Low-educated Individuals Research Articles

Stuck at the Bottom? Gender and Immigrants’ Entrapment in Low-skilled Work

Immigrant women are widely portrayed as facing a serious labor market disadvantage, yet gender differences in immigrants’ occupational mobility have been little explored. The article studied gender gaps in immigrants’ occupational entrapment, defined as entering and remaining in low-skilled/low-prestige work rather than moving on to more skilled/prestigious work. The analyses were based on longitudinal register data and followed five immigrant cohorts arriving in Sweden in the early 2000s over a 12-year period. The results show that immigrant women were more likely than men to start out in a low-skilled/low-prestige job and less likely to experience occupational mobility. However, tertiary education strongly mitigated these gender gaps. At the same time, the differences between high- and low-educated individuals widened more among women than among men. Family-related factors and country-specific human capital did not explain these patterns, but the findings indicate that occupational gender segregation can be crucial to immigrants’ mobility prospects.

Digital adoption and human capital upscaling: a regional study of the manufacturing sector

AbstractWe study the effect of the diffusion of digitalization, measured as the level of expenditures in digital technologies, on labor demand within the manufacturing sector. We exploit unique information from a focus study of the quarterly survey of Unioncamere Piemonte (one of Italy’s most industrialized and technologically advanced regions) to measure the extent to which planned digital technologies investments impact hiring propensity, differentiated by educational level. Based on a representative sample of non-micro firms, our findings suggest a positive relationship between digital investments and the probability of hiring highly educated workers, mainly driven by the demand for individuals with a post-secondary technical institute (ITS) diploma and post-MSc qualifications or a PhD in STEM fields. Conversely, we also find that digital investments negatively influence the probability of hiring low-educated individuals, primarily referring to the demand for workers with secondary education. Our results reveal firms’ human capital upscaling dynamics powered by digitalization processes.

Fire Safety Disparities in Sweden: Sociodemographic Influences and the Impact of Societal Protection on Personal Fire Prevention Measures

AbstractPrevious research has identified sociodemographic inequalities in fire prevention measures. This study examined whether sociodemographic differences persist in the Swedish population concerning fire prevention measures and particularly whether there remains an inverted u-curve related to age in protection habits. Additionally, it investigated whether fire protection practices are influenced by the level of societal protection. The research utilised survey data and register data from The Swedish Civil Contingencies Agency and Statistics Sweden. A latent class analysis was conducted, dividing respondents into four latent classes, followed by two binomial regression analyses. The study revealed three key findings regarding fire protection measures. First, certain demographic groups, namely the young, women, single and childfree households, low-income and low-education individuals, immigrants, and urban residents, are disproportionately lacking optimal fire safety measures. Second, although a safety maturity curve is still observed, older adults in Sweden today are considerably more protected compared to 15–20 years ago, indicating that safety practices employed during middle age continue into old age. Third, a trend is observed where individuals living in areas with more efficient professional rescue services tend to have lower levels of personal fire protection, suggesting a rational choice based on the perceived level of societal protection.

Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people

Objective To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs). Design Cross-sectional study. Setting 99 Swedish healthcare centers. Intervention Metabolic risk factors and health behaviors were assessed. THDs were provided. Subjects 1831 (62.3%) THD participants that consented to take part in the research project. Main outcome measures (1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls. Results Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3–4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs. Conclusion Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups. ClinicalTrials.gov NCT04912739

The association between ultra-processed food consumption and health-related quality of life differs across lifestyle and socioeconomic strata

