Emotional and behavioural problems of left behind children in Lithuania: a comparative analysis of youth self-reports and parent/caregiver reports using ASEBA

BACKGROUND

Children being left behind (LBC) in their home countries due to parental emigration is a global issue. Research shows that parents' emigration negatively affects children's mental health and well-being. Despite a high number of LBC, there is a dearth of data from Eastern European countries. The present study aims to collect and analyse self-reported data on LBC emotional and behavioural problems and compare children's reports with those of parents/caregivers.

METHODS

A cross-sectional study was conducted in 24 Lithuanian schools, involving parents/caregivers and their children aged 12 to 17. We employed self-reported measures, including the Achenbach System of Empirically Based Assessment (ASEBA) tools - Child Behaviour Checklist (CBCL 6/18) and Youth Self Report (YSR 11/18), to evaluate the emotional and behavioural problems of the children. These instruments had been translated, standardised, and validated for the Lithuanian population. Data collection took place between January 2022 and April 2023. In addition to descriptive analysis, multivariate regression was used to adjust for various sociodemographic factors.

RESULTS

A total of 760 parents/caregivers and 728 of their children participated in the study. LBC exhibited higher total problem scores (57.7; 95% CI 52.0-63.4) compared to non-LBC (47.1; 95% CI 44.7-49.4). These differences were consistent across all YSR 11/18 problem scales. However, no significant differences were observed in CBCL 6/18 scores. Furthermore, LBC self-reported a higher total problem score (57.7; 95% CI 52.0-63.4) compared to their parents/caregivers (24.9; 95% CI 18.9-30.9), and this pattern persisted across all scales. Being female, having school-related problems and having LBC status were associated with higher YSR 11/18 scores in the multivariable regression, while female gender, living in rural areas, school-related problems, and having hobbies were associated with higher CBCL 6/18 scores.

CONCLUSION

This study highlights that LBC report more emotional and behavioural challenges than their non-LBC peers, while parent/caregiver assessments show lower problem scores for LBC. Gender, living environment, school-related issues, and engagement in hobbies have influenced these outcomes. These findings underscore the multifaceted nature of the experiences of LBC and the importance of considering various contextual factors in understanding and addressing their emotional and behavioural well-being.

Prevalence of major non-communicable diseases and their associated risk factors in Afghanistan: a systematic review and meta-analysis

Background

Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors.

Objective

This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan.

Method

We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets.

Results

Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn't be calculated due to the heterogeneity of articles.

Conclusion

Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.

Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey

BACKGROUND

The government-subsidized health insurance scheme Seguro Integral de Salud ("SIS") was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal - "PEAS" (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages.

METHODS

Relying on the 2021 round of the nationally-representative survey "ENDES" (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15-49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum.

RESULTS

Only 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the "SIS" group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14-1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17-1.48), ANC education (aOR = 1.59; 95% CI 1.41-1.80) and ANC screening (aOR = 1.46; 95% CI 1.27-1.69) during pregnancy, compared with women in the "Standard Insurance" group [aOR = 1.35 (95% CI 1.13-1.62), 1.22 (95% CI 1.04-1.42), 1.34 (95% CI 1.18-1.51) and 1.31(95% CI 1.15-1.49)] respectively. In addition, women in the "Standard Insurance" group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33-3.55) compared with the women in the "SIS" insurance group (aOR = 2.12; 95% CI 1.41-3.17).

CONCLUSIONS

Our findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under "Standard Insurance" or "SIS". Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.

Cardiometabolic risk profile among children with migrant parents and role of parental education: the IDEFICS/I.Family cohort

BACKGROUND AND AIMS

Evidence shows that migrant children have a higher risk of developing obesity than those with native parents. We aimed to investigate the association between parental migration background and cardiometabolic health in children and adolescents in Europe.

METHODS AND RESULTS

We included 8745 children aged 2-17 from the second follow-up of the European IDEFICS/I.Family cohort. Linear regression models were used to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and body mass index (BMI), metabolic syndrome (MetS) score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We adjusted for age, sex, country, and parental education, and additionally for parental income, lifestyle including dietary factors, and maternal BMI. On average, children with two migrant parents had higher z-scores of BMI (+0.24 standard deviation (SD)) and MetS score (+0.30 SD) compared to those with native parents, whereas no significant differences were seen for children with one migrant parent. Associations were attenuated when controlling for maternal BMI and sports club activity. Parental education modified the associations with BMI and MetS z-scores such that they were more pronounced in children with low parental education.

CONCLUSION

Children with two migrant parents were at higher risk for adverse cardiometabolic health compared to children with native parents, especially in families with low parental education. These associations were explained by lower physical activity and maternal body weight and encourages early intervention strategies by schools and communities.

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

BACKGROUND

Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial.

METHODS

Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression.

RESULTS

1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%).

CONCLUSION

Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved.

TRIAL REGISTRATION

NCT02381275.

Intensity-modulated radiotherapy for the management of primary and recurrent chordomas: a retrospective long-term follow-up study

Background

Chordomas have a high risk of recurrence. Radiotherapy (RT) is required as adjuvant therapy after resection. Sufficient radiation doses for local control (LC) can be achieved using either particle therapy, if this technology is available and feasible, or intensity-modulated radiotherapy.

Materials and methods

57 patients (age, 11.8-81.6 years) with chordomas of the skull base, spine and pelvis who received photon radiotherapy between 1995 and 2017 were enrolled in the study. Patients were treated at the time of initial diagnosis (68.4%) or during recurrence (31.6%). 44 patients received adjuvant radiotherapy and 13 received definitive radiotherapy. The median total dose to the physical target volume was 70 Gy equivalent dose in 2 Gy fractions (EQD2) (range: 54.7-82.5) in 22-36 fractions.

Results

LC was 76.4%, 58.4%, 46.7% and 39.9% and overall survival (OS) was 98.3%, 89%, 76.9% and 47.9% after 1, 3, 5 and 10 years, respectively, with a median follow-up period of 6.5 years (range, 0.5-24.3 years). Age, dose and treatment concept (post-operative or definitive) were significant prognostic factors for OS. Primary treatment, macroscopic tumour at RT and size of the irradiated volume were statistically significant prognostic factors for LC.

Conclusion

Photon treatment is a safe and effective treatment for chordomas if no particle therapy is available. The best results can be achieved against primary tumours if the application of curative doses is possible due to organs at risk in direct proximity. We recommend high-dose radiotherapy, regardless of the resection status, as part of the initial treatment of chordoma, using the high conformal radiation technique if particle therapy is not feasible.

The prevalence of emotional abuse in children living in Sub-Saharan Africa - A systematic review

OBJECTIVES

This study is meant to put a focus on the prevalence of emotional abuse in low-income states like the Sub-Saharan region.

METHODOLOGY

Searching PubMed, Google scholar, and web of science during February and April 2021 a total of 2264 articles were identified, 27 met the inclusion criteria. We added the results of 13 VAC (Violence Against Children and Youth) studies, conducted by UNICEF capturing information about experienced sexual, physical, or emotional violence in 13-24-year-olds, as well as 56 MIC (Multiple Indicator Cluster) studies, conducted by the CDC to research the disciplinary methods used with children aged 1-14 years in the past month by older household members. Finally, in a meta-analytic approach, we aimed to calculate a pooled estimate of the prevalence.

RESULTS

The included studies depicted a wide range in prevalence rates across countries. For example, while the VAC study in Lesotho in 2018 showed low incidence rates of emotional violence (6.9 % Females, 3.8 % Males), the average prevalence recorded by the MIC study was as high as 57.8 % for females and 59.2 % for males. On average, the MIC studies displayed a higher incidence and the discrepancy of prevalence of emotional abuse between females and males was small. Calculating a pooled estimate of the prevalence was not possible, due to the heterogeneity of the data.

CONCLUSIONS

In general countries displayed a high prevalence. A standardized use of a uniform definition of emotional abuse might help to display a more homogenous data set in the future, giving the opportunity for pooled estimates of prevalence.

The gender gap in adolescents' emotional and behavioural problems in Georgia: a cross-sectional study using Achenbach's Youth Self Report

BACKGROUND

Adolescents, particularly girls, are vulnerable to mental health disorders. Knowledge about young people's mental health in Eastern European countries is limited. This study is the first to investigate adolescents' self-reported emotional and behavioural problems in Georgia from a public mental health perspective.

