need to adjust for data misclassification-applying corrections for biases such as self-reported data and interpolating for missing entries. In some instances, a pooled estimate from multiple data sources is developed. A specific case will be presented to illustrate our approach in practice. This critical evaluation is pivotal, as the quality of data underpins the entire health information pyramid. The integrity of our data directly influences our ability to convert data into actionable health wisdom, ultimately affecting public health decision-making and policy formulation.

The Relationship Between Mental Health Status and Daily Step Count in Adults: A Cross-Sectional Study

Abstract Aim This study was conducted to determine the relationship between the mental health status and daily step count of adult individuals. Methods The research was conducted between November 2023 and April 2024 with a descriptive cross-sectional design. The research population consisted of 386 individuals over the age of 18 who voluntarily filled out public electronic forums on online platforms. Data were collected with the socio-demographic characteristics diagnostic form consisting of 21 questions, the average number of steps in the last week, and the General Health Survey-28 (GHQ-28). Data were evaluated using descriptive statistics, normality statistics, analysis of variance (ANOVA), t test, Kruskal Wallis variance analysis, Mann-Whitney U test. Statistical significance level was accepted as p < 0.05 Results GHQ-28 total score average was found to be 5.59 ± 6.52. 42.0% of the participants received a score of 5 or above on the GHQ-28 and were considered at risk for mental health. The individuals’ average weekly step count was mean=5269±3065 steps and 43% were basal-limited active. According to GHQ-28, the average weekly step count of individuals in the mental health risk group (4528.62 ±2892.31) was lower than those who were not at risk (5804.63 ±3081.67) (p < 0.05). According to step count categories, individuals who were basal-limited active (51.2%) and low active (39.4%) were found to be at higher risk for mental health than those who were slightly active (36.0%) and active-highly active (18.4%) (p < 0.05). A weak negative correlation was found between the average number of steps and the scores obtained from the GHQ-28 (r = -.187; p = 0.000). Conclusions It was determined that more than half (51.2%) of the individuals (42.0%) in the risk group in terms of mental health were sedentary, that is, basal-limited active (less than 2500-4999 steps). Key messages • Increasing awareness about the positive effects of individuals’ daily step counts on mental health can contribute positively to the promotion of health. • As part of policies aimed at enhancing mental health within society, implementations directed towards increasing daily step counts can contribute positively to the improvement of public health.

Effects of three different strains of Bacillus-based probiotics and Saccharomyces cerevisiae-based prebiotic on performance, egg components and gene expression of laying hens during phase II of production

This study aimed to investigate the impacts of three strains of probiotics (Bacillus spp. (B.)) and one prebiotic based on Saccharomyces cerevisiae cell wall (SCCW) supplements on performance, egg quality and immune-related gene expression of laying hens. The experiment lasted 16 weeks (52–68 weeks), during which 450 Hisex white layers at 52 weeks were randomly allocated into five dietary regimens (five replications of 18 birds per floor pen): T1, basal diet; T2, basal + 0.5 g/kg B. subtilis (DSM17299); T3, basal + 0.5 g/kg B. subtilis (DSM 5750) and B. licheniformis (DSM 5749); T4, basal + 0.4 g/kg B. subtilis PB6; and T5, basal + 0.25 g/kg SCCW. The results showed that hen-day egg production (HDEP) improved in T4 and T5, egg mass (EM) improved in T3, T4 and T5, and feed conversion ratio (FCR) improved in T4 and T5 compared to T1 (p < .001). Relative wet and dry yolk weight were higher in hens received T2, T4 and T5 (p < .05) and T2, T3, T4 and T5 (p < .001), respectively, compared to T1. Moreover, T2, T4 and T5 had higher expression of GnRH-2 gene compared to T1 (p < .01). In conclusion, the dietary inclusion of SCCW-based prebiotic (T5) and Bacillus spp. probiotic strains, especially T4 B. subtilis PB6 improved production performance, egg components and GnRH-II gene expression of laying hens during phase II of the production cycle and hold a great promise for boosting productivity and supporting health status of layers raised on AGPs-free diets.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.