Sociodemographic Characteristics Research Articles

Professional health literacy of health professions in Austria - results of the HLS-PROF-AT study

Abstract Background Health professions play a crucial role in strengthening the health literacy (HL) of the population - provided that they themselves have the necessary professional HL. This encompasses competencies related to information and knowledge management, conveying information and knowledge, patient involvement and shared decision-making, and professional digital HL. In 2022 and 2023, data on professional HL were collected in Austria. Methods Nearly 4,400 healthcare professionals (doctors, nurses, physiotherapists, pharmacists, midwives, dieticians) were asked about their challenges across the four domains of professional HL. A score was calculated for each domain, with five additional subscores for the domain conveying information and knowledge. The relationship between socio-demographic, job-related and organisational characteristics and professional HL were investigated using T-tests, variance analyses and multivariate regression models. Results The greatest challenge for all healthcare professions is supporting patients in dealing with digital information, followed by conveying information and knowledge. Apart from pharmacists, the least difficulties were found in the domain patient involvement and shared decision-making. Furthermore, the results demonstrate that a high level of professional HL is associated with more favourable organisational conditions for HL-promoting patient communication and (very) good preparation in training for the tasks of professional HL. There is no systematic correlation between professional HL and years of professional experience. Conclusions Overall, healthcare professionals rated their professional HL positively. However, the results also highlight areas for improvement. Alongside promoting professional HL in the context of (further) training, it is important to enhance organisational framework conditions for promoting patients’ HL - ideally supported by initiatives to promote the organisational HL in healthcare organisations. Key messages • The greatest challenge for the health professions surveyed is to support patients in dealing with digital information and to convey information and knowledge to their patients. • Good preparation in training for the tasks of professional HL and favourable organisational conditions for HL-promoting patient communication are associated with a higher professional HL.

Characterizing Risk Profiles and Transitions across Living and Care Settings in Sweden

Abstract Background Older adults are at increased risk of frequent healthcare transitions between health care (hospitals) and social care providers (formal care and institutions). Therefore, our objective was to quantify and characterize the potential risk profiles of multiple transitions between living and care settings for older adults. Methods Data were obtained from the National E-Infrastructure for Aging Research (NEAR), including the Swedish National Study on Aging and Care (SNAC) and the National Patient Register, to evaluate living and care transitions of over 7,000 individuals aged 60+, across homes, formal care, nursing homes, hospitals, and post-acute facilities. A multi-state model was used to represent moving likelihood. Results Over 15 years, the average length of stay was two years at home, one year in home care, one year in institutionalization, eight days in the hospital, and 17 days in post-acute facilities. Older age and being a woman increased the chance of receiving home care after hospital discharge (Hazard Ratio [HR] range 1.35-4.38, 1.06-1.08), whereas multimorbidity and slow walking speed were associated with an 11%-50% increased hazard of hospitalization and home care. Generally, cognitive impairment increased the hazard of institutionalization (HR range 1.99-2.15), and disability was associated with a higher hazard of nursing home placement (HR range 2.57-3.07). Conclusions These findings underscore that care transition patterns are associated with different sociodemographic, clinical, and functional characteristics. This highlights the complex and dynamic interplay between these characteristics and social and health care use. Key messages • The study emphasizes that hospitalization is a major driver of transitions between living and care settings for older adults. • Age, gender, multimorbidity, walking speed, cognitive impairment, and disability all play a role in shaping older adults’ transition patterns between different care settings.

Effectiveness of a check-up for rehabilitation and prevention needs in primary care

