District-Level Mortality Convergence in Reunified Germany: Long-Term Trends and Contextual Determinants.

The mortality gap between former East and West Germany decreased rapidly in the decade following the reunification of the country in 1990. However, because no previous study has estimated life expectancy (e0) over time for all German districts, the extent of mortality convergence across districts and its determinants are largely unknown. We used a novel relational Bayesian model to estimate district e0 in Germany during 1997-2016, examined mortality convergence using a novel convergence groups approach, and explored the role of selected district characteristics in the process. Differences in e0 between German districts decreased for both sexes during 1997-2016, mainly driven by rapid mortality improvements in eastern German districts. However, considerable heterogeneity in district-level e0 trajectories within federal states was evident. For example, district clusters in northwestern Germany showed increasing e0 disadvantage, which led to a north-south divergence in mortality. A multinomial regression analysis showed a robust association between the e0 trajectory and the district-level tax base and long-term unemployment but not with hospital density. Thus, an equitable "leveling up" of health seems possible with policies investing in places and the people who inhabit them.

A sentiment and content analysis of tweets on monkeypox stigma among the LGBTQ+ community: A cue to risk communication plan.

Background: The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community. Methods: The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study. Findings: This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation. Interpretation: This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing.

A sentiment and content analysis of tweets on monkeypox stigma among the LGBTQ+ community: A cue to risk communication plan.

Background: The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community. Methods: The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study. Findings: This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation. Interpretation: This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing.

Rapid review on monkeypox policies among the G20 nations: relevance to policy and practitioner.

Background: Monkeypox has been declared as a Public Health Emergency of International Concern (PHEIC) by the WHO Director General (WHO-DG). Most of the G20 nations have reported Monkeypox outbreak. Policies developed and implemented in G20 countries for the prevention and control of monkeypox preparedness and response have global consequences. This rapid review aimed to map the monkeypox prevention and control policies planned and implemented in G20 nations in line with temporary recommendations issued by the WHO-DG. Methods: We mapped monkeypox prevention and control policies in G20 nations based on the WHO-DG recommendations. Medline (through PubMed), Scopus, and ProQuest Health and Medical Complete were searched to understand G20 preventative, diagnostic, and therapeutic policies. We also performed an extensive gray literature search through the Ministry of Health websites and newspaper through Google.  The documents/ studies that had an information on prevention, control and management guidelines/policies and published through journal, news articles and health ministry websites of G20 nations on monkeypox were included. We excluded the editorials, opinion, and perspective papers and studies published prior to May 6, 2022. Results: We obtained 671 articles with 10 articles included in the review. Additionally, we identified 55 documents from the gray literature. We included national guidelines of the 18 countries on the control, prevention, and management of monkeypox. National guidelines were compared with the WHO guidelines in terms of implementing coordinated response, engaging and protecting communities, surveillance and public health measures and international travel, clinical management and infection, prevention and control (IPC) measures and medical countermeasures research. Depending on the availability of resources, some recommendations are followed by nations while others are not. Conclusions: Coordinated response among states is key to contain the transmission of monkeypox. To bring a coordinated response, G20 nations are following temporary recommendations that are context specific to their nation.

Effectiveness of self-management applications in improving clinical health outcomes and adherence among diabetic individuals in low and middle-income countries: a systematic review.

INTRODUCTION: A variety of mobile health (mHealth) applications are available to monitor an individual's health or lifestyle to make it convenient to access healthcare facilities at home. The usability of mHealth applications in controlling HbA1c (estimated average blood glucose) levels is unclear despite their increasing use. The burden of type 2 diabetes mellitus (T2DM) is high in low and middle-income countries (LMICs), with the highest burden in the Indian population. Our objective is to identify the effectiveness of mHealth applications in managing blood glucose levels of individuals with T2DM and to assess the impact of using mHealth applications in managing T2DM concerning health-promoting behaviour among the LMICs in the context of India. METHODS AND ANALYSIS: The electronic databases included for search are PubMed, Ovid Medline, EBSCO, CINAHL, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials; additional sources of the search will be grey literature available on diabetes management websites and reference lists of included studies. Studies published in the English language in indexed and peer-reviewed sources will be considered. Studies reporting the effectiveness of mobile applications in the management of T2D in LMICs will be eligible for inclusion. The Population-Intervention-Comparison-Outcomes framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2021 will be used for reporting. Data analysis will be carried out using narrative synthesis, and a meta-analysis may be conducted if we come across homogenous data for the outcome. ETHICS AND DISSEMINATION: As this study is a systematic review, we will not be recruiting any participants for the study and hence will not require ethical approval. The study summary will be disseminated at a conference. PROSPERO REGISTRATION NUMBER: CRD42021245517.

Oscillatory dissipative solitons stabilized by nonlinear gradient terms: The transition to localized spatiotemporal disorder.

