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Bertuccio P, Vigezzi GP, Amerio A, Cavalieri D'oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project. Scand J Public Health 2024; 52:262-270. [PMID: 37688313 DOI: 10.1177/14034948231184516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
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Affiliation(s)
- Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Italy
| | | | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
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2
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Tugrul H, Stuckler D, Aassve A. Long-term impact of parenting-related leave policies on adolescents' well-being: a systematic review of quasi-experiments. Eur J Public Health 2024; 34:272-282. [PMID: 38197325 PMCID: PMC10990559 DOI: 10.1093/eurpub/ckad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Parenting-related leave policies have gained increasing endorsement across Organisation for Economic Co-operation and Development (OECD) countries in recent decades. Previous reviews have focused on the short-term impacts and found predominantly positive effects on children. Although there is a growing interest in the long-term impact during adolescence and young adulthood, a comprehensive assessment of this aspect is currently lacking. METHODS We systematically reviewed studies from three electronic databases (Scopus, Web of Science and PubMed), which used quasi-experimental design and examined policies legislating the introduction or expansion of parenting-related leave policies in North America or Europe. We looked at studies focused on well-being beyond the age of 12 and analyzed the findings across different domains of well-being: health, education and labour market outcomes. RESULTS The quasi-experimental evidence is rather limited. The introduction of leave policies or gender-specific quotas produces substantial benefits in the long run. Further, maternal socioeconomic and educational background appears to play a substantial moderating role between leave and adolescents' well-being. Adolescents with mothers who have higher levels of education have demonstrated a more pronounced advantage from the extended time spent together, thereby accentuating pre-existing disparities. CONCLUSIONS Though the expansion of already long leaves might not generate significant outcomes, the introduction of leave policies or gender-specific quotas produces substantial long-term benefits. This evidence entails considerable policy implications for countries that lack a national leave policy or offer only short durations of paid leave, such as the USA.
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Affiliation(s)
- Hande Tugrul
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milano, Italy
| | - Arnstein Aassve
- Department of Social and Political Sciences, Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milano, Italy
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3
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Santoso C, Serrano-Alarcón M, Stuckler D, Serban S, McKee M, Nagy A. Do missing teeth cause early-onset cognitive impairment? Re-examining the evidence using a quasi-natural experiment. Soc Psychiatry Psychiatr Epidemiol 2024; 59:705-714. [PMID: 36565317 PMCID: PMC10960740 DOI: 10.1007/s00127-022-02410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Multiple studies have reported a positive association between missing teeth and cognitive impairment. While some authors have postulated causal mechanisms, existing designs preclude assessing this. METHODS We sought evidence of a causal effect of missing teeth on early-onset cognitive impairment in a natural experiment, using differential exposure to fluoridated water during critical childhood years (ages 5-20 years) in England as the instrument. We coded missing teeth from 0 (≤ 12 missing) to 3 (all missing) and measured the association with cognitive impairment in the English Longitudinal Study of Ageing data (2014-5), covering 4958 persons aged 50-70 years. RESULTS We first replicated previous evidence of the strongly positive association of missing teeth with cognitive impairment (β = 0.25 [0.11, 0.39]), after adjusting for socio-demographic covariates, such as age, gender, education, and wealth. Using an instrumental variable design, we found that childhood exposure to water fluoridation was strongly associated with fewer missing teeth, with being exposed to fluoridated water during childhood (16 years) associated with a 0.96 reduction in the missing teeth scale (β = - 0.06 [- 0.10, - 0.02]). However, when using the instrumented measure of missing teeth, predicted by probability of fluoride exposure, we found that missing teeth no longer had an association with cognitive impairment (β = 1.48 [- 1.22, 4.17]), suggesting that previous oral health-cognitive impairment associations had unobserved confounding. CONCLUSIONS Our findings are consistent with the possibility that unobserved confounding leads to the oft-observed association between missing teeth and early-onset cognitive impairment, suggesting that the relationship is spurious rather than causal.
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Affiliation(s)
- Cornelia Santoso
- Faculty of Public Health, University of Debrecen, Kassai 26, Debrecen, 4012, Hungary.
| | | | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Stefan Serban
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, Kassai 26, Debrecen, 4012, Hungary
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4
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Ingold H, Gomez GB, Stuckler D, Vassall A, Gafos M. "Going into the black box": a policy analysis of how the World Health Organization uses evidence to inform guideline recommendations. Front Public Health 2024; 12:1292475. [PMID: 38584925 PMCID: PMC10995388 DOI: 10.3389/fpubh.2024.1292475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background The World Health Organization (WHO) plays a crucial role in producing global guidelines. In response to previous criticism, WHO has made efforts to enhance the process of guideline development, aiming for greater systematicity and transparency. However, it remains unclear whether these changes have effectively addressed these earlier critiques. This paper examines the policy process employed by WHO to inform guideline recommendations, using the update of the WHO Consolidated HIV Testing Services (HTS) Guidelines as a case study. Methods We observed guideline development meetings and conducted semi-structured interviews with key participants involved in the WHO guideline-making process. The interviews were recorded, transcribed, and analysed thematically. The data were deductively coded and analysed in line with the main themes from a published conceptual framework for context-based evidence-based decision making: introduction, interpretation, and application of evidence. Results The HTS guideline update was characterized by an inclusive and transparent process, involving a wide range of stakeholders. However, it was noted that not all stakeholders could participate equally due to gaps in training and preparation, particularly regarding the complexity of the Grading Recommendations Assessment Development Evaluation (GRADE) framework. We also found that WHO does not set priorities for which or how many guidelines should be produced each year and does not systematically evaluate the implementation of their recommendations. Our interviews revealed disconnects in the evidence synthesis process, starting from the development of systematic review protocols. While GRADE prioritizes evidence from RCTs, the Guideline Development Group (GDG) heavily emphasized "other" GRADE domains for which little or no evidence was available from the systematic reviews. As a result, expert judgements and opinions played a role in making recommendations. Finally, the role of donors and their presence as observers during GDG meetings was not clearly defined. Conclusion We found a need for a different approach to evidence synthesis due to the diverse range of global guidelines produced by WHO. Ideally, the evidence synthesis should be broad enough to capture evidence from different types of studies for all domains in the GRADE framework. Greater structure is required in formulating GDGs and clarifying the role of donors through the process.
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Affiliation(s)
- Heather Ingold
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Unitaid, Global Health Campus, Geneva, Switzerland
| | - Gabriela B. Gomez
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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Serrano-Alarcón M, Mckee M, Palumbo L, Salvi C, Johansen A, Stuckler D. How to increase COVID-19 vaccination among a population with persistently suboptimal vaccine uptake? Evidence from the North Macedonia mobile vaccination and public health advice caravan. Health Policy 2024; 139:104966. [PMID: 38101148 PMCID: PMC10788482 DOI: 10.1016/j.healthpol.2023.104966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
Over three years since the first COVID-19 vaccine was approved, many countries still have suboptimal vaccination rates despite holding great amounts of vaccines. Overall, there is little evidence on which policies are more effective to encourage vaccination, particularly in countries where a large share of the population remains unvaccinated. In this study, we examine the effectiveness of a community-based intervention carried out in March 2022 in North Macedonia, a country with a large and persistent share of the population that remains unvaccinated. The intervention, spearheaded by the Ministry of Health and supported by the World Health Organization and UNICEF, consisted of a mobile caravan offering vaccination and public health advice to different locations across the country on different days. Results from our staggered difference-in-difference model show that the mobile vaccination caravan increased daily vaccination rates by 7.7 vaccines per 100,000 inhabitants during the three weeks after the day of the caravan visit. This corresponds to a 35 % increase with respect to pre-intervention vaccination rates. We estimate a cost-effectiveness of 25.4 US dollars (USD) per additional vaccination induced. These results point to mobile caravan vaccines as an effective and cost-effective strategy to increase COVID-19 vaccination rates, even in a context of persistently suboptimal uptake.
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Affiliation(s)
- Manuel Serrano-Alarcón
- European Commission, Joint Research Centre (JRC), Ispra, Italy; Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy.
| | - Martin Mckee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | | | | | | | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy; Department of Social & Political Sciences, Bocconi University, Milano, Italy
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Serrano-Alarcón M, Ardito C, Leombruni R, Kentikelenis A, d'Errico A, Odone A, Costa G, Stuckler D. Health and labor market effects of an unanticipated rise in retirement age. Evidence from the 2012 Italian pension reform. Health Econ 2023; 32:2745-2767. [PMID: 37667427 DOI: 10.1002/hec.4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/25/2023] [Accepted: 07/21/2023] [Indexed: 09/06/2023]
Abstract
As retirement ages increase around the world, not all workers may be equally able to extend their working lives. In this article, we examine the health and labor market effects of an Italian pension reform that suddenly increased the normal retirement age up to 7 years for women and up to 2 years for men. To do this, we use linked labor and healthcare administrative data, jointly with survey data and difference-in-difference methods. Our results show that the reform was effective in postponing retirement among both genders, as pension claiming dropped substantially for older workers. However, there were also side effects as the reform significantly pushed previously employed men and women into unemployment and disability pension. Among women only, the reform also increased sick leave and hospitalizations related to mental health and injuries. These effects were driven by women with previously low health status, suggesting that undifferentiated and abrupt increases in pension age might harm more vulnerable workers. Coherently with the milder tightening of retirement age experienced by men, labor market responses were smaller in size, and they did not suffer any significant health effects.
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Affiliation(s)
- Manuel Serrano-Alarcón
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- DONDENA Research Centre, Bocconi University, Milano, Italy
| | - Chiara Ardito
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Roberto Leombruni
- Department of Economics and Statistics, University of Torino, Torino, Italy
| | | | - Angelo d'Errico
- Epidemiology Unit of Piedmont Region, ASL TO3, Grugliasco, Turin, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giuseppe Costa
- Epidemiology Unit of Piedmont Region, ASL TO3, Grugliasco, Turin, Italy
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - David Stuckler
- DONDENA Research Centre, Bocconi University, Milano, Italy
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Gallus S, Mosconi G, Stival C, Amerio A, Bertolini G, Bosetti C, Cavalieri d'Oro L, Fanucchi T, Iacoviello L, Lugo A, Stuckler D, Vigezzi GP, Zucchi A, Odone A. Who are the superheroes? A cross-sectional study on the determinants of good health among Italian older adults. Aging Clin Exp Res 2023; 35:2961-2969. [PMID: 37875705 DOI: 10.1007/s40520-023-02586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND People who reach old age enjoying good physical and mental health can be defined as (health) "superheroes", given their relatively low impact on healthcare expenditure and the desirable model they represent. AIM To evaluate prevalence and possible determinants of being "physical superheroes" (i.e., free from the ten major chronic conditions, plus obesity), "mental superheroes" (i.e., free from major mental symptoms), and "superheroes" (i.e., both mental and physical superheroes). METHODS A telephone-based cross-sectional study (LOST in Lombardia) was conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥ 65 years from Lombardy region, northern Italy. All participants provided both current data and data referring to one year before. RESULTS Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men, and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥ 80 years. Multivariable analysis showed that female sex, higher age, disadvantaged socio-economic status, and physical inactivity (p for trend < 0.001) were inversely related to being superheroes. People not smoking (adjusted odds ratio, aOR = 1.40), alcohol abstainers (aOR = 1.30), and those free from feelings of hopelessness (aOR = 5.92) more frequently met the definition of superheroes. During COVID-19 pandemic, the proportion of superheroes decreased by 16.3%. CONCLUSIONS Differences in the older adults' health status are largely attributable to their lifestyles but are also likely due to gender, educational, and socio-economic disparities, which should be properly addressed by public health policies.
