Population Subgroups Research Articles

Inequalities in the diagnosis of 275 chronic conditions in UK primary care between 2006 and 2021: a cohort study

BackgroundHealth inequalities in the UK have been brought to the forefront of public health concerns, especially disparities in life expectancy and health quality of socioeconomically deprived and minority ethnic populations. This study systematically examined the incidence and prevalence of 275 chronic conditions which present in UK primary care, describing inequalities across diverse population subgroups. MethodsWe conducted a population-based retrospective cohort and cross-sectional study using primary care data from Clinical Practice Research Datalink Gold (986 general practices), from Jan 1, 2006 to Dec 31, 2023. We studied chronic conditions responsible for over 10 000 days of hospital activity. Incidence and prevalence estimates were calculated annually, stratified by sex, age, ethnicity (UK high-level), and GP practice deprivation, and standardised using UK mid-year population estimates for 2021. We used statistical process control to describe variation and identify outlier conditions in population subgroups. A public dashboard was created to explore the outputs. FindingsThe study included 13 419 645 participants. Hypertension was the most prevalent condition in 2019 (22·47%). Black, Asian, Others, and Mixed had over 30% lower chance of any given diagnosis than overall population. Depression showed a gradient of increasing prevalence with increasing deprivation, but for actinic keratosis, a condition associated with sun exposure, prevalence increased in less deprived populations. In a cardiometabolic conditions deep dive, minority groups had increased diabetes prevalence, but lower rates of myocardial infarction. InterpretationThis study provides a crucial resource for addressing health disparities in the UK. Lower prevalence in Black, Asian, and Mixed ethnicities is likely to be underdiagnosis and not a 30% lower disease prevalence, highlighting an urgent need across many conditions for tailored healthcare strategies to ensure equitable diagnosis and treatment access. Detailed population breakdowns in this dataset generates insight that can guide the development of more inclusive health policies, ultimately reducing health inequalities and improving public health outcomes. FundingNone.

Comparative analysis of COVID-19 vaccine booster dose (VBD) acceptance among trainees and students of health professions in Bangladesh

BackgroundDespite the proven therapeutic potential of bivalent vaccine primer doses against COVID-19, acceptance of vaccine booster doses (VBD) varies among various subgroups of the global population. This study investigated the acceptance of COVID-19 VBD among trainees and students of health professions in Bangladesh and compared the potential factors influencing their VBD decisions. MethodsThe questionnaire was deployed in an online-enabled layout and conveniently sent to encounters between 10th June 2023 and 10th September 2023. Data from 501 trainees and 501 students were compared (response rate 80.8% vs.78.3%) to explore the study objectives. ResultsThe pooled COVID-19 VBD acceptance rates were 90.2% (95% Confidence Interval [CI]:87.6─92.8) vs. 93.2% (95% [CI]: 91.2─95.2) between trainees and students. The binary logistic analysis revealed that out of twelve factors “equal safety” (Adjusted odds ratio [aOR]: 4.476 vs. 6.459), “efficacy” ([aOR]:3.673 vs. 2.913), “repeated immunity” ([aOR]: 1.729 vs. 2.247), and “self-priority” ([aOR]:3.108 vs. 4.645) had a significant positive association (p<0.01 and p<0.05) with VBD acceptance in both groups. There were varied effects on several predictors. Among trainee professionals, "communication" and "booster mandate" were associated significantly ([aOR]:1.534 and 1.748, respectively; p<0.05) with VBD acceptance, whereas "information source" and "culture" were associated ([aOR]:3.692 and 3.151, respectively; p<0.05) significantly with VBD acceptance in the student cohort. ConclusionsThere was a satisfactory acceptance level of COVID-19 VBD among healthcare participants, and several multidimensional factors influenced their VBD decisions in different ways. For enhancing public booster immunization decisions against COVID-19, individual health expectations must be linked to wider societal influences.

