Public Policy Priorities Research Articles

Improving the Estimate of Trafficking in Human Beings and Modern Slavery by Integrating Data From ILO/Walk Free/IOM and UNODC

Abstract An improved global estimate of the amount of trafficking in human beings/modern slavery is produced. The paper develops the methodology for data to populate Indicator 16.2.2 in the UN SDGs, ‘the estimated number of victims of human trafficking per 100,000 population, by sex, age, and form of exploitation’. The improved estimate is constructed by integrating data from the International Labour Organization/Walk Free/International Organization for Migration (ILO/Walk Free/IOM) with administrative data from United Nations Organization on Drugs and Crime (UNODC) rather than from the Counter Trafficking Global Data Collaborative (CTDC). The data from the UNODC is more comprehensive and less volatile than that from the CTDC on registered victims of trafficking. The new estimate is more than 30% larger, increases the proportion of trafficking for purposes of sexual exploitation from 27 to 56%, and increases the proportion of victims of trafficking who are female from 54 to 64%. This has implications for the priorities for social and public policy for prevention and for the provision of services to mitigate harms.

Austerity, Ageism, and the Rhetoric of Self-reliance: The Policy Drivers and Socio-cultural Attitudes Contributing to the Loneliness Experienced by Older Residents in an Underprivileged Community in South Wales

Reducing loneliness amongst older people is an international public health and policy priority, with signs of decreasing importance in the UK. A growing body of research on tackling loneliness indicates it is a complex challenge. Most interventions imply they address loneliness, when in fact they offer social connectedness to address social isolation and can inadvertently responsibilise the individual for the causes and solutions for loneliness. This article presents research that explored loneliness in an underprivileged community in South Wales through interviews and focus groups with nineteen older people and eighteen local service providers. Their perspective supports a growing body of evidence that loneliness amongst older people is driven by wider structural and socio-cultural exclusion. Interventions to build social connections will be more effective if coupled with policies that reverse the reduction in public services (including transport and healthcare), and challenge socio-cultural norms, including a culture of self-reliance and ageism.

Bridging Public Health Research and State-Level Policy: The Texas Research-to-Policy Collaboration Project.

Significant barriers to the implementation of evidence-based policy exist. Establishing an infrastructure and resources to support this process at the state level can accelerate the translation of research into practice. This study describes the adaptation and initial evaluation of the Texas Research-to-Policy Collaboration (TX RPC) Project, focusing on the adaptation process, legislative public health policy priorities, and baseline researcher policy knowledge and self-efficacy. The federal Research-to-Policy Collaboration (RPC) method was adapted to the Texas legislative process in 2020. Policymakers and public health researchers were recruited using direct outreach and referrals. Legislators or their aides were interviewed to determine health policy needs, which directed the development of legislator resources, webinars, and recruitment of additional public health researchers with specific expertise. Researchers were trained to facilitate communication with policymakers, and TX RPC Project staff facilitated legislator and researcher meetings to provide data and policy input. Baseline surveys were completed with legislators to assess the use of health researchers in policy. Surveys were also administered before training to researchers assessing self-efficacy, knowledge, and training needs. Qualitative data from the legislator interviews were analyzed using inductive and deductive approaches. Quantitative survey data were analyzed using descriptive statistics for scales and individual survey items. Legislative offices (n = 21) identified health care access, mental health, and health disparities as key health issues. Legislators reported that health data were important but did not actively involve researchers in legislation. Researchers (n = 73) reported that policy informed their work but had low engagement with legislators. Researcher training surveys indicated lower policy self-efficacy and knowledge and the need for additional training. Adaptation of the RPC model for state-level health policy is feasible but necessitates logistical changes based on the unique legislative body. Researchers need training and resources to engage with policymakers.