Abstract Background General practitioners play a central role in initiating rehabilitation and prevention services. However, systematic screening for rehabilitation and prevention needs has not been carried out in general practices so far. The legislation encourages the implementation and evaluation of so-called ‘check-up 45+’, which target individuals aged 45 and older. The study aims to evaluate the effectiveness of a check-up 45+ in primary care. Methods A pragmatic, randomized controlled trial was conducted in 26 general practices in the German states of Berlin and Brandenburg among patients aged 45 to 59 years (DRKS00028303). The control group (n = 695) received usual care plus a questionnaire on sociodemographic and health-related characteristics. The intervention group (n = 706) completed additionally the 2-page ‘screening 45+’, which captures rehabilitation and prevention needs in five dimensions. After algorithm-based ad hoc evaluation by practice staff, the general practice could modify the recommendation based on available information (e.g., diagnoses, social situation). Information and application documents were provided in case of identified needs. Applications (primary outcome) and approvals (secondary outcome) of rehabilitation and prevention services were recorded using routine data. Results In the intervention group, 64.2% were women, compared to 63.0% in the control group (mean age 52.1 (SD 4.3) and 52.5 (SD 4.4) years). In the intervention group, 85 applications (12.0%) for medical rehabilitation or prevention services were submitted within two months after the study participation, compared to 20 applications (2.9%) in the control group (p < 0.001). The number of approvals for these services was 59 vs. 17 (p < 0.001). Conclusions The application rate for rehabilitation and prevention services was significantly higher in the intervention group compared to the control group, with a relative risk difference by a factor of 4 and an absolute risk difference of 9.1%pt. Key messages • The implementation of a check-up 45+ in primary care leads to a higher rate of applications for rehabilitation and prevention services compared to usual care. • The check-up 45+ may assist general practitioners in systematically identifying rehabilitation and prevention needs of their patients and in applying for these services.

Co-use of psychedelics with other substances: Findings from the global psychedelic survey.

While most psychedelic substances are considered to carry a relatively low risk of acute or long-term harm, co-use with other psychoactive substances may increase health and social harm. Using a large international survey of adults who use psychedelics, we sought to comprehensively characterize psychedelic co-use. We used data from the 2023 Global Psychedelic Survey, a web-based survey of adults ⩾21 with lifetime use of psychedelics. We explored patterns of co-use (prevalence, secondary substances used, timing, and motives of co-use) and examined sociodemographic and psychedelic use-related characteristics associated with co-use overall and by specific psychedelics. In total, 5370 respondents were included in this analysis, of whom 3228 (56.3%) reported typically co-using at least one of the 11 psychedelic substances of interest, with co-use lowest for ayahuasca (14.8%) and highest for nitrous oxide (54.5%). Cannabis and alcohol were the most common secondary substances. Depressants were the only secondary substance class that increased in use following psychedelic experiences. Greater experience with psychedelics was significantly associated with co-use, as was using for recreational purposes or to reduce/substitute the use of other substances. Personal exploration and therapeutic purposes for psychedelic use were negatively associated with co-use. In this detailed analysis of psychedelic co-use, we observed high rates of co-use with certain psychedelics, specifically when used recreationally. Our findings highlight psychedelic-specific consumers for whom harm reduction messaging around co-use practices may be best tailored. Further research is justified to assess whether specific patterns of co-use might reduce or increase potential harms.

Income transfer and COVID-19 pandemic in Brazil: wrong and right at the same time

Abstract To alleviate the effects of socioeconomic inequalities and of the fall in economic activity on vulnerable populations during the COVID-19 pandemic, many countries have implemented or expanded income distribution programs. Brazil, amid the political and economic 2020 crisis, exacerbated by the pandemic, established Emergency Aid (EA). This longitudinal ecological study aimed to analyze whether the availability of EA contributed to the reduction of morbidity and mortality due to COVID-19 in the Brazilian 5,570 municipalities, from March 2020 to December 2021. The theoretical model considered as control covariates socioeconomic, sociodemographic and morbidity characteristics and access to health services, including COVID-19 testing availability and vaccination. Classical variable selection methods were applied considering the theoretical model, culminating in the adjustment of Bayesian hierarchical models with the inclusion of spatial and temporal effects. First dose COVID-19 vaccine coverage and EA had a protective effect against hospitalization (RR = 0.982 and RR = 0.986) and mortality (RR = 0.978 and RR = 0.976) due to COVID-19 in Brazil, when controlled by socioeconomic variables, access to health services and spatial-temporal effects. The results highlight the important role of income transfer in morbidity and mortality due to the disease, however, the way in which EA was implemented in Brazil presented a series of problems, the main ones being discontinued payment of aid, reduction in values throughout the duration of the benefit, in addition to the use of public resources to pay people who did not meet the eligibility criteria. Such problems might not have happened if the federal government had maintained the registration structure of Bolsa Familia Program (BFP), which did not happen. Furthermore, vaccination was started late for several reasons, that is, its role in reducing morbidity and mortality could have been even greater if started as soon as it become available. Key messages • Even with planning and execution problems, income transfer and specific vaccination were important in reducing COVID-19 morbidity and mortality in Brazil during the COVID-19 pandemic. • Income transfer during the COVID-19 pandemic in Brazil was not done in the best way possible, due to discontinued payment, reduction in values and payment to not eligible people.