Vulnerability Appeals in the COVID-19 Pandemic: Insights from a National Survey Experiment

Abstract This study explores the impact of vulnerability appeals during the COVID-19 pandemic using a nationally representative, preregistered survey experiment (N = 4,087) conducted in mid-2021. We explore whether providing citizens with information about the vulnerability of ethnic minority and disabled citizens to COVID-19 fosters empathy and increased support for behavioral restrictions. We observe minimal statistically significant or substantive effects, although the presence of subtle effects cannot be entirely ruled out. We identify some limited indications that individuals with disabilities exhibit increased support for restrictions when exposed to information about the vulnerability of disabled people to COVID-19, but these effects are inconsistent. Therefore, our findings provide limited evidence to confirm or rule out that using vulnerability appeals alone is effective for influencing public attitudes toward behavioral restrictions. The findings point toward avenues for future research, including a closer examination of heterogeneous responses to public health messaging among population subgroups.

Investigating the association between housing mobility and self-reported adolescent suicidality and mental health.

Suicide continues to be a public health crisis among adolescents in the United States. Suicide prevention requires a comprehensive understanding of the factors that lead to death from suicide. Housing stability is an important social determinant of health, and literature has begun to describe how housing instability can affect mental health, as well as suicidal behavior. The aim of the present study was to assess the relationship between lifetime housing mobility among adolescents and suicidal behavior (both ideation and attempt). This study examines disparities in housing mobility and suicidal behavior to determine whether certain population subgroups are disproportionately impacted. We undertook a cross-sectional study using data from Wisconsin's Youth Risk Behavior Survey administered during the Fall of 2019, which assessed Wisconsin middle and high school students. We find that housing mobility, as measured in the lifetime number of residences, was associated with an increased risk of suicidal ideation and behavior. We also demonstrate disparities by race, disability status, and sexual orientation. Findings from this study can be used to not only drive change to support students at the school or school district level but also to drive policy change at the societal level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sleep health across the life cycle: an unmet and neglected public health priority

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

Malnutrition in infants aged 6-23 months in China’s poorest rural counties from 2016 to 2021: cross sectional study

ObjectivesTo assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China’s poorest rural counties.DesignSix consecutive cross sectional surveys were conducted annually.SettingThe study was...

Health selection in three cohorts of outmigrants, return migrants and non-migrants

Abstract Background The two main hypotheses behind the healthy migrant effect are selection of healthier migrants and the salmon bias. However, these hypotheses have not been thoroughly and simultaneously investigated in distinct cohorts due to data limitations. Methods Linking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. We included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. Results Outmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. Conclusions Contrary to common belief, health selection is not restricted to international immigrants but also among interprovincial migrants and the local population. Migration dynamics may bias comparisons between population subgroups. Key messages • Migration is not only associated with positive health selection among international immigrants but also among interprovincial migrants and the local population. • Selective migration may represent a source of bias in health-related population-based studies.

Burden of disease due to road traffic noise in Flanders, Belgium

Abstract This study estimates the disease burden of ischemic heart disease (IHD), stroke and diabetes mellitus attributable to road traffic noise in the Flemish Region (Belgium) for the year 2020, expressed in disability-adjusted life years (DALYs). The research proposes an approach to stratify population exposure to noise according to age and sex, which allows to examine internal differences in noise burden related to both varying risk and baseline burden. Stratification of population exposure to noise is achieved by (1) linking modelled noise exposure to age- and sex-stratified population data at small area-level, (2) dividing the prevalence in each exposure class proportionally over the strata, and (3) aggregating the small areas to a Flemish total per stratum. Annual day-evening-night level exposure is translated into the fraction of attributable burden relying on relative risks (RR) from the WHO’s Environmental Noise Guidelines and more recent studies. Baseline burden for the three outcomes is sourced from the Belgian National Burden of Disease Study. The lower and upper bound of the RR’s 95% confidence interval (CI) are used to calculate the uncertainty range on the burden estimates. The total noise DALYs estimated are 1092 (95% CI: 135, 2061) for IHD, 761 (379, 1017) for stroke, and 671 (486, 918) for diabetes. Noise burden rates rise steeply with age for all outcomes, although the wide CIs on the IHD estimates prevent to ascertain a significant trend. The IHD burden is twice as high in men as in women, while both sexes are almost equal for the other outcomes. The variations between age and sex groups are largely explained by differences in baseline burden, as exposure is fairly constant across strata. This study estimates age- and sex-stratified disease burden attributable to noise traffic in Flanders, Belgium. As differential exposure between the population subgroups is limited, any variation in noise DALYs is mainly related to stratum-specific baseline burden. Key messages • Road traffic noise is responsible for hundreds of healthy life years lost in Flanders, Belgium. • The noise burden for stroke and diabetes rises sharply with age, and the burden for ischemic heart disease is twice as high in men as in women.