BackgroundIn this prospective study, we aimed to examine the association between ultra-processed foods and health-related quality of life (HRQoL) and to evaluate the effect of lifestyle and socioeconomic factors on this association.MethodsThis study included 1766 adults (aged 18 to 78, 54.3% women), who took part in the Tehran Lipid and Glucose study. The Short-Form 12-Item Health Survey version 2 was used to determine HRQoL, which includes the physical component summary (PCS) and mental component summary (MCS) scores. Ultra-processed food consumption was assessed using a validated semi-quantitative food frequency questionnaire. Lifestyle (physical activity and smoking status) and socioeconomic factors (education level and employment status) were also determined. General linear models (GLM) were applied to estimate the mean (95% confidence interval) for MCS and PCS scores across the ultra-processed foods tertiles. Additionally, the effect of lifestyle and socioeconomic factors on the relationship between ultra-processed foods and HRQoL was examined using GLM.ResultsThe median consumption of ultra-processed foods was 11.9% (IQR: 8.2 to 16.8) of total energy intake. There was a significant inverse association between ultra-processed foods consumption and PCS, but not MCS, after adjustment for confounding factors. Significant interactions were observed between ultra-processed food consumption, sex, and occupation on PCS score (all P values < 0.001). The interaction test tended to be significant for smoking status, education levels, and physical activity levels. As ultra-processed food consumption increased, the PCS score significantly decreased in women (P = 0.043), low physical active subjects (P = 0.014), smokers (P = 0.015), and lower-educated individuals (P = 0.022). Non-employed individuals with higher ultra-processed food intake showed a decline in their PCS and MCS scores. While there was no significant difference in MCS score among different strata of lifestyle and socioeconomic status across tertiles of ultra-processed foods.ConclusionsHigher intake of ultra-processed foods was associated with poorer physical health, particularly among women, those with unhealthy lifestyles, and low socioeconomic conditions.

Deepening Labor Market Inequalities During the COVID-19 Pandemic: Evidence from Turkey

This article investigates how the COVID-19 pandemic affected the labor market in Turkey, using a unique dataset collected via face-to-face interviews in the fall of 2020. In a developing country where labor market gaps are already stark, the study shows that the COVID-19 pandemic has exacerbated existing vulnerabilities in labor markets. Results indicate that women, low-educated individuals, parents, self-employed, and informal sector employees were at greater risk of worsened labor market outcomes. Moreover, the individuals at the intersection of these vulnerabilities suffered more. These findings suggest that the labor market policies introduced at the onset of the pandemic remained limited in protecting the jobs of vulnerable groups. HIGHLIGHTS COVID-19 magnified existing inequalities in the labor market in Turkey. The intersection between gender, education, and parenthood shaped the labor outcomes. Women without a high school degree and with children were the most vulnerable. Low-educated parents in particular were more likely to face income and job loss. Informally employed and the self-employed were more likely to suffer income losses.

Proton pump inhibitors use is associated with a higher prevalence of kidney stones: NHANES 2007–2018

BackgroundProton pump inhibitors (PPIs) are widely used throughout the world as an effective gastrointestinal drug. Nevertheless, according to the existing literature, PPIs can reduce the excretion of magnesium, calcium and other components in urine, which may promote the formation of kidney stones. We used the National Health and Nutrition Examination Survey (NHANES) database to further investigate the association between the use of PPIs and the prevalence of kidney stones.MethodsWe performed a cross-sectional analysis using data from 2007 to 2018 NHANES. PPIs use information of 29,910 participants was obtained by using prescription medications in the preceding month, and kidney stones were presented by a standard questionnaire. Multiple regression analysis and stratified analysis were used to estimate the association between PPIs use and kidney stones after an adjustment for potential confounders.ResultsThe multiple logistic regression indicated that the PPIs exposure group (P1) had a significantly higher risk of nephrolithiasis than the PPIs non-exposure group (P0) in Model 3 (OR 1.24, 95% CI 1.10–1.39, P < 0.001). The stratified analyses indicated there were significant statistical differences between PPIs use and kidney stones among females (OR 1.36, 95% CI 1.15–1.62, P < 0.001), non-Hispanic whites (OR 1.27, 95% CI 1.09–1.48, P = 0.002), individuals with an education level than 11th grade (OR 1.41, 95% CI 1.13–1.76, P = 0.002) and individuals with an annual family income of $0 to $19,999 (OR 1.32, 95% CI 1.06–1.65, P = 0.014) and $20,000 to $44,999 (OR 1.25, 95% CI 1.02–1.54, P = 0.033) in Model 3.ConclusionsOur study revealed that PPIs use is associated with a higher prevalence of kidney stones for the US population, primarily among women, non-Hispanic whites, individuals with low education levels and individuals with low household income levels. Further studies are required to confirm our findings.

