Integrated Real-World Data Warehouses Across 7 Evolving Asian Health Care Systems: Scoping Review.

BACKGROUND: Asia consists of diverse nations with extremely variable health care systems. Integrated real-world data (RWD) research warehouses provide vast interconnected data sets that uphold statistical rigor. Yet, their intricate details remain underexplored, restricting their broader applications. OBJECTIVE: Building on our previous research that analyzed integrated RWD warehouses in India, Thailand, and Taiwan, this study extends the research to 7 distinct health care systems: Hong Kong, Indonesia, Malaysia, Pakistan, the Philippines, Singapore, and Vietnam. We aimed to map the evolving landscape of RWD, preferences for methodologies, and database use and archetype the health systems based on existing intrinsic capability for RWD generation. METHODS: A systematic scoping review methodology was used, centering on contemporary English literature on PubMed (search date: May 9, 2023). Rigorous screening as defined by eligibility criteria identified RWD studies from multiple health care facilities in at least 1 of the 7 target Asian nations. Point estimates and their associated errors were determined for the data collected from eligible studies. RESULTS: Of the 1483 real-world evidence citations identified on May 9, 2023, a total of 369 (24.9%) fulfilled the requirements for data extraction and subsequent analysis. Singapore, Hong Kong, and Malaysia contributed to ≥100 publications, with each country marked by a higher proportion of single-country studies at 51% (80/157), 66.2% (86/130), and 50% (50/100), respectively, and were classified as solo scholars. Indonesia, Pakistan, Vietnam, and the Philippines had fewer publications and a higher proportion of cross-country collaboration studies (CCCSs) at 79% (26/33), 58% (18/31), 74% (20/27), and 86% (19/22), respectively, and were classified as global collaborators. Collaboration with countries outside the 7 target nations appeared in 84.2% to 97.7% of the CCCSs of each nation. Among target nations, Singapore and Malaysia emerged as preferred research partners for other nations. From 2018 to 2023, most nations showed an increasing trend in study numbers, with Vietnam (24.5%) and Pakistan (21.2%) leading the growth; the only exception was the Philippines, which declined by -14.5%. Clinical registry databases were predominant across all CCCSs from every target nation. For single-country studies, Indonesia, Malaysia, and the Philippines favored clinical registries; Singapore had a balanced use of clinical registries and electronic medical or health records, whereas Hong Kong, Pakistan, and Vietnam leaned toward electronic medical or health records. Overall, 89.9% (310/345) of the studies took >2 years from completion to publication. CONCLUSIONS: The observed variations in contemporary RWD publications across the 7 nations in Asia exemplify distinct research landscapes across nations that are partially explained by their diverse economic, clinical, and research settings. Nevertheless, recognizing these variations is pivotal for fostering tailored, synergistic strategies that amplify RWD's potential in guiding future health care research and policy decisions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43741.

Strategies to Promote Vaccine Uptake in the COVID-19 Pandemic: Exploring the "Ladder of Intrusiveness" in Three Countries.

CONTEXT: A key task for countries around the world facing the COVID-19 pandemic was to achieve high vaccination coverage of the population. To overcome "vaccination inertia," governments adopted a variety of policy instruments. These instruments can be placed along a "ladder of intrusiveness" based on their degree of constraint of individual freedoms. The aim of this study is to investigate how the governments of three European countries moved along the ladder of intrusiveness and how the choice of policy instruments was influenced by contextual factors. METHODS: The study draws on secondary data sources, including academic and gray literature, policy documents, and opinion polls, over an observation period from December 2020 to summer 2022. The study employs inductive logic to analyze data and identify the factors explaining similarities and differences across England, Germany, and Italy. FINDINGS: The study identifies similarities and differences in how the three countries advanced along the ladder of intrusiveness. Contextual factors such as policy legacy, social acceptability, and ideological orientation contribute to explain the observations. CONCLUSIONS: Country-specific contextual factors play an important role in understanding the choice of policy instruments adopted by the three countries. Policy makers should carefully consider these factors when planning immunization strategies.

Prevalence and Severity of Food Insecurity Before and During the Coronavirus Disease 2019 Pandemic Among Adults and Youth in Australia, Canada, Chile, Mexico, the United Kingdom, and the United States.