Association of physical activity with health-related quality of life in rectal cancer survivors

Abstract Background Health-related quality of life (HRQoL) in rectal cancer survivors after completion of surgical treatment may be influenced by various factors including physical activity. The purpose of this study was to examine the association between regular exercise and physical and mental health in rectal cancer survivors. Methods People who underwent surgical resection of rectal cancer with temporary ileostomy from 2018 to 2021 were invited to participate. Participants were drawn from the Clinic for Digestive Surgery and the Clinic for Emergency Surgery of the University Clinical Center of Serbia, as well as the nationwide laparoscopic program - LapSerb consortium. Data were collected through interviews in late 2022 and early 2023. The HRQoL was evaluated using the physical composite score (PCS) and mental composite score (MCS) of the Short Form-36 (SF-36) questionnaire. Socio-demographic, clinical and behavioral characteristics including the frequency of exercise were analyzed in multiple linear regression models. Results A total of 134 rectal cancer survivors were tested. Few participants (18.7%) exercised regularly, while most of the study population occasionally (41.8%) or never engaged (39.5%) in physical activity. Rectal cancer survivors who exercised regularly had significantly higher scores of physical (75.5 vs. 62.8, p = 0.019) and mental quality of life (78.9 vs. 63.8, p = 0.008). Regular exercise remained associated with better physical and mental health after the adjustment for demographic, clinical and behavioral characteristics. Conclusions Consistent physical exercise seems to be significant contributor of better physical and mental quality of life in rectal cancer survivors after completion of surgical treatment. Key messages • Physical exercise may help rectal cancer survivors improve their physical and mental health. • Promotion of physcial activity in rectal cancer survivors could optimize recovery after surgery.

Factors associated with type 2 diabetes control in hard-to-reach communities in Esmeraldas, Ecuador

Abstract Background The rising prevalence of type 2 diabetes mellitus (T2DM) and its detrimental effects on population health make it an urgent public health concern. Maintaining blood glucose control is crucial for avoiding complications; however, there are notable socioeconomic disparities in disease management, especially in low- and middle-income settings. We aimed to examine the factors associated with controlled fasting capillary glucose in a difficult-to-access rural setting of Esmeraldas, Ecuador, and to examine the role of social support in this context. Methods Between October 2020 and May 2022, we conducted a cross-sectional study of T2DM adult patients in Esmeraldas’ Eloy Alfaro health district. We collected data on socio-demographic and clinical patient characteristics using a questionnaire and measured Fasting Capillary Blood Glucose levels. We estimated the prevalence of controlled glycaemia and used logistic regression to calculate odds ratios (OR) with 95% confidence intervals. Results Only 18.1% (95%CI: 14.9-21.8) of the 476 study participants had controlled glucose levels, with a significantly higher percentage in men (28.2%) compared to women (13.8%). Participants reported moderate perceived social support (median=2.33, on a scale of 1 to 4), without significant impact on glycaemic control. Women in urbanised areas were more likely to have controlled glucose levels compared to those in rural areas (aOR=2.34, 95%CI: 1.23-4.44) after adjusting for family support. In contrast, unemployed and older men had non-significant trends towards better odds of achieving controlled fasting glycaemia. Conclusions The complex interplay of factors affecting diabetes management and glycaemic control highlights the need for targeted, context and gender-specific public health strategies to address diabetes disparities in vulnerable populations. Key messages • The majority of individuals with T2DM residing in the remote communities of Eloy Alfaro district in Esmeraldas (Ecuador) have uncontrolled glycaemia, showing notable gender-specific disparities. • Participants reported a moderate level of social support, with family as the most important source. Yet, this perceived support may not effectively overcome contextual barriers in T2DM management.

Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)

Abstract Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs 75% of white women, p < 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p < 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p < 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities. Key messages • Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues. • Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.

Maternal near-miss and mortality associated with being referred: a case control study in Luanda

Abstract Background Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola. Methods A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value <0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI). Results Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89). Conclusions According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting. Key messages • Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola. • Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.

Analysis of Job Satisfaction and Turnover Intention According to the Characteristics of Forest Industry Workers

The forest industry is a key sector in South Korea, significantly contributing to the national economy. Despite the growth of the forest industry, workers often face physically demanding tasks, high job stress, and factors reducing job satisfaction, such as remote locations and limited career opportunities. This study analyzes differences in job satisfaction and turnover intentions among forest industry workers based on socio-demographic and job characteristics. A survey of 654 workers across various sectors—including production, processing, retail, transportation, leisure, and services—was conducted. The data were analyzed using t-tests and ANOVA. The results indicate that job satisfaction and turnover intentions significantly vary with age, education, income, employment type, workplace location, and working days. The workers with graduate degrees reported lower job satisfaction and higher turnover intentions. The non-regular employees and field workers exhibited lower job satisfaction and higher turnover intentions. The findings suggest that improving job conditions, creating quality positions for highly educated workers, and providing stable employment could enhance job satisfaction and reduce turnover intentions in the forest industry, aiding workforce retention and sustainability.

Epidemiology of hepatitis C from 2015 to 2022 in a central Italian region: the OPT-HepaC project

Abstract Background Chronic hepatitis C virus (HCV) infection is a major global public health problem. This study investigated the evolving landscape of HCV in Tuscany (Italy) from 2015 to 2022, considering demographic shifts, clinical profiles, treatment regimens, and outcomes. Methods The study was conducted in order to characterize HCV-positive patients who started treatment between 2015 and 2022 in Tuscan prescribing centers. The study was part of OPT-HepaC, a project funded by Regional Health Service. Data on demographics, clinical history and outcomes were collected. Three different temporal eras were analysed: the period before andfter the universal availability of direct-acting antivirals (DAA) and the COVID-19 era. Treatment’s effectiveness was evaluated by the Sustained Virological Response (SVR12), assessed 12 weeks after the end of treatment. Outcomes included SVR12, non-SVR12 and lost to follow-up (LTFU). ANOVA, Kruskal-Wallis test and multinomial logistic regression were used for statistical analysis. Results 6882 HCV patients (age: 58.88±14.21) were treated by the centres participating at the study. Males (56.4%) and Italian (91.8%) were predominant. Sociodemographic and variable characteristics vary across the time. While the overall SVR12 remained stable over time (χ2(2)=0.357, p = 0.837), the LTFU rate significantly increased during the COVID-19 era. Facilitating factors for the non-SVR12 and LTFU outcomes were male gender (Odds Ratio (OR)=2.134, p = 0.006)/cirrhosis (OR = 1.713, p = 0.040)/HIV co-infection (OR = 3.251, p = 0.005) and DAA treatment of third generation (OR = 4.187, p = 0.006), respectively. Conclusions The study provides a comprehensive view of the HCV landscape, highlighting demographic changes, treatment regimens and outcomes. The COVID-19 pandemic affected service delivery, delaying HCV diagnosis/treatment and influencing the LTFU rate. Despite challenges, the region maintained high SVR12 rates, emphasizing the importance of sustained efforts in HCV care. Key messages • The study highlights the dynamic nature of HCV management in Tuscany. • The study emphasises the need for continuous adaptation to public health challenges, providing insights for future public health strategies.