Quantifying the economic value of a national hydrometric network for households

This study reports the results of a Choice Experiment to quantify households’ willingness-to-pay for river gauging programmes in Scotland. The hydrometric network is operated and maintained by the Scottish Environment Protection Agency (SEPA), Scotland’s principal environment regulator, a non-department public body of the Scottish Government. Results from mixed logit and latent class modelling show that most households (‘Hydrometric Maximisers’ − around 70 %) have significant, positive willingness-to-pay values for river gauging programmes, but a minority (‘Hydrometric Satisficers’ − around 30 %) do not view this as a major public policy priority. On average, hydrometric data collection delivers non-market benefits worth £84,625,562 to the Scottish economy, with a minimum economic Benefit-to-Cost ratio of 25:1. This is in addition to the infrastructure value and any private returns made by commercial users of the data. The findings demonstrate that traditional approaches to assessing the benefits of hydrometric networks often underestimate their value. The research also highlights the importance of public information campaigns and household engagement initiatives to increase awareness of hydro-meteorological services, and to develop the business case more fully for public investment in environmental observation networks.

A ATIVIDADE FÍSICA COMO FERRAMENTA DE PROMOÇÃO DA SAÚDE E QUALIDADE DE VIDA PARA PESSOAS IDOSAS

Demographic ageing is defined by the increase in the proportion of elderly people in the total population. This demographic context highlights the need to create specific policies and actions to meet the demands of this growing population. The aim of this study is to review the existing literature on the use of physical activity to promote health and quality of life in the elderly. However, to understand the recurring physiological changes of the ageing process and the benefits of physical activity for improving the quality of life of the population in question. Therefore, this study is justified by the need to encourage physical activity among the elderly population, with the aim of minimizing the negative impacts of sedentary lifestyles and promoting healthy and active ageing. This article is a literature review with a qualitative approach. This study analyzed 20 articles, the findings of which indicate that physical activity is an important tool for promoting health and improving quality of life among the elderly. Based on the theoretical foundation, the benefits of practicing physical activities in improving basic daily activities were discussed, as well as their relationship with physiological changes. Evidence shows that regular physical exercise can mitigate the effects of loss of muscle mass and the risk of chronic diseases, as well as improving functional independence and mental well-being. In view of this, the promotion of physical activity should be a priority in public policy, with concrete incentives and an integrated approach among health professionals. It can be concluded that including physical exercise in everyday life not only prevents disease, but also contributes to healthier and more active ageing.

The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review.

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p < 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p < 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p < 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework.

A novel framework for evidence-based assessment of flood resilience integrating multi-source evidence: A case study of the Yangtze River Economic Belt, China

Floods are extremely destructive to the society, economy and nature, and severely restrict sustainable urban development. There is an urgent need to assess the level of flood resilience, analyze its evolutionary characteristics and improve the flood resilience of the region. However, few previous studies have integrated multi-source evidence into a framework for assessing flood resilience over a longer time span. This study integrated multi-source evidence to analyze the Yangtze River Economic Belt, including literature-based evidence, policy texts and social media data. Subsequently, the Kruskal algorithm and Jaccard coefficient were used to construct collinear networks and identify the clustering dimensions of flood resilience. After evidence judgment, a flood resilience indicator system was constructed. The flood resilience index was calculated using the improved Critic method. The dynamic evolution characteristics and key influencing factors were illustrated by the Kernel density and Grey correlation methods, respectively. The principal contribution is to integrate multi-source evidence to assess flood resilience, with a newly constructed indicator system that systematically considers local public demand, policy priorities and common indicators from previous literature. The results show that: the flood resilience index of the Yangtze River Economic Belt is in the range of [0.16, 0.75] from 2000 to 2022, with higher values in the downstream compared to those in the midstream and upstream. The social dimension dominating the overall flood resilience. The kernel density curve of the YREB is characterized by a right trailing. The inter-regional differences tend to widen and have a polarization effect. The special funds for water conservancy finances and the length of flood prevention levees are key factors influencing the level of flood resilience. Finally, strategies for enhancing flood resilience were proposed. This study provides a feasible framework for constructing an indicator system and assessing flood resilience by integrating multi-source data. It is important for flood risk management and helps to the development of urban flood prevention and resilience strategies.

Wetland restoration: can short‐term success criteria predict long‐term outcomes?