METHODS

This study utilized Achenbach's Youth Self-Reported syndrome scales among 933 adolescents studying from grades 7-12 in 18 public schools in Georgia. We compared the gender-specific results with each other and with the Achenbach's Normative Sample using two-sample t-tests. Linear regression was used to assess associations between internalizing and externalizing problems and individual as well as demographic characteristics such as parental migration experience (being 'left-behind' or 'staying behind').

RESULTS

The study found that girls obtained higher scores than boys in Youth Self-Reported empirical syndrome scales and the internalizing broadband scale. Rule-breaking behaviour was the only syndrome scale where boys scored higher. Compared to Achenbach's Normative Sample, adolescents in Georgia scored higher on all scales. Regression analyses showed that illnesses, having fewer than three close friends, problems at school, and worse relationships with peers/siblings/parents (compared to peers) were associated with higher internalizing and externalizing problems scores in both genders. Performing household chores, living with only one parent, or having a migrant parent showed no associations in either gender.

CONCLUSION

Emotional and behavioural difficulties of adolescents in Georgia, especially girls, require attention. Having close friends, developing strong relationships with family members, and a supportive school environment could help mitigate emotional and behavioural problems among adolescents in Georgia.

Prevalence of anemia among Indigenous children in Latin America: a systematic review

OBJECTIVE

To describe the prevalence pattern of anemia among Indigenous children in Latin America.

METHODS

PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date.

RESULTS

Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ≥ 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America.

CONCLUSIONS

Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children.

Parental migration and left-behind children in Georgia - school teachers' experience and perception: a qualitative study

INTRODUCTION

Georgia, like other Eastern European countries, showed a dramatic increase of international labour emigration after becoming independent in 1991. The collapse of the Soviet Union caused economic instability, unemployment and poverty resulting in labour migration. Since then, thousands of children have been left behind in the care of extended family members while their parents work abroad. The aim of this study is to explore schoolteachers' perceptions on parental migration and left-behind children (LBC) in Georgia as schoolteachers are the main contact persons for LBC and their caregivers.  METHODS: We conducted six focus-group discussions with public school teachers, namely class-tutors and six in-depth interviews with school principals from two migrant sending regions. We applied reflexive thematic analysis to systematically analyse the data and identify main and sub-themes. The contextual model of family stress underpins this study.

RESULTS

We identified the following themes expressed by both, teachers, and school principals: social and economic impact of migrant labour and relationships between schools and migrant families. School teachers and principals acknowledged some positive aspects of migrant labour, but primarily perceived parental migration as a negative experience for children leading to problems in mental health, well-being, and academic performance. Structural factors, lack of support and lack of community involvement were expressed to further worsen the situation. Teachers saw themselves as one of the main supporters for LBC while they described the role of caregivers ranging from caring to unhelpful or even destructive. School principals stated mitigating the situation by regular meetings with class tutors, extra-tutoring for LBC, psychological counselling, and developing/enacting internal guidelines.

CONCLUSIONS

Our findings suggest that LBCs and transnational families could benefit from the provision of psychological services at schools.

Facing COVID-19 in Georgia - left behind children coping better with COVID-19 precautions

Background

Georgia, a major migrant sending country, with about 39% of children living with their caregivers while at least one of the parents migrated (left-behind children, LBC) has been severely affected by the COVID-19 pandemic. The main aim of this study was to qualitatively explore LBC’s perception and experience during the pandemic.

Methods

Between December 2021 and January 2022, we conducted 39 (29 LBC, 10 non-LBC) individual in-depth interviews with schoolchildren aged 12-18 in a public school from a migrant sending region. We conducted life history narrative interviews and used a thematic analysis approach.

Results

Preliminary findings show four salient themes: (1) Family members’ first reactions to the pandemic influence children’s emotional health irrespective of parents’ working arrangements. Children express less stress and anxiety when families show emotional stability and are not overwhelmed by the pandemic; (2) All interviewed children find COVID-19 and home-schooling a challenge. (3) LBC express more intense fear about infecting their grandparents than non-LBC. (4) Closer family ties to parents and siblings and access to better equipment help LBC to cope better than non-LBC. LBC view a positive side of Covid-19 in being able to enjoy more time with a parent, who would have otherwise worked abroad.

Conclusions

Overall, all children perceive the COVID-19 pandemic as a challenge, yet closeness with a returned parent and with siblings and more affluence helps LBC to cope better than non-LBC with COVID-19 precautionary measures like home-schooling.

Key messages

• All children are affected by the COVID-19 pandemic. Emotional stability in the family is important in fostering resilience and coping mechanisms among children.

• LBC experience the added benefit of better equipped homes and enjoy the presence of the migrant parent at home.

Self-reported physical and emotional health among left behind children in Lithuania. A pilot study

Background

Left behind children (LBC) are children living with caregivers, while their parents work abroad. In recent decades Lithuania had lost ¼ of its population due to emigration, but the prevalence of LBC and their health needs are not sufficiently studied. The aim of study was to evaluate the association between self-reported health, emotional and behavioural difficulties between LBC and non-LBC.

Methods

The cross-sectional study was approved by the Biomedical Research Ethics Committee, No. 2021/11-1378-861. In March 2022, this pilot study collected data from adolescents aged 12-17 years at three randomly selected schools from the migration affected regions. Parents and children provided informed consent to participate in pilot study. Self-reported measures collected from the participants: Strengths, and Difficulties Questionnaire (Goodman, 2005) and a questionnaire on demographics and on the health situation. Chi² tests and logistic regression were calculated by using Stata (version 15.1).

Results

The sample consisted of 127 children (mean age 15.2, SD 1.27; 54 boys, 72 girls) including 39 LBC. Mostly fathers left to work abroad (n = 36), but majority of children (n = 36) regularly communicated remotely with their migrated parents. Binary logistic regression results show that LBC children tend to evaluate their health as ‘poor, ‘bad', or ‘very bad’ (OR 2,33; 95CI [1,02-5,33]). There were no differences for emotional and behavioural problems. Preliminary results from multiple regression model showed that children with self-reported emotional/behavioural difficulties (OR 3,06; 95CI [1,12-7,84]), females (OR 4,99;95CI [1,55-16,13]) and LBC (OR 2,44; 95CI 0,95-6,25]) more likely evaluate their health as ‘poor', ‘bad’ or ‘very bad’ (likelihood-ratio test=23,72; model p < 0.001).

Conclusions

This pilot study found negative association between parental migration and children’s self-reported health. However, a more comprehensive study with a larger sample size is needed.

Key messages

• Pilot study suggests negative association between parents migration and children’s self-reported health.

• More comprehensive study in bigger sample for the emotional/behavioural/communication difficulties between left behind children needs to be done.

Health interventions for migrants and refugees in host Southeast Asian countries: a systematic review

Background

Understanding the different types of health interventions that have been conducted for migrants and refugees is crucial for the improvement and implementation of future health interventions for these populations. This systematic review aimed to identify and to look at the scope and outcomes of health interventions focused on migrants and refugees in the main host counties in Southeast Asia which are Thailand, Singapore, and Malaysia.

Methods

This study was conducted in line with the PRISMA guidelines and its protocol has been submitted to PROSPERO. The following databases were searched until June 2021: PubMed, Web of Science, Science Direct, Cochrane, and Google Scholar. Studies were excluded if: 1) they were conducted outside Thailand, Singapore, and Malaysia; 2) had only had qualitative results; 3) were non-peer reviewed; 4) not written in English.

Results

The search yielded 8,266 studies, out of which 33 were included in the review. The majority of the studies (79%) were conducted in Thailand of which most were focused on migrants or refugees from Myanmar (85%). Besides two randomized controlled trials (RCTs) of mental health interventions, most Thai studies were observational (81%) and focused on infectious disease-related interventions (33%) or the evaluation of health-related programs (29%). Six studies were conducted in Malaysia (18%) of which 4 assessed mental health interventions in refugees. Three of these studies were RCTs, whereas 1 was an observational study. Only 1 study was situated in Singapore and was an RCT evaluating treatments for COVID-19 in migrant workers. Even in studies with similar interventions, outcomes were too diverse to conduct a meta-analysis.