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Affiliation(s)
- Silvano Gallus
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Giansanto Mosconi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Chiara Stival
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Guido Bertolini
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Tiziana Fanucchi
- Unit of Health Promotion, Epidemiology, and Government of Territorial Demand, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Licia Iacoviello
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Alessandra Lugo
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Giacomo P Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, 27100, Pavia, Italy
| | | | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
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8
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Vigezzi GP, Bertuccio P, Amerio A, Bottini G, Gandola M, Cavalieri d'Oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Grandparenting during pandemic times: pros and cons for mental health. J Public Health (Oxf) 2023; 45:816-821. [PMID: 37632408 DOI: 10.1093/pubmed/fdad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/02/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and associated lockdown measures posed an unprecedented challenge to the crucial role of grandparenting in family-oriented cultures, such as Italy. Reduced contact with grandchildren during this period potentially threatened grandparents' mental health and well-being. METHODS We analysed data from the LOckdown and lifeSTyles in Lombardia cross-sectional study conducted in November 2020. The study included a representative sample of 4400 older adults from Lombardy, Italy, of which 1289 provided childcare to their grandchildren. RESULTS A decrease in self-reported grandparenting was associated with an increased likelihood of experiencing depressive symptoms among grandparents (OR 1.50, 95% CI 1.01-2.24). Conversely, an increase in grandparenting was linked to poorer sleep quality (OR 11.67, 95% CI 5.88-23.17) and reduced sleep quantity (OR 2.53, 95% CI 1.45-4.41). CONCLUSIONS Despite the barriers posed by the pandemic, grandparenting played a beneficial role in maintaining the mental health and well-being of older adults. However, it is crucial to recognise specific vulnerabilities, such as gender, feelings of hopelessness and overcrowding, which can have detrimental effects during and beyond emergency situations. Careful attention to these factors is essential for developing targeted support systems and interventions aimed at safeguarding the mental health of older adults and enhancing their resilience in crises.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
- PhD Programme in Psychology, Neuroscience and Data Science, Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, 20162 Milan, Italy
| | - Martina Gandola
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, 20162 Milan, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, 21100 Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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9
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Galasso V, Pons V, Profeta P, McKee M, Stuckler D, Becher M, Brouard S, Foucault M. Addressing vaccine hesitancy: experimental evidence from nine high-income countries during the COVID-19 pandemic. BMJ Glob Health 2023; 8:e012658. [PMID: 37739450 PMCID: PMC10533725 DOI: 10.1136/bmjgh-2023-012658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
We study the impact of public health messages on intentions to vaccinate and vaccination uptakes, especially among hesitant groups. We performed an experiment comparing the effects of egoistic and altruistic messages on COVID-19 vaccine intentions and behaviour. We administered different messages at random in a survey of 6379 adults in December 2020, following up with participants in the nationally representative survey Citizens' Attitudes Under COVID-19 Project covering nine high-income countries (Australia, Austria, France, Germany, Italy, New Zealand, Sweden, the UK and the USA). Four alternative interventions were tested, based on narratives of (1) self-protection, (2) protecting others, (3) reducing health risks and (4) economic protection. We measure vaccination intentions in the December 2020 survey and elicit actual vaccination behaviour by respondents in the June/July 2021 survey. Messages conveying self-protection had no effect on vaccine intentions but altruistic messages, emphasising protecting other individuals (0.022, 95% CI -0.004 to 0.048), population health (0.030, 95% CI 0.003 to 0.056) and the economy (0.038, 95% CI 0.013 to 0.064) had substantially stronger effects. These effects were stronger in countries experiencing high COVID-19 mortality (Austria, France, Italy, Sweden, the UK and the USA), where health risks may have been more salient, but weaker and, in several cases, not significant where mortality was low (Australia, Germany and New Zealand). On follow-up at 6 months, these brief communication interventions corresponded to substantially higher vaccination uptake. Our experiments found that commonly employed narratives around self-protection had no effect. However, altruistic messages about protecting individuals, population health and the economy had substantially positive and enduring effects on increasing vaccination intentions. Our results can help structure communication campaigns during pandemics and are likely to generalise to other vaccine-preventable epidemics.
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Affiliation(s)
- Vincenzo Galasso
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Vincent Pons
- Harvard Business School, Boston, Massachusetts, USA
| | - Paola Profeta
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Michael Becher
- School of Politics, Economics, and Global Affairs, IE University, Madrid, Spain
| | - Sylvain Brouard
- Centre de recherches politiques (CEVIPOF), Sciences Po, Paris, France
| | - Martial Foucault
- Centre de recherches politiques (CEVIPOF), Sciences Po, Paris, France
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McNamara CL, Kotzias V, Bambra C, Labonté R, Stuckler D. Have COVID-19 Stimulus Packages Mitigated the Negative Health Impacts of Pandemic-Related Job Losses? A Systematic Review of Global Evidence from the First Year of the Pandemic. Int J Soc Determinants Health Health Serv 2023; 53:311-322. [PMID: 37272269 PMCID: PMC10243096 DOI: 10.1177/27551938231176374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/06/2023]
Abstract
Social protection can buffer the negative impacts of unemployment on health. Have stimulus packages introduced during the COVID-19 pandemic mitigated potential harms to health from unemployment? We performed a systematic review of the health effects of job loss during the first year of the pandemic. We searched three electronic databases and identified 49 studies for inclusion. Three United States-based studies found that stimulus programs mitigated the impact of job loss on food security and mental health. Furloughs additionally appeared to reduce negative impacts when they were paid. However, despite the implementation of large-scale stimulus packages to reduce economic harms, we observed a clear pattern that job losses were nevertheless significantly associated with negative impacts, particularly on mental health, quality of life, and food security. We also observe suggestive evidence that COVID-related job loss was associated with child maltreatment, worsening dental health, and poor chronic disease outcomes. Overall, although we did find evidence that income-support policies appeared to help protect people from the negative health consequences of pandemic-related job loss, they were not sufficient to fully offset the threats to health. Future research should ascertain how to ensure adequate access to and generosity of social protection programs during epidemics and economic downturns.
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Affiliation(s)
- Courtney L. McNamara
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Centre for Global Health Inequalities Research (CHAIN). Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Virginia Kotzias
- Centre for Global Health Inequalities Research (CHAIN). Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Centre for Global Health Inequalities Research (CHAIN). Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Department of Social & Political Sciences, Bocconi University, Milano, Italy
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11
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Atli Gunnarsson J, Ruskin G, Stuckler D, Steele S. Big food and drink sponsorship of conferences and speakers: a case study of one multinational company's influence over knowledge dissemination and professional engagement. Public Health Nutr 2023; 26:1094-1111. [PMID: 36450363 PMCID: PMC10346015 DOI: 10.1017/s1368980022002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/26/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Research identifies that multinational corporations, including The Coca-Cola Company ('Coca-Cola'), seek to influence public health research and policy through scientific events, such as academic and professional conferences. This study aims to understand how different forms of funding and sponsorship impact the relationship between Coca-Cola, academic institutions, public health organisations, academics and researchers. DESIGN The study was conducted using Freedom of Information (FOI) requests and systematic website searches. SETTING Data were collected by twenty-two FOI requests to institutions in the USA and UK, resulting in the disclosure of 11 488 pages, including emails and attachments relating to 239 events between 2009 and 2018. We used the Wayback Machine to review historical website data to evaluate evidence from 151 available official conference websites. PARTICIPANTS N/A. RESULTS Documents suggest that Coca-Cola provides direct financial support to institutions and organisations hosting events in exchange for benefits, including influence over proceedings. Coca-Cola also provided direct financial support to speakers and researchers, sometimes conditional on media interviews. Also, indirect financial support passed through Coca-Cola-financed non-profits. Often, such financial support was not readily identifiable, and third-party involvement further concealed Coca-Cola funding. CONCLUSION Coca-Cola exerts direct influence on academic institutions and organisations that convene major public health conferences and events. These events offer Coca-Cola a vehicle for its messaging and amplifying viewpoints favourable to Coca-Cola's interests. Such corporate-sponsored events should be viewed as instruments of industry marketing. Stronger rules and safeguards are needed to prevent hidden industry influence, such as complete disclosure of all corporate contributions for public health conferences and their speakers.
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Affiliation(s)
| | - Gary Ruskin
- U.S. Right to Know, Oakland, California, USA
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
- Intellectual Forum, Jesus College, Cambridge, UK
| | - Sarah Steele
- Intellectual Forum, Jesus College, Cambridge, UK
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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12
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McKee M, Parbst M, Stuckler D. Looking Back: Does Social Capital Still Matter for Health? Revisiting Pearce and Davey Smith 20 Years On. Am J Public Health 2023; 113:609-611. [PMID: 37079873 DOI: 10.2105/ajph.2023.307292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Martin McKee
- Martin McKee is with the London School of Hygiene & Tropical Medicine, London, UK. Matthew Parbst is with the University of Toronto, Toronto, Canada. David Stuckler is with the University of Bocconi, Milan, Italy
| | - Matthew Parbst
- Martin McKee is with the London School of Hygiene & Tropical Medicine, London, UK. Matthew Parbst is with the University of Toronto, Toronto, Canada. David Stuckler is with the University of Bocconi, Milan, Italy
| | - David Stuckler
- Martin McKee is with the London School of Hygiene & Tropical Medicine, London, UK. Matthew Parbst is with the University of Toronto, Toronto, Canada. David Stuckler is with the University of Bocconi, Milan, Italy
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13
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Kentikelenis A, Ghaffar A, McKee M, Dal Zennaro L, Stuckler D. Global financing for health policy and systems research: a review of funding opportunities. Health Policy Plan 2023; 38:409-416. [PMID: 36546732 PMCID: PMC10019567 DOI: 10.1093/heapol/czac109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Health policy and systems research (HPSR) is a neglected area in global health financing. Despite repeated calls for greater investment, it seems that there has been little growth. We analysed trends in reported funding and activity between 2015 and 2021 using a novel real-time source of global health data, the Devex.com database, the world's largest source of funding opportunities related to international development. We performed a systematic search of the Devex.com database for HPSR-related terms with a focus on low- and middle-income countries. We included 'programs', 'tenders & grants' and 'contract awards', covering all call statuses (open, closed or forecast). Such funding opportunities were included if they were related specifically to HPSR funding or had an HPSR component; pure biomedical funding was excluded. Our findings reveal a relative neglect of HPSR, as only ∼2% of all global health funding calls included a discernible HPSR component. Despite increases in funding calls until 2019, this situation reversed in 2020, likely reflecting the redirection of resources to rapid assessments of the impacts of the coronavirus disease 2019 (COVID-19) pandemic. Most identified projects represented small-scale opportunities-commonly for consultancies or technical assistance. To the extent that new data were generated, these projects were either tied to a specific large intervention or were narrow in scope to meet a specific challenge-with many examples informing policy responses to the Covid-19 pandemic. Nearly half of advertised funding opportunities were multi-country projects, usually addressing global policy priorities like health systems strengthening or development of coordinated public health policies at a regional level. The Covid-19 pandemic has shown why investing in HPSR is more important than ever to enable the delivery of effective health interventions and avoid costly implementation failures. The evidence presented here highlights the need to scale up efforts to convince global health funders to institutionalize the inclusion of HPSR components in all funding calls.