Worldwide wetland loss over the past 50 years has made wetland conservation a public policy priority, leading to an increase in wetland restoration programs. However, predicting long‐term restoration outcomes remains difficult. The monitoring of these programs rarely exceeds 5–10 years, forcing wetland managers to rely on short‐term success criteria that may be criticized by the scientific community. Our objective was to assess the significance of four short‐term success criteria (Carex ssp. shoot density, Salix ssp. survival, invasive species cover, and hydrologic dissimilarity to reference sites) used in a restoration program of 12 wetlands monitored for 5 years post‐restoration in predicting restoration outcomes 15 years post‐restoration. We defined the success of restoration efforts after 15 years using a cluster analysis‐based approach, and the clusters were described using principal coordinate analysis and Tukey's post hoc honest significant difference test. Finally, we assessed the pertinence of each short‐term success criteria in predicting long‐term restoration outcomes using Pearson correlation tests and spatial regressive models. Our results demonstrate that stress‐based short‐term success criteria can be reliable predictors of longer‐term success for communities with shallow water tables, whereas target‐species‐based short‐term success criteria are not. Hydrologic dissimilarity to the reference site was appropriate for willow‐sedge community outcome predictions, while invasive species cover was best for sedge community outcome predictions. For communities in drier habitats, such as the willow‐herb community, none of the tested short‐term success criteria were significant predictors of long‐term restoration outcomes, and further research is required to identify suitable short‐term success criteria.

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity

ObjectiveTo investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. MethodsCross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. ResultsNulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. ConclusionsThe high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practiceThe need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

Autonomy, independence, and participation of nursing home habitants addressed by assistive technology: a scoping review

Context Assistive technologies have been identified by researchers and public policies of the Western world to be promising tools to face the challenge of maintaining quality of life of older people, and especially for nursing home habitants. Independence, autonomy, and participation are major determinants of quality of life of nursing homes habitants. Maintaining quality of life is nowadays a priority for public health policies and institutions of the where the population is growing older every year. Method This PRISMA-ScR review aims to determine which assistive technologies are used to promote autonomy, independence, and social participation of nursing home habitants. An electronic search was conducted for English, French articles to identify research studies using CINAHL, PubMed, Cochrane Library, PsycINFO, and Googlescholar. Results 12 papers published between 2009 and 2023 described 6 assistive technologies: technologies integrated into the environment, monitoring technologies, surveillance technologies, information and communication technology, social assistance robots, virtual reality. Six types of AT are currently used worldwide to maintain autonomy, independence and participation of people living in nursing homes. Their use is mainly perceived as positive by habitants, care and non-care staff, next of kin, and experts despite some concerns regarding ethical, financial, consideration. Discussion Nevertheless, their impact on habitant’s autonomy, independence and participation still needs to be measured using suitable tools to understand their real impact on the quality of life of the elderly.

The journey of patients with lung cancer: The gap between symptom onset and treatment.

e23119 Background: Prompt access to health care services is a priority in public health policies. The aim of this study was to map the journey of patients (pts) diagnosed with lung cancer (LC) and determine the time interval (TI) from symptom onset (SO) to treatment initiation and assess the impact on survival. Methods: A retrospective cohort study was conducted at the University Hospital of Larissa. Pts’ demographic and disease-related data were captured from medical records. The TI from SO to first doctor visit (StD), SO to first oncologist visit (StO), diagnosis to treatment initiation (DtT) and SO to treatment initiation (StT) were estimated. Overall survival (OS) was defined as the TI between treatment initiation and the date of death or the date of last follow-up. OS were estimated using the Kaplan–Meier analysis and the comparisons were computed with the log-rank test. Results: Overall, 251 sequential pts with metastatic LC were included in the study. Pts’ mean age was 71 years (range 35-88). The majority were men (82%) and 24%, 32%, 28% and 16% were diagnosed with small cell lung cancer (SCLC), squamous cell (SCC), adenocarcinoma (ADC) and large cell (LCC) LC, respectively. The median StD and StO was 32 (0-212) days and 102 (11-608) days, respectively. No difference was detected across genders, age ( &gt; or &lt; 70), family history of cancer or not, and area of residence (rural, urban). The median StT and DtT was 123 (30-851) days and 26 (1-105) days, respectively, with this time intervals being shorter among pts with SCLC compared to pts with non-small cell LC (NSCLC) ( p: 0.006 and p&lt; 0.001, respectively). Pts with sort StT intervals had significantly improved OS, compared to pts with longer StT intervals (SCLC p:0.044, NSCLC p:0.004). Conclusions: To the best of our knowledge, this is the first study aiming to determine specific TI from SO to treatment initiation for pts with LC in Greece and assess the potential impact on OS. Our data revealed a substantially prolonged StT (~4months) that is associated with worse survival rates. This indicates a need to improve public awareness of LC symptoms, enable pts’ access to specialized health care services and facilitate earlier diagnosis and treatment.