Conclusions

The low number of studies highlights the gap in literature on health interventions for migrants and refugees, especially in Malaysia and Singapore. More rigorous and cohesive intervention-related research needs to be conducted in Southeast Asia.

Key messages

• More intervention-related research for migrant and refugee populations in the main Southeast Asian host countries is needed.

• Interventions for migrant and refugee populations in host countries in Southeast Asia often do not follow the gold standard RCT study design, limiting the knowledge on their effectiveness.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

OBJECTIVES

To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries.

DESIGN

Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020.

SETTING

Population based survey data.

PARTICIPANTS

1 231 068 individuals aged 15 years and older.

MAIN OUTCOME MEASURES

Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco).

RESULTS

The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age.

CONCLUSIONS

Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.

Accuracy of HPV testing on self-collected and clinician-collected samples for different screening strategies in African settings: A systematic review and meta-analysis

OBJECTIVES

Cervical cancer still poses a considerable threat to women in low- and middle-income countries, particularly on the African continent. Self-collection of a vaginal sample promises advantages over the established sampling by clinicians. We aimed to assess the accuracy of self-sampling compared to clinician sampling in order to inform its application in primary care in the African context.

METHODS

We searched Pubmed, Livivo, Web of Science, Cochrane Library and African Index Medicus on the 07th of February 2022. The eligibility criteria were: reporting (i) self-sampling against clinician-sampling, (ii) study location in Africa, (iii) relevant outcome-measures: (a) Cohen's kappa (b) sensitivity and specificity of self-sampling tests. We combined Cohen's kappa effects, additionally sensitivity and specificity estimates using random-effects models. The study is registered with PROSPERO (CRD42020218081).

RESULTS

We included 28 studies in the systematic review and 21 studies in the meta-analysis. Self-sampling was used to test for high-risk HPV infections. Two studies additionally tested for low-risk HPV infections. The pooled Cohen's kappa was 0.66 (95%CI: 0.61-0.71). Populations at risk yielded 0.63 (95%CI: 0.56-0.71). Target amplification tests based on PCR performed best with a kappa of 0.68 (95%CI: 0.63-0.73) compared to isothermal mRNA tests, 0.61 (95%CI: 0.51-0.71). Point of care tests performed exceptionally well, 0.73 (95%CI: 0.67-0.80). Sensitivities are close to 80% and specificities close to 90% of self-sampling to detect high-risk HPV.

CONCLUSIONS

Self-sampling agrees moderately to substantially with clinician sampling in the African context. Point of care tests might be particularly suited for application in cervical cancer primary screening in low- and middle-income countries. Populations at risk should get special attention while using self-sampling. Screening protocols should be established.

Comparison of female breast cancer between Russia and Germany: A population-based study on time trends and stage at diagnosis

OBJECTIVES

While a mammography-screening program (MSP) is being offered systematically in Germany since 2009, the dispanserizatsiya has been implemented in Russia since 2013. This study examined trends of stage at breast cancer diagnosis in two Russian regions and compared the results with the development in Germany. In addition, we aimed to gain further insights into the early detection of breast cancer in Russia.

METHODS

Incidence data from two cancer registries in Russia and 12 population-based cancer registries in Germany were used to analyse breast cancer incidence rates among women above age 30 over time. Further, we calculated rate ratios to compare the age group-specific incidence rates after the implementation of MSP in Germany (2010-2014) with the period before implementation (2003-2005) separately for each tumour stage and all stages combined.

RESULTS

During the study period from 2003 to 2014, age-standardised rates for breast cancer were 54.6 and 116.7 per 100,000 for Russia and Germany, respectively. The proportion of the T1 stage at diagnosis among Russian women aged 50 + is half than that in Germany. Nevertheless, we observed an increasing trend of early-stage alongside the reduction of advanced-stage incidence rates of breast cancer in Russia.

CONCLUSIONS

The observed trend in Russia may reflect overall positive changes in early detection of breast cancer, with actual proportion of T1 stage still far behind Germany. Advances in breast cancer screening efforts through the dispanserizatsiya may help to further reduce the breast cancer burden.

Longitudinal evidence on treatment discontinuation, adherence, and loss of hypertension control in four middle-income countries

Managing hypertension is a highly dynamic process, yet current evidence on hypertension control in middle-income countries (MICs) is largely based on cross-sectional data. Using multiple waves of population-based cohort data from four MICs (China, Indonesia, Mexico, and South Africa), we undertook a longitudinal investigation into how individuals with hypertension move through care over time. We classified adults aged 40 years and over (N = 8527) into care stages at both baseline and follow-up waves and estimated the probability of transitioning between stages using Poisson regression models. Over a 5- to 9-year follow-up period, only around 30% of undiagnosed individuals became diagnosed [Mexico, 27% (95% confidence interval: 23%, 31%); China, 30% (26%, 33%); Indonesia, 30% (28%, 32%); and South Africa, 36% (31%, 41%)], and one in four untreated individuals became treated [Indonesia, 11% (10%, 12%); Mexico, 24% (20%, 28%); China, 26% (23%, 29%); and South Africa, 33% (29%, 38%)]. The probability of reaching blood pressure (BP) control was lower [Indonesia, 2% (1%, 2%); China, 9% (7%, 11%); Mexico, 12% (9%, 14%); and South Africa, 24% (20%, 28%)] regardless of treatment status. A substantial proportion of individuals discontinued treatment [Indonesia, 70% (67%, 73%); China, 36% (32%, 40%); Mexico, 34% (29%, 39%); and South Africa, 20% (15%, 25%)], and most individuals lost BP control by follow-up [Indonesia, 92% (89%, 96%); Mexico, 77% (71%, 83%); China, 76% (69%, 83%); and South Africa 45% (36%, 54%)]. Our results highlight that policies solely aimed at improving diagnosis or initiating treatment may not lead to long-term hypertension control improvements in MICs.

Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data

Background

The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to describe the potential effects of the COVID-19 pandemic on malaria cases observed in health facilities in the Northern Region of Ghana.

Methods

Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analysed. Overall outpatient department visits (OPD) and malaria case rates from the years 2015–2019 were compared to the corresponding data of the year 2020.

Results

Compared to the corresponding periods of the years 2015–2019, overall visits and malaria cases in paediatric and adult OPDs in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Cases slightly rebounded afterwards in 2020, but stayed below the average of the previous years. Malaria data from inpatient departments showed a similar but more pronounced trend when compared to OPDs. In pregnant women, however, malaria cases in OPDs increased after the first COVID-19 wave.

Conclusions

The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of northern Ghana, with declines in inpatient and outpatient rates except for pregnant women. They may have experienced reduced access to insecticide-treated nets and intermittent preventive malaria treatment in pregnancy, resulting in subsequent higher malaria morbidity. Further data, particularly from community-based studies and ideally complemented by qualitative research, are needed to fully determine the impact of the pandemic on the malaria situation in Africa.

What makes people quit tobacco and succeed at it? An exploratory analysis of smoked and smokeless tobacco from India

Tobacco cessation is a key component of WHO's Framework Convention on Tobacco Control. However, success rates decline significantly from intending to quit tobacco, through attempting and becoming a successful quitter. Among Indian adults, the prevalence of smoking and smokeless tobacco use was 10.7% and 21.4% respectively in 2016. Furthermore, 9% of all deaths were estimated to be attributable to tobacco. This study aims to explore associations of socio-demographic, environmental and behavioural dimensions of tobacco users with the process of successful quitting. Multivariable logistic regression analyses were conducted to study (i) attempting to quit and (ii) being a successful quitter for smoked and smokeless tobacco, using cross-sectional Global Adult Tobacco Survey (GATS) datasets for India (2009-10 and 2016-17), where data was pooled from the two surveys (n = 53,463). Advise to quit by health care provider was associated with quit attempts of smoking (1.82, 95% CI: [1.51; 2.20]), and smokeless tobacco (1.71, 95% CI: [1.45; 2.01]). Never being exposed to smoke at home was the strongest environmental factor for successful smoking cessation (4.04, 95% CI: [2.59; 6.31]). Noticing label warnings and advertisements was also associated with attempting to quit smoked and smokeless tobacco. Being a former smoker/smokeless tobacco user was positively connected with attempting to quit the current use of the other tobacco form. We recommend strategies to promote smoke-free homes, and incorporating 'tobacco cessation advocacy' into the curriculum of health care workers. Strengthening the tobacco control law and program promulgated in India since 2003 and its implementation would significantly promote tobacco cessation.

Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union

Exposure to second-hand smoke (SHS) is an important public health problem. We assessed SHS exposure in restaurants and bars across the European Union (EU) and studied associations with country-level smoke-free legislation. Data of Eurobarometer surveys 2014 and 2017 were used to estimate country-specific prevalence of observing smoking in restaurants and bars, which can be considered a marker of SHS exposure. Additionally, we used multilevel logistic regression models to study associations with comprehensiveness of national smoke-free regulations in restaurants and bars, which were derived from the Tobacco Control Scale. In total, 44,809 people from all 28 EU member states were included in the analysis. The results of the multilevel logistic analysis show that in countries with complete and extensive bans, respondents were less likely to have observed people smoking inside restaurants than in countries with partial bans, which represented the lowest level of smoke-free policy implementation (OR 0.24, 95%CI 0.10-0.57 for complete ban and OR 0.23, 95%CI 0.10-0.54 for incomplete but extensive ban). Also, the prevalence of seeing people smoking in a bar was lower in the countries with an extensive ban (OR 0.23 95%CI 0.11-0.45) and with a complete ban (OR 0.20 95%CI 0.10-0.40). Between 2014 and 2017, SHS exposure in restaurants and bars decreased significantly. Our results confirm that in countries with extensive or complete smoking bans, people were less exposed to SHS in restaurants and bars; and that partial bans are less effective in reducing SHS exposure.

Ethnic diversity and mortality in northwest Burkina Faso: An analysis of the Nouna health and demographic surveillance system from 2000 to 2012

Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established especially in low-middle- income countries. Our study aims to explore the association between ethnic diversity and all-cause mortality in rural areas of Burkina Faso. We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths was compared to the expected deaths based on the entire HDSS taking into account sex, age, rainy season, calendar year, and village. SMR were calculated for ethnic and religious diversity on a village level (using the Simpson Index), sub-region, wealth, and distance to Healthcare Facilities (HCF). Furthermore, we modeled SMR with a multilevel random intercept Poisson regression considering individual ethnic and religious groups in addition to the above-mentioned village-level information. Village wealth (poorest fifth: SMR 1.07; 95% CI: 1.02-1.13, richest fifth: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and sub-region showed significant associations with overall mortality. Villages belonging to the third with the highest ethnic diversity had lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the entire HDSS, while those belonging to the lowest diversity third yielded elevated SMR (1.13; 95% CI: 1.09-1.17). The multilevel model confirmed the association. Our study showed that historically established ethnic diversity in rural areas of Burkina Faso was associated with lower all-cause mortality. Generally, the literature suffers from a lack of standardization in defining ethnic diversity, along with measuring it. More research is needed to understand this relation and to establish it in different settings.

OUP accepted manuscript

Background

Malaria in pregnancy remains a significant cause of morbidity and mortality, affecting the highly endemic countries of sub-Saharan Africa (SSA). Insecticide-treated nets (ITNs) are effective for malaria prevention. However, poor adherence in SSA remains a challenge.

Methods

We conducted a standard questionnaire survey among 710 pregnant women from 37 primary care clinics in the Upper West Region of Ghana from January through May 2019. Using a sequential explanatory design, we integrated the survey data from six focus group discussions with pregnant women.

Results

While 67% of women had some general knowledge about malaria prevention, only 19% knew the specific risks in pregnancy. Determinants of ITN use included ITN ownership (odds ratio [OR] 2.4 [95% confidence interval {CI} 1.3 to 4.4]), good maternal knowledge of the risks of malaria in pregnancy (OR 2.4 [95% CI 1.3 to 4.3]) and more antenatal care (ANC) contacts (OR 1.3 [95% CI 1.0 to 1.5)]. Focus group discussions showed that non-use of ITNs resulted from inappropriate hanging infrastructure, a preference for other malaria prevention alternatives, allergy and heat.

Conclusions

Specific maternal knowledge of malaria risks in pregnancy was low and influenced the regular use of ITNs. Community and ANC-based malaria interventions should prioritize increasing knowledge of the specific risks of malaria.

The Health Status and Healthcare Utilization of Ethnic Germans in Russia

Ethnic German resettlers from the former Soviet Union are one of the largest migrant groups in Germany. In comparison with the majority of the German population, resettlers exhibit worse subjective health and utilize fewer preventive measures. However, there is little evidence on health among ethnic Germans who remained in Russia. Hence, the objective of this study was to determine the differences in subjective health, diabetes, smoking, and utilization of health check-ups between ethnic Germans and the majority population in Russia. We used data from the Russian Longitudinal Monitoring Survey II from 1994 to 2018 (general population of Russia n = 41,675, ethnic Germans n = 158). Multilevel logistic regression was used to calculate odds ratios (ORs) adjusted for age, sex, period, and place of residence. Analyses were furthermore stratified by the periods 1994-2005 and 2006-2018. Ethnic Germans in Russia rated their health less often as good compared with the Russian majority population (OR = 0.67, CI = 0.48-0.92). Furthermore, ethnic Germans were more likely to smoke after 2006 (OR = 1.91, CI = 1.09-3.37). Lower subjective health among ethnic Germans in Russia is in line with findings among minority populations in Europe. Increased odds of smoking after 2006 may indicate the deteriorating risk behavior of ethnic Germans in Russia.

Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review

Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

Uptake challenges of intermittent preventive malaria therapy among pregnant women and their health care providers in the Upper West Region of Ghana: A mixed-methods study

BACKGROUND

Malaria in pregnancy remains a major public health problem in endemic countries, especially in sub-Saharan Africa (SSA). Existing interventions such as intermittent preventive therapy in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) are effective against placental malaria. However, low uptake of this intervention is a challenge in SSA. This study assessed factors affecting IPTp-SP uptake among pregnant women as well as their health care providers, including health system-related factors.

METHODS

From November 2018 until May 2019 a mixed-methods study was conducted in one urban and one rural district of the Upper West Region of Ghana. A multi-stage sampling technique was used to recruit 740 3rd trimester pregnant women and 74 health service providers from 37 antenatal care (ANC) facilities. Quantitative data was collected through a standard questionnaire from pregnant women and ANC service providers. Three focus group discussions (FGDs) were conducted in each district with pregnant women who had defaulted on their IPTp doses to collect information about the challenges in accessing IPTp-SP. The primary outcome was the uptake of IPTp-SP during antenatal care visits. In addition, the health care provider and health system-related factors on the administration of SP were assessed, as well as details of folic acid (FA) supplementation. Data were analysed using descriptive statistics and Poisson regression.

RESULTS

Responses from 697 pregnant women were analysed. Of these, 184 (26.4%) had taken the third dose of SP (SP3) in line with international guidelines. IPTp-SP uptake was low and significantly associated with the number of maternal ANC contacts and their gestational age at 1st ANC contact. Most pregnant women were regularly co-administered SP together with 5 mg of FA, in contrast to the international recommendations of 0.4 mg FA. The main challenges to IPTp-SP uptake were missed ANC contacts, knowledge deficiencies among pregnant women of the importance of IPTp, and frequent drug stock outs, which was confirmed both from the ANC providers as well as from the pregnant women. Further challenges reported were provider negligence/absenteeism, adverse drug reactions, and mobile residency of pregnant women.

CONCLUSIONS

The uptake of IPTp-SP in the study area is still very low, which is partly explained by frequent drug stock outs at health facilities, staff absenteeism, knowledge deficiencies among pregnant women, and missed ANC contacts. The high dosing of co-administered FA is against international recommendations. These observations need to be addressed by the national public health authorities.

Parent emigration and physical health of children left behind: a systematic review of literature

Background

The aim of our study was to systematically review the literature on physical health and related consequences of internal and international parental migration on left-behind children (LBC).