Changes in educational inequalities in knee and hip osteoarthritis surgery and non-surgery specialist care visits over time in Sweden

ObjectiveTo examine changes in prevalence and socioeconomic inequalities in knee and hip OA outcomes, in more specific surgery and non-surgery specialist care visits, from 2001 to 2011 in Sweden and to what extent sociodemographic factors can explain the changes. DesignWe included all individuals aged ≥35 years resident in Sweden from 2001 to 2011. Individual-level data was retrieved from the Swedish Interdisciplinary Panel. Highest educational attainment was used as socioeconomic measure and the concentration index was used to assess relative and absolute educational inequalities. We used decomposition method to examine changes in prevalence and relative educational inequalities. ResultsA total of 4,794,693 and 5,359,186 people were included for the years 2001 and 2011, respectively. The crude prevalence of surgery and specialist visits for knee and hip OA was 36–83% higher in 2011 than in 2001. The increase in hip OA outcomes was largely explained by changes in the sociodemographic composition of the population, whereas for knee OA outcomes, changes in the strength of the associations with sociodemographic factors appeared more important. All outcomes were concentrated among people with lower education in all study years. The relative inequalities declined over the study period, while the absolute inequalities increased for knee OA outcomes and remained stable for hip OA. ConclusionOur findings show an increasing burden of all studied OA outcomes. Moreover, our findings suggest persistent educational inequalities with more surgeries and specialist visits among lower-educated individuals. Future research should incorporate additional variables to better understand and address these inequalities.

Extreme temperatures and morbidity in old age in Europe

Understanding the relationship between extreme temperatures and health among older adults is of paramount importance for public health in ageing societies. This study aims to enhance our understanding of the impact of extreme temperatures on morbidity, i.e. the risk of being hospitalised, using medications for heart conditions, and experiencing the onset of cardiovascular diseases (CVDs) among older adults in Europe (65+ years old) using five waves from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004–2015). It also explores heterogeneity in this impact depending on an array of factors that affect exposure and vulnerability to climate, including geographical location, gender, age, educational level, having a partner/child and living in an urban or a rural area. Results from individual fixed-effects models show that extremely cold temperatures increase the risk of being hospitalised and suffering from CVDs, while heat exposure has no noteworthy effect. Broken down by geographical location, the results indicate that one additional extremely cold day influences the risk of hospitalisation in the coldest and the warmest European regions, while extreme heat influences this risk in the warmest European regions. Finally, the oldest old and low educated individuals appear to be the most vulnerable social groups. The study concludes by discussing the advantages and the limitations of using survey data to study climate and health, and the strategies suggested by the relevant literature to prevent temperature-related illness.

IJCM_240A: A cross sectional study to assess the health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore.

Background: WHO defines health literacy as cognitive and social skills that determine the motivation and ability of people to understand, gain access and use the information to obtain good health. Inadequate health literacy has been linked to increased hospital admissions, poorer physical and mental health, lower use of preventive health services like vaccinations and screening tests. These ultimately lead to higher healthcare costs. This study was conducted to assess health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Objectives: To estimate proportion of inadequate health literacy and its associated factors among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Methodology: A cross-sectional study was conducted among adult attendees (i.e., patients and companions) of outpatient clinics of a government tertiary care hospital in urban Bangalore. Based on a study done by Almaleh. R et al. (P = 34.3%) with 7% absolute precision, the sample size was calculated as 200. A total of 200 adults attending outpatient clinics at the government tertiary care hospital were selected using simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire for sociodemographic factors and HLS-EU-Q16 (European Health Literacy Survey Questionnaire short version) for assessing health literacy. The data collected was entered in MS Excel and analysed using SPSS 21.0. Results: The proportion of inadequate health literacy among study participants was observed to be 38%. Factors like educational status, age, and gender were found to have an association with it. Health literacy was found to be least in lower-educated individuals. Conclusion: From the present study, it was found that a large part of adult population had limited health literacy. It should be addressed through proper interventions, like ensuring basic education and health awareness programmes.

