Impact of digital services on healthcare and social welfare: An umbrella review.

BACKGROUND: Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. METHODS: The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. RESULTS: A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management. CONCLUSIONS: Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.

Changes in alcohol behaviour among adolescents in North-West Russia between 1995 and 2004.

BACKGROUND: Among Russian adults, alcohol consumption with binge drinking was high and increased during past decades. Little is known regarding adolescents' drinking. The present study investigates changes in alcohol-related behaviour among Russian youth between 1995 and 2004. METHODS: A cross-sectional survey was conducted among the 15-year-old youths from all schools in Pitkäranta, Republic of Karelia, Russia. In 1995, 385 students participated (response 95%), in 2004-395 (response 85%). RESULTS: The proportion of abstainers decreased: boys from 26% to 13% (P = 0.002), girls from 23% to 12% (P = 0.007). The age of first alcohol consumption decreased among both genders. First alcohol drinking with friends increased among boys from 65% to 79% (P = 0.031), among girls from 49% to 70% (P = 0.001). Weekly drinking increased: boys from 13% to 28% (P < 0.001), girls from 6% to 15% (P = 0.001). The prevalence on inebriation increased among girls from 45% to 60% (P = 0.012), beer consumption from 8% to 21% (P = 0.006) by 2004. Gender differences were less prominent in 2004. CONCLUSION: Negative changes: early drinking initiation and more frequent alcohol consumption were observed among Russian youth by 2004. Regular monitoring, effective policy measures, and health education are necessary to prevent further increase in alcohol consumption and subsequent burden of alcohol-related diseases in Russia.