Methods

This study followed the PRISMA guidelines. We searched relevant databases for studies published up to 15 May 2020. The quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

We included 34 studies out of 6061 in the final analysis. Results from internal migration shows that compared with children of non-migrant parents, LBC were more susceptible to illness and had a higher prevalence of acute and chronic diseases, have a higher risk of getting injured, were more likely to engage risky behaviours such as unhealthy diet, physical inactivity, sedentary lifestyle, smoking, and drinking. Studies included in this review found a lower coverage of vaccination among LBC. Results from international migration found that left-behind adolescents reported poorer physical health than non-LBC. It was found that the prevalence of stunting (11.5% vs. 14.8%), wasting (18.1% vs. 21.5%), and underweight (24.3% vs. 26.2%) was lower among LBC as compared with non-LBC, respectively. Physical activity among LBC was lower than non-LBC. We provided comparative analysis of the outcomes of the internal and international migration. We found that, despite the type of migration/region, LBC suffer from poor general health, are at a higher risk of developing poor nutrition, overweight or obesity, addictive behaviours, physical inactivity, lower vaccination coverage, and more frequent injuries than non-LBC.

Conclusions

This study found that both internal and international parental migration is mostly negatively associated with LBC general health, nutrition, weight and height, injuries, and immunization. However, in low- and middle-income countries parental migration might also prevent LBC from undernutrition.

Key messages

Internal and international migration parental migration is negatively associated with child physical health outcomes. Issue is well addressed in China, but there are substantial research gap from other migration affected regions of the world.

Long-term outcomes of in utero Ramadan exposure: a systematic review

Background

Previous systematic reviews have documented perinatal health effects of in utero Ramadan exposure on children. Our study aims to review possible long-term consequences.

Methods

Following PRISMA guideline, we searched PubMed, PsycINFO, EconLit, Index Islamicus, Web of Science, Cochrane Library, WHO Global Index Medicus, WHO Virtual Health Library and Google Scholar for original research articles analysing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes.

Results

Fourteen studies from 4874 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower math, writing and reading scores, as well as lower probability to own a home were associated with Ramadan exposure during conception or first trimester of pregnancy. Further, age and sex of the child seem to play a pivotal role on the association.

Conclusions

Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

Key messages

In utero Ramadan exposure may adversely impact long-term health and economic well-being. Some negative effects are observed particularly when Ramadan occurred during the first trimester of pregnancy.

The impact of parental migration background on cardiometabolic health in European children

Background

There is accumulating evidence that children from migrant families have higher risk of developing overweight and obesity than their peers in the host population. This study aims to investigate the association between parental migration and cardiometabolic health, including the metabolic score and its components, in children and adolescents in Europe.

Methods

Data was collected from 8,828 children (aged 2-17) in eight European countries included in the multicentre IDEFICS/I.Family cohort. Multilevel linear regression models were used (accounting for correlations between siblings) to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and the cardiometabolic health outcomes body mass index (BMI), metabolic score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We controlled for socioeconomic indicators, maternal weight status, as well as lifestyle and dietary patterns.

Results

We found a higher mean BMI z-score (+0.24 SD, p &lt; 0.001) and overall metabolic z-score (+0.28 SD, p &lt; 0.001) among children with two migrant parents in comparison to children with two native parents. No differences could be seen between children with one versus no migrant parent. The effects were attenuated when controlling for maternal weight status and levels of sport club activity. Parental education modified the associations for some health outcomes (BMI and waist circumference) such that they were more pronounced in children with low parental education.

Conclusions

European children and adolescents with two-parent migration background seem to be at higher risk of developing adverse cardiometabolic health than their peers. Children with one migrant parent seem to have similar risk as children with native parents. Maternal BMI and levels of physical activity partly explained the higher risk, a risk which was more prevalent in families with lower education level.

Key messages

European children and adolescents with two-parent migration background have higher risks of developing adverse cardiometabolic health than their peers with one or two native parents. The higher risk of being overweight and having cardiometabolic risk factors among children with two-parent migration background was most pronounced in families with low level of education.

Ethnic diversity and mortality in northwestern Burkina Faso: a cohort analysis from 2000 to 2012

Background

Ethnic diversity has been a topic of contention across the globe, contrasted with economic development, social security, and political stability. The link between health and ethnic diversity is not yet well established. This study aims to explore the association between ethnic diversity and all-cause mortality.

Methods

We used data from the Nouna Health & Demographic Surveillance System (HDSS) collected between 2000 and 2012. To derive Standardized Mortality Ratios (SMR), the observed number of deaths for each village was compared to the expected deaths based on the whole HDSS accounting for sex, age, rainy season, calendar year, and village. SMR were calculated on a village level for ethnic diversity (using the Simpson Index), geographical region, wealth, distance to Healthcare Facility (HCF), and religious diversity (Simpson Index). Also, we modeled SMR with a multilevel random intercept Poisson model considering individual ethnic and religious groups in addition to the above-mentioned village-level information.

Results

Village wealth (poorest quintile: SMR 1.07; 95% CI: 1.02-1.13, richest quintile: SMR 0.85; 95% CI: 0.82-0.88), distance to HCF (within the village: SMR 0.88; 95% CI: 0.85-0.91, further than 5km: SMR 1.13; 95% CI: 1.10-1.16), and village geographical region showed significant associations with overall mortality. Villages in the high ethnic diversity tertile had a lowered SMR (0.86; 95% CI: 0.84-0.89) compared to the overall HDSS, while those with low diversity yielded an elevated SMR (1.13; 95% CI: 1.09-1.17). The multivariable model including all co-variables confirmed the association.

Conclusions

This study shows a link between ethnic diversity and health. Historically established ethnic diversity in rural areas of Burkina Faso is associated with lower all-cause mortality. A lack of standardization exists in defining and measuring ethnic diversity. More research is needed to understand this relation and to establish it in different settings.

Key messages

Ethnic diversity is potentially linked to health. Further studies in different settings are needed to fully understand the relation between ethnic diversity and health.

School teachers’ perception on parental migration and left-behind children in rural Georgia

Background

Georgia, like other Eastern European countries, showed a dramatic increase of international labour emigration after becoming independent in 1991. Since then, thousands of children are left-behind (LBC) in the care of extended family members while their parents work abroad. School teachers are frequently in contact with LBC and their caregivers. The main aim of this study is to explore school teachers' perceptions on parental migration and LBC in rural Georgia.

Methods

In this qualitative study, we conducted six focus-group discussions with public school teachers and six in-depth interviews with school principals from two migrant sending regions. We applied a reflexive thematic analysis approach, systematically analysed data and identified main themes and sub-themes from the collected data. The theoretical framework of the socio-ecological model of human development underpins this study.

Results

We identified the following themes expressed by both teachers and school principals: parental migration and transnational families as a survival strategy; LBC's vulnerabilities and dangers due to migratory separation; school teachers as mediators and supporters for LBC. School teachers and school principals perceive parental migration as a negative experience for children causing problems of physical and mental health, well-being and academic performance. Structural factors such as poverty, lack of support and lack of community involvement further worsen this situation. Teachers see themselves as the only supporters for LBC and their transnational families. School principals mitigate the situation by employing various strategies, such as regular meetings with class tutors, extra-tutoring for LBC, psychological counselling and developing/enacting internal guidelines.

Conclusions

LBC, transnational families and public schools in Georgia are in urgent need of external support such as providing psychological services at schools.

Key messages

Left-behind children in transnational families are vulnerable. Community and school-based interventions are needed to support LBC and teachers in fostering resilience and coping mechanisms among LBC.

Porphyromonas Gingivalis as a Risk Factor to Alzheimer's Disease: A Systematic Review

BACKGROUND

Alzheimer's disease (AD) is a chronic neurodegenerative disease that accounts for more than 50% of all dementia cases worldwide. There is wide consensus on the risk factors of AD; however, a clear etiology remains unknown. Evidence suggests that the inflammatory-mediated disease model, such as that found with periodontal disease due to Porphyromonas gingivalis (P. gingivalis), plays a role in AD progression.

OBJECTIVE

This study aims to systematically review the literature on the association between P. gingivalis to AD, and to identify the homogeneity of the methods used across studies to measure P. gingivalis involvement in AD.

METHODS

We systematically searched studies on Cochrane library, Ovid Medline, PubMed, Web of Science, WHOLIS, Google Scholar databases, and reference lists of identified studies.

RESULTS

6 studies out of 636 identified records fulfilled all eligibility criteria. Results showed no clear pathophysiology of AD due to P. gingivalis and its various virulence factors. No consensus was found in the literature pertaining to the method of measurement of AD or P. gingivalis and its virulence factors.