BACKGROUND: Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth. OBJECTIVES: The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries. METHODS: Repeated cross-sectional data were collected among adults aged 18-100 y (n = 63,278) in 5 countries in November to December in 2018-2020 and among youth aged 10-17 y (n = 23,107) in 6 countries in November to December in 2019 and 2020. Food insecurity in the past year was captured using the Household Food Security Survey Module and the Child Food Insecurity Experiences Scale. Changes in the prevalence and severity of food insecurity were examined using logistic and generalized logit regression models, respectively. Models included age, gender, racial-ethnic identity, and other sociodemographic characteristics associated with food insecurity to adjust for possible sample differences across waves. Models were weighted to reflect each country's population. RESULTS: Adults [adjusted OR (AOR): 1.15; 95% CI: 1.02, 1.31] and youth (AOR: 1.43; 95% CI: 1.19, 1.71) in Mexico were more likely to live in food-insecure households in 2020 compared to 2019. Adults in Australia (AOR: 0.81; 95% CI: 0.72, 0.92) and Canada (AOR: 0.87; 95% CI: 0.77, 0.99) were less likely to live in food-insecure households in 2020. Trends in severity aligned with changes in prevalence, with some exceptions. Youth in Australia (AOR: 2.24; 95% CI: 1.65, 3.02) and the United States (AOR: 1.39; 95% CI: 1.04, 1.86) were more likely to have many compared with no experiences of food insecurity in 2020 compared to 2019. There was no evidence of change among adults and youth in the remaining countries. CONCLUSIONS: Except for Mexico, few changes in food insecurity among adults and youth were observed from before to during the COVID-19 pandemic. Action is needed to support households at risk of food insecurity.

Public risk perception of air pollution in the general population of Italy and Sweden during the COVID-19 pandemic: Environmental and socio-demographic drivers.

Air pollution is an important anthropogenic hazard due to its effect on human health and the environment. Understanding how the population perceives the risk associated with air pollution is a crucial aspect to inform future policies and communication strategies. The aim of this study is to examine the association between air pollution concentrations and public risk perception of air pollution, also exploring socio-demographic patterns in the general population of Italy and Sweden. To this end, we derived 3-year PM10 average concentrations from ground monitoring stations and integrated with a population-based survey carried out in August 2021 in both countries. Relative perceived likelihood and impact on the individual were considered as domains of risk perception. In addition this, information on direct experience and socio-demographic factors were included as possible determinants of risk perception. Linear regression models were performed to examine the association of PM10 average concentrations at regional level and individual level factors with risk perception domains. In both countries, respondents who live in the most densely populated regions report a higher perceived likelihood of air pollution. Direct experience is the main driver of risk perception in both countries. Being male and smokers in Italy, older age and having left/centre-left political orientation in both countries are associated with a higher perceived likelihood and impact of air pollution. These findings will inform future health and environmental studies regarding the public risk perception of air pollution highlighting individual's awareness and the socio-demographic patterns.

Profiling Hesitancy to COVID-19 Vaccinations in Six European Countries: Behavioral, Attitudinal and Demographic Determinants.

Vaccination hesitancy is an important barrier for the effective control of the COVID-19 pandemic. Identifying determinants of COVID-19 vaccination hesitancy is essential in order to reduce mortality rates. Further, given the variability of the factors and the different recommendations used in each country, it is important to conduct cross-country research to profile individuals who are hesitant toward COVID-19 vaccinations. This cross-sectional study aimed to examine cross-country differences and the behavioral, attitudinal and demographic characteristics of vaccine hesitant individuals. Adults living in six European countries (Cyprus, France, Germany, Italy, Poland, and Spain) were eligible to participate. A total of 832 individuals completed the online survey, with 17.9% reporting being hesitant to COVID-19 vaccination. Vaccine accepters were significantly older (M = 38.9, SD = 14.3), more educated (master/postgraduate studies) and lived in a place with a higher number of residents (>500,000 people) compared to those hesitant to COVID-19 vaccination. Discriminant analysis confirmed that the hesitant profile includes a person of younger age, living alone in smaller communities, and without children. Additionally, hesitant participants reported COVID-19-specific characteristics such as lower institutional trust, less adherence to COVID-19 protective behaviors and higher pandemic fatigue. When tackling COVID-19 vaccination hesitancy both socio-demographic and behavioral/attitudinal aspects should be taken into account. Stakeholders are advised to implement targeted vaccination programs while at the same time building trust with population illness cognitions addressed in order to reduce hesitancy rates. Further, stakeholders and public health authorities in each country are suggested to target interventions according to different population characteristics as behavioral and attitudinal determinants of COVID-19 vaccination hesitancy differed between countries.