EFECTIVIDAD DEL MODELO DE SALUD FAMILIAR EN LA ATENCIÓN PRIMARIA DE SALUD CHILENA

Effectiveness evaluation of the “Comprehensive Family and Community Care Model” imple­mented at Primary Care Heatlh Care level in Chile has not been a priority for public policy. However, studies that address criteria related to this area reveal important improvements in user satisfaction, reduction in avoidable hospitalizations and health spenditures, as well.

Risky conclusions regarding shrinking rhino horns

Abstract Image‐based analyses from an online repository on rhino horns asserted that declines in size over time could be the consequence of poaching and hunting. We provide reflections on whether the sample was representative enough to make generalizations, the study adequately accounted for the main sources of horn‐size variation and the statistical methods were adequate to be confident in the results. The sample had a limited representation, most coming from zoo animals. We highlight several sources of variance in horn size that such a sample could not evaluate robustly using linear regressions, both for establishing a proxy for horn size corrected for size of a rhino and assessing trends over time. Nevertheless, horn poaching continues to be the key threat to rhinos. Addressing the underlying drivers of poaching and trafficking are key priorities for responsible public debate, policy making and interventions. Read the free Plain Language Summary for this article on the Journal blog.

A cost-effectiveness analysis of a South African pregnancy support grant

Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion ‐ ZAR23.2 billion/ $1.57 billion ‐ $264 million) and averted 59,000 DALYs (95% CI: -6,400–110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.

The role of liver enzymes in the association between ozone exposure and diabetes risk: a cross-sectional study of Zhuang adults in China.

Background: Growing evidence has demonstrated the role of ambient air pollutants in driving diabetes incidence. However, epidemiological evidence linking ozone (O3) exposure to diabetes risk has been scarcely studied in Zhuang adults in China. We aimed to investigate the associations of long-term exposure to O3 with diabetes prevalence and fasting plasma glucose (FPG) and estimate the mediating role of liver enzymes in Zhuang adults. Methods: We recruited 13 843 ethnic minority adults during 2018-2019 based on a cross-sectional study covering nine districts/counties in Guangxi. Generalized linear mixed models were implemented to estimate the relationships between O3 exposure and diabetes prevalence and FPG. Mediation effect models were constructed to investigate the roles of liver enzymes in the associations of O3 exposure with diabetes prevalence and FPG. Subgroup analyses were conducted to identify potential effect modifications. Results: Long-term exposure to O3 was positively associated with diabetes prevalence and FPG levels in Zhuang adults, with an excess risk of 7.32% (95% confidence interval [CI]: 2.56%, 12.30%) and an increase of 0.047 mmol L-1 (95% CI: 0.032, 0.063) for diabetes prevalence and FPG levels, respectively, for each interquartile range (IQR, 1.18 μg m-3) increment in O3 concentrations. Alanine aminotransferase (ALT) significantly mediated 8.10% and 29.89% of the associations of O3 with FPG and diabetes prevalence, respectively, and the corresponding mediation proportions of alkaline phosphatase (ALP) were 8.48% and 30.00%. Greater adverse effects were observed in females, obese subjects, people with a low education level, rural residents, non-clean fuel users, and people with a history of stroke and hypertension in the associations of O3 exposure with diabetes prevalence and/or FPG levels (all P values for interaction < 0.05). Conclusion: Long-term exposure to O3 is related to an increased risk of diabetes, which is partially mediated by liver enzymes in Chinese Zhuang adults. Promoting clean air policies and reducing exposure to environmental pollutants should be a priority for public health policies geared toward preventing diabetes.