Focus on residents’ mental health: the Public Health Residents’ Anonymous Survey in Italy (PHRASI)

Abstract The ‘Public Health Residents’ Anonymous Survey in Italy” (PHRASI) represented the first study to specifically investigate mental health and its determinants among Italian public health residents (PHRs). Using a voluntary, anonymous, electronic, 88-item questionnaire, the PHRASI study generated evidence on well-being, eating disorders, sleep disorders, alcohol abuse, depressive symptoms, and anxious symptoms among PHRs. This highlights the correlation with sociodemographic, lifestyle, and work-related characteristics during COVID-19 pandemic. The data was collected in a nationally representative sample of PHRs enrolled in any of the four course years of Italian Public Health schools. The recruitment took place through the communication channels of the Medical Residents’ Council of the Italian Society of Hygiene and Preventive Medicine in the summer 2022. The key findings reveal prevalence rates of mental health conditions comparable to those seen in other healthcare workers during the COVID-19 pandemic: 61% of residents report depressive symptoms and 36% report anxious symptoms. The study also highlights a negative correlation of these symptoms with characteristics of the training and working environment, such as the level of supervision and peer-to-peer support. A stronger social network and higher levels of physical activity emerged to be positively associated with well-being and depression. These and other findings will be available in the final report of the survey that will be presented during the congress. PHRASI led the way to the Residents’ Mental health Investigation, a Dynamic longitudinal study in Italy (ReMInDIt), that aims to explore potential cause-effect relationships between risk/protective factors and mental health outcomes. This evidence could guide the scientific community, school directors, universities, and policymakers in the continuous process of improving the educational quality and working conditions of PHRs. Key messages • Residency training and work environment impact the mental health of the PHR workforce. • It is important to deploy concrete efforts into building healthy work environments and guarantee adequate training for PHRs.

Spectrum of heart failure in 16 sub-saharan countries: drugs strategies and 8-year trends (the february study 2016-2023)

Abstract Background Heart failure (HF) is a growing public health concern in Sub-Saharan Africa (SSA). The hospital prevalence studies estimate that in SSA, HF is responsible for 9.4% to 42.5% of all medical admission. However, little is known about the management of HF in hospitalization in SSA. Purpose To describe in hospital drugs strategies and 8-year trends in Africa. Methods We conducted a transversal and longitudinal study in cardiology departments of 37 hospitals(public and private) in 16 SSA countries. The February study is an ongoing observatory included all inpatients in February from each year since 2016. Collected data included socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, medicines, length of stay were collected by the investigating physicians. HF severity was defined according to proportion of Left Ventricular Ejection Fraction(LVEF):reduced(LVEF<40%), mildly reduced(LVEF[41-49%] or preserved(LVEF>50%). All analyses were performed with random effect on countries through scripts developed in the R software(4.0.3(2020-10-10)). Results Overall, 2351 patients(57±17.5 years; 54% men) were admitted for HF in the February study. HF representing 44.6% of all patients admitted. Proportions of patients included for HF varied across countries from 28% Democratic Republic of the Congo to 75% in Guinea. At admission, 56% of patients had reduced LVEF; 12.5% had mildly reduced and 31.5% had preserved LVEF. Proportions of drug classes varied significantly according to LVEF: diuretics were significantly less prescribed in patients with preserved LVEF(65%) compared to patients with mildly reduced(77%) or reduced(73%) LVEF (P>0.01). The same result was observed for betablockers(BB)(30%VS46% and 46%) and angiotensin-converting enzyme inhibitors(ACEI)(50%vs77% and 71%)(p<0.01). Mineralocorticoid receptor antagonists were significantly more prescribed in patients with preserved LVEF(p<0.01). The proportion of treated with BB increased significantly over the years(p<0.05) from 17% in 2016 to 62% in 2023. Proportions of drugs strategies differed significantly across countries adjusted for LVEF. Drugs strategies differed significantly according to LVEF(p<0.01). The more reduced the LVEF, the more the drugs strategy increased. In patients with preserved LVEF, the proportion of monotherapy was 20%; this decreased to 9% in patients with reduced LVEF. Combinations of three drugs increased from 35% in patients with preserved LVEF to 46% in patients with reduced LVEF. Overall, drugs strategies differed across years(p<0.05): three-drug strategies increased from 35% in 2016 to 51% in 2023 and two-drug strategies decreased from 38% in 2016 to 23% in 2023. Conclusion Up-titrated strategies were prescribed according to severity of HF and access to BB increased across years according to international guidelines. However, novel drugs classes remain unavailable in SSA.