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Affiliation(s)
- Alexander Kentikelenis
- Department of Social and Political Sciences, Bocconi University, via Roentgen 1, Milan 20136, Italy
| | | | - Martin McKee
- *Corresponding author. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, via Roentgen 1, Milan 20136, Italy
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14
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Amerio A, Stival C, Lugo A, Fanucchi T, d'Oro LC, Iacoviello L, Odone A, Stuckler D, Zucchi A, Serafini G, Gallus S, Jarach CM, Santucci C, Amore M, De Sena R, Ghislandi S, Wang Y, Bonaccio M, Gianfagna F, Signorelli C, Mosconi G, Vigezzi GP, Rognoni M, Paroni L, Ciampichini R. COVID-19 pandemic impact on mental health in a large representative sample of older adults from the Lombardy region, Italy. J Affect Disord 2023; 325:282-288. [PMID: 36627059 PMCID: PMC9824954 DOI: 10.1016/j.jad.2023.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/26/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aimed to assess the prevalence of depressive and anxiety symptoms, hopelessness and insomnia in the older adults before and during the COVID-19 pandemic identifying subgroups at higher risk of mental distress. METHODS Within the Lost in Lombardy project, a web-based cross-sectional study was conducted on a representative sample of 4400 older adults aged 65 years or more from the Lombardy region recruited between November 17th and 30th 2020. RESULTS The prevalence of depressive symptoms increased by +112 % during the pandemic, anxiety symptoms by +136 %, insufficient sleep by +12 %, unsatisfactory sleep by +15 %. Feelings of hopelessness were more frequent among women compared to men and increased with increasing age. A worsening in each of the four specific mental health outcomes was more frequently observed in women (OR = 1.50, depression; OR = 1.31, anxiety; OR = 1.57, sleep quality; OR = 1.38, sleep quantity), in subjects who decreased their physical activity during the pandemic (OR = 1.64, depression; OR = 1.48, anxiety; OR = 2.05, sleep quality; OR = 1.28, sleep quantity), and with increasing number of pre-existing chronic diseases. The use of at least one psychotropic drug - mostly antidepressants/anxiolytics - increased by +26 % compared to pre-pandemic. LIMITATIONS Pre-pandemic symptoms were retrospectively reported during the Covid pandemic. Potential information and recall bias should not be ruled out. CONCLUSIONS If confirmed by future longitudinal studies, our findings could support evidence-based health and welfare policies on responding to this pandemic and on how to promote mental health and wellbeing, should future waves of infection emerge.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Tiziana Fanucchi
- SOD Alcologia - Centro Alcologico Regionale Toscano, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | | | - Licia Iacoviello
- School of Medicine, University of Insubria, Varese, Italy; IRCCS Neuromed, Pozzilli, Italy.
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy.
| | | | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - the “LOST in Lombardia” Study InvestigatorsBosettiCristina1JarachCarlotta Micaela1SantucciClaudia1AmoreMario23De SenaRoberto4GhislandiSimone4WangYuxi4BonaccioMarialaura56GianfagnaFrancesco56SignorelliCarlo7MosconiGiansanto8VigezziGiacomo Pietro8RognoniMagda9ParoniLuca9CiampichiniRoberta10Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, ItalyIRCCS Ospedale Policlinico San Martino, Genoa, ItalyDepartment of Social Sciences and Politics, Bocconi University, Milan, ItalySchool of Medicine, University of Insubria, Varese, ItalyIRCCS Neuromed, Pozzilli, ItalySchool of Medicine, Vita-Salute San Raffaele University, Milan, ItalyDepartment of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, ItalyATS Brianza, Monza, ItalyATS Bergamo, Bergamo, Italy
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15
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Bakola M, Peritogiannis V, Stuckler D, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Who is coercively admitted to psychiatric wards? Epidemiological analysis of inpatient records of involuntary psychiatric admissions to a University General Hospital in Greece for the years 2008-2017. Int J Soc Psychiatry 2023; 69:267-276. [PMID: 35232289 DOI: 10.1177/00207640221081793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.
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Affiliation(s)
- Maria Bakola
- Postgraduate Program of Public Health, Medical School, University of Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - David Stuckler
- Department of Social and Political Sciences, University of Bocconi, Milan, Italy
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Greece
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16
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Serrano-Alarcón M, Wang Y, Kentikelenis A, Mckee M, Stuckler D. The far-right and anti-vaccine attitudes: lessons from Spain's mass COVID-19 vaccine roll-out. Eur J Public Health 2023; 33:215-221. [PMID: 36655519 PMCID: PMC10066477 DOI: 10.1093/eurpub/ckac173] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Far-right politicians in several countries have been vocal opponents of COVID-19 vaccination. But can this threaten vaccine roll-out? METHODS We take advantage of repeated cross-sectional surveys with samples of around 3800 individuals across Spain conducted monthly from December 2020 to January 2022 (n = 51 294) to examine any association between far-right politics and vaccine hesitancy through the whole vaccine roll-out. RESULTS Consistent with prior data, we found that far-right supporters were almost twice as likely to be vaccine-hesitant than the overall population in December 2020, before vaccines became available. However, with a successful vaccine roll out, this difference shrank, reaching non-significance by September 2021. From October 2021, however, vaccine hesitancy rebounded among this group at a time when the leadership of the far-right promoted a 'freedom of choice' discourse common among anti-vax supporters. By the latest month analysed (January 2022), far-right voters had returned to being twice as likely to be vaccine-hesitant and 7 percentage points less likely to be vaccinated than the general population. CONCLUSIONS Our results are consistent with evidence that far-right politicians can encourage vaccine hesitancy. Nonetheless, we show that public attitudes towards vaccination are not immutable. Whereas a rapid and effective vaccine rollout can help to overcome the resistance of far-right voters to get vaccinated, they also seem to be susceptible to their party leader's discourse on vaccines.
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Affiliation(s)
- Manuel Serrano-Alarcón
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Yuxi Wang
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Alexander Kentikelenis
- Department of Social & Political Sciences, Bocconi University, Milan, Italy.,Centre for Business Research, University of Cambridge, Cambridge, UK
| | - Martin Mckee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - David Stuckler
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy.,Department of Social & Political Sciences, Bocconi University, Milan, Italy
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17
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Nour N, Stuckler D, Ajayi O, Abdalla ME. Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review. BMC Med Educ 2023; 23:18. [PMID: 36631816 PMCID: PMC9835212 DOI: 10.1186/s12909-022-03899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is increasing recognition of including social determinants of health (SDOH) in teaching for future doctors. However, the educational methods and the extent of integration into the curriculum vary considerably-this scoping review is aimed at how SDOH has been introduced into medical schools' curricula. METHODS A systematic search was performed of six electronic databases, including PubMed, Education Source, Scopus, OVID (Medline), APA Psych Info, and ERIC. Articles were excluded if they did not cover the SDOH curriculum for medical students; were based on service-learning rather than didactic content; were pilot courses, or were not in English, leaving eight articles in the final study. RESULTS The initial search yielded 654 articles after removing duplicates. In the first screening step, 588 articles were excluded after applying inclusion and exclusion criteria and quality assessment; we examined 66 articles, a total of eight included in the study. There was considerable heterogeneity in the content, structure and duration of SDOH curricula. Of the eight included studies, six were in the United States(U.S.), one in the United Kingdom (U.K.) and one in Israel. Four main conceptual frameworks were invoked: the U.S. Healthy People 2020, two World Health Organisation frameworks (The Life Course and the Michael Marmot's Social Determinants of Health), and the National Academic of Science, Engineering, and Medicine's (Framework For educating Health Professionals to Address the Social Determinants of Health). In general, programs that lasted longer appeared to perform better than shorter-duration programmes. Students favoured interactive, experiential-learning teaching methods over the traditional classroom-based teaching methods. CONCLUSION The incorporation of well-structured SDOH curricula capturing both local specification and a global framework, combined with a combination of traditional and interactive teaching methods over extended periods, may be helpful in steps for creating lifelong learners and socially accountable medical school education.
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Affiliation(s)
- Nehal Nour
- School of Medicine, University of Limerick, Faculty of Education & Health Services, Garraun, Castletroy, V94 T9PX, Co. Limerick, Ireland.
| | - David Stuckler
- Dondena Center for Research On Social Dynamics and Department of Social & Political Sciences, Bocconi University, 4 Via Roentgen 20136, Milan, Italy
| | - Oluwatobi Ajayi
- School of Medicine, University of Limerick, Faculty of Education & Health Services, Garraun, Castletroy, V94 T9PX, Co. Limerick, Ireland
| | - Mohamed Elhassan Abdalla
- School of Medicine, University of Limerick, Faculty of Education & Health Services, Garraun, Castletroy, V94 T9PX, Co. Limerick, Ireland
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18
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Kentikelenis A, Ghaffar A, McKee M, Dal Zennaro L, Stuckler D. Donor support for Health Policy and Systems Research: barriers to financing and opportunities for overcoming them. Global Health 2022; 18:106. [PMID: 36564847 PMCID: PMC9782264 DOI: 10.1186/s12992-022-00896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The vast investments that have been made in recent decades in new medicines, vaccines, and technologies will only lead to improvements in health if there are appropriate and well-functioning health systems to make use of them. However, despite the growing acceptance by major global donors of the importance of health systems, there is an enthusiasm gap when it comes to disbursing funds needed to understand the intricacies of how, why and when these systems deliver effective interventions. To understand the reasons behind this, we open up the black box of donor decision-making vis-à-vis Health Policy and Systems Research (HPSR) financing: what are the organizational processes behind the support for HPSR, and what are the barriers to increasing engagement? METHODS We conducted 27 semi-structured interviews with staff of major global health funders, asking them about four key issues: motivations for HPSR financing; priorities in HPSR financing; barriers for increasing HPSR allocations; and challenges or opportunities for the future. We transcribed the interviews and manually coded responses. RESULTS Our findings point to the growing appreciation that funders have of HPSR, even though it is often still seen as an 'afterthought' to larger programmatic interventions. In identifying barriers to funding HPSR, our informants emphasised the perceived lack of mandate and capacities of their organizations. For most funding organisations, a major barrier was that their leadership often voiced scepticism about HPSR's long time horizons and limited ability to quantify results. CONCLUSION Meeting contemporary health challenges requires strong and effective health systems. By allocating more resources to HPSR, global donors can improve the quality of their interventions, and also contribute to building up a stock of knowledge that domestic policymakers and other funders can draw on to develop better targeted programmes and policies.