We investigate properties of oscillatory dissipative solitons (DSs) in a cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. As a main result we find a transition to dissipative solitons with spatiotemporal disorder as a function of the diffusion coefficient. This transition proceeds via quasiperiodicity and shows incommensurate satellites next to the fundamental frequency and its harmonics indicating a possible route to localized spatiotemporal chaos. The transition back to oscillatory DSs follows a similar scenario.

Europeanization of health policy in post-communist European societies: Comparison of six Western Balkan countries.

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on "Consumer and health protection" and other chapters that contained the words "health" or "population health". Evidence indicates that Europeanization influences Western Balkans' policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health.

Digital health literacy as a super determinant of health: More than simply the sum of its parts.

•Civic literacy refers to the ability to engage meaningfully with one's community.•Digital, health, and civic literacy are key predictors for digital health literacy.•The extent to which these three affect digital health literacy remains unclear.•Building digital health literacy is vital to limit inequalities from expanding.

Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study.

BACKGROUND: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians' and pharmacists' experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. METHODS: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. RESULTS: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants' poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. CONCLUSIONS: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

Ferromagnetic nematics: A macroscopic two-fluid description.

We present the macroscopic dynamic description of a ferromagnetic nematic, where the nematic part and the magnetic part can move relative to each other. The relative velocity that describes such movements can be a slowly relaxing variable. Its couplings to the nematic and the magnetic degrees of freedom are particularly interesting since the symmetry properties (behavior under spatial inversion and time reversal) of the three vectorial quantities involved are all different. As a consequence, a number of new crosscouplings involving the relative velocity exist. Some of them are discussed in more detail. First, we demonstrate that transverse temperature gradients generate transverse relative velocities and, vice versa, that transverse relative velocities give rise to temperature gradients. Second, we show that a simple shear flow in the relative velocity with the preferred direction in the shear plane can lead in a stationary situation to a tilt of the magnetization.

A two-fluid model for the macroscopic behavior of polar nematic fluids and gels in a nonchiral or a chiral solvent.

We present the macroscopic dynamics of polar nematic liquid crystals in a two-fluid context. We investigate the case of a nonchiral as well as of a chiral solvent. In addition, we analyze how the incorporation of a strain field for polar nematic gels and elastomers in a solvent modifies the macroscopic dynamics. It turns out that the relative velocity between the polar subsystem and the solvent gives rise to a number of cross-coupling terms, reversible as well as irreversible, unknown from the other two-fluid systems considered so far. Possible experiments to study those novel dynamic cross-coupling terms are suggested. As examples we just mention that gradients of the relative velocity lead, in polar nematics to heat currents and in polar cholesterics to temporal changes of the polarization. In polar cholesterics, shear flows give rise to a temporal variation in the velocity difference perpendicular to the shear plane, and in polar nematic gels uniaxial stresses or strains generate temporal variations of the velocity difference.

Dissipative solitons stabilized by nonlinear gradient terms: Time-dependent behavior and generic properties.

We study the time-dependent behavior of dissipative solitons (DSs) stabilized by nonlinear gradient terms. Two cases are investigated: first, the case of the presence of a Raman term, and second, the simultaneous presence of two nonlinear gradient terms, the Raman term and the dispersion of nonlinear gain. As possible types of time-dependence, we find a number of different possibilities including periodic behavior, quasi-periodic behavior, and also chaos. These different types of time-dependence are found to form quite frequently from a window structure of alternating behavior, for example, of periodic and quasi-periodic behaviors. To analyze the time dependence, we exploit extensively time series and Fourier transforms. We discuss in detail quantitatively the question whether all the DSs found for the cubic complex Ginzburg-Landau equation with nonlinear gradient terms are generic, meaning whether they are stable against structural perturbations, for example, to the additions of a small quintic perturbation as it arises naturally in an envelope equation framework. Finally, we examine to what extent it is possible to have different types of DSs for fixed parameter values in the equation by just varying the initial conditions, for example, by using narrow and high vs broad and low amplitudes. These results indicate an overlapping multi-basin structure in parameter space.

The European Health Union: European Union's Concern about Health for All. Concepts, Definition, and Scenarios.

The COVID-19 pandemic brought visibility and intensified the discussions on the European Union's (EU) health mandate. The proposals of the European Commission (EC) to move towards a European Health Union (EHU) can be seen as a starting point towards more integration in health. However, the definition of what the EHU will look like is not clear. This paper searches to find a common definition, and/or features for this EHU through a systematic literature review performed in May 2021. "European Union's concern about health for all" is suggested as a definition. The main drivers identified to develop an EHU are: surveillance and monitoring, crisis preparedness, funding, political will, vision of public health expenditures, population's awareness and interest, and global health. Based on these findings, five scenarios were developed: making a full move towards supranational action; improving efficiency in the actual framework; more coordination but no real change; in a full intergovernmentalism direction; and fragmentation of the EU. The scenarios show that the development of a EHU is possible inside the current legal framework. However, it will rely on increased coordination and has a focus on cross-border health threats. Any development will be strongly linked to political choices from Member States.