Past-year mental health issues: discrepant survey &amp; administrative data

Abstract Introduction Accurately measuring mental health disorder prevalence is crucial for public health planning. Administrative and survey data are common methods, but often yield differing results. This study compares case identification of mental health issues across these data sources in Slovenia. Methods We linked the 2019 European Health Interview Survey (EHIS) with three Slovenian health administrative databases: the National Hospital Health Care Statistics Database, Outpatient Prescription Drugs Database, and Absence From Work Database. Case identification utilized self-report of any mental health issue in the past 12 months and healthcare utilization records in 12 months preceding participation in EHIS. Multinomial logistic regression was used to examine the association between socio-demographic factors and case identification across data sources. Results Significant differences were found in 12 month prevalence of any mental health issue estimates between data sources. Only 45.9% of self-reported cases were identified in administrative data, and 36.6% of administrative cases self-reported mental health issues (Kappa = 0.302). Socio-demographics, including age, gender, education, and employment status, were significantly associated with the likelihood of identification in specific data sources. Discussion Our findings underscore the importance of data source and assessment tool selection on mental health prevalence estimates. Variations in identification across population subgroups could reflect differences in healthcare access and self-disclosure biases. Linking data sources and considering their inherent limitations is crucial for accurate burden estimation. Key messages • Data source and assessment methods significantly impact how we identify individuals with mental health issues in the past year. • Combining data sources and understanding their limitations is essential for improving mental health burden estimation.

Patient characteristics and incidence of cardiac amyloidosis: an observational study in the UK clinical setting using electronic health records

Abstract Background Cardiac amyloidosis (CA) is associated with a high mortality rate due to sudden or progressive heart failure. It is often misdiagnosed due to non-specific symptoms, and its true incidence and prevalence in the United Kingdom (UK) remain uncertain. Purpose To describe patient characteristics and incidence of CA in the UK clinical setting using electronic health records. Methods In this retrospective observational study, anonymised, linked primary and secondary care data (Clinical Practice Research Datalink, CPRD and Hospital Episode Statistics, HES) were used to describe individuals diagnosed with CA. The CPRD database contains de-identified patient data sourced from a sample of general practitioner (GP) practices in the UK. Patients aged 18 years and older with a recorded Read or SNOMED-CT diagnosis code for CA or record of treatment with tafamidis (a licensed but not reimbursed treatment for transthyretin amyloid cardiomyopathy, ATTR-CM in the UK) in the period between January 2004 to December 2021 were included. The index date was defined as the earliest recorded date of CA diagnosis or tafamidis treatment. Demographic and clinical data were summarised using descriptive statistics. Incidence rates were reported per 100,000 person-years (PY). Results There were a total of 3,788 patients with CA (mean age: 67 years; 61% males) of which only 277 were coded as having wild-type transthyretin (ATTRwt) CA in mostly older patients (mean age: 79 years). The low patient counts of ATTRwt amyloidosis could be attributed to the lack of specificity in CA types and the low utilisation of ATTR amyloidosis codes. Heart Failure, essential hypertension and dyspnoea were the most common clinical presentations recorded in the 12 months to first diagnosis code or tafamidis prescription for CA (Table). The incidence of CA varied from 0.75 in 2004 to a peak of 1.96 in 2021, per 100,000 PY; a 2.9-fold increase in newly coded diagnoses in CA. There was a slight decline in the rates in 2020 and 2021 (Figure). Incidence rates in males and females increased over the 17-year period, with males consistently having higher rates than females. The incidence rate in females started from a lower base at 0.62/100,000 PY in 2004, increased by a factor of 1.9 to 1.1/100,000 PY, whereas in males it started at 0.88/100,000 PY and rose by a factor of 2.9 to 2.5 /100,000 PY. Incidence rates in subgroup populations have also been analysed. Conclusions In the UK clinical setting, the incidence rate of newly coded CA increased overall between 2004 and 2021, as well as in both male and female subgroups. The data suggest CA is becoming more common, or that awareness has improved, and there is now an urgent need for enhanced methods of detection, characterisation, and the need for thorough data capture to shape future pathway advancements.

STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study

Abstract Background Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. Methods We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. Results According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests. Conclusions Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors. Key messages • According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups. • Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.

Association between high versus low cardiovascular risk in individuals with corresponding unexpected absent versus severe subclinical coronary atherosclerosis, a nationwide, multicenter study

Abstract Background It remains unclear as to why some individuals at low risk of cardiovascular disease (CVD) develop severe coronary atherosclerosis, while those at high CVD risk may remain free from coronary atherosclerosis. Purpose Using Coronary Computed Tomography Angiography (CCTA), we aimed to identify factors associated with absence and severe coronary atherosclerosis in subjects from the general population with very high and low-moderate CVD risk, respectively. Methods We assessed cross-sectionally a nationwide, multicenter population-based cohort, consisting of 30,154 individuals randomly recruited from the general population (age range 50-64 years, 51.4% women). Coronary calcified plaque burden was estimated by coronary artery calcium score (CACS) assessed by CCTA. Absent coronary atherosclerosis was defined as CACS 0 and severe coronary atherosclerosis was defined as CACS ≥301. We investigated only individuals with low-moderate (&amp;lt;5%) and very high CVD risk (≥10%) according to SCORE2 were included. Individuals with CACS 0 and prevalent CVD were excluded, as well as those with moderate CACS (1-300) or SCORE2 risk 5-9%. Out of 26 722 subjects with complete data on CACS and SCORE2, 13 075 were included. Logistic regression was performed adjusted for age and sex. Results The overall distribution of CACS in relation to SCORE2 CVD risk is illustrated in the Figure. Study characteristics are displayed in Table 1. Severe-extensive CACS in combination with low-moderate CVD risk was present in 2.3% (n=296). A further 2.3% (n=311) had very high CVD risk but CACS 0. Factors associated with CACS 0 despite a very-high estimated CVD risk included: lower age, being female, being born in Sweden, not having hypertension or hyperlipidemia, fewer pack-years of smoking, and lower waist circumference in men. On the contrary, severe-extensive CACS despite a low-moderate estimated CVD risk was associated with higher age, being male, being an ex-smoker, reporting more pack-years of smoking, having higher HbA1c, higher BMI, higher waist circumference, and prevalent hyperlipidemia and hypertension (Table 2). Conclusions We identified extreme cardiovascular risk phenotypes (subgroups) in the general population that either lacked coronary calcifications despite being at very high estimated CVD risk or had severe subclinical coronary atherosclerosis despite being at estimated low-moderate CVD risk. Further studies are warranted to elucidate putative enhancing or protective mechanisms explaining this unexpected phenomenon.

