Representative Population Sample Research Articles

Public perception of scientific advisory bodies: the case of France’s Covid-19 Scientific Council

Abstract During the Covid-19 pandemic, many governments have resorted to scientific advisory bodies to aid in public health decision-making. What then has been the public’s perception of those new structures of scientific advice? In this article, we draw on a survey conducted in November 2020 among a representative sample of the French adult population (n = 1,004) designed specifically to explore public perceptions of the dedicated Covid-19 Scientific Council created in March 2020 and of scientific advice in general. After only 8 months, three-quarters of French people said they had heard of it, but only a quarter had a positive opinion about its usefulness. Despite the diversity of perceptions of what scientific advice is and should be, it appeared that scientific advice bodies are perceived as useful mainly by a public already largely supportive of the delegation of the management of public life to the government and public institutions.

Access to health care for people with intellectual disability in Belgium: challenges and solutions

Abstract Background people with intellectual disability (PWID), such as those living with Down syndrome, experience poorer health outcomes, are more at-risk of comorbidities and have a lower life expectancy than the general population. Moreover, they are more likely to experience discrimination and refusal of care than other citizens. To support the implementation of the rights of PWID as promoted by the United Nations Convention on the Rights of Persons with Disabilities, the Belgian Health Care Knowledge Centre measured the health disparities between PWID and without ID in Belgium, collected the barriers faced by PWID and suggested solutions. Methods a mixed method study was conducted in 2020-2022. Quantitative data were obtained from linking the social security data related to PWID to the health expenditures data. A representative population sample was obtained to allow for compare PWID with the general population. Experiences and needs of PWID and of professionals were collected through semi-directive interviews and nominal groups. Stakeholders from handicap and health sectors joined an online survey to gather possible options for solutions. Results data of 17 155 PWID were analysed and compared to a sample of the Belgian population. PWID have, i.e., a lower access to dental care (49.8% for PWID vs 65.8% in 2019) or breast cancer screening (42.6% for PWID vs 59.7%). We found no difference for contact with a GP and diabetes follow-up. Five categories of barriers emerged: stereotypes and prejudices; lack of knowledge and competences; poor communication; organisational gaps; lack of sociopolitical support. We identified 25 actions, aiming at 8 objectives, with 3 preliminary conditions: more time, universal design and reasonable adjustment. Conclusions focusing on universal design, that is tailoring health services to the needs of the most vulnerable patients that are PWID, can increase access to health care to all patients and not only the PWID. Key messages • People with intellectual disability lack of access to preventive health care. • Focusing on universal design increases access to health care for all.

The impact of the covid-19 pandemic on the subjective well-being of the Belgian population

Abstract Background Data from European studies suggest that well-being declined during the first year of the COVID-19 pandemic. However, the pandemic's consequences on an overall nations’ well-being remains inadequately explored, especially over time. This study aims to map the long-term impact of the pandemic on the subjective well-being (SWB) of Belgian citizens. Methods Using a repeated cross-sectional study design, data were collected in representative samples of the Belgian population at 5 different time points during the period from February 2020 until December 2022. Life evaluation was measured with the Cantril ladder. Positive and negative affect were assessed with the short version of the Positive and Negative Affect Schedule. ANOVA were used to evaluate the evolution in SWB. Moderation analyses were performed to investigate the differential impact of the pandemic for different age categories. Results Our results show that the pandemic negatively impacted the SWB of the Belgian population. Life evaluation (F(4,7605)=18.12, p<.001) and positive affect (F(4,7605)=16.83, p<.001) significantly decreased during the second wave and after the fourth wave compared to before the pandemic with a decline of .52 and .37 points respectively for life evaluation and a decline of .18 and .42 points respectively for positive affect (both on a scale between 0 and 10). No statistically significant differences in negative affect were found (F(4,7605)=1.08, p = 0.363). Citizens over the age of 50 appeared to be more resilient than younger citizens as the negative impact of the pandemic was either smaller or delayed in this group for all SWB indicators. Conclusions The COVID-19 pandemic clearly impacted the SWB of the Belgian population, and particularly the well-being of younger individuals suffered. We urge policymakers to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society. Key messages • The COVID-19 pandemic and its related measures negatively impacted the well-being of the Belgian population, with younger individuals being more susceptible to the negative effects of the pandemic. • We urge policymakers and governments to consider all aspects of health during pandemics and to attend in particular the mental health needs of younger members of their society.