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Affiliation(s)
- Alexander Kentikelenis
- Department of Social and Political Sciences, Bocconi University, via Roentgen 1, 20136, Milano, Italy.
| | - Abdul Ghaffar
- grid.3575.40000000121633745Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK
| | - Livia Dal Zennaro
- grid.3575.40000000121633745Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - David Stuckler
- grid.7945.f0000 0001 2165 6939Department of Social and Political Sciences, Bocconi University, via Roentgen 1, 20136 Milano, Italy
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19
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Hernandez Carballo I, Bakola M, Stuckler D. The impact of air pollution on COVID-19 incidence, severity, and mortality: A systematic review of studies in Europe and North America. Environ Res 2022; 215:114155. [PMID: 36030916 PMCID: PMC9420033 DOI: 10.1016/j.envres.2022.114155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality. OBJECTIVES We systematically reviewed studies investigating the relationship between air pollution and COVID-19 cases, non-fatal severity, and mortality in North America and Europe. METHODS We searched PubMed, Web of Science, and Scopus for studies investigating the effects of harmful pollutants, including particulate matter with diameter ≤2.5 or 10 μm (PM2.5 or PM10), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2) and carbon monoxide (CO), on COVID-19 cases, severity, and deaths in Europe and North America through to June 19, 2021. Articles were included if they quantitatively measured the relationship between exposure to air pollution and COVID-19 health outcomes. RESULTS From 2,482 articles screened, we included 116 studies reporting 355 separate pollutant-COVID-19 estimates. Approximately half of all evaluations on incidence were positive and significant associations (52.7%); for mortality the corresponding figure was similar (48.1%), while for non-fatal severity this figure was lower (41.2%). Longer-term exposure to pollutants appeared more likely to be positively associated with COVID-19 incidence (63.8%). PM2.5, PM10, O3, NO2, and CO were most strongly positively associated with COVID-19 incidence, while PM2.5 and NO2 with COVID-19 deaths. All studies were observational and most exhibited high risk of confounding and outcome measurement bias. DISCUSSION Air pollution may be associated with worse COVID-19 outcomes. Future research is needed to better test the air pollution-COVID-19 hypothesis, particularly using more robust study designs and COVID-19 measures that are less prone to measurement error and by considering co-pollutant interactions.
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Affiliation(s)
- Ireri Hernandez Carballo
- Department of Social and Political Sciences, Bocconi University, Milan, Lombardy, Italy; RFF-CMCC European Institute of Economics and the Environment, Centro Euro-Mediterraneo Sui Cambiamenti Climatici, Milan, Lombardy, Italy.
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Lombardy, Italy; DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Lombardy, Italy
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20
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Santoso C, Stuckler D, Ihle A. Investigating longitudinal associations of hair cortisol and cortisone with cognitive functioning and dementia. Sci Rep 2022; 12:20642. [PMID: 36450857 PMCID: PMC9712516 DOI: 10.1038/s41598-022-25143-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
We rigorously investigated potential longitudinal associations of hair cortisol and cortisone with verbal memory, time orientation, and dementia, adjusting for sociodemographic and health confounders. Data from the English Longitudinal Study of Ageing wave 6-9 (6-year follow-up, covering 4399 persons aged 50+) were analysed using linear random effects and cox regression models. In unadjusted models, hair cortisol was associated with worsened verbal memory (β 0.19; SE 0.08), but not with time orientation (β 0.02; SE 0.01), or dementia (β 0.07; SE 0.16). Hair cortisone was associated with worsened verbal memory (β 0.74; SE 0.14) and time orientation (β 0.06; SE 0.02), but not with dementia (β 0.47; SE 0.28). However, in the fully adjusted models, neither hair cortisol nor cortisone was associated with verbal memory, time orientation, or dementia. Consistent with prior studies, we found that more advanced age was associated with worsened verbal memory (β 0.15; SE 0.01), time orientation (β 0.01; SE 0.00), and dementia risk (β 0.11; SE 0.02). Our rigorous analyses did not detect robust associations of neither hair cortisol nor cortisone with cognitive functioning or dementia across 6 years. More detailed insights into potential mechanisms are discussed.
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Affiliation(s)
- Cornelia Santoso
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| | - David Stuckler
- grid.7945.f0000 0001 2165 6939Dondena Centre for Research On Social Dynamics, Bocconi University, Milan, Italy
| | - Andreas Ihle
- grid.8591.50000 0001 2322 4988Department of Psychology, University of Geneva, 1205 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland ,grid.425888.b0000 0001 1957 0992Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
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21
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Meckawy R, Stuckler D, Mehta A, Al-Ahdal T, Doebbeling BN. Effectiveness of early warning systems in the detection of infectious diseases outbreaks: a systematic review. BMC Public Health 2022; 22:2216. [PMCID: PMC9707072 DOI: 10.1186/s12889-022-14625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Global pandemics have occurred with increasing frequency over the past decade reflecting the sub-optimum operationalization of surveillance systems handling human health data. Despite the wide array of current surveillance methods, their effectiveness varies with multiple factors. Here, we perform a systematic review of the effectiveness of alternative infectious diseases Early Warning Systems (EWSs) with a focus on the surveillance data collection methods, and taking into consideration feasibility in different settings.
Methods
We searched PubMed and Scopus databases on 21 October 2022. Articles were included if they covered the implementation of an early warning system and evaluated infectious diseases outbreaks that had potential to become pandemics. Of 1669 studies screened, 68 were included in the final sample. We performed quality assessment using an adapted CASP Checklist.
Results
Of the 68 articles included, 42 articles found EWSs successfully functioned independently as surveillance systems for pandemic-wide infectious diseases outbreaks, and 16 studies reported EWSs to have contributing surveillance features through complementary roles. Chief complaints from emergency departments’ data is an effective EWS but it requires standardized formats across hospitals. Centralized Public Health records-based EWSs facilitate information sharing; however, they rely on clinicians’ reporting of cases. Facilitated reporting by remote health settings and rapid alarm transmission are key advantages of Web-based EWSs. Pharmaceutical sales and laboratory results did not prove solo effectiveness. The EWS design combining surveillance data from both health records and staff was very successful. Also, daily surveillance data notification was the most successful and accepted enhancement strategy especially during mass gathering events. Eventually, in Low Middle Income Countries, working to improve and enhance existing systems was more critical than implementing new Syndromic Surveillance approaches.
Conclusions
Our study was able to evaluate the effectiveness of Early Warning Systems in different contexts and resource settings based on the EWSs’ method of data collection. There is consistent evidence that EWSs compiling pre-diagnosis data are more proactive to detect outbreaks. However, the fact that Syndromic Surveillance Systems (SSS) are more proactive than diagnostic disease surveillance should not be taken as an effective clue for outbreaks detection.
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22
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Affiliation(s)
- Yuxi Wang
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
| | | | | | - Deepti Gurdasani
- The William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University, London
| | | | - Mohammed Abba-Aji
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
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23
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Bertuccio P, Vigezzi GP, Signorelli C, Zucchi A, Cavalieri d'Oro L, Stuckler D, Iacoviello L, Gallus S, Odone A. Healthcare services access during the COVID-19 pandemic among older people. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The COVID-19 pandemic strongly impacted older people, not only in terms of clinical outcome but also in care provision. Investigating trends of changes in healthcare services access among older subjects during the pandemic, along with studying potential determinants, is of utmost interest to identify the most at-risk individuals. We used data from LOST in Lombardia, a cross-sectional study conducted on a representative sample of 4,400 older adults (aged 65 or more) in autumn 2020. Data were collected about lifestyles, mental health, and access to healthcare services before and during the pandemic. To investigate potential determinants of changes in healthcare access, we presented prevalence ratios (PRs) estimated through multivariable log-binomial regression models. Twenty-one per cent of the participants increased telephone contacts with general practitioner (GP), 9.6% specialist visits for a fee, while 22.4% decreased GP visits, 7.5% ED access, 6% hospitalisations, 12.3% outpatient visits, 9.1% diagnostic exams. The prevalence of the cancellation or delay of medical appointments by the patient's decision was 23.8%, with higher proportions among men, among individuals aged 75 or over as compared to those aged 65-74, and among individuals with a higher self-reported economic status (p-value<0.05). People with comorbidities more frequently cancelled or postponed visits, reduced ED access or hospitalisations. Moreover, individuals with worsened mental health status showed a higher prevalence to cancel or delay visits and to reduce ED access. The decrease in healthcare provision and consultations could result in mortality and morbidity excess. Our results should inform targeted intervention to bridge the gaps and overcome the health inequalities that the pandemic has deepened. Exploring the underlying reasons and determinants for healthcare avoiding or delaying among the most vulnerable groups is crucial for epidemic preparedness and planning future interventions.
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Affiliation(s)
- P Bertuccio
- Department of Public Health, University of Pavia , Pavia, Italy
| | - GP Vigezzi
- Department of Public Health, University of Pavia , Pavia, Italy
- Ca’ della Paglia College, Ghislieri Foundation , Pavia, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | | | - D Stuckler
- Department of Social Sciences and Politics, Bocconi University , Milan, Italy
| | - L Iacoviello
- EPIMED, Insubria University , Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
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24
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Mosconi G, Stival C, Signorelli C, Amerio A, Cavalieri d'Oro L, Iacoviello L, Stuckler D, Zucchi A, Odone A, Gallus S. Assessing determinants of SARS-CoV-2 infection in a large older adult representative sample. Eur J Public Health 2022. [PMCID: PMC9594361 DOI: 10.1093/eurpub/ckac129.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Most COVID-19-related deaths occurred in older adults, however to date, evidence on determinants of SARS-CoV-2 infection in this population is limited and mostly based on case series without a comparison group. A telephone-based cross-sectional study was conducted in November 2020 on a representative sample of 4,400 people aged ≥65 years from the Italian region of Lombardy. We determined the prevalence of participants reporting a SARS-CoV-2 infection in the period between the onset of the pandemic and the time of the interview. To investigate the determinants of the infection, we estimated odds ratios (OR) and their corresponding 95% confidence intervals (CI) thorough unconditional multiple logistic models. We further evaluated if the infection was a determinant of a worsening in mental health wellbeing. Overall, 4.9% of participants reported a history of SARS-CoV-2 infection. No significant relationship between sex and infection was observed. SARS-CoV-2 infection was less frequently reported in subjects aged ≥70 (OR = 0.55; 95% 0.41-0.74) compared to 65-69 years. We didn't observe any trend after 70 years of age. Participants reporting at least one chronic condition had a lower infection rate compared to healthy subjects (OR = 0.68 95% CI: 0.49-0.93). Separated/divorced subjects more frequently reported infection than married/cohabiting ones (OR = 2.33 95% CI: 1.29-4.20). Self-reported history of SARS-CoV-2 infection resulted being a determinant of an increase in depressive symptoms (OR = 1.57; 95% CI: 1.17-2.10). In this large study - among the few assessing the determinants of SARS-CoV-2 infection in a representative sample of older adults -, the prevalence of a history of infection in November 2020 approached 5%. We found that persons aged 70 and above and those with chronic conditions, thus individuals with likely less social interactions, were less frequently exposed to SARS-CoV-2 infection.