Gambling Disorder among Croatian University Students

Abstract Background Gambling has become a routine form of entertainment for many young people studying in universities. This study aimed to investigate the prevalence and characteristics of gambling disorder among Croatian university students. Methods A cross-sectional study using an anonymous self-administered questionnaire with sociodemographic and socioeconomic questions along with the Croatian version of the South Oaks Gambling Screen questionnaire (SOGS-CRO) was conducted in a representative sample of Croatian university students from Osijek, Eastern Croatia during January, and February 2020. Results A total of 844 students participated in the study, 45.6% males and 54.4% females, with a median age of 19.00 years (interquartile range 19.00-23.00 years). Gambling activities were performed by 66.2% of the students, most commonly lotteries, sports bets, and bingo. The final scores of the SOGS-CRO suggested that 21.1% of students may have a gambling disorder, with 16.4% being “probable pathological gamblers” and 4.7% being “problem gamblers”. Playing cards for money, animal bets, stocks bets, slot machines bets, pull-tabs, and other gambling activities such as online or videogames or mobile games present a higher risk of gambling disorder (p &amp;lt; 0.001, p &amp;lt; 0.001, p &amp;lt; 0.001, p &amp;lt; 0.001, p &amp;lt; 0.001, p &amp;lt; 0.001, respectively). Being male, repeating the year of study, being a student in interdisciplinary or technical field of study, and having a mother with gambling disorder (p &amp;lt; 0.001, p = 0.029, p &amp;lt; 0.001, p &amp;lt; 0.001, respectively) were the revealed contributing factors to the development of gambling disorder in study participants. Conclusions The study points to the fact that gambling disorder is quite a prevalent public health issue in the Croatian university student population. Specific public health preventive programs need to be designed and implemented in the study population to successfully prevent the development of investigated behavioral addiction. Key messages • Public health interventions directed toward the prevention of gambling must involve younger population subgroups, such as university students. • When designing the preventive programs for the successful prevention of gambling within the university student population selected sociodemographic variables should be considered.

Quantifying the health burden of environmental stressors

Abstract The Burden of Disease (BoD) concept has gained increasing importance for health risk assessments, driven by the World Health Organization (WHO) and the Global Burden of Disease (GBD) studies. BoD utilizes the disability-adjusted life year (DALY) to express the population health impact of a disease, injury or risk factor. This information is essential for priority-setting in health, monitoring and evaluation of preventive interventions. However, calculating DALYs, particularly DALYs attributable to risk factors, requires a range of choices with regards to input data and methodological aspects. In this presentation we will focus on comparative risk assessment (CRA), a frequently used method to calculate the attribution of DALYs to risk factors. CRA consists of determining outcomes that are associated with a certain risk factor and relative risks of the identified outcomes as a function of exposure. This information is usually derived from systematic literature review(s). Next, information on the level of exposure in a population is required, usually by age, sex, location and/or year, and usually using a range of data sources on level of exposure. Additionally, the level of exposure associated with a minimum risk is assessed. Population attributable fractions (PAFs) are then multiplied by the relevant outcome quantity for each population subgroup to calculate the number of DALYs attributable to risk factors. Finally, mediation of risk factors through other risk factors can be taken into account. Knowledge of and uniformity in methods used to perform CRAs will facilitate the coherence and usability of estimates of the health impacts of risk factors and strengthen evidence-based decision-making in health policy. In this presentation, we will introduce the CRA approach and outline a number of innovations that are being driven by the BEST-COST project, including new methods for correlated outdoor exposures and for outdoor exposures penetrating to indoor environments.

The efficacy of vaccination against respiratory syncytial virus across priority population subgroups