CONCLUSION

The included studies suggest that P. gingivalis bacteria play a role in the process of systemic inflammation which leads to cerebrospinal fluid inflammation and indirectly cause hastening of AD onset and progression. Our included studies revealed heterogeneity in the methodologies of measurement of AD and/or P. gingivalis and its virulence factors, which opens discussion about the benefits and weakness of possible standardization.

Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis

Objective

We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population.

Methods

PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted.

Results

The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I² 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures.

Conclusion

We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.

Role of community health volunteers in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Malawi: a qualitative study

Background

In recent years, there has been greater recognition of the important role of community health volunteers in many countries and their important role informs many health programs. This include health education, provision of services such as screening, monitoring and referral to health facilities. Their roles are better understood in the areas of communicable diseases like HIV infection, Tuberculosis and Malaria however little is known about their role in non-communicable diseases. This study seeks to explore perception of CHVs’ functions, tasks, and their fulfilment in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Lilongwe, Malawi.

Methods

This was a qualitative naturalistic research design utilizing observation and semi-structured interviews with community health volunteers working in Lilongwe, Malawi. Interviews were carried out with the researcher. Participants were recruited from the ZaMaC project. An interview guide was developed with a category-guided deductive approach. The interviews were recorded through note taking. Data analysis was performed using content analysis approach.

Results

Community health volunteers have multiple roles in prevention and monitoring of hypertension. They act as health educators and provide lifestyle counselling. They screened for hypertension and monitored blood pressure and assisted community members to navigate the health system such as linkage to health facilities. These roles were shaped in response to community needs.

Conclusion

This study indicates the complexities of the roles of community health volunteer in identifying people with elevated BP for diagnosis and monitoring of hypertension. Understanding community health volunteers’ roles provides insight into their required competencies in provision of their daily activities as well as required training to fill in their knowledge gaps.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02171-7.

Performance of alternative COPD case-finding tools: a systematic review and meta-analysis

RATIONALE

Guidelines recommend pre-/post-bronchodilator spirometry for diagnosing COPD, but resource constraints limit the availability of spirometry in primary care in low- and middle-income countries. Although spirometry is the diagnostic gold standard, we shall assess alternative tools for settings without spirometry.

METHODS

A systematic literature review and meta-analysis was conducted, utilising Cochrane, CINAHL, Google Scholar, PubMed and Web of Science (search cut-off was May 01, 2020). Published studies comparing the accuracy of diagnostic tools for COPD with post-bronchodilator spirometry were considered. Studies without sensitivity/specificity data, without a separate validation sample and outside of primary care were excluded. Sensitivity, specificity and area under the curve (AUC) were assessed.

RESULTS

Of 7578 studies, 24 were included (14 635 participants). Hand devices yielded a larger AUC than questionnaires. The meta-analysis included 17 studies and the overall AUC of micro-spirometers (0.84, 95% CI 0.80-0.89) was larger when compared to the COPD population screener (COPD-PS) questionnaire (0.77, 95% CI 0.63-0.85) and the COPD diagnostic questionnaire (CDQ) (0.72, 95% CI 0.64-0.78). However, only the difference between micro-spirometers and the CDQ was significant.

CONCLUSIONS

The CDQ and the COPD-PS questionnaire were approximately equally accurate tools. Questionnaires ensured testing of symptomatic patients, but micro-spirometers were more accurate. A combination could increase accuracy but was not evaluated in the meta-analysis.

Colorectal Cancer among Resettlers from the Former Soviet Union and in the General German Population: Clinical and Pathological Characteristics and Trends

This study examined time trends and clinical and pathological characteristics of colorectal cancer (CRC) among ethnic German migrants from the Former Soviet Union (resettlers) and the general German population. Incidence data from two population-based cancer registries were used to analyze CRC as age-standardized rates (ASRs) over time. The respective general populations and resettler cohorts were used to calculate standardized incidence ratios (SIRs) by time-period (before and after the introduction of screening colonoscopy in 2002), tumor location, histologic type, grade, and stage at diagnosis. Additionally, SIRs were modeled with Poisson regression to depict time trends. During the study period from 1990 to 2013, the general populations showed a yearly increase of ASR, but for age above 55, truncated ASR started to decline after 2002. Among resettlers, 229 CRC cases were observed, resulting in a lowered incidence for all clinical and pathological characteristics compared to the general population (overall SIR: 0.78, 95% CI 0.68–0.89). Regression analysis revealed an increasing SIR trend after 2002. Population-wide CRC incidence decreases after the introduction of screening colonoscopy. In contrast the lowered CRC incidence among resettlers is attenuating to the general population after 2002, suggesting that resettlers do not benefit equally from screening colonoscopy.

Biological larviciding against malaria vector mosquitoes with Bacillus thuringiensis israelensis (Bti) - Long term observations and assessment of repeatability during an additional intervention year of a large-scale field trial in rural Burkina Faso

The first line of malaria vector control to date mainly relies on the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). For integrated vector management, targeting the vector larvae with biological larvicides such as Bacillus thuringiensis israelensis (Bti) can be an effective additional mainstay. This study presents data from the second intervention year of a large-scale trial on biological larviciding with Bti that was carried out in 127 rural villages and a semi-urban town in Burkina Faso. Here we present the reductions in malaria mosquitoes that were achieved by continuing the initial interventions for an additional year, important to assess sustainability and repeatability of the results from the first intervention year. Larviciding was performed applying two different larviciding choices ((a) treatment of all environmental breeding sites, and (b) selective treatment of those that were most productive for Anopheles larvae indicated by remote sensing based risk maps). Adult Anopheles spp. mosquito abundance was reduced by 77.4% (full treatment) and 63.5% (guided treatment) compared to the baseline year. The results showed that malaria vector abundance can be dramatically reduced using biological larviciding and that this effect can be achieved and maintained over several consecutive transmission seasons.

Parent Emigration, Physical Health and Related Risk and Preventive Factors of Children Left Behind: A Systematic Review of Literature

The aim of our study was to systematically review the literature on physical health and related consequences of internal and international parental migration on left-behind children (LBC). This review followed PRISMA guidelines. We searched the PubMed, Web of Science, Academic Search Complete, PsycINFO, and Cochrane databases and included studies reporting physical health-related outcomes of children affected by parental migration. The quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We selected 34 publications from a total of 6061 search results. The study found that LBC suffer from poor physical health as compared with non-LBC. Physical health-related risk factors such as underweight, lower weight, stunted growth, unhealthy food preferences, lower physical activity, smoking, alcohol consumption, injuries, and incomplete vaccination tend to be more prevalent among LBC in China. Studies focussing on international migration argue that having migrant parents might be preventive for undernutrition. Overall, our study showed that children affected by internal or international migration tend to have similar physical health outcomes. Moreover, we identified a lack of evidence on international parental migration that may have influenced the overall impacts. Further studies addressing international migration would contribute to better understand the impacts of migration for LBC.

Global progress in tobacco control: the question of policy compliance

Background: Currently, about 65% of the world's population is covered by at least one MPOWER tobacco control policy measure. The impact of such policies might rely on policy compliance. Objective: This study aims to describe and compare global trends in legislation and compliance of the following three tobacco control policies between 2009 and 2019: direct advertisement, promotion and sponsorship, and smoke-free environments. Method: Data from the six most recent WHO Tobacco Control (2009-2019) reports were used to show the development of and possible associations between legislated policies and policy compliance. Data pertaining to the three indicators direct advertisement, promotion and sponsorship, and smoke-free environments were collected and analysed per country income category, according to the Organization for Economic Co-operation and Development. For each country, we (i) calculated the legislation describing the situation according to the law as a percentage of fulfilled MPOWER measurements and (ii) present the level of compliance (ranging from 0 to 10) for the corresponding policy. Results: Both tobacco control policy legislation and compliance for direct advertising improved worldwide - between 2009 and 2019 the median increased from 37.5% to 87.5% for policy and from 5 to 8 for compliance. In contrast, promotion and sponsorship restrictions hardly developed since 2011 and are especially weak among low- and middle-income countries. With respect to smoke-free environments, global policy legislation increased steadily over time while the relative compliance hardly increased. In 2019 data did not show significant correlations between policy legislation and compliance: direct advertising ρ = -0.003, p = 0.970; promotion and sponsorship ρ = 0.140, p = 0.107; smoke-free environments ρ = 0.158, p = 0.070. Conclusion: There is a clear need to understand the barriers in achieving tobacco control policy compliance and to routinely collect and incorporate data on compliance in research in order to generate a more reliable basis for further improvements in tobacco control.