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Affiliation(s)
- G Mosconi
- Department of Public Health, University of Pavia , Pavia, Italy
| | - C Stival
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
| | - C Signorelli
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - A Amerio
- DINOGMI, University of Genoa , Genoa, Italy
- IRCCS San Martino Polyclinic Hospital , Genoa, Italy
| | | | - L Iacoviello
- EPIMED, Insubria University , Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed , Pozzilli, Italy
| | - D Stuckler
- Department of Social Sciences and Politics, Bocconi University , Milan, Italy
| | - A Zucchi
- Bergamo Health Protection Agency , Bergamo, Italy
| | - A Odone
- Department of Public Health, University of Pavia , Pavia, Italy
- School of Medicine, Vita-Salute San Raffaele University , Milan, Italy
| | - S Gallus
- Department of Environmental Health Sciences, IRCCS Mario Negri Institute for Pharmacologic Research , Milan, Italy
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25
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Vigezzi GP, Bertuccio P, Bossi CB, Amerio A, d'Oro LC, Derosa G, Iacoviello L, Stuckler D, Zucchi A, Lugo A, Gallus S, Odone A. COVID-19 pandemic impact on people with diabetes: results from a large representative sample of Italian older adults. Prim Care Diabetes 2022; 16:650-657. [PMID: 35778238 PMCID: PMC9212916 DOI: 10.1016/j.pcd.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
AIMS Restrictions imposed to prevent SARS-CoV-2 transmission should be weighed against consequences on vulnerable groups' health. Lifestyles and disease management of older people with diabetes might have been differentially impacted compared to non-chronic individuals. METHODS A cross-sectional study (LOST in Lombardia) was conducted on a representative full sample of 4 400 older adults (17th-30th November 2020), collecting data on lifestyles, mental health and access to care before and during the pandemic. RESULTS We compared 947 (51.9%) people with diabetes and 879 (48.1%) healthy subjects reporting no chronic conditions. People with diabetes reported more frequently increased physical activity (odds ratio, OR 2.65, 95% confidence internals, CI 1.69-4.13), drinks/week reduction (OR 6.27, 95%CI 3.59-10.95), increased consumption of fruit (OR 2.06, 95%CI 1.62-2.63), vegetables (OR 1.41, 95%CI 1.10-1.82), fish (OR 2.51, 95%CI 1.74-3.64) and olive oil (OR 3.54, 95%CI 2.30-5.46). People with diabetes increased telephone contacts with general practitioners (OR 3.70, 95%CI 2.83-4.83), hospitalisations (OR 9.01, 95%CI 3.96-20.51), visits and surgeries cancellations (OR 3.37, 95%CI 2.58-4.42) and treatment interruptions (OR 1.95, 95%CI 1.33-2.86). CONCLUSIONS Pandemic adverse effects occurred but are heterogenous in a population with chronic diseases, who seized the opportunity to improve health behaviours, despite health system difficulties guaranteeing routine care, within and beyond COVID-19.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Collegio Ca' della Paglia, Fondazione Ghislieri, Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Camilla Bonfadini Bossi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Centre of Diabetes and Metabolic Diseases, University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Licia Iacoviello
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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26
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Bakola M, Hernandez Carballo I, Jelastopulu E, Stuckler D. The impact of COVID-19 lockdown on air pollution in Europe and North America: a systematic review. Eur J Public Health 2022; 32:962-968. [PMID: 36074061 PMCID: PMC9494388 DOI: 10.1093/eurpub/ckac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple studies report reductions in air pollution associated with COVID-19 lockdowns. METHODS We performed a systematic review of the changes observed in hazardous air pollutants known or suspected to be harmful to health, including nitrogen dioxide (NO2), nitrogen oxides (NOx), carbon monoxide (CO), sulfur dioxide (SO2), ozone (O3) and particulate matter (PM). We searched PubMed and Web of Science for studies reporting the associations of lockdowns with air pollutant changes during the COVID-19 pandemic in Europe and North America. RESULTS One hundred nine studies were identified and analyzed. Several pollutants exhibited marked and sustained reductions. The strongest was NO2 (93% of 89 estimated changes were reductions) followed by CO (88% of 33 estimated pollutant changes). All NOx and benzene studies reported significant reductions although these were based on fewer than 10 estimates. About three-quarters of PM2.5 and PM10 estimates showed reductions and few studies reported increases when domestic fuel use rose during COVID-19 lockdowns. In contrast, O3 levels rose as NOx levels fell. SO2 and ammonia (NH3) had mixed results. In general, greater reductions appeared when lockdowns were more severe, as well as where baseline pollutant levels were higher, such as at low-elevation and in densely populated areas. Substantial and robust reductions in NO2, NO, CO, CO2, PM2.5, PM10, benzene and air quality index pollution occurred in association with COVID-19 lockdowns. O3 levels tended to increase, while SO2 and NH3 had mixed patterns. CONCLUSIONS Our study shows the profound impact of human activity levels on air pollution and its potential avoidability.
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Affiliation(s)
- Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece.,Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - Ireri Hernandez Carballo
- Department of Social and Political Sciences, Bocconi University, Milan, Italy.,RFF-CMCC European Institute of Economics and the Environment, Centro Euro-Mediterraneo sui Cambiamenti Climatici, Milan, Italy
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Patras, Greece
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy.,Department of Social & Political Sciences and Dondena Research Centre, University of Bocconi, Milan, Italy
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27
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Vigezzi GP, Bertuccio P, Amerio A, Bosetti C, Gori D, Cavalieri d’Oro L, Iacoviello L, Stuckler D, Zucchi A, Gallus S, Odone A, Investigators LILP. Older Adults' Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project. Int J Environ Res Public Health 2022; 19:ijerph191811271. [PMID: 36141544 PMCID: PMC9565221 DOI: 10.3390/ijerph191811271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults' changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient's decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05-1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00-1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Collegio Ca’ della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16124 Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Science, University of Bologna, 40126 Bologna, Italy
| | | | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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28
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Bosetti C, Rognoni M, Ciampichini R, Paroni L, Scala M, d'Oro LC, Zucchi A, Amerio A, Iacoviello L, Ghislandi S, Odone A, Stuckler D, Gallus S. A real world analysis of COVID-19 impact on hospitalizations in older adults with chronic conditions from an Italian region. Sci Rep 2022; 12:13704. [PMID: 35962037 PMCID: PMC9374749 DOI: 10.1038/s41598-022-17941-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022] Open
Abstract
Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Bergamo—from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017–2019 and quantified differences using rate ratios (RRs). Overall, in 2017–2019 there were a mean of 374,855 older adults with ≥ 1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017–2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.
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Affiliation(s)
- Cristina Bosetti
- Department of Oncology, Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Magda Rognoni
- Epidemiology Unit, Agenzia per la Tutela della Salute della Brianza, Monza, Italy
| | | | - Luca Paroni
- Epidemiology Unit, Agenzia per la Tutela della Salute della Brianza, Monza, Italy
| | - Marco Scala
- Epidemiology Unit, Agenzia per la Tutela della Salute della Brianza, Monza, Italy
| | - Luca Cavalieri d'Oro
- Epidemiology Unit, Agenzia per la Tutela della Salute della Brianza, Monza, Italy
| | - Alberto Zucchi
- Agenzia per la Tutela della Salute di Bergamo, Bergamo, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, Università di Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Simone Ghislandi
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Eusebio C, Bakola M, Stuckler D. How to Achieve Universal Health Coverage: A Case Study of Uganda Using the Political Process Model Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective". Int J Health Policy Manag 2022; 12:7307. [PMID: 35942962 PMCID: PMC10125088 DOI: 10.34172/ijhpm.2022.7307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
How can resource-deprived countries accelerate progress towards universal health coverage (UHC)? Here we extend the analysis of Nanini and colleagues to investigate a case-study of Uganda, where despite high-level commitments, health system priority and funding has shrunk over the past two decades. We draw on the Stuckler-McKee adapted Political Process model to evaluate three forces for effecting change: reframing the debate; acting on political windows of opportunity; and mobilising resources. Our analysis proposes a series of pragmatic steps from academics, non-governmental organisations, and government officials that can help neutralise the forces that oppose UHC and overcome fragmentation of the pro-UHC movement.
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Affiliation(s)
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - David Stuckler
- Dondena Centre for Research on Social and Population Dynamics, Milan, Italy
- Cergas Centre for Research on Health and Social Care Management, Milan, Italy
- Department of Social & Political Sciences, Bocconi University, Milan, Italy
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30
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Vellakkal S, Khan Z, Alavani H, Fledderjohann J, Stuckler D. Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature. Public Health 2022; 207:73-81. [PMID: 35567826 DOI: 10.1016/j.puhe.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN This study was a systematic review of the literature. METHODS We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.
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Affiliation(s)
- S Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kalyanpur, Uttar Pradesh, India.
| | - Z Khan
- IIPH Bhubaneshwar, Bhubaneshwar, Odisha, India
| | - H Alavani
- Department of Economics and Finance, BITS Pilani, KK Birla Goa Campus, Zuarinagar, Goa, India
| | - J Fledderjohann
- Department of Sociology, Lancaster University, Lancaster, UK
| | - D Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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Koltai J, Raifman J, Bor J, McKee M, Stuckler D. COVID-19 Vaccination and Mental Health: A Difference-In-Difference Analysis of the Understanding America Study. Am J Prev Med 2022; 62:679-687. [PMID: 35012830 PMCID: PMC8674498 DOI: 10.1016/j.amepre.2021.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/17/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Mental health problems increased during the COVID-19 pandemic. The knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. This study tests whether psychological distress declined in those vaccinated against COVID-19 in the U.S. and whether changes in anticipatory fears mediated any association. METHODS A nationally representative cohort of U.S. adults (N=8,090) in the Understanding America Study were interviewed regularly from March 2020 to June 2021 (28 waves). Difference-in-differences regression tested whether vaccination reduced distress (Patient Health Questionnaire 4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death. RESULTS Vaccination was associated with a 0.04-SD decline in distress (95% CI= -0.07, -0.02). Vaccination was associated with a 7.77-percentage point reduction in perceived risk of infection (95% CI= -8.62, -6.92), a 6.91-point reduction in perceived risk of hospitalization (95% CI= -7.72, -6.10), and a 4.68-point reduction in perceived risk of death (95% CI= -5.32, -4.04). Including risk perceptions decreased the vaccination-distress association by 25%. Event study models suggest that vaccinated and never vaccinated respondents followed similar Patient Health Questionnaire 4 trends before vaccination, diverging significantly after vaccination. Analyses were robust to individual and wave fixed effects and time-varying controls. The effect of vaccination on distress varied by race/ethnicity, with the largest declines observed among American Indian and Alaska Native individuals (β= -0.20, p<0.05, 95% CI= -0.36, -0.03). CONCLUSIONS COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of receiving the COVID-19 vaccine.
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Affiliation(s)
- Jonathan Koltai
- Department of Sociology, University of New Hampshire, Durham, New Hampshire.