Limitations and recommendations regarding the Mini-Mental State Examination (MMSE) in illiterate and low educated older adults

Increasing life expectancy has been associated with higher rates of dementia. As illiterate/uneducated individuals are typically over-represented among older cohorts, it is imperative that we identify and/or develop appropriate, non-biased scales and psychometric tests for early detection of, and screening for, cognitive impairment in this group. Given that many traditional neuropsychological tests may underestimate cognitive abilities in illiterate/uneducated and low educated individuals, their use in these groups needs to be reappraised or their format adapted. One of the most commonly used screening tests worldwide is the Mini-Mental State Examination (MMSE). Level of education has been shown to be a significant predictor of performance on the MMSE, hence, there is dispute among researchers related to its applicability in populations with low or no schooling. A wide range of recommendations have been made by scholars for overcoming the education effect on the MMSE, as well as other sources of bias, but some methodological limitations remain, and new ones have emerged concerning its administration to illiterate/uneducated and low educated older individuals. In the present study, we present a theoretical discussion of the challenges inherent in the administration and interpretation of MMSE performance in illiterate/uneducated and low educated individuals, consider previous recommendations and address their limitations, and highlight the optimal methods for clinical assessment of these groups when the MMSE is used.

The roles of the general practitioner and sexual health centre in HIV testing: comparative insights and impact on HIV incidence rates in the Rotterdam area, the Netherlands - a cross-sectional population-based study

BackgroundAccess to HIV testing is crucial for detection, linkage to treatment, and prevention. In less urbanised areas, reliance on general practitioners (GPs) for HIV testing is probable, as sexual health centres (SHC) are mostly located within urbanised areas. Limited insight into individuals undergoing HIV testing stems from sparse standard registration of demographics at GPs. This cross-sectional study aims (1) to assess and compare HIV testing at the GP and SHC, and (2) to assess population- and provider-specific HIV incidence.MethodsIndividual HIV testing data of GPs and SHC were linked to population register data (aged ≥ 15 years, Rotterdam area, 2015–2019). We reported the proportion HIV tested, and compared GP and SHC testing rates with negative binomial generalised additive models. Data on new HIV diagnoses (2015–2019) from the Dutch HIV Monitoring Foundation relative to the population were used to assess HIV incidence.ResultsThe overall proportion HIV tested was 1.14% for all residents, ranging from 0.41% for ≥ 40-year-olds to 4.70% for Antilleans. The GP testing rate was generally higher than the SHC testing rate with an overall rate ratio (RR) of 1.61 (95% CI: 1.56–1.65), but not for 15-24-year-olds (RR: 0.81, 95% CI: 0.74–0.88). Large differences in HIV testing rate (1.36 to 39.47 per 1,000 residents) and GP-SHC ratio (RR: 0.23 to 7.24) by geographical area were observed. The GPs’ contribution in HIV testing was greater for GP in areas further away from the SHC. In general, population groups that are relatively often tested are also the groups with most diagnoses and highest incidence (e.g., men who have sex with men, non-western). The overall incidence was 10.55 per 100,000 residents, varying from 3.09 for heterosexual men/women to 24.04 for 25–29-year-olds.ConclusionsGPs have a pivotal role in HIV testing in less urbanised areas further away from the SHC, and among some population groups. A relatively high incidence often follows relatively high testing rates. Opportunities to improve HIV testing have been found for migrants, lower-educated individuals, in areas less urbanised areas and further away from GP/SHC. Strategies include additional targeted testing, via for example SHC branch locations and outreach activities.

Cognitive reserve moderates Alzheimer’s disease‐related tauopathic mechanism on cognition mediated by structural connectivity networks

AbstractBackgroundCognitive reserve (CR) is the capacity of an individual to maintain cognitive function despite brain damage (Stern et al., 2002). It moderates the effect of Alzheimer’s disease (AD)‐related brain damage on cognition, which is difficult to demonstrate using residual analysis. Recent research has shown a strong effect of tauopathy on the brain damage (Renaud La Joie et al., 2020), but how the CR affects this relationship is still unknown.MethodWe obtained 121 amyloid‐positive individuals, including 15 cognitive unimpaired (CU) individuals, 44 patients with mild cognitive impairment (MCI), and 58 AD. We first identified structural connectivity subnetworks where the relationships between edges’ weights (the number of streamlines) and tauopathy (global cortical tau standard uptake value ratio, standardized by the mean and standard deviation of the amyloid‐negative CU individuals) were modified by the years of education, as a proxy for cognitive reserve, using the network‐based statistics. We chose a subnetwork where its total connectivity significantly mediated the effect of the tauopathy on memory score, based on the Baron and Kenny method (Baron, Kenny et al., 1986). Through the path analysis, we verified the moderated mediation model, in which the moderating effects of education were added to the mediation model.ResultOne subnetwork whose edges were significantly affected by the tauopathy and moderation of education showed partial mediation in the tauopathic mechanism on cognition. The moderated mediation model based on the total connectivity of the subnetwork showed an appropriate model fit (CFI = 0.999, SRMR = 0.006) and a significant moderating effect on both stages of the indirect effect path of mediation when tested using the bootstrap method with 10000 resamples. The simple slope and intercept analyses implied that the highly educated individuals on the AD continuum show higher memory function than the lower educated individuals in the absence of tauopathy, but this score decreased more rapidly as tau increased.ConclusionWe conclude that education modifies the effect of tauopathy on structural connectivity as well as the effect of structural connectivity on cognition when AD‐related tauopathy affects memory score through the structural connectivity subnetwork.