Food insecurity impacts diet quality and adherence to the gluten-free diet in youth with celiac disease.

Celiac disease (CD) is an autoimmune gastrointestinal disorder that requires a strict lifelong gluten-free diet (GFD). Gluten-free (GF) foods are more expensive and less readily accessible than gluten-containing foods, contributing to an increased risk for food insecurity (FI). The study aimed to determine associations between GF-FI, sociodemographic risk factors and child dietary adherence and diet quality (DQ). A 26-item, cross-country online survey was administered through social media to parents of children with CD on the GFD. The survey elicited household and CD child sociodemographic and clinical characteristics (e.g., duration of CD), measures of household FI, child DQ and GFD adherence, and parents' concerns related to GF food. Household GF-FI was evaluated using the validated Hunger Vital Sign™ and the US Department of Agriculture Six-Item Short Form Household Food Security Survey Module. GF-FI occurred in 47% of households with children with CD with >30% reporting low to very low food security. Sociodemographic risk factors identified included lower income, renters, rural residency, single-parental households, and having children with additional dietary restrictions (p < 0.001). Regardless of FI status, a majority of households reported experiencing significantly higher GF food expenditure. GF-FI was associated with reduced adherence to the GFD, increased consumption of processed GF food, and lower intakes of fresh fruits and vegetables and GF grains among children with CD (p < 0.05). GF-FI is prevalent in this multiethnic cohort of households with CD children and is associated with worsening DQ and GFD adherence. Policy interventions are urgently needed to address GF-FI.

Differences in the work-family experience of mothers and fathers of a southern European country

Abstract Background The intense childrearing years often coincide with the heightened work demands and responsibilities of the career-building years. We aimed to evaluate the association between family-life stage and men’s and women’s experience of work and private demands, and the conflict between these demands. Methods We evaluated 3532 mothers and 731 fathers as part of the Portuguese population-based birth cohort Generation XXI (2018-2020). Data on family-life stage (exposure), work demands, private demands, and work-to-family conflict (outcomes) were retrieved at the 13-year follow-up wave, as well as data on sociodemographic and household characteristics. Family-life stage was operationalized according to the age of the youngest child: stage 1 (≤5 years), stage 2 (6-11 years), and stage 3 (≥12 years). Ordinal logistic regression models were used to estimate associations. Results Men reported more frequently long working hours, while women spent more time on household and child-related tasks. After adjustment for parents’ and household characteristics, mothers and fathers with younger children were more likely to report spending more time on child-related tasks (ORmothers = 1.83; 95%CI 1.44, 2.33; ORfathers = 2.36; 95%CI 1.41, 3.94), compared to those with older children. Fathers with younger children were also more likely to report spending more time on household tasks (OR = 2.20; 95%CI 1.30, 3.73 for routine tasks and OR = 1.75; 95%CI 1.03, 2.97 for sporadic tasks). Mothers exhibited a significant association between family-life stage and time-based work-to-family conflict when they had younger children (OR = 1.24; 95% CI 1.05, 1.47 for family-life stage 2 and OR = 1.28; 95% CI 1.00, 1.63 for family-life stage 1). Conclusions Both fathers and mothers with young children experienced increased private demands, but only mothers experienced work-to-family conflict. This reveals that family and working arrangements remain marked by a gendered pattern against women.