Prevalence of overweight among Tunisian adolescents: Trend analysis 1996-2016

Abstract Background Overweight among adolescents is a growing public health concern worldwide, and Tunisia is no exception. However, prevalence trends of overweight among Tunisian adolescents have not been well documented. This study aimed to determine prevalence trends of overweight among adolescents in Tunisia between 1996 and 2016. Methods Data were collected from three national surveys conducted in Tunisia between 1996 and 2016. The first was conducted in 1996 (n = 729). The second was the Epidemiological Transition and Health Impact in North Africa Survey (TAHINA-2005, n = 1019), and the third was the Tunisia National Health Examination Survey (THES-2016, n = 482). All surveys used a similar methodology and included a representative sample of the Tunisian population. Overweight was defined as Body Mass Index≥ 85th percentile. STATA software was used for statistical analysis and chi-squared test for trend was performed. Results A total of 2230 participants was enrolled (sex ratio=0.99). The prevalence of overweight among adolescents increased from 10.8% (4.3% for boys and 17.7% for girls) in 1996 to 18.9% (17.2% for boys and 20.7% for girls) in 2005, then to 30.5% (22% for boys and 39.2% for girls) in 2016. Linear trend test concluded to significant increase in overweight prevalence estimated at 179.6% in two decades. The results showed a significant effect of time on overweight prevalence (p < 10-3), as well as a significant effect of sex group (p < 10-3). The model estimated that the prevalence of overweight increased by 1.29% per year from 1996 to 2016. The odds of overweight increased significantly over time, with an Odds Ratio (OR = 1.79, (95% CI: 1.39-2.30)) for TAHINA survey and (OR = 2.80 (95% CI: 2.21-3.55)) for THES survey. Conclusions Our study showed a significant increase in the prevalence of overweight among Tunisian adolescents over the past two decades. It is crucial to refine the analysis of associated risks to develop targeted interventions and adapt current policies. Key messages • The prevalence of overweight increased significantly among Tunisian adolescents in the past two decades. • Targeted interventions and policies to address this issue are therefore urgent.

Correlates of adherence to a posteriori derived dietary patterns of an Italian sample of adults

Abstract There is emerging evidence that the Italian population is switching away from the traditional Mediterranean dietary pattern towards unhealthy eating habits. We derived adults’ dietary patterns (DP) using a principal component analysis (PCA) on food groups intake of a representative sample of the Italian population (INRAN-SCAI 2005-2006), and correlated diet adherence scores with sociodemographic characteristics through multivariable linear regressions. After PCA, “High-fat”, “Western”, “Health-conscious”, “Italian, traditional” and “Junk, out of meal” DPs were retained. Female gender (β = 0.5103; p < 0.001) showed an association with higher adherence scores on the Health conscious pattern. Conversely, being female was associated with lower Z-scores on the High fat (β=-0.1849; p = 0.024), Western (β= -0.0711;p= 0.004) and Italian traditional (β=-0.4799;p<0.001) patterns. Age (β per one year increase=-0.0077;p<0.001) was associated with lower adherence scores in the Western and in the Junk, out of meal (β=-0.0078;p<0.001) pattern. Having either a secondary (β=-0.1301;p=0.016) or tertiary (β=-0.2156;p= 0.001) education level were independently associated with lower dietary Z- scores in the Italian traditional” pattern. Finally, there was wide regional variation, coming from different regions predicted adherence to different DPs. A substantial share of our sample showed unhealthy eating habits, which is consistent with the latest Italian dietary trends. Key messages • Future policies to improve diet quality at the national level should promote food literacy interventions targeting the differences between women and man among different age groups. • This work will provide the basis to investigate the environmental impact of higher pattern adherence scores.