Abstract Background Respiratory syncytial virus (RSV) has recently become a vaccine-preventable disease as two vaccines have been approved for use and a third one is likely to become available by the end of the year. National Immunization Technical Advisory Groups as well as scientific societies across the world have issued recommendations on RSV vaccination that differ in respect to the identification of the target group. The latter has been identified in respect to age or underlying medical conditions mostly according to epidemiological data. In order to strengthen the evidence basis for future decisions, we performed a stratified meta-analysis of efficacy data considering all the three RSV vaccines currently or soon available. Methods We searched Randomized Controlled Trials (RCTs) assessing the efficacy of RSV vaccines in terms of reduction of RSV-related Lower Respiratory Tract Infection (LRTI). The research was conducted on PubMed and clinicaltrial.gov. The extraction of relevant data was stratified by pre-defined age groups (60-69, 70-79, 80+) and presence of underlying conditions increasing the risk for RSV. Results Three RCTs, one for each of the three vaccines, were considered for the quantitative analysis. Considering the overall 60+ population, the efficacy of RSV vaccines was 78% (95%CI 76-86%) in preventing LRTI. Considering the different age groups (60-69, 70-79, 80+), efficacy was respectively 72% (95%CI 53-84%), 90% (95%CI 66-97%) and 57% (95%CI 0-93%). The efficacy in healthy people and those with at least one underlying condition was similar, namely 77% (95%CI 60-87%) and 78% (95%CI 50-90%). Conclusions The available evidence shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. Further studies may contribute to better understanding if the efficacy may change according to individual characteristics, that could be highly relevant in the decision-making process. Key messages • The available evidence from RCTs shows the efficacy of RSV vaccines in reducing LRTI with no differences across different priority groups. • National recommendations on RSV vaccination can be further informed for future studies investigating RSV vaccines efficacy across different subgroups.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

Trends in non-daily cigarette smoking in England, 2006–2024

BackgroundCigarette smoking is incredibly harmful, even for people who do not smoke every day. This study aimed to estimate trends in non-daily smoking in England between 2006 and 2024, how these differed across population subgroups, and to explore changes in the profile of non-daily smokers in terms of their sociodemographic and smoking characteristics and vaping and alcohol consumption.MethodsData were collected monthly between November 2006 and April 2024 as part of a nationally representative, repeat cross-sectional survey of adults (≥ 18 years; n = 353,711). We used logistic regression to estimate associations between survey wave and non-daily smoking and used descriptive statistics to characterise the profile of non-daily smokers across 3-year periods.ResultsThe proportion who smoked non-daily was relatively stable between November 2006 and November 2013, at an average of 10.5% [10.1–10.9%] of cigarette smokers, then increased to 27.2% [26.0–28.4%] of cigarette smokers (4.0% [3.7–4.2%] of adults) by April 2024. This increase was particularly pronounced among younger adults (e.g. reaching 52.8%, 20.4%, and 14.4% of 18-, 45-, and 65-year-old cigarette smokers by April 2024) and those who vape (reaching 34.2% among vapers vs. 23.1% among non-vapers). Over time, there were reductions in non-daily smokers’ mean weekly cigarette consumption (from 34.3 in 2006–2009 to 21.1 in 2021–2024), urges to smoke (e.g. the proportion reporting no urges increased from 29.2 to 38.0%), and motivation to stop smoking (e.g. the proportion highly motivated to quit within the next 3 months decreased from 30.8 to 21.0%).ConclusionsAn increasing proportion of adults in England who smoke cigarettes do not smoke every day, particularly younger adults. Although non-daily smokers report smoking fewer cigarettes and weaker urges to smoke than they used to, which may make it easier for them to stop smoking, they appear to be decreasingly motivated to quit.

Seroprevalence patterns of viral hepatitis B, C, and E among internally displaced persons in Borno State, Nigeria