Dental Caries among Refugees in Europe: A Systematic Literature Review

Oral health is one of the most neglected aspects of refugee health. The study aimed to systematically review evidence on prevalence of dental caries and dental care services provided to refugees in Europe. Following PRISMA guidelines, we searched PubMed, Cochrane, WHOLIS, Web of Science, Medline Ovid, and Google Scholar identifying studies on dental caries among refugees in Europe after the 2015 refugee crisis. From 3160 records, fourteen studies were included in the analysis. Eight studies on oral health showed caries prevalence of between 50% and 100%, while it ranged from 3% to 65% in six general health studies. Caries prevalence was proportional to age and inversely associated with education, whereas gender and country of origin showed no significant association. Nowhere is oral health part of general health assessment on arrival and is complaint based. Primary focus on resettlement, language, cultural, and economic barriers emerged as explanatory models for limited access. Our study identified a high prevalence of caries and limited access to dental health services as main challenges. Integrating oral health check-ups may contribute in shifting towards preventive oral care. Further research is urgently needed to better understand the dental needs of refugees in Europe.

The Incidence of Intestinal Gastric Cancer among Resettlers in Germany-Do Resettlers Remain at an Elevated Risk in Comparison to the General Population?

Objective: Previous studies have shown that the incidence of gastric cancer (GC), and particularly intestinal GC, is higher among resettlers from the former Soviet Union (FSU) than in the general German population. Our aim was to investigate if the higher risk remains over time. Methods: GC cases between 1994 and 2013, in a cohort of 32,972 resettlers, were identified by the respective federal cancer registry. Age-standardized rates (ASRs) and standardized incidence ratios (SIRs) were analyzed in comparison to the general population for GC subtypes according to the Laurén classification. Additionally, the cohort was pooled with data from a second resettler cohort from Saarland to investigate time trends using negative binomial regression. Results: The incidence of intestinal GC was elevated among resettlers in comparison to the general population (SIR (men) 1.64, 95% CI: 1.09–2.37; SIR (women) 1.91, 95% CI: 1.15–2.98). The analysis with the pooled data confirmed an elevated SIR, which was stable over time. Conclusion: Resettlers’ higher risk of developing intestinal GC does not attenuate towards the incidence in the general German population. Dietary and lifestyle patterns might amplify the risk of GC, and we believe that further investigation of risk behaviors is needed to better understand the development of disease pattern among migrants.

Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017

Background

Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called “Sistema Integral de Salud (SIS)” to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom.

Methods

Relying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33,168 women aged 15–49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women’s socio-demographic and economic characteristics.

Results

Out of the 33,168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be “Spanish”, and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance.

Conclusions

Our study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

Increased circulation time of Plasmodium falciparum underlies persistent asymptomatic infection in the dry season

The dry season is a major challenge for Plasmodium falciparum parasites in many malaria endemic regions, where water availability limits mosquito vectors to only part of the year. How P. falciparum bridges two transmission seasons months apart, without being cleared by the human host or compromising host survival, is poorly understood. Here we show that low levels of P. falciparum parasites persist in the blood of asymptomatic Malian individuals during the 5- to 6-month dry season, rarely causing symptoms and minimally affecting the host immune response. Parasites isolated during the dry season are transcriptionally distinct from those of individuals with febrile malaria in the transmission season, coinciding with longer circulation within each replicative cycle of parasitized erythrocytes without adhering to the vascular endothelium. Low parasite levels during the dry season are not due to impaired replication but rather to increased splenic clearance of longer-circulating infected erythrocytes, which likely maintain parasitemias below clinical and immunological radar. We propose that P. falciparum virulence in areas of seasonal malaria transmission is regulated so that the parasite decreases its endothelial binding capacity, allowing increased splenic clearance and enabling several months of subclinical parasite persistence.

Patterns of healthcare seeking among people reporting chronic conditions in rural sub-Saharan Africa: findings from a population-based study in Burkina Faso

OBJECTIVE

Non-communicable diseases are rapidly becoming one of the leading causes of morbidity and mortality in sub-Saharan Africa. Yet, little is known about patterns of healthcare seeking among people with chronic conditions in these settings. We aimed to explore determinants of healthcare seeking among people who reported at least one chronic condition in rural Burkina Faso.

METHODS

Data were drawn from a cross-sectional population-based survey conducted across 24 districts on 52 562 individuals from March to June 2017. We used multinomial logistic regression to assess factors associated with seeking care at a formal provider (facility-based care) or at an informal provider (home and traditional treatment) compared to no care.

RESULTS

1124 individuals (2% of all respondents) reported at least one chronic condition. Among those, 22.8% reported formal care use, 10.6% informal care use, and 66.6% no care. The presence of other household members reporting a chronic condition (RRR = 0.57, 95%-CI [0.39, 0.82]) was negatively associated with seeking formal care. Wealthier households (RRR = 2.14, 95%-CI [1.26, 3.64]), perceived illness severity (RRR = 3.23, 95%-CI [2.22, 4.70]) and suffering from major chronic conditions (RRR = 1.54, 95%-CI [1.13, 2.11]) were positively associated with seeking formal care.

CONCLUSION

Only a minority of individuals with chronic conditions sought formal care, with important differences due to socio-economic status. Policies and interventions aimed at increasing the availability and affordability of services for early detection and management in peripheral settings should be prioritised.

We still dońt know who bleeds in Dengue. A systematic review of the literature

Background

Already, Dengue affects 400 million individuals every year. Its main drivers, urbanization, globalization, and climate change, however, will spread the disease even further and potentially threaten billions. In Dengue, bleeding occurs frequently. Severe bleeding strongly increases mortality and immediate medical response is crucial for survival. Predicting the occurrence and course of bleeding in advance would improve clinical outcome, reduce unnecessary hospitalization, and improve economic efficiency.

Methods

Following the PRISMA-guidelines, we conducted a systematic review of the literature to identify predictors of bleeding in acute confirmed Dengue. We searched Pubmed, Web of Science, IRIS, LILACS, and the Cochrane Archives and included all prospective longitudinal studies restricting neither language nor study sample characteristics.

Results

We included 19 studies but found that most data suffered from high risk of bias because of poor reporting and not accounting for confounding. Only five studies were more reliable, and they unanimously reported that age-, and platelet count predicted bleeding severity. The body of evidence was too weak to draw conclusions for the other 23 markers investigated. Crucially, the researchers had defined central concepts in fundamentally different ways and thus prevented the comparison of their findings.

Conclusions

Our systematic review of the literature showed that more research is needed to create a reliable prediction model for bleeding in Dengue. We have moderate certainty that platelet count- and age predict bleeding severity. Our study exposed the urgent need to improve the quality of research in Dengue epidemiology. Most importantly, our findings illustrate the necessity to harmonize central concepts within the Dengue research community. To tackle the challenge that Dengue is bound to become, we need dialogue across research groups and collaboration that overcomes the limited impact of individual studies.

Key messages

We know too little about predictors of bleeding in Dengue. Reliable data is needed to identify new markers and to confirm existing markers that are carried by a weak body of evidence. We urge investigators to collaborate. To overcome the limitations of individual studies, we need better comparability and a scientific dialogue based on common definitions of core concepts in Dengue.

Impacts of international labor migration on the mental health and well-being of left-behind children

Background

Labor migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families with the particularly vulnerable groups of left-behind children (LBC). These families, where family members of migrant workers are 'left-behind' are becoming common practice in many developing countries. In this systematic literature review, we aimed to investigate the impacts of parental labor migration on the mental health and well-being of their LBC.

Methods

Following the PRISMA guidelines, we performed a systematic literature search in English using PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar for studies, investigating mental health and well-being among LBC who live in transnational families. Case-reports, qualitative studies as well as opinion papers were excluded. We summarized the evidence and additionally compared quantitative results.