The dimensional structure of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and predictors of camouflaging in a representative general population sample

ObjectivesSome autistic people “camouflage” their differences by modeling neurotypical behaviors to survive in a neurotypical-dominant social world. It remains elusive whether camouflaging is unique to autism or if it entails similar experiences across human groups as part of ubiquitous impression management (IM). Here we examined camouflaging engagement and theoretical drivers in the general population, drawing on the transactional IM framework and contextualizing findings within both contemporary autism research and the past IM literature. MethodsA large representative U.S. general population sample (N = 972) completed this survey study. We combined exploratory item factor analysis and graph analysis to triangulate the dimensional structure of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and examined its correspondence with prior autism-enriched psychometric findings. We then employed hierarchical regression and elastic-net regression to identify the predictors of camouflaging, including demographic (e.g., age, gender), neurodivergence (i.e., autistic and ADHD traits), socio-motivational, and cognitive factors. ResultsWe found a three-factor/dimensional structure of the CAT-Q in the general population, nearly identical to that found in previous autism-enriched samples. Significant socio-motivational predictors of camouflaging included greater social comparison, greater public self-consciousness, greater internalized social stigma, and greater social anxiety. These camouflaging drivers overlap with findings in recent autistic camouflaging studies and prior IM research. ConclusionsThe novel psychometric and socio-motivational evidence demonstrates camouflaging as a shared social coping experience across the general population, including autistic people. This continuity guides a clearer understanding of camouflaging and has key implications for autism scholars, clinicians, and the broader clinical intersecting with social psychology research. Future research areas are mapped to elucidate how camouflaging/IM manifests and functions within person-environment transactions across social-identity and clinical groups.

Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study

BackgroundThe association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.MethodsThe study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994–2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).ResultsDuring the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.ConclusionThe findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.

Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus

BackgroundParenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population.MethodsThis study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction.ResultsABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning.ConclusionsA fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders’ experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.

Considerations for Use of Blood-Based Biomarkers in Epidemiologic Dementia Research.

Dementia represents a growing public health burden with large social, racial, and ethnic disparities. The etiology of dementia is poorly understood, and the lack of robust biomarkers in diverse, population-representative samples is a barrier to moving dementia research forward. Existing biomarkers and other measures of pathology-derived from neuropathology, neuroimaging, and cerebrospinal fluid samples-are commonly collected from predominantly White and highly educated samples drawn from academic medical centers in urban settings. Blood-based biomarkers are noninvasive and less expensive, offering promise to expand our understanding of the pathophysiology of dementia, including in participants from historically excluded groups. Although largely not yet approved by the Food and Drug Administration or used in clinical settings, blood-based biomarkers are increasingly included in epidemiologic studies on dementia. Blood-based biomarkers in epidemiologic research may allow the field to more accurately understand the multifactorial etiology and sequence of events that characterize dementia-related pathophysiological changes. As blood-based dementia biomarkers continue to be developed and incorporated into research and practice, we outline considerations for using them in dementia epidemiology, and illustrate key concepts with Alzheimer's Disease Neuroimaging Initiative (2003-present) data. We focus on measurement, including both validity and reliability, and on the use of dementia blood-based biomarkers to promote equity in dementia research and cognitive aging. This article is part of a Special Collection on Mental Health.

Pancreatitis Prevention in Tabuk City, Kingdom of Saudi Arabia: Evaluating Public Knowledge and Raising Awareness of Risk Factors and Symptoms.