ObjectivesFollowing the outbreak of hepatitis E in camps for internally displaced persons (IDPs) in Borno State in 2017, we assessed hepatitis B, C, and E biomarkers (hepatitis B surface antigen [HBsAg], anti-HBC, anti-hepatitis E virus [HEV] immunoglobulin [Ig] G, and anti-HEV IgM) among IDPs in three camps in Borno State, Nigeria, to determine seroprevalence rates in these understudied populations. MethodsA total of 454 IDPs, including pregnant women and breastfeeding mothers, were randomly selected, and their demographic, clinical, and epidemiological data were collected. Blood samples were tested for HBsAg and anti-hepatitis C virus (HCV) using rapid tests, anti-HEV IgM, and anti-HEV IgG using enzyme-linked immunosorbent assay. ResultsThe seroprevalences were 13.7% for HBsAg, 1.3% for anti-HCV, 41.9% for anti-HEV IgG, and 0% for anti-HEV IgM. There were differences between the camps depending on the displaced community. Common detection occurred in 0.2% for HBsAg/anti-HCV, 4.2% for HBsAg/anti-HEV IgG, and 0.7% for anti-HCV/anti-HEV IgG. In pregnant women, HBsAg/anti-HEV IgG co-detection rate was 28.6%, whereas HBsAg and anti-HEV IgG rates alone were 13.4% and 32.8%, respectively. Among breastfeeding mothers, 17.1%, 2.4%, and 36.6% were positive for HBsAg, anti-HCV, and anti-HEV IgG, respectively, whereas 2.2% of them were positive for both HBsAg and anti-HEV IgG. ConclusionsThe prevalence of viral hepatitis biomarkers among the IDPs studied was higher than those reported in national figures and differed according to camps and population subgroups. There is a need for improved surveillance and access to testing for viral hepatitis biomarkers for the purpose of improved disease prevention and control in these medically underserved populations.

Oral Health Status of School-Going Children Aged 12-15 Years in Tiruvallur District, Tamil Nadu- A Cross-Sectional Study

Introduction and Aim: Oral health can have dire consequences on the physiological and psychosocial aspects of a child’s well-being. The prevalence of oral diseases among children varies with region and population subgroups. It is necessary to assess the oral health of children as this epidemiological data will serve as the foundation for developing appropriate preventive and treatment strategies. Hence, the aim of this study was to assess the oral health status of school going children aged 12-15 years in Tiruvallur district of Tamil Nadu, India. Methodology: This cross sectional study was conducted among 842 children aged 12-15 years who were chosen following a multistage random sampling technique. The oral health status of the children was assessed using Oral Hygiene Index- Simplified (OHI-S), Loe and Silness' Gingival Index (GI), Decayed Missing Filled Teeth (DMFT) index in permanent teeth, and the presence or absence of fluorosis &amp; oral premalignant lesions (OPML). The recorded data was then subjected to statistical analysis. Results: The prevalence of gingivitis in the population was 53.4%. The highest mean DMFT was seen among males aged 12-13 years (3.20 +/- 3.102) and the least mean DMFT was seen among females aged 14-15 years (2.76 +/-2.67). 1.3% of the population had tobacco pouch keratosis and 10.8% of the population exhibited dental fluorosis. Conclusion: This study has established that the children of Tiruvallur exhibit poor oral health status. Data from this study can serve as a valuable contributor to the development of oral health initiatives with the ultimate goal being improvement in oral health.

Work-Related Stress and Coping: A Comparative Analysis of On-Site and Office-Based Workers in UK Building Construction.

There are increasing mental health concerns in the construction industry workforce, with stress being a primary concern. This qualitative study investigates stress experiences and the management of stress in office-based and on-site workers in the UK building construction sector. This study can provide key insights for construction, but also potentially other industries which struggle with high stress levels among their employees. A total of 40 semi-structured interviews (20 on-site/20 office-based) were conducted at large-scale building construction projects in the southeast UK. Framework method analysis was used to derive an understanding of stress in the workplace and coping strategies. The study identified two major themes: the negative influence of work stress on personal and professional wellbeing, and the management of stress through proactive and reactive coping strategies. Results indicated that on-site workers frequently cited high workloads, tight deadlines, and safety concerns, whereas office-based workers tended to highlight job complexity and organisational pressures. Both population sub-groups reported stress affecting their work performance, with site-workers having the added concern of physical health and safety. Coping strategies among workers tended to rely on support networks, outside-the-workplace hobbies, and boundary-setting, among others. Stress remains a significant problem in the workplace and affects wellbeing; however, there are ways to mitigate the stress. Our findings could provide a foundation for intervention development.