Original

Anaemia in women of reproductive age (WRA) can adversely affect maternal health and birthoutcomes. Despite numerous policies and initiatives, anaemia among women continues to be asignificant public health issue in India, with West Bengal (WB) having the highest burden ofanaemia. In order to establish priorities for public health policy, this study attempted to exam-ine the factors associated with anaemia among WRA in West Bengal. Data was drawn from theNational Family and Health Survey-5, 2019-21. A cross-sectional sample of 21408 women aged 15-49 years was analysed. Cross-tabulation was used to compute the prevalence of anaemiaby background characteristics of women and Chi-squared test to check the bivariate associa-tion. Furthermore, binary logistic regression model was run to examine the contribution of thepredictor variables on anaemia. Seven out of ten women in West Bengal were found anaemic.Women aged 40-49 years (Odds Ratio: 1.27, 95% Confidence Interval: 1.12-1.44, SC (OR:1.24, 95% CI: 1.13-1.36), ST (OR: 1.72, 95% CI: 1.47-2.02), and Rural women (OR 1.26, 95%CI: 1.15-1.38); those who had no formal education (OR: 1.12, 95% CI: 0.92-1.28), belonged tothe poorest households (OR 1.34, 95% CI: 1.27-1.43), used groundwater for drinking (OR1.13, 95% CI: 1.04-1.22), were underweight (OR 1.24, 95% CI: 1.12-1.37) and lactating (OR1.11, 95% CI: 0.98-1.24); had three or more children (OR 1.15, 95% CI: 0.98-1.36) reported significantly higher likelihood of being anaemic. Age, education, household wealth, social group,source of drinking water, residence, nutritional status, maternity status were significantly asso-ciated with anaemia. Therefore, targeted interventions considering the discussed determinantsmay help in reducing anaemia.For instance, haemoglobin levels of women should be measured on regular basis.

Формирование общепрофессиональных компетенций у бакалавров педагогического образования в процессе освоения дополнительных образовательных программ

The emergence of new public policy priorities in the field of education changes the role of lifelong education in the system of socialization of the individual, as well as the nature of interaction between various subjects within the educational process and beyond. To increase competitiveness in the labor market, students of higher educational institutions need to be prepared to quickly master new knowledge and skills to meet the requirements of professional activity in the labor market. One of the forms of obtaining specific knowledge and skills for students in parallel with higher education is additional education. The purpose of the study is to analyze the pedagogical conditions for the formation of general professional competencies among bachelors of pedagogical education using additional education programs. Materials and methods of research. The research materials are the methodologically based on a scientific review of research approaches developed in domestic pedagogy in the field of improving the system of training generalist specialists in the development of additional education programs. The research methods are the study and analysis of scientific and methodological literary sources, as well as questioning of students. Research results. At the Chuvash State Pedagogical University named after I.Ya. Yakovlev Center for Continuing Education. To determine the possibility of additional professional education, a study was conducted among students of this university in order to identify their awareness of the possibilities of mastering additional education programs. The results of the survey, according to which many students plan to undergo additional education in standard programs, 20% plan to receive certificates or certificates in a whole range of programs. Conclusions. The system of additional education adapts future teachers to the specifics of modern socio-economic conditions, high demands from the labor market and, ultimately, forms a highly qualified specialist with a wide profile, capable of a continuous process of self-improvement in the process of professional activity.

POPULATION ATTRIBUTABLE FRACTION OF POOR ORAL HEALTH FOR THE INCIDENCE OF DEMENTIA: A POPULATION-BASED COHORT STUDY

Abstract Emerging evidence indicates a positive association between suboptimal oral health and increased risks of dementia. Despite the preventable and treatable nature of many oral health problems, oral health has not been considered in the risk factors for dementia that shape public health policy and research priorities. We aimed to quantify and compare the fractions of incident dementia attributable to poor oral health and other modifiable risk factors. The research included a nationally-representative sample of 15,474 cognitively intact adults aged≥50 from the Health and Retirement Study, with the outcome of incident dementia between 2006 to 2016. We estimated the multivariate-adjusted hazard ratio (HR) and population attributable fraction (PAF) of edentulism and nine risk additional dementia factors. Additional analyses were conducted on 1,239 individuals who completed the “Dental Health Module” in 2008, examining oral health problems as an exposure. Edentulism was associated with a higher risk of dementia for both men (HR,1.38; 95%CI, 1.15-1.66) and women (HR, 1.32; 95%CI, 1.16-1.51). The PAF of edentulism for dementia was 4.64%, which exceeded that of hearing impairment (3.58%) and hypertension (2.90%). Oral health problems were also a significant factor for men (HR, 2.01; 95%CI, 1.49-3.39) and women (HR, 1.15; 95% CI, 1.02-1.30), with a PAF of 11.84% among men, the second-largest following less education (22.60%). The substantial estimated proportion of dementia attributed to poor oral health in the aging population, particularly in men, warrants more attention. Dental care should be an integral component of a comprehensive approach to promoting cognitive health.