Pancreatitis is an inflammation of the pancreas.The pancreas is a flat, elongated gland situated in the upper abdomen, beyond the stomach. It produces digestive enzymes and hormones that regulate glucose absorption in the body. Pancreatitis can be acute, developing rapidly and lasting for several days, or chronic, persisting over an extended period and affecting specific individuals. While treatment can improve mild cases of pancreatitis, severe cases can be fatal. This study utilizes a cross-sectional survey design with 549 participants, allowing data collection from a representative sample of Tabuk City's adult population. The participants' knowledge about the risk factors and symptoms of pancreatitis was inadequate. Among those who did not receive any information about pancreatitis and its risk factors, the count was 352 (64.1%). On the other hand, there was increased awareness of pancreatitis and its risk factors, which would lead to early detection and prevention. A total of 483 participants (88%) expressed adequate agreement, and 305 participants (55.6%) demonstrated an adequate response regarding seeking medical attention if they experienced any symptoms of pancreatitis. Our findings revealed a lack of knowledge about the risk factors and symptoms of pancreatitis. Furthermore, there was inadequate awareness regarding governmental initiatives or programs that support access to pancreatitis knowledge and awareness in Tabuk City.

Evaluating an Association Between Prenatal Smoking Behavior and Exclusive Breastfeeding: A Population-Based Study

Background: Prenatal smoking is consistently associated with adverse breastfeeding outcomes. We aimed to evaluate the association of smoking cessation or continuation during pregnancy with exclusive breastfeeding in a representative sample of the general Canadian population. Methods: We used the pooled sample of 9860 females with pregnancy experience of last under-five child from the Canadian Community Health Surveys 2015-2018 public use microdata file. We categorized self-reported prenatal smoking status as continuing, quitting, or no smoking. We evaluated the association between exclusive breastfeeding for 6 months or more with prenatal smoking status using multivariable logistic regression, adjusted for socio-demographic variables. Results: With the pooled prevalence of 33.2% (95% CI 31.7, 34.8), 34.4% (95% CI 32.8, 36.1) of non-smokers, 25.7% (95% CI 20.2, 32.2) of those who quit and 15.7% (95% CI 10.8, 22.2) of those who continued smoking reported exclusive breastfeeding for 6 months or more. Continuing smoking had lower odds of exclusive breastfeeding (aOR .47; 95% CI 0.30,0.75) but quitting smoking had no difference (aOR .78;95% CI 0.56,1.08) when compared to non-smokers. Conclusion: Continuing smoking during pregnancy was associated with lower rates of exclusive breastfeeding of infants for 6 months or more. Smoking cessation interventions during prenatal visits may improve exclusive breastfeeding rates.

Positive parent-child interactions moderate certain maltreatment effects on psychosocial well-being in 6-year-old children.

Positive parental interactions may buffer maltreated children from poor psychosocial outcomes. The study aims to evaluate the associations between various types of maltreatment and psychosocial outcomes in early childhood, and examine the moderating effect of positive parent-child interactions on them. Data were from a representative Chinese 6-year-old children sample (n = 17,088). Caregivers reported the history of child maltreatment perpetrated by any individuals, completed the Strengths and Difficulties Questionnaire as a proxy for psychosocial well-being, and reported the frequency of their interactions with children by the Chinese Parent-Child Interaction Scale. Physical abuse, emotional abuse, neglect, and sexual abuse were all associated with higher odds of psychosocial problems (aOR = 1.90 [95% CI: 1.57-2.29], aOR = 1.92 [95% CI: 1.75-2.10], aOR = 1.64 [95% CI: 1.17-2.30],aOR = 2.03 [95% CI: 1.30-3.17]). Positive parent-child interactions were associated with lower odds of psychosocial problems after accounting for different types of maltreatment. The moderating effect of frequent parent-child interactions was found only in the association between occasional only physical abuse and psychosocial outcomes (interaction term: aOR = 0.34, 95% CI: 0.15-0.77). Maltreatment and positive parent-child interactions have impacts on psychosocial well-being in early childhood. Positive parent-child interactions could only buffer the adverse effect of occasional physical abuse on psychosocial outcomes. More frequent parent-child interactions may be an important intervention opportunity among some children. It provides the first data on the prevalence of different single types and combinations of maltreatment in early childhood in Shanghai, China by drawing on a city-level population-representative sample. It adds to evidence that different forms and degrees of maltreatment were all associated with a higher risk of psychosocial problems in early childhood. Among them, sexual abuse posed the highest risk, followed by emotional abuse. It innovatively found that higher frequencies of parent-child interactions may provide buffering effects only to children who are exposed to occasional physical abuse. It provides a potential intervention opportunity, especially for physically abused children.