Depressive symptoms among medical students

Abstract Background Adolescence is a period of psychological development which is associated with an increased risk of developing mental health disorders. Medical students have a higher prevalence of depression compared to the general population, but they are given low priority in the healthcare system. The aim of this study was to examine the prevalence of clinically significant scores on the Patient Health Questionnaire 9 (PHQ-9), and factors associated with clinically significant scores. Methods The research was conducted through a cross-sectional study among fifth-year medical students, using a 95-item questionnaire anonymously filled out. The questionnaire examined: socio-demographic and socio-economic characteristics of the students; students’ lifestyles (including alcohol consumption, binge drinking, smoking cigarettes, electronic cigarettes, use any of other tobacco products); Patient Health Questionnaire (PHQ-9); International Physical Activity Questionnaire (IPAQ); Zung’s Anxiety Scale; and Problematic Internet Use Scale. Based on the score on PHQ-9, the participants were classified in two groups: with clinically significant scores (score ≥10) and without clinically significant scores (score &amp;lt;10). Results The study included 461 medical students who completed the PHQ-9. Average score on PHQ-9 scale was 5.25±4.53 and total of 66 students (14.3%) had the PHQ-9 indicative of clinically significant depressive symptoms (PHQ-9 ≥10). The clinically significant depression was associated with smoking of any tobacco product (OR:3.02, 95% CI: 1.37-6.63), score on social support scale (0.94, 95% CI: 0.90-0.98), age (OR: 1.42, 95% CI: 1.06-1.90) and score on Zung anxiety scale (OR: 1.15, 95% CI: 1.16-1.34). Conclusions Considering that medical students, are at higher risk of developing clinically significant symptoms of depression, it is crucial to form psychological and social support programs. Key messages • Monitoring the mental health of young individuals holds significant importance. • It is crucial to detect risk factors in time and develop prevention programs.

Expression of Plasma miRNA-133a is Significantly Lower in Acute Coronary Syndrome (ACS) than in Healthy/Non-ACS Subjects

BACKGROUND: The current biomarker diagnostic modality for acute coronary syndrome (ACS), cardiac troponin, has several limitations. Emerging studies showed that micro-RNA (miR)-133a was released from infarcted heart to circulation, yet the diagnostic value of miR-133a in ACS demonstrated a conflicting result. Therefore, this study was conducted to investigate the potency of plasma miR-133a as a biomarker candidate of ACS.METHODS: This was a case-controlled study, involving ACS and control subjects. The sociodemographic and clinical characteristics were assessed through medical records. A final of 39 ACS and 31 control subjects (consist of healthy and non-ACS subjects) passed the selection procedure by demonstrating a high purity of RNA. miR-133a from ACS and control subjects were detected by quantitative polymerase chain reaction (qPCR). Expression of miR-133a was evaluated for sensitivity and specificity as an ACS biomarker diagnostic using the receiver operating characteristic (ROC) curve.RESULTS: Plasma miR-133a expression was stably found in ACS subjects. The plasma miR-133a level was lower in ACS than in control subjects. miR-133a effectively distinguished ACS subjects from healthy subjects (AUC=0.911) and exhibited high diagnostic performance, with a sensitivity of 87.1% and specificity of 100% at a cut-off value of 44.035. In an extended model including both control subjects (healthy and non-ACS with comorbid conditions), miR-133a maintained diagnostic significance (AUC=0.874), showing sensitivity of 76.9% and specificity of 100% at a cut-off value of 11.69.CONCLUSION: Plasma miR-133a is significantly lower and effectively distinguishes ACS patients from both healthy individuals and non-ACS individuals with comorbid, with a cut-off value of 11.69. Therefore, plasma miR-133a is suggested to be a good candidate for diagnostic biomarkers of ACS.KEYWORDS: circulating miRNA, miRNA-133a, acute coronary syndrome, diagnostic biomarker

Factors associated with major adverse cardiovascular events among Arabs and Jews in Israel: a population-based cohort study