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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Wang Y, Lugo A, Amerio A, d'Oro LC, Iacoviello L, Odone A, Zucchi A, Gallus S, Stuckler D. The Impact of COVID-19 Lockdown Announcements on Mental Health: Quasi-Natural Experiment in Lombardy, Italy. Eur J Public Health 2022; 32:488-493. [PMID: 35412581 PMCID: PMC9159307 DOI: 10.1093/eurpub/ckac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Evidence showed that mental health problems have risen markedly during COVID-19. It is unclear if part of the mental sufferings relates to the climate of uncertainty and confusion originated from rough communication by health officials and politicians. Here, we test the impact of unanticipated policy announcements of lockdown policies on mental health of the older population. Methods We used a representative telephone-based survey of 4400 people aged 65 years or older in Italy’s Lombardy region to compare information on self-reported symptoms of anxiety, depression and poor-quality sleep of subjects interviewed on the days of the policy announcement with that of subjects interviewed on other days. We used regression models adjusting for potential socio-demographic confounders as well study design with inverse probability weighting. Results On days when policymakers announced to extend the lockdown, mental health deteriorated on average by 5.5 percentage points [95% confidence interval (CI): 1.1–9.8] for self-reported anxiety symptoms and 5.1 percentage points (95% CI: 2.7–7.4) for self-reported depressive symptoms. The effect of the announcement to shorten the lockdown is more moderate but statistically significant. These associations were short term in duration; after just 1 day, self-reported mental health and sleep quality return to levels better than pre-announcement until a new policy change. Conclusions Our research shows that lockdown policy announcements are associated with short-term worsening in mental distress, highlighting the importance of appropriate communication strategies and political determinations in crisis times.
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Affiliation(s)
- Yuxi Wang
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Italy, Genoa.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Cavalieri d'Oro
- Epidemiology Unit, Agenzia per la Tutela della Salute -ATS- della Brianza (Local Public Health Authority), Monza, Italy
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Agenzia per la Tutela della Salute-ATS-di Bergamo (Local Public Health Authority), Italy, Bergamo
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Science, Bocconi University, Milan, Italy
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Jarach CM, Lugo A, Stival C, Bosetti C, Amerio A, Cavalieri d'Oro L, Iacoviello L, Odone A, Stuckler D, Zucchi A, van den Brandt P, Garavello W, Cederroth CR, Schlee W, Gallus S. The Impact of COVID-19 Confinement on Tinnitus and Hearing Loss in Older Adults: Data From the LOST in Lombardia Study. Front Neurol 2022; 13:838291. [PMID: 35330807 PMCID: PMC8940241 DOI: 10.3389/fneur.2022.838291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a direct relationship between tinnitus or hearing difficulties and COVID-19 has been suggested, current literature provides inconsistent results, and no research has been undertaken in older adults. Methods In November 2020, we conducted the LOST in Lombardia survey, a telephone-based cross-sectional study on a sample of 4,400 individuals representative of the general population aged ≥65 years from Lombardy region, Northern Italy. Individuals with diagnosed tinnitus and/or hearing loss were asked whether their conditions had improved or deteriorated in 2020 compared to 2019. Results Overall, 8.1% of older adults reported a diagnosis of tinnitus and 10.5% of hearing loss. In 2020 compared to 2019, among individuals with tinnitus, those with increasing severity (5.0%) were similar to those decreasing it (5.3%). Among individuals with hearing loss, more people reported an increase (13.6%) than a decrease (3.2%) in their disease severity. No individual with a diagnosis in 2020 of tinnitus (n = 6) or hearing loss (n = 13) had COVID-19. The incidence of tinnitus was lower in 2020 (rate: 14.8 per 10,000 person-years) than in previous years (rate in 1990–2019: 36.0 per 10,000 person-years; p = 0.026). There was no change in the incidence of hearing loss (p = 0.134). Conclusions In this large representative sample of older adults, on average neither COVID-19 confinement nor SARS-CoV-2 infection appeared to increase the severity or incidence of tinnitus. The increased severity of hearing difficulties may totally or partially be explained by physiologic deterioration of the condition, or by a misperception due to the use of face-masks.
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Affiliation(s)
- Carlotta Micaela Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.,Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | | | - Piet van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Christopher R Cederroth
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Nottingham Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,Division of Clinical Neuroscience, Hearing Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Bonaccio M, Gianfagna F, Stival C, Amerio A, Bosetti C, Cavalieri d’Oro L, Odone A, Stuckler D, Zucchi A, Gallus S, Iacoviello L. Changes in a Mediterranean lifestyle during the COVID-19 pandemic among elderly Italians: an analysis of gender and socioeconomic inequalities in the “LOST in Lombardia” study. Int J Food Sci Nutr 2022; 73:683-692. [DOI: 10.1080/09637486.2022.2040009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Chiara Stival
- Department of Environmental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | | | - Silvano Gallus
- Department of Environmental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Steele S, Sarcevic L, Ruskin G, Stuckler D. Correction to: Confronting potential food industry 'front groups': case study of the international food information Council's nutrition communications using the UCSF food industry documents archive. Global Health 2022; 18:28. [PMID: 35260174 PMCID: PMC8903556 DOI: 10.1186/s12992-022-00824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sarah Steele
- Cambridge Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
| | - Lejla Sarcevic
- Intellectual Forum, Jesus College, Jesus Lane, Cambridge, CB5 8BL, UK
| | - Gary Ruskin
- U.S. Right to Know, 4096 Piedmont Ave. #963, Oakland, CA, 94611, USA
| | - David Stuckler
- Bocconi University, Milan, Italy, and Intellectual Forum, Jesus College, Jesus Lane, Cambridge, CB58BL, UK
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Steele S, Sarcevic L, Ruskin G, Stuckler D. Confronting potential food industry ‘front groups’: case study of the international food information Council’s nutrition communications using the UCSF food industry documents archive. Global Health 2022; 18:16. [PMID: 35151342 PMCID: PMC8841072 DOI: 10.1186/s12992-022-00806-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2022] [Indexed: 01/24/2023] Open
Abstract
Abstract
Background
There are growing concerns that the public’s trust in science is eroding, including concerns that vested interests are corrupting what we know about our food. We know the food industry funds third-party ‘front groups’ to advance its positions and profits. Here we ask whether this is the case with International Food Information Council (IFIC) and its associated Foundation, exploring its motivations and the potential for industry influence on communications around nutritional science.
Method
We systematically searched the University of California San Francisco’s Food Industry Documents Archive, for all documents pertaining to IFIC, which were then thematically evaluated against a science-communication influence model.
Results
We identified 75 documents which evidence that prominent individuals with long careers in the food industry view IFIC as designed to: 1) advance industry public relations goals; 2) amplify the messages of industry-funded research organizations; and 3) place industry approved experts before the press and media, in ways that conceal industry input. We observed that there were in some cases efforts made to conceal and dilute industry links associated with IFIC from the public’s view.
Discussion
Instances suggesting IFIC communicates content produced by industry, and other industry-funded organisations like ILSI, give rise to concerns about vested interests going undetected in its outputs. IFIC’s deployment to take on so-called “hard-hitting issues” for industry, summating evidence, while countering evidence that industry opposes, give rise to concerns about IFIC’s purported neutrality. IFIC’s role in coordinating and placing industry allies in online and traditional press outlets, to overcome industry’s global scientific, legislative, regulatory and public relations challenges, leads also to concerns about it thwarting effective public health and safety measures.
Conclusions
IFIC’s promotion of evidence for the food industry should be interpreted as marketing strategy for those funders. Effective science communication may be obfuscated by undeclared conflicts of interests.
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Galofré-Vilà G, McKee M, Gómez-León M, Stuckler D. The 1918 Influenza Pandemic and the Rise of Italian Fascism: A Cross-City Quantitative and Historical Text Qualitative Analysis. Am J Public Health 2022; 112:242-247. [PMID: 35080961 PMCID: PMC8802602 DOI: 10.2105/ajph.2021.306574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/04/2022]
Abstract
Evidence linking past experiences of worsening health with support for radical political views has generated concerns about the consequences of the COVID-19 pandemic. The influenza pandemic that began in 1918 had a devastating health impact: 4.1 million Italians contracted influenza and about 500 000 died. We tested the hypothesis that deaths from the 1918 influenza pandemic contributed to the rise of Fascism in Italy. To provide a "thicker" interpretation of these patterns, we applied historical text mining to the newspaper Il Popolo d'Italia (Mussolini's newspaper). Our observations were consistent with evidence from other contexts that worsening mortality rates can fuel radical politics. Unequal impacts of pandemics may contribute to political polarization. (Am J Public Health. 2022;112(2):242-247. https://doi.org/10.2105/AJPH.2021.306574).
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Affiliation(s)
- Gregori Galofré-Vilà
- Gregori Galofré-Vilà is with the Department of Economics, Universidad Pública de Navarra, Pamplona, Spain. Martin McKee is with the London School of Hygiene and Tropical Medicine, London, UK. María Gómez-León is with the Department of Economic Analysis, Universitat de València, València, Spain. David Stuckler is with the Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Martin McKee
- Gregori Galofré-Vilà is with the Department of Economics, Universidad Pública de Navarra, Pamplona, Spain. Martin McKee is with the London School of Hygiene and Tropical Medicine, London, UK. María Gómez-León is with the Department of Economic Analysis, Universitat de València, València, Spain. David Stuckler is with the Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - María Gómez-León
- Gregori Galofré-Vilà is with the Department of Economics, Universidad Pública de Navarra, Pamplona, Spain. Martin McKee is with the London School of Hygiene and Tropical Medicine, London, UK. María Gómez-León is with the Department of Economic Analysis, Universitat de València, València, Spain. David Stuckler is with the Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - David Stuckler
- Gregori Galofré-Vilà is with the Department of Economics, Universidad Pública de Navarra, Pamplona, Spain. Martin McKee is with the London School of Hygiene and Tropical Medicine, London, UK. María Gómez-León is with the Department of Economic Analysis, Universitat de València, València, Spain. David Stuckler is with the Department of Social and Political Sciences, Bocconi University, Milan, Italy
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Serrano‐Alarcón M, Kentikelenis A, Mckee M, Stuckler D. Impact of COVID-19 lockdowns on mental health: Evidence from a quasi-natural experiment in England and Scotland. Health Econ 2022; 31:284-296. [PMID: 34773325 PMCID: PMC8646947 DOI: 10.1002/hec.4453] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has been associated with worsening mental health but it is unclear whether this is a direct consequence of containment measures, like "Stay at Home" orders, or due to other considerations, such as fear and uncertainty about becoming infected. It is also unclear how responsive mental health is to a changing situation. Exploiting the different policy responses to COVID-19 in England and Scotland and using a difference-in-difference analysis, we show that easing lockdown measures rapidly improves mental health. The results were driven by individuals with lower socioeconomic position, in terms of education or financial situation, who benefited more from the end of the strict lockdown, whereas they suffered a larger decline in mental health where the lockdown was extended. Overall, mental health appears to be more sensitive to the imposition of containment policies than to the evolution of the pandemic itself. As lockdown measures may continue to be necessary in the future, further efforts (both financial and mental health support) are required to minimize the consequences of COVID-19 containment policies for mental health.