The universe identification and sampling design of consumer surveys in trade mark lawsuits

A consumer survey is a scientific method of presenting evidence of mental associations by canvassing a representative sample of the relevant population. Its admissibility and probative weight depend upon an evaluation of the quality of the survey’s methodology. Since courts have found many different requirements for a proper universe and representative sample, these areas have become constant sources of criticism for survey evidence. This article focuses on two aspects of a consumer survey: the determination of the relevant universe of consumers and the sampling method of a consumer survey. Section 1 briefly discusses the use and application of consumer surveys in China trade mark lawsuits. Section 2 explores the determination of the relevant universe and Section 3 investigates the representativeness of the survey sample. Section 4 examines the current problems in the judicial treatment of survey evidence and offers some possible solutions.

How Do Adherence to COVID-19 Mitigation Measures and Its Predictors Change between 2020 and 2021? An Explorative Investigation in Eight European Union and Non-European Union Countries

Introduction: Adherence to COVID-19 mitigation measures is an important vehicle that has contributed to the fight against the pandemic. The present study investigated potential changes of the level of adherence and its predictors between 2020 and 2021 in eight countries. Methods: Adherence to COVID-19 measures and its potential predictors (perception of usefulness of the measures, rating of the governmental COVID-19 communication, mental health variables, COVID-19 burden) were compared between representative population samples from European Union countries (France, Germany, Poland, Spain, Sweden) and non-European Union countries (Russia, UK, USA) assessed in 2020 (N = 7,658) and 2021 (N = 8,244). Results: In the overall sample, multiple analyses of variance revealed significantly higher levels of adherence to the measures, their perception as useful, positive mental health, and feelings of being well supported and well informed by governments in 2020 than in 2021. In contrast, feelings of being left alone and symptoms of depression, anxiety, and stress were significantly higher in 2021 than in 2020. In France, Poland, Spain, and the UK, the adherence level was significantly higher in 2020 than in 2021. In European Union countries, ratings of governmental communication were less positive, and levels of mental health were lower in 2021 than in 2020. In non-European countries, an opposite result pattern was found. Conclusion: The current results indicate a decrease in adherence to the mitigation measures and factors that could foster it. Potential ways how governments and authorities could enhance the population’s trust in COVID-19 mitigation measures are discussed.

Watching the Watchdogs: Using Transparency Cues to Help News Audiences Assess Information Quality

The myriad of information sources available online can make it hard for the average reader to know whether a piece of content is credible or not. This research aims to understand if the public’s assessment of the credibility of information could be more accurate with the help of transparency features that act as heuristic cues under the elaboration likelihood model and the heuristic-systematic model, and if the cues increase cognitive absorption. Two between-subjects studies were performed, one with a young demographic (<em>N</em> = 68) and another with a representative sample of the adult population (<em>N</em> = 325). The stimuli contained information boxes designed to indicate that the story was not written in a traditional journalistic style (message cues) and missing background information on the author (source cues). Results show significant effects of the cues on credibility assessment and cognitive absorption.

Bioactive compounds intake in the Brazilian population: Trends and determinants of socioeconomic inequalities between 2008 and 2018.