Factors Related to Cognitive Resilience according to Education Level in Normal and Cognitively Impaired Individuals

AbstractBackgroundCognitive resilience (CR) is a concept to explain the difference between pathologic burden and cognitive function. Understanding CR is important as increasing CR can be applied to dementia prevention strategies. CR is closely related to education and it was widely used as proxy for CR. However, using an education as proxy of CR may have limitation in reflecting the CR of low educated individuals. Related factors to CR can be different according to the educational level. However, factors related to low educated individuals has not been sufficiently investigated. Therefore, we aimed to investigate factors related to cognitive resilience in low‐ and highly educated individuals using residual approach.MethodWe collected 1,085 patients who underwent neuropsychological assessment and MRI from the Establishment of Precision Medicine Platform for Early Diagnosis of Mild Cognitive Impairment (PREMIER) Cohort (305 SCD, 639 MCI, 141 AD). To capture CR using residual approach, firstly, cognitive score was predicted on global cortical thickness, adjusted for age, sex, education, and disease stage. Then, individual differences between predicted and observed cognitive score were used as the measure of CR(CR_rsd). Next, we divided the participants into two groups based on their education level. To investigate the factors related to CR_rsd between two groups, we used multiple linear regression and logistic regression model after adjusted age, sex. Demographic, socioeconomic and psychiatric factors were evaluated.ResultMean age was 70.5 years and 65.3% were female. There were 286 patients in low educated group (26.4%). Depression, literacy, cognitive activity, and presence of diabetes were related to CR_rsd. Literacy was related to CR_rsd in both low‐ and high‐education group (low education group, p = 0.035; high education group, p = &lt;0.001). Depression was associated with low CR_rsd only in high education group (p = 0.001). Cognitive activity was associated with high CR_rsd in both group (low education group, p = 0.042; high education group, p = &lt;0.001). However, social activity was only related to high CR_rsd low education group (p = 0.044).ConclusionOur findings suggest that factors related to CR could be different according to the educational level.

Non-standard family histories and wellbeing at older ages

The life course approach emphasizes that health and wellbeing at older ages are influenced by experiences occurred in the previous stages of life. We contribute to the literature by focusing on the role of the non-standardness of family histories and argue that individuals who experienced non-standard trajectories have been exposed to social sanctions throughout their life course with negative long-term consequences on wellbeing.In our study, non-standardness of family histories is the extent an individual's family history differs from those of the others within reference groups, defined combining birth cohort, gender and country of residence. Family histories between age of 15 and 49 are analyzed using Sequence Analysis, thus accounting for events related to fertility and union formation (marriage and cohabitation) and dissolution, and their timing. Dissimilarities between family sequences are measured using optimal matching and are standardized within the reference groups.We use retrospective data from the seventh wave of the Survey of Health Ageing and Retirement in Europe (SHARE) and estimate linear regression models to assess the association between non-standardness of family histories and older people's life satisfaction. Quality of life and depressive symptoms are examined in additional analyses.A negative association is found between non-standardness of family histories and wellbeing, which is stronger for lower educated individuals and in Southern European countries.Results are consistent with the idea that uncommon family behaviors may have a long-term negative effect on wellbeing. Individual resources and a more tolerant societal context can reduce or eliminate the negative consequences of engaging in non-standard family behaviors.

The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach

The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities.

A Life of Leisure? Investigating the Differential Impact of Retirement on Leisure Activity.