Regional health and social inequalities in Bulgaria

Abstract Background The administrative division of Bulgaria divides it into 28 regions, which differ significantly in terms of both socioeconomic development and a number of demographic indicators. The death rate is an indicator according to which our country has been at the top of the world rankings for several years. Cardiovascular diseases stand out among the leading causes of death and they are one of the most important problems facing our society and health system. The study aims to analyse the relationship between the death rate due to CVD in different regions in Bulgaria with the average annual salary of employed persons as an indicator for the socioeconomic development of the regions. Methods The regional differences in the death rate due to CVD and the average annual salary of employed persons were analysed based on the National Statistical Institute data. Analysis and calculations were performed by MS Excel 2019. Results The death rate due to CVD in Bulgaria varies widely - from 1739.7 per 100000 in region Vidin, 1685,2 in region Montana to 878.0 in the city of Sofia, with a national average of 1163.2 /2021/. At the same time, Vidin and Montana regions are also among the regions with a very low average annual salary of employed persons - respectively 12 855 and 13 983 BGN, which is much lower than the average for the country - 21 128 and than the capital Sofia - 25 724 BGN /2021/. Conclusions The regional health inequalities in Bulgaria are very important in order to control and decrease the level of mortality in the country, especially the death rate due to CVD. Bulgaria is among the counties that have the most serious challenges related to high cardiovascular deaths and should be among the priorities of public policy. The profound regional differences that were found impose permanent monitoring and directing the regional social and public health policies to avoid their unfavourable effects. Society should be making major and cost-effective efforts to reduce mortality. Key messages • The elimination of regional inequalities in the country is one of the possible ways to deal with the difficult demographic situation which occurred in the years after the democratic changes. • Regional health inequalities create the need for a long-term health policy that will improve the population's health status and the effective functioning of the healthcare system in our country.

Alcohol per capita and prevalence of alcohol exposed pregnancies: systematic review and meta-analysis

Abstract Background Alcohol is a teratogen that crosses the placenta. While studies have estimated the global burden of alcohol use in pregnancy, reliable and valid data on alcohol consumption during pregnancy in many countries is lacking. Alcohol consumption per capita (APC) data are available worldwide. This systematic review, by investigating the association between APC and alcohol consumption in pregnancy by country, aims to evaluate the accuracy of using APC data to predict the prevalence of prenatal alcohol exposure (PAE). Methods This study combines studies identified in a systematic review by Popova et al. 2017 and a systematic search of MEDLINE from 2015 through 6th October 2022, to identify additional papers. Papers identified in either search were on the prevalence of PAE or fetal alcohol syndrome (FAS). Two authors independently screened titles, abstracts, full-text articles and performed data extraction and quality assessment. APC data,per country, by year, was obtained from the World Health Organization (WHO) website. A meta-analysis, assuming a random effects model will be performed. Sensitivity analyses, including restricting by population, timing of exposure, time and method of ascertainment of alcohol consumption will be carried out. Results Of 24,935 PAE and 12,231 FAS prevalence articles identified, 400 PAE studies and 77 FAS studies met the inclusion criteria. Studies represent data from 1959-2020 from all 6 WHO regions, with APC between 0.012-14.78. Preliminary analysis suggests a statistically significant correlation between prevalence of alcohol consumption during pregnancy and APC. Conclusions Preliminary results from this study suggest that publicly available data on APC can be used to predict the population-based prevalence of alcohol use in pregnancy in different countries. Effective policies and interventions are required to reduce APC and thus, alcohol use in pregnancy and associated detrimental child health outcomes around the globe. Key messages • Knowing the prevalence of FAS and its main risk factor- prenatal alcohol use, will inform the setting of priorities for public health policy, public health initiatives, and health-care planning. • By investigating the association between alcohol intake in pregnancy and APC we will assess whether APC can predict alcohol intake in pregnancy.