The present study aims at evaluating trends and determinants of socioeconomic inequalities in consumption of bioactive compounds in representative sample of the Brazilian population the period from 2008-2009 to 2017-2018. Data from two cross-sectional population-based surveys were analyzed in the study, using descriptive analysis and estimation of inequalities in consumption. Trends in polyphenol and carotenoid intake were estimated using food consumption data from National Dietary Survey (NDS) 2008-2009 (n = 34,003) and 2017-2018 (n = 46,164). Evolution and determinants of inequalities in bioactive compounds intake were identified using analysis of inequality based on concentration index. Consumption of total polyphenols, phenolic acids, flavonoids and carotenoid classes (except for zeaxanthin) was significantly associated with per capita income after adjustment for potential confounders, being higher income associated with higher intake of bioactive compounds. Disaggregation of inequalities showed that education was the main factor associated with consumption of flavonoids, other polyphenols and β-cryptoxanthin in 2008-2009; whilst income was the main barrier to intake of polyphenols and carotenoids in 2017-2018. Income level and educational attainment have been important determinants to inequalities in bioactive compounds intake in the Brazilian population throughout the period of analysis, being higher intake of bioactive compounds-rich foods and beverages associated with higher income.

SAT288 Development Of CAH-specific Patient Reported Outcome (PRO) Instrument To Assess Health-related Quality Of Life (HRQoL)

Abstract Disclosure: M.E. Flokas: None. L. Yang: None. K. Middleton: None. R.W. Persky: None. S. Kollender: None. M. Parker: None. D.P. Merke: Grant Recipient; Self; Diurnal, received unrelated research funds through the National Institutes of Health Cooperative Research and Development Agreement., D.P.M. received unrelated research funds from Neurocrine Biosciences through the National Institutes of Health Cooperative Research and Development Agreement. Objectives: Measuring health-related quality of life (HRQoL) is a crucial and often required process of evaluating health care outcomes. The aim of our study is to develop a disease-specific patient reported outcome (PRO) instrument to evaluate the HRQoL of patients >16 years old with classic congenital adrenal hyperplasia (CAH). Methods: Following the FDA guidelines for developing PRO instruments, we developed a conceptual framework for the instrument. The process involved interviewing a representative sample of the CAH population and along with expert feedback and review of the literature. We are assessing the instruments’ validity and reliability with the assistance of patient participation. Internal consistency of the instrument is being evaluated using Cronbach’s alpha. We are also assessing the validity by comparing the scores of our instrument with scores from widely used instruments for HRQoL namely, Short Form Health Survey-36 (SF-36), AddiQol, Tuebingen CD-25 and Female Sexual Functioning Index. Furthermore, we collected data regarding the clinical outcomes, symptoms and patient characteristics to investigate the correlation between patient-reported and provider- observed outcomes. Results: Twelve patients with CAH, aged between 16 to 68 years old were interviewed and provided insight on the CAH - related health outcomes that were most relevant to them. A preliminary instrument was developed and subjected to validity testing in the form of cognitive interviewing. The edited instrument consisting of 73 questions covering 9 preliminary domains (General Health, Adrenal Insufficiency, Glucocorticoid Excess, Androgen Excess, Physical Functioning, Sexual Functioning and Fertility, Mental Health and Cognition, Social Functioning and CAH Management). Sixty-nine participants aged 16 to 75 years old participated in validating our preliminary instrument. Forty- six participants (67%) had salt-wasting CAH while 23 (33%) had simple virilizing CAH. Fifty-one percent of participants identified as male, 46% female, while 3% as other gender. Preliminary results show mostly acceptable (>0.7) Cronbach’s alpha, showing reliability in most domains. Further data analysis is underway. Conclusion: This is the first PRO instrument to capture the HRQoL outcomes in the CAH population. In addition to its anticipated use in the clinical setting, the instrument could be used to assess the efficacy of novel treatments in development. The final instrument is currently under development. Presentation: Saturday, June 17, 2023