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Affiliation(s)
- Manuel Serrano‐Alarcón
- DONDENA Centre for Research on Social Dynamics and Public PolicyBocconi UniversityMilanoItaly
| | - Alexander Kentikelenis
- DONDENA Centre for Research on Social Dynamics and Public PolicyBocconi UniversityMilanoItaly
- Department of Social & Political SciencesBocconi UniversityMilanoItaly
| | - Martin Mckee
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineUniversity of LondonLondonUK
| | - David Stuckler
- DONDENA Centre for Research on Social Dynamics and Public PolicyBocconi UniversityMilanoItaly
- Department of Social & Political SciencesBocconi UniversityMilanoItaly
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Abba-Aji M, Stuckler D, Galea S, McKee M. Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators. J Migr Health 2022; 5:100086. [PMID: 35194589 PMCID: PMC8855618 DOI: 10.1016/j.jmh.2022.100086] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background There are widespread concerns that ethnic minorities and migrants may have inadequate access to COVID-19 vaccines. . Improving vaccine uptake among these vulnerable groups is important towards controlling the spread of COVID-19 and reducing unnecessary mortality. Here we perform a systematic review of ethnic minorities’ and migrants’ access to and acceptance of COVID-19 vaccines. Methods We searched PubMed and Web of Science databases for papers published between 1 January 2020 and 7 October 2021. Studies were included if they were peer-reviewed articles; written in English, included data or estimates of ethnic minorities’ or migrants’ access to vaccines; and employed either qualitative or quantitative methods. Of a total of 248 studies screened, 33 met these criteria and included in the final sample. Risk of bias in the included studies was assessed using Newcastle Ottawa Scale and Critical Appraisal Skills Program tools. We conducted a Synthesis Without Meta-analysis for quantitative studies and a Framework synthesis for qualitative studies. Results 31 of the included studies were conducted in high-income countries, including in the US (n = 17 studies), UK (n = 10), Qatar (n = 2), Israel (n = 1) and France (n = 1). One study was in an upper middle-income country -China (n = 1) and another covered multiple countries (n = 1). 26 studies reported outcomes for ethnic minorities while 9 studies reported on migrants. Most of the studies were quantitative -cross sectional studies (n = 24) and ecological (n = 4). The remaining were qualitative (n = 4) and mixed methods (n = 1). There was consistent evidence of elevated levels of COVID-19 vaccine hesitancy among Black/Afro-Caribbean groups in the US and UK, while studies of Hispanic/Latino populations in the US and Asian populations in the UK provided mixed pictures, with levels higher, lower, or the same as their White counterparts. Asians in the US had the highest COVID-19 vaccine acceptance compared to other ethnic groups. There was higher vaccine acceptance among migrant groups in Qatar and China than in the general population. However, migrants to the UK experienced barriers to vaccine access, mainly attributed to language and communication issues. Lack of confidence, mainly due to mistrust of government and health systems coupled with poor communication were the main barriers to uptake among Black ethnic minorities and migrants. Conclusions Our study found that low confidence in COVID-19 vaccines among Black ethnic minorities driven by mistrust and safety concerns led to high vaccine hesitancy in this group. Such vaccine hesitancy rates constitute a major barrier to COVID-19 vaccine uptake among this ethnic minority. For migrants, convenience factors such as language barriers, fear of deportation and reduced physical access reduced access to COVID-19 vaccines. Building trust, reducing physical barriers and improving communication and transparency about vaccine development through healthcare workers, religious and community leaders can improve access and facilitate uptake of COVID-19 vaccines among ethnic minority and migrant communities.
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Mendez-Lopez A, Stuckler D, McKee M, Semenza JC, Lazarus JV. The mental health crisis during the COVID-19 pandemic in older adults and the role of physical distancing interventions and social protection measures in 26 European countries. SSM Popul Health 2022; 17:101017. [PMID: 34977323 PMCID: PMC8713431 DOI: 10.1016/j.ssmph.2021.101017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic and associated policy responses, such as physical distancing interventions, pose risks to mental health that could be mitigated by social support systems. We examine associations between changes in mental health in the population aged 50 years and older in Europe and stringency of pandemic responses and social protection. Methods We analysed data from the Survey of Health, Ageing and Retirement in Europe: n = 50,278 individuals aged 50 years and older in 26 European countries between June and August 2020. Linear multivariable regression models were used to evaluate potential risk factors for deterioration in self-reported mental health and investigate whether social protection systems mitigate it. Results Across the European Union, 28.1% (95% CI:27.1–29.2) of participants reported worsening mental health since the beginning of the pandemic, ranging from 16.1% in Slovakia to 54.8% in Portugal. Factors associated with increased risk of deterioration included: being female (12.7 percentage points (ppt), 95%CI:9.2–16.2); experiencing unmet healthcare needs during the pandemic (14.6 ppt, 95%CI:11.2–18.1); job loss during the pandemic (6.2 ppt, 95%CI:1.1–11.8); and financial hardship (5.1 ppt, 95%CI:2.9–7.2). Greater stringency of physical distancing measures in countries was associated with worsening mental health (0.2 ppt per each one point increase on a stringency index, 95% CI:0.09–0.4); however, country-level pre-pandemic expenditures on various social protection packages was associated with decreased probability of worsening mental health (−1.3 ppt, 95%CI: 0.3 to −2.3 per €1,000 increase in health care expenditures per capita and, among the unemployed, −3.8 ppt, 95%CI: 1.6 to −2.4 per €100 increase in unemployment expenditure per capita). Conclusions The COVID-19 pandemic has been associated with substantial mental health deterioration exhibiting social inequalities. Adverse mental health has been exacerbated by policy responses to the pandemic regulating physical distancing, but social protection expenditure might have helped mitigate the impact. Strengthening social protection systems might render the mental health of the population more resilient to the consequences of crises such as the COVID-19 pandemic. Multi-country study on mental health in the population aged 50 years and older in Europe during the COVID-19 pandemic. Mental health decline among older adults varies by socioeconomic group. More stringent physical distancing increases mental health decline in older adults. Stronger social protection might have mitigated risk of worse mental health in older adults.
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Affiliation(s)
- Ana Mendez-Lopez
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy and Department of Social & Political Sciences, Bocconi University, Milan, Italy
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jan C Semenza
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Stival C, Lugo A, Bosetti C, Amerio A, Serafini G, Cavalieri d’Oro L, Odone A, Stuckler D, Iacoviello L, Bonaccio M, van den Brandt P, Zucchi A, Gallus S. COVID-19 confinement impact on weight gain and physical activity in the older adult population: data from the LOST in Lombardia study. Clin Nutr ESPEN 2022; 48:329-335. [PMID: 35331509 PMCID: PMC8802547 DOI: 10.1016/j.clnesp.2022.01.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Background & aims COVID-19 containment measures significantly impacted lifestyle of the general population, including physical activity. Although the older adults are particularly susceptible to the potential consequences of sedentary lifestyle and inactivity, few studies investigated pandemic effects in this segment of the population. We aimed to evaluate COVID-19 pandemic effects on weight gain and physical activity in the Italian older adults, and assess the impact of possible changes in physical activity on mental health wellbeing. Methods In November 2020, a cross-sectional survey was conducted on a representative sample of 4400 older adults (aged 65 or more) from the Lombardy region, Northern Italy. Changes in body mass index (BMI) and physical activity were assessed, compared to the previous year. Using unconditional multiple logistic models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) of a decrease in physical activity during COVID-19 pandemic and we evaluated if decreased physical activity was a determinant of a worsening in psychological wellbeing. Results Neither weight gain nor increase in obesity prevalence occurred during the pandemic. Mean time spent in physical activity significantly decreased, with 43.8% of participants reporting a decrease of 1 h/week or more during COVID-19 pandemic. A decreased physical activity was determinant of a worsening of selected mental health outcomes, such as: sleep quality (OR = 2.45; 95% CI: 1.91–3.15) and quantity (OR = 1.54; 95% CI: 1.18–2.02), anxiety (OR = 1.31; 95% CI: 1.14–1.52) and depressive symptoms (OR = 1.61; 95% CI: 1.38–1.88). Conclusion During the COVID-19 pandemic, while no major changes in BMI were observed, physical activity significantly declined in the older adults. In this population, the lack of physical activity might have contributed to the observed worsening in mental health. During emergency periods, encouraging physical activity might be effective also to preserve psychological wellbeing.
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Stuckler D, McKee M, Kentikelenis A. Are we making the same mistakes in fighting COVID‑19 as in past pandemics? Lessons from HIV show the urgent need to invest in HPSR. Public Health Res Pract 2021; 31:3142116. [PMID: 34753161 DOI: 10.17061/phrp3142116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Are we repeating the mistakes of the human immunodeficiency virus (HIV) epidemic in our approach to combating coronavirus disease 2019 (COVID-19)? Is the world's emphasis on developing vaccines overshadowing investment in the health systems that can deliver them? We analyse a report on the politics of investing in health policy and systems research (HPSR) and conclude by outlining three critical actions, using the Stuckler-McKee model of social change in health. These are: exploiting a political window of opportunity; changing the conversation; and mobilising a campaign to drive the agenda. When implemented together, these actions could help accelerate investment in health systems to combat the immediate COVID-19 pandemic and prepare health systems for the next crisis.
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Affiliation(s)
- David Stuckler
- Department of Social and Political Sciences, Università Bocconi, Milan, Italy;
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, UK
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Abstract
Background There are widespread concerns that workers in precarious employment have suffered the most in the COVID-19 pandemic and merit special attention. The aim of this rapid scoping umbrella review was to examine what evidence exists about how COVID-19 has affected the health of this highly vulnerable group, and what gaps remain to be investigated. Methods Five databases were searched for systematic or scoping reviews from January 2020 to May 2021. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews. Results We identified 6 reviews that reported 30 unique relevant primary studies. The included studies indicate that essential (non-health) workers are at greater risk of COVID-19 infection and case fatality than others in their surrounding community. The occupational risk of exposure to COVID-19 also seems to be greater among more precarious categories of workers, including younger workers and workers in low-income and low-skilled occupations. Further, hazardous working conditions faced by many essential workers appear to have amplified the pandemic, as several occupational sites became ‘super-spreaders’, due to an inability to socially distance at work and high contact rates among workers. Finally, employment and financial insecurity generated by the pandemic appears to be associated with negative mental health outcomes. The quality of the included reviews however, and their primary studies, were generally weak and many gaps remain in the evidence base. Conclusions Our study highlights that COVID-19 is creating new health risks for precarious workers as well as exacerbating the pre-existing health risks of precarious employment.
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Affiliation(s)
- Courtney L McNamara
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics, Department of Social & Political Sciences, Bocconi University, Milano, Italy
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44
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Serrano-Alarcón M, Kentikelenis A, Stuckler D. How to protect people in response to COVID-19 economic downturns: Insights from past economic crises. Scand J Public Health 2021; 50:4-5. [PMID: 34689636 DOI: 10.1177/14034948211051912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Manuel Serrano-Alarcón
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy
| | - Alexander Kentikelenis
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy.,Department of Social and Political Sciences, Bocconi University, Italy
| | - David Stuckler
- DONDENA Centre for Research on Social Dynamics and Public Policy, Bocconi University, Italy.,Department of Social and Political Sciences, Bocconi University, Italy
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45
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Mialon M, Vandevijvere S, Carriedo A, Bero L, Gomes F, Petticrew M, McKee M, Stuckler D, Sacks G. Mechanisms for addressing the influence of corporations on public health. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Manufacturers, such as producers of cigarettes, drugs or ultra-processed foods, influence health policy, research and practice. This influence is one of the main barriers against the implementation of public health policies around the world. Our goal was to identify existing mechanisms to limit this influence.