Results

25 studies were selected for the final analysis. We found that mental health and well-being outcomes of LBC differ across regions and sometimes even within regions. Only studies conducted in South America and South Asia observed purely negative effects. Overall, LBC show abnormal SDQ (Strengths and Difficulties Questionnaire) scores and report higher levels of depression and loneliness, than children who do not live in transnational families. Evidence suggests that gender of migrant parent, culture and other transnational family characteristics such as family arrangement, the role of the mother and the role of the father contribute to the well-being and psychological health of LBC.

Conclusions

International migration of parents has more negative than positive effects (e.g. through remittances) on the mental health and well-being of LBC. However, the effects strongly depend on family arrangements and care giving practices in migrants' sending countries.

Key messages

Further research utilizing longitudinal data is needed to better explore the complex and long-term effects of parental migration on LBC. Multidimensional family characteristics are crucial and should be better explored when examining the impacts of migratory separation on left-behind children.

Dental caries among refugees in Europe: A systematic Literature Review

Background

Oral health is one of the most neglected aspects of refugee health. Conflict, violence, loss and unfamiliarity faced by refugees and the reliance on the host country make it difficult to achieve good oral health. The aim of the study was to systematically review the evidence on the prevalence of dental caries among refugees and to evaluate the provided dental care services in the European region.

Methods

Following the PRISMA guidelines, we searched PubMed, Cochrane, WHOLIS, Web of Science, Medline Ovid, and Google Scholar identifying studies on dental caries among refugees in Europe focusing on articles published after 2015 till September 2019. The words caries, decay, DMF, and dental health, refugee and asylum seeker were used.

Results

We obtained 3004 records and included 11 studies in the analysis. The 6 studies primarily focusing on oral health showed a prevalence of caries between 55.8% and 100%, while it ranged from 3% to 65% in the remaining 5 studies investigating the general health of refugees. Caries prevalence was proportional to age and inversely associated with education, whereas gender and country of origin showed no significant association. Oral health is nowhere part of the general health assessment done on arrival and is mainly complain based. Treatment is available at an emergency basis and in equivalence as that of local populations only after the acceptance of refugee status. Lack of orientation, primary focus on resettlement, lack of uniformity, language, cultural and economic barriers emerged as explanatory models for the limited access to oral health care.

Conclusions

Our study identified a high prevalence of caries and limited access to dental health services as the main challenges. The necessity of oral health check-ups will help to shift from curative to preventive oral health care. Further research is urgently needed to better understand the dental health needs of refugees in Europe.

Key messages

Necessity of oral health check-up irrespective of need will help make shift from curative to preventive oral health care. Further research is urgently needed to better understand dental health needs of refugees in Europe.

Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union

Background

Second-hand smoke (SHS) is still an important public health problem. With joining the Framework Convention on Tobacco Control (FCTC), all parties acknowledged the health risks of SHS and agreed to implement policies to protect their populations from SHS in public places. The aim of this study was to explore the SHS exposure in restaurants and bars as well as its associations with smoke-free legislation in the European Union.

Methods

Data of Eurobarometer surveys 2014 and 2017 were used to estimate prevalence of SHS exposure. We also extracted data on individual confounders such as smoking status, gender, sex, age and information on social economic status. Additionally, we collected data on country specific data on smoking regulations in restaurants and bars from the Tobacco Control Scale to analyse associations with SHS exposure using multilevel logistic regression. Smoking regulations were categorized into the following three categories: partial ban, comprehensive ban with minor exceptions, and complete ban.

Results

Preliminary results on the prevalence of SHS in restaurants showed a decrease from 11.8% (95% confidence intervals (CI) 11.2-12.5) in 2014 to 8.8% (95% CI 8.3-9.3) in 2017. The crude multilevel model controlling only for smoking prevalence resulted in an odds ratio of 0.39 (95% CI 0.19-0.77) for comprehensive ban with minor exceptions and 0.28 (95% CI 0.16-0.50) for complete ban versus partial ban. Odds ratios remained at significant levels when controlling for all available confounders.

Conclusions

Between 2014 and 2017, SHS exposure in restaurants decreased significantly. Furthermore, strong associations with smoking regulations were observed suggesting a high compliance. Many tobacco control policies have been introduced during the last years but several countries need to strengthen their smoke-free tobacco control policies to further reduce SHS exposure preventing death, disease and disability.

Key messages

SHS exposure remains a significant public health challenge. The implementation of effective measures could be strengthened through a convergence of tobacco control strategies and policies among European Union member states.

Effects of International Labour Migration on the Mental Health and Well-Being of Left-Behind Children: A Systematic Literature Review

Labour migration is a challenge for the globalised world due to its long-term effects such as the formation of transnational families. These families, where family members of migrant workers are “left-behind”, are becoming a common phenomenon in many low- and middle-income countries. Our systematic literature review investigated the effects of international parental labour migration on the mental health and well-being of left-behind children. Following the PRISMA guidelines, we performed searches in PubMed, PsychINFO, Web of Science, Cochrane Library and Google Scholar, resulting in 30 finally included studies. We found that mental health and well-being outcomes of left-behind children differed across and sometimes even within regions. However, only studies conducted in the Americas and South Asia observed purely negative effects. Overall, left-behind children show abnormal Strengths and Difficulties Questionnaire scores and report higher levels of depression and loneliness than children who do not live in transnational families. Evidence from the studies suggests that gender of the migrant parent, culture and other transnational family characteristics contribute to the well-being and mental health of left-behind children. Further research utilising longitudinal data is needed to better understand the complex and lasting effects on left-behind children.

AB1303-HPR TIME UNTIL DIAGNOSIS IN RHEUMATOLOGICAL PRACTICE: RESULTS FROM A CROSS-SECTIONAL MIDDLE-EUROPEAN COHORT COMPARED TO DATA FROM A SYSTEMATIC LITERATURE REVIEW

Background:

The time from first symptom to diagnosis (= diagnostic delay) is considered as key factor for better outcome in many chronic inflammatory rheumatic diseases, especially for rheumatoid arthritis (RA) and vasculitides like giant cell arteritis (GCA). A longer diagnostic delay may cause pain, reduced functionality, reduced life-quality and increased morbidity, as well as structural damages of the organs linked with higher mortality. This retrospective study assessed the diagnostic delay in consecutive Middle-European outpatients and compared results with those of a systematic literature review (SLR).

Objectives:

To compare disease-specific diagnostic delays of consecutive rheumatic patients with international data from a systematic literature review.

Methods:

Charts of a single-centre cohort with consecutively recruited patients were retrospectively reviewed for patients’ and diseases’ characteristics at a Middle-European university outpatient clinic for rheumatology. A SLR was performed according to PRISMA guidelines.

Results:

The average mean ± SD time from first symptom to established diagnosis was 7.9 ± 11.7 (0.02-56.7) years. Spondyloarthritis patients showed the longest diagnostic delay with 13.1 ± 14.2 (0.1-56.7) years, whereas polymyalgia rheumatica-patients had the shortest diagnostic delay with 1.5 ± 0.4 (0.3-18.0) months. In the SLR, most data for diagnostic delays are comparable to the Innsbruck cohort, but the diagnostic delay for psoriatic arthritis in Innsbruck is longer than in the Danish DANBIO registry (p<0.001). Independent risk factors for prolonged diagnostic delays could not be identified.

Conclusion:

For this Middle-European area, initiatives are justified especially to shorten diagnostic delays of SpA and PsA.

References:

[1]O’Dell JR. Treating rheumatoid arthritis early: A window of opportunity? Arthritis Rheum. 2002;46:283–5.

[2]Seo MR, Baek HL, Yoon HH, Ryu HJ, Choi HJ, Baek HJ, et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol. 2015;34:1397–405.

[3]Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74:1045–50.

[4]Dejaco C, Brouwer E, Mason JC, Buttgereit F, Matteson EL, Dasgupta B. Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities. Nat Rev Rheumatol. Nature Publishing Group; 2017;13:578–92.

Acknowledgments:

We acknowledge and thank all patients who could be recruited to the SolutionX project. Ethical vote was obtained by the local ethics committee of the Medical University of Innsbruck (AN2017-0041 370/4.18).

Disclosure of Interests:

Rick Mc-Cutchan: None declared, Sarah Maier: None declared, Valentin Winkler: None declared, Bernhard Gruber: None declared, Michael Schirmer Grant/research support from: total <3000.- €, Speakers bureau: total <3000.- €