What is COVID-19 anyway? Narcissism and pandemic attitudes and behaviours

Researchers have demonstrated relationships between dark personality traits (e.g., narcissism) and pandemic behaviours (e.g., disregard for public health interventions). Individuals who disregard public health measures risk spreading COVID-19 infection, which has important public health implications. The present study was designed to examine the relationship between narcissism and pandemic attitudes and behaviours using a large population representative sample of North American adults (N = 5812). Participants completed measures of narcissism, psychological entitlement, non-adherence to non-pharmaceutical public health interventions (NPI), COVID disregard, anti-vaccination attitudes, reasons for social distancing, and COVID stress. Results of MANOVA demonstrated that individuals with high levels of narcissism self-reported greater levels of non-adherence to NPI, COVID disregard, COVID stress, anti-vaccination attitudes, and psychological entitlement compared to those with low levels of narcissism. Further, men with high levels of narcissism self-reported greater levels of non-adherence to NPI, COVID disregard, COVID stress, and psychological entitlement, in comparison to women with high levels of narcissism. These findings provide a nuanced understanding of the relationship between narcissistic traits, sex, and pandemic attitudes and behaviours and have implications for tailoring pandemic-specific public health interventions based on individual difference variables.

VOLY: The Monetary Value of a Life-Year at the End of Patients' Lives.

We explored the monetary value of the end-of-life (EoL) health gains, that is, the value of a life-year (VOLY) gained at the end of a patient's life in Croatia. We tested whether the nature of the illness under valuation (cancer and/or rare disease) is a factor in the valuation of EoL-VOLYs. The aim was for our results to contribute to the health and longevity valuation literature and more particularly to the debate on the appropriate cost-effectiveness threshold for EoL treatments as well as to provide input into the debate on the justifiability of a cancer and/or a rare disease premium when evaluating therapies. A contingent valuation was conducted in an online survey using a representative sample of the Croatian population (n = 1500) to calculate the willingness to pay for gains in the remaining life expectancy at the EoL, from the social-inclusive-individual perspective, using payment scales and an open-ended payment vehicle. Our approach mimics the actual decision-making problem of deciding whether to reimburse therapies targeting EoL conditions such as metastatic cancer whose main purpose is to extend life (and not add quality to life). Average EoL-VOLY across all scenarios was estimated at €67,000 (median €40,000). In scenarios that offered respondents 1 full year of life extension, EoL-VOLY was estimated at €33,000 (median €22,000). Our results show that the type of illness is irrelevant for EoL-VOLY evaluations. The pressure to reimburse expensive therapies targeting EoL conditions will continue to increase. Delivering "value for money" in healthcare, both in countries with relatively higher and lower budget restrictions, requires the valuation of different types of health gains, which should, in turn, affect our ability to evaluate their cost effectiveness.

Nationwide retrospective mortality and seroprevalence of SARS-CoV-2 antibodies in Cameroon

BackgroundAlthough the first year of the COVID-19 pandemic in Africa did not produce the expected catastrophe, the true impact of COVID-19 in the Cameroonian population was unclear. We therefore assessed the seroprevalence of anti-SARS-CoV-2 antibodies and retrospective mortality in a representative sample of the general population in the 10 administrative regions of Cameroon more than one year after the first confirmed cases of COVID-19 in these regions. We aimed to assess the extent of SARS-COV-2 infection and to detect potential increases in the crude mortality rate (CMR) during the SARS-COV-2 pandemic phase. MethodsWe assessed retrospective mortality and seroprevalence of anti-SARS-CoV-2 antibodies in the 10 capital cities of Cameroon using representative samples of the general population. The study included nested anti-SARS-CoV-2 antibody prevalence surveys and retrospective mortality surveys and was conducted between 27 July 2021 and 31 August 2021. To further analyze crude mortality rates by age group and COVID wave, pre-pandemic and pandemic periods were stratified. Both laboratory-based assays (ELFA) and rapid diagnostic tests (RDT) were used to measure anti-SARS-CoV-2 seroprevalence. ResultsThe crude mortality rate (CMR) increased from 0.06 deaths per 10 000 persons per day (pre-pandemic) to 0.17 deaths per 10 000 persons per day (pandemic). The increase in CMR was more pronounced in people aged 20–35 years (pre-pandemic 0.02 deaths per 10 000 persons per day; pandemic 0.06 deaths per 10 000 persons per day). The estimated seroprevalence among unvaccinated persons was 9.5 % (RDT) and 15.4 % (laboratory-based). ConclusionThe seroprevalence results showed that cases were significantly underdetected by the national surveillance systems.