Remaining active in older adulthood is widely endorsed by governments and policy-makers as a way of promoting public health and curbing welfare spending. Despite links between greater leisure activity in older adulthood and better health, cognitive function, and subjective well-being, there is a dearth of research investigating the impact of retirement on leisure activity engagement. Therefore, the primary goal of this study is to address this knowledge gap and investigate the impact of retirement on leisure activity engagement. Using panel data from 2 waves of a large-scale longitudinal survey of Dutch older workers (N = 4,927), we investigated the impact of retirement on hours spent engaging in physical, social, and self-development activities. We further investigated the differential impact of retirement on leisure activity in retirement based on various sociodemographic characteristics. Although leisure activity increased across all 3 activity domains, conditional change ordinal least square regression models revealed that retirement resulted in significantly greater increases in activity relative to nonretirees. Additional analyses including interaction terms revealed that the impact of retirement on self-development and social activity differed significantly based on gender and education. Our study demonstrates that while time in leisure activity largely increases in response to retirement the nature and magnitude of the impact of retirement on leisure activity is not uniform. From a policy perspective, findings that certain groups, namely men and lower--educated individuals, may be at greater risk of lower activity levels may help guide interventions promoting active aging and retirement.

Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000–2015: a register-based study

BackgroundDrowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000–2015.MethodsData for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65–W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30–74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality.ResultsDrowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000–2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000–2015.ConclusionDespite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000–2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.

Awareness of the Attendants of Primary Health Care Centers about Screening Investigations

Purpose: Screening investigations are group of tests designed to the risks of subsequent disease or early detection of diseases in apparently healthy individuals. Seeking for screening tests is influenced by awareness of the individuals about its importance. The current study aimed at estimating the level of awareness about screening investigations among attendants of the primary health care centers.&#x0D; Methodology: Through a cross-sectional design, 389 attendants were randomly selected form four primary health care centers in Jeddah governorate, they responded to a predesigned questionnaire including items reflecting awareness of the respondents about the importance and types of screening investigations in the primary health care centers. Data entry and statistical analysis were done using Statistical Package for Social Science (SPSS) version (26). The awareness scores were tested for normality using Shapiro Wilk’s test, accordingly, for testing significance in difference between two subgroups. Independent sample t test was used, and ANOVA test was used for more than two groups. To detect significant factors predicting the level of awareness, linear logistic regression was used. Statistical significance was set at P-value &lt;0.05 and confidence interval of (95%).&#x0D; Findings: Out of all interviewed participants (n=389), females formed two thirds (68.9%), and the great majorities were Saudis (87.4%) and most of the respondents had university qualifications (79.9%). The overall awareness score accounted for 3.82±0.48 that corresponds to 76.4%. The majority were aware that checking blood pressure 368(94.6%) and blood sugar 343(88.2%) are among the recommended routine medical checkup for individuals. Almost one third undergone previous routine medical checkup (36.7%). The awareness score was significantly higher among females (3.87±0.49), Saudis (3.85±0.48) and highly educated individuals (3.87±0.48) p&lt;0.05.&#x0D; Recommendations: The attendants of the primary health care centers have a good level of awareness about the importance. Types of routine screening investigation, nevertheless, their utilization of these services is suboptimal. The level of awareness was found to be higher in females and highly educated individuals. It is recommended that health education should be provided to the attendants of the primary health care centers focusing on males and the low educated individuals.

Making the factors underlying the implicit discount rate tangible

Leading energy-economic models used for policy assessment employ implicit discount rates (IDRs) to model household energy efficiency technology adoption, typically assuming identical IDRs across households and countries. To help modelers and policy-makers get tangible insights about the IDR, we empirically analyse the relations among key factors underlying the IDR and socio-demographic characteristics based on large-scale demographically representative household surveys in eight EU countries. These factors include behavioral parameters (time preferences, risk aversion, loss aversion, present bias), environmental identity, preferences for adhering to social norms, and access to capital. The findings suggest that these factors vary by country and socio-demographic characteristics. Notably, higher age, higher income and higher education of individuals typically imply a lower IDR, ceteris paribus. Policy-makers may rely on the results to tailor policy interventions towards socio-economic groups. For example, results on time discounting suggest that policies such as rebates or loans should target low-education individuals. Results on risk aversion suggest that policies such as warranties or energy performance contracting should target older and low-education individuals and low-income households. Finally, policies addressing lack of access to capital such as grants and soft loans appear most effective for younger, low-education individuals and single, low-income, non-urban households.