The Short-Term Effects of European Integration on Mortality Convergence: A Case Study of European Union's 2004 Enlargement.

Although European integration can be expected to result in mortality convergence (reduced mortality differences), a life expectancy divide persists in the European Union (EU) between the old Member States (OMS) in the west and the new Member States (NMS) in the east. Studies investigating the impact of European integration on mortality convergence are rare and did not consider regional differences. We examine the short-term effects of the 2004 enlargement on mortality convergence at the supranational, national, and subnational levels. Using sex-specific life expectancies for 23 Member States (1990-2017) and the NUTS 2 regions in Czechia, Hungary, and Poland for 1992-2016, we examined the trend in sigma and beta mortality convergence measures at the country and regional levels using joinpoint regression. We found no compelling evidence that EU accession influenced the process of mortality convergence between OMS and NMS, or within the three NMS, over the short term. While there was overall beta and sigma convergence at the national level during 1990-2017, no regional convergence showed, and the trends in convergence did not significantly change at the time of EU accession or soon after (2004-2007). The accession in 2004 did not visibly impact the overall process of mortality convergence over the short term, likely because of the greater influence of country and region-specific policies and characteristics. The interaction of Member State and regional contexts with the mechanisms of European integration requires further study. Future enlargement procedures should emphasise tailored support to ensure more equitable gains from European integration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10680-021-09596-y.

Two-fluid model for a fluid with tetrahedral-octupolar order.

We investigate the macroscopic dynamics of a two-fluid system with tetrahedral order. As all normal-fluid two-fluid systems one has-compared to a simple fluid-the velocity difference between the two subsystems and the concentration of one component as additional macroscopic variables. Depending on the type of system, the concentration can either be a conserved quantity or relax on a long, but finite timescale. Due to the existence of the tetrahedral order such a system breaks parity symmetry. Here we discuss physical systems without preferred direction in real space, meaning that our description applies to optically isotropic materials. We find a number of reversible as well as dissipative dynamic cross-coupling terms due to the additional octupolar order, when compared to a fluid mixture. As the most interesting cross-coupling term from an experimental point of view, we identify a dissipative cross-coupling between the relative velocity and the usual velocity gradients. Applying a shear flow in a plane, this dissipative cross-coupling leads to a velocity difference perpendicular to the shear plane. As a result one can obtain a spatially homogeneous oscillation of the relative velocity. In addition, this induced relative velocity can couple as a function of time and space to the concentration, which gives rise to an overdamped propagating soundlike mode, where the overdamping arises from the fact that velocity difference is a macroscopic variable and not strictly conserved. We also show that electric field gradients are connected with an analogous reversible cross-coupling and can lead in a planar shear geometry to an overdamped propagating mode as well.

Multiplicative noise can induce a velocity change of propagating dissipative solitons.

We investigate the influence of spatially homogeneous multiplicative noise on propagating dissipative solitons (DSs) of the cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. Here we focus on the nonlinear gradient terms, in particular on the influence of the Raman term and the delayed nonlinear gain. We show that a fairly small amount of multiplicative noise can lead to a change in the mean velocity for such systems. This effect is exclusively due to the presence of the stabilizing nonlinear gradient terms. For a range of parameters we find a velocity change proportional to the noise intensity for the Raman term and for delayed nonlinear gain. We note that the dissipative soliton decreases the modulus of its velocity when only one type of nonlinear gradient is present. We present a straightforward mean field analysis to capture this simple scaling law. At sufficiently high noise strength the nonlinear gradient stabilized DSs collapse.

Prevalence and sociodemographic correlates of medication intake adherence among primary health-care users in Albania.

BACKGROUND: Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant. AIMS: To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania. METHODS: A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence. RESULTS: Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication. CONCLUSION: We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.

Interaction of dissipative solitons stabilized by nonlinear gradient terms.

We study the interaction of stable dissipative solitons of the cubic complex Ginzburg-Landau equation which are stabilized only by nonlinear gradient terms. In this paper we focus for the interactions in particular on the influence of the nonlinear gradient term associated with the Raman effect. Depending on its magnitude, we find up to seven possible outcomes of theses collisions: Stationary bound states, oscillatory bound states, meandering oscillatory bound states, bound states with large-amplitude oscillations, partial annihilation, complete annihilation, and interpenetration. Detailed results and their analysis are presented for one value of the corresponding nonlinear gradient term, while the results for two other values are just mentioned briefly. We compare our results with those obtained for coupled cubic-quintic complex Ginzburg-Landau equations and with the cubic-quintic complex Swift-Hohenberg equation. It turns out that both meandering oscillatory bound states as well as bound states with large-amplitude oscillations appear to be specific for coupled cubic complex Ginzburg-Landau equations with a stabilizing cubic nonlinear gradient term. Remarkably, we find for the large-amplitude oscillations a linear relationship between oscillation amplitude and period.