Abstract Introduction Arabs in Israel are at higher risk of cardiovascular mortality; however, there are no data on factors associated with disparities in major adverse cardiovascular events (MACE) incidence among Arabs and Jews. Purpose To study factors associated with MACE incidence among Arabs and Jews in Israel. Materials and Methods This is a cohort study carried out in urban localities of Hadera District in Israel. The study sample included 1,100 participants, stratified in equal numbers by ethnicity (Arab and Jewish), sex, and five 10-year age group (mean age: 51 years, range: 26-77). Data collected via in-person interviews conducted between 2001-2006 included socio-demographic characteristics and health-related behaviors (smoking, physical activity, and diet). Data on baseline diabetes, hypertension, dyslipidemia, and cardiovascular disease were collected from interviews and participants' health records. Information on MACE occurring during follow-up was determined based on hospital discharge diagnoses, recorded in the Israel Ministry of Health hospital admission database. MACE was defined as an acute coronary, cerebrovascular or peripheral artery event, or invasive procedure for its treatment. Factors associated with the time to first MACE were tested in Cox proportional hazards models. Sensitivity analysis included death from any cause as a competing risk, using Fine and Gray’s model. Results During a median follow-up period of 20 years, there were 221 first MACE during follow-up; 91 among Jewish participants and 130 among Arab participants, hazard ratio (HR) Arab vs. Jewish: 1.59; 95% confidence interval (CI) 1.22, 2.09, adjusted for age and sex. Arab ethnicity was no longer significantly associated with MACE, following further adjustment for years of education; HR: 1.32; 95%CI 0.95, 1.84. The HR (95%CI) associated with ethnicity after additional adjustment for health-related behaviors, body weight and baseline chronic morbidity was 1.02 (95%CI: 0.73, 1.42). A subgroup analysis among 950 participants, who did not have a baseline diagnosis of cardiovascular disease, produced similar results. These participants experience 147 first MACE during follow-up. The age and sex-adjusted HR (95%CI) associated with Arab ethnicity was 1.72 (1.23, 2.40), compared to 1.08 (0.72, 1.64) in a fully adjusted model. Competing risk analysis did not materially change these results. Conclusions Arabs in Israel are at higher risk for MACE. Lower socioeconomic position and higher prevalence of unhealthy lifestyle and cardiovascular risk factors may explain the excess risk of MACE among Arabs. Improving cardiovascular health among Arabs should consider social determinants of health and cultural aspects.

Factors of mental health patients’ uptake in social prescribing: a mixed methods study in Portugal

Abstract Successfully addressing mental health challenges demands comprehensive, community-driven solutions. Social prescribing (SP) emerges as an innovative approach, fostering integrated care by connecting healthcare patients to community resources. Research in this topic proved effects of SP in mental health and well-being promotion, but factors influencing patients’ uptake remain underexplored. This study examined the factors associated with the uptake in patients with mental health needs in SP project in Portugal. This mixed methods study examined registries data of 403 patients referred to SP for mental health needs. A logistic regression was used to analyse sociodemographic characteristics and referral details associated with SP uptake. Semi-structured interviews were conducted with stakeholders to explore challenges and facilitators of users uptake. Most users were female (71.7%) and elder (average age 64.4 years, SD ± 20.0). Mental health needs included social isolation, loneliness, anxiety, and depression. 43.7% of referred patients had diagnosed mental illnesses and 55.8% attended at least one SP appointment. SP uptake was more likely among patients referred for social and financial support (OR 2.02; 95%CI 1.32-3.07; p = 0.001) and referred during the Covid-19 period (OR 1.64; 95%CI 1.08-2.49; p = 0.020). increased the probability of SP uptake. In contrast, SP uptake was less likely among those having diabetes (OR 0.49; 95%CI 0.28-0.88; p = 0.016). Health professionals’ proactive engagement with patients facilitated uptake in SP, yet challenges arose from users’ complex needs, low awareness, motivation, and acceptance of non-traditional responses such as community-based activities, along with mistrust of their effectiveness. SP has the potential to foster mental health and well-being through person-centred holistic care, yet challenges in uptake related to health and psychosocial factors must be addressed to optimize the SP positive impacts. Key messages • Factors influencing the uptake of patients with mental health needs in SP initiative in Portugal involved need of social and financial support, pandemic period and health professionals’ attitudes. • Despite SP potential, for effective implementation it is key to address challenges, like complexity of patients’ needs, awareness gaps and patient mistrust, to maximize its positive outcomes.

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

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