Methods
We conducted a scoping review in 2019. We searched five scientific databases: Web of Science Core Collection; BIOSIS; MEDLINE; Base; Scopus. Twenty-eight institutions and networks related to our research objective were also contacted to identify additional mechanisms and examples. In addition, we identified mechanisms and examples drawn from our collective experience. We have classified the mechanisms into two groups: those of international organizations and governments; those for universities, the media and civil society.
Results
Thirty-one publications were included in our review, including eight scientific articles. Nine mechanisms focused on several industries; while the other documents targeted specific industries. We identified 49 mechanisms that could help limit corporate influence in health policy, science and practice. For 41 of these mechanisms, we found examples, around the world, where they have been implemented. The main objectives of the mechanisms identified were to manage conflicts of interest and ethical issues, while increasing the transparency of public-private interactions. Mechanisms for governments (n = 17) and universities (n = 13) were most frequently identified, with fewer examples existing to protect the media and civil society.
Discussion
The development, implementation and monitoring of these mechanisms are essential to protect public health from industrial influence.
Key messages
We found 49 mechanisms that could help limit corporate influence in health policy, science and practice. There are fewer mechanisms to protect the media and civil society, than to protect governments and universities.
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Affiliation(s)
- M Mialon
- Trinity College Dublin, Dublin, Ireland
| | | | - A Carriedo
- World Public Health Nutrition Association, London, UK
| | - L Bero
- University of California San Francisco, San Francisco, USA
| | - F Gomes
- Pan American Health Organization, Washington, USA
| | | | | | | | - G Sacks
- Deakin University, Burwood, Australia
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46
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Rajan S, Santoso C, Abba-Aji M, Stuckler D, McKee M, Hutchinson E, Onwujekwe O, Balabanova D. Gender Differences in Informal Payments for Healthcare: Evidence from 36 African Countries. Health Policy Plan 2021; 37:132-139. [PMID: 34662388 DOI: 10.1093/heapol/czab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving Universal Health Coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particularly in low- and middle-income countries. Our study aimed to examine gender disparities in paying informally for healthcare in Africa. We used Afrobarometer Round 7 survey data collected between September 2016 and August 2018 from 34 African countries. The final sample was 44 715 adults. We used multiple logistic regression to evaluate associations between gender and paying informally to obtain healthcare. Our results show that 12% of women and 14% of men reported paying informally for healthcare. Men were more likely to pay informally for healthcare than women in African countries (OR 1.22 [95% CI 1.13-1.31]), irrespective of age, residential location, educational attainment, employment status, occupation, and indicators of poverty. To make meaningful progress towards improving Universal Healthcare Coverage in African countries, we must improve our understanding of the gendered aspects of informal payments in healthcare, which can act as both a barrier to accessing care and a determinant of poor health.
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Affiliation(s)
- Selina Rajan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Cornelia Santoso
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | | | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Eleanor Hutchinson
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, Health Policy Research Group, University of Nigeria Nsukka (Enugu campus), Enugu, Nigeria
| | - Dina Balabanova
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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47
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Koltai J, Varchetta FM, McKee M, Stuckler D. The softer they fall: a natural experiment examining the health effects of job loss before and after Fornero's unemployment benefit reforms in Italy. Eur J Public Health 2021; 31:724-730. [PMID: 34491345 DOI: 10.1093/eurpub/ckab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Job loss is a well-established social determinant of health. Recent research has taken an 'institutional turn', asking whether unemployment support could buffer the health consequences of job loss. Here, we exploit a quasi-natural experiment based on the Fornero reforms in Italy, which increased wage replacement rates from 60% to 75% on 1 January 2013. METHODS We employed difference-in-difference models using longitudinal data covering 202 incidents of job loss from the EU-Survey on Income and Living Conditions to quantify the impact of job loss on changes in self-reported health prior to and after the Fornero reforms (2011-14). RESULTS Job loss pre-Fornero was associated with health declines -0.342 [95% confidence interval (CI): -0.588 to -0.096] but did not significantly influence health post-Fornero 0.031 (95% CI: -0.101 to 0.164). The difference-in-difference estimate was 0.373 (95% CI: 0.107-0.639), or a -0.51 standard deviation in self-reported health, consistent with the buffering hypothesis. To put the magnitude of this estimate in perspective, the incidence of a chronic illness, such as diabetes, results in a similar magnitude decline in self-reported health. CONCLUSIONS Our analysis contributes to a growing body of evidence that the impact of job loss on health depends critically on the strength of social protection systems and, in some cases, could be eliminated completely.
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Affiliation(s)
- Jonathan Koltai
- Sociology Department, University of New Hampshire, Durham, NH, USA
| | - Francesco Maria Varchetta
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
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48
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Toffolutti V, Stuckler D, McKee M, Wolsey I, Chapman J, J Pimm T, Ryder J, Salt H, M Clark D. The employment and mental health impact of integrated Improving Access to Psychological Therapies: Evidence on secondary health care utilization from a pragmatic trial in three English counties. J Health Serv Res Policy 2021; 26:224-233. [PMID: 33771070 DOI: 10.1177/1355819621997493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with a combination of long-term physical health problems can face barriers in obtaining appropriate treatment for co-existing mental health problems. This paper evaluates the impact of integrating the improving access to psychological therapies services (IAPT) model with services addressing physical health problems. We ask whether such services can reduce secondary health care utilization costs and improve the employment prospects of those so affected. METHODS We used a stepped-wedge design of two cohorts of a total of 1,096 patients with depression and/or anxiety and comorbid long-term physical health conditions from three counties within the Thames Valley from March to August 2017. Panels were balanced. Difference-in-difference models were employed in an intention-to-treat analysis. RESULTS The new Integrated-IAPT was associated with a decrease of 6.15 (95% CI: -6.84 to -5.45) [4.83 (95% CI: -5.47 to -4.19]) points in the Patient Health Questionnaire-9 [generalized anxiety disorder-7] and £360 (95% CI: -£559 to -£162) in terms of secondary health care utilization costs per person in the first three months of treatment. The Integrated-IAPT was also associated with an 8.44% (95% CI: 1.93% to 14.9%) increased probability that those who were unemployed transitioned to employment. CONCLUSIONS Mental health treatment in care model with Integrated-IAPT seems to have significantly reduced secondary health care utilization costs among persons with long-term physical health conditions and increased their probability of employment.
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Affiliation(s)
- Veronica Toffolutti
- Advanced Research Fellow in Health Economics, Centre for Health Economics & Policy Innovation (CHEPI), Department of Economics & Public Policy, Imperial College London, UK
| | - David Stuckler
- Professor of European Public Health, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Martin McKee
- Anxiety and Depression Network Manager, Coach, Trainer and Facilitator, The Oxford Academic Health Sciences Network, UK
| | - Ineke Wolsey
- Development Director, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Judith Chapman
- Development Director, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | - Theo J Pimm
- Consultant Counselling Psychologist, Oxford Health NHS Foundation Trust, UK
| | - Joanne Ryder
- Consultant Clinical and Health Psychologist, Oxford Health NHS Foundation Trust; and the Oxford Academic Health Sciences Network, UK
| | - Heather Salt
- Professor and Chair of Experimental Psychology, Department of Experimental Psychology, University of Oxford, UK
| | - David M Clark
- Professor and Chair of Experimental Psychology, Department of Experimental Psychology, University of Oxford, UK
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Vigezzi GP, Gaetti G, Gianfredi V, Frascella B, Gentile L, d'Errico A, Stuckler D, Ricceri F, Costa G, Odone A. Transition to retirement impact on health and lifestyle habits: analysis from a nationwide Italian cohort. BMC Public Health 2021; 21:1670. [PMID: 34521363 PMCID: PMC8439097 DOI: 10.1186/s12889-021-11670-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023] Open
Abstract
Background Retirement is a life-course transition likely to affect, through different mechanisms, behavioural risk factors’ patterns and, ultimately, health outcomes. We assessed the impact of transitioning to retirement on lifestyle habits and perceived health status in a nationwide cohort of Italian adults. Methods We analysed data from a large cohort of Italian adults aged 55–70, derived from linking six waves of the Participation, Labour, Unemployment Survey (PLUS), a national survey representative of the Italian workforce population, conducted between 2010 and 2018. We estimated relative-risk ratios (RRR) of transition to retirement and their corresponding 95% confidence intervals (CIs) for selected behavioural risk factors and health outcomes using multivariable logistic regression models. We used propensity score matching (PSM) to account for potential confounders. Results We included 5169 subjects in the study population, of which 1653 retired between 2010 and 2018 (exposed, 32%). Transition to retirement was associated with a 36% increased probability of practising sports (RRR 1.36, 95% CI 1.12–1.64). No statistically significant changes were reported for smoking habit (current smoker RRR: 1.18, 95% CI 0.94–1.46) and BMI (overweight/obese RRR: 0.96, 95% CI 0.81–1.15). Overall, retiring was associated with improved self-rated health status (RRR 1.26, 95% CI 1.02–1.58). Conclusion Individual data-linkage of multiple waves of the PLUS can offer great insight to inform healthy ageing policies in Italy and Europe. Transition to retirement has an independent effect on perceived health status, physical activity and selected behavioural risk factors. It should be identified as a target moment for preventive interventions, with particular reference to primary prevention so as to promote health and wellbeing in older ages. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11670-3.
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Affiliation(s)
| | - Giovanni Gaetti
- School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | - Angelo d'Errico
- Department of Epidemiology, ASL TO3, Piedmont Region, Grugliasco, Turin, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Costa
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, via Forlanini, 2, Pavia, Italy.
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McKee M, Gugushvili A, Koltai J, Stuckler D. Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe". Int J Health Policy Manag 2021; 10:511-515. [PMID: 32668893 PMCID: PMC9056195 DOI: 10.34172/ijhpm.2020.124] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/04/2020] [Indexed: 11/09/2022] Open
Abstract
Do populist leaders contribute to the spread of coronavirus disease 2019 (COVID-19)? While all governments have struggled to respond to the pandemic, it is now becoming clear that some political leaders have performed much better than others. Among the worst performing are those that have risen to power on populist agendas, such as in the United States, Brazil, Russia, India, and the United Kingdom. Populist leaders have tended to: blame "others" for the pandemic, such as immigrants and the Chinese government; deny evidence and show contempt for institutions that generate it; and portray themselves as the voice of the common people against an out-of-touch 'elite.' In our short commentary, focusing on those countries with the most cases, we find that populist leaders appear to be undermining an effective response to COVID-19. Perversely, they may also gain politically from doing so, as historically populist leaders benefit from suffering and ill health. Clearly more research is needed on the curious correlation of populism and public health. Notwithstanding gaps in the evidence, health professionals have a duty to speak out against these practices to prevent avoidable loss of life.
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Affiliation(s)
- Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
| | - Jonathan Koltai
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
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