Differences in energy and nutrient content of menu items served by large chain restaurants in the USA and the UK in 2018.

OBJECTIVE: To quantify the sector-wide energy and nutritional differences of both adult and children's restaurant menu items in the UK and the USA in 2018. DESIGN: Cross-sectional study. SETTING: Energy and nutritional information provided on restaurant websites. PARTICIPANTS: Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains. RESULTS: Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45·6 kcal for energy and 3·2 g for fat. Comparable figures for children's menu items were 43·7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3·2 g, 95 % CI (0·5, 6)), and children's menu items had higher Na content (181·1 mg, 95 % CI (108·4, 253·7)). Overall, 96·8 % of UK and 95·8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars. CONCLUSIONS: Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children's items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.

The age structure of cases as the key of COVID-19 severity: Longitudinal population-based analysis of European countries during 150 days.

AIMS: Over a million confirmed cases of the coronavirus disease (COVID-19) across 16 European countries were observed during the first wave of the pandemic. Epidemiological measures like the case fatality rate (CFR) are generally used to determine the severity of the illness. The aim is to investigate the impact of the age structure of reported cases on the reported CFR and possibilities of its demographic adjustment for a better cross-country comparison (age-standardized CFRs, time delay between cases detection and death). METHODS: This longitudinal study uses prospective, population-based data covering 150 days, starting on the day of confirmation of the 100th case in each country. COVerAGE-DB and the Human Mortality Database were used in this regard. The age-standardized CFRs were calculated with and without the time delay of the number of deaths after the confirmation of the cases. RESULTS: The observed decline in the CFRs at the end of the first wave is partly given by the changes in the age structure of confirmed cases. Using the adjusted (age-standardized) CFRs with time delay, the risk of death among confirmed cases is much more stable in comparison to crude (observed) CFRs. CONCLUSIONS: Preventing the spread of COVID-19 among the elderly is an important way to positively influence the overall fatality rate, decrease the number of deaths, and not overload the health systems. The crude CFRs (still often presented) are not sufficient for a proper evaluation of the development across populations nor as a means of identifying the influencing factors.

Comparing relationships between health-related behaviour clustering and episodic memory trajectories in the United States of America and England: a longitudinal study.

BACKGROUND: Health-related behaviours (HRBs) cluster within individuals. Evidence for the association between HRB clustering and cognitive functioning is limited. We aimed to examine and compare the associations between three HRB clusters: "multi-HRB cluster", "inactive cluster" and "(ex-)smoking cluster" (identified in previous work based on HRBs including smoking, alcohol consumption, physical activity and social activity) and episodic memory trajectories among men and women, separately, in the United States of America (USA) and England. METHODS: Data were from the waves 10-14 (2010-2018) of the Health and Retirement Study in the USA and the waves 5-9 (2010-2018) of the English Longitudinal Study of Ageing in England. We included 17,750 US and 8,491 English participants aged 50 years and over. The gender-specific HRB clustering was identified at the baseline wave in 2010, including the multi-HRB (multiple positive behaviours), inactive and ex-smoking clusters in both US and English women, the multi-HRB, inactive and smoking clusters in US men, and only the multi-HRB and inactive clusters in English men. Episodic memory was measured by a sum score of immediate and delayed word recall tests across waves. For within country associations, a quadratic growth curve model (age-cohort model, allowing for random intercepts and slopes) was applied to assess the gender-stratified associations between HRB clustering and episodic memory trajectories, considering a range of confounding factors. For between country comparisons, we combined country-specific data into one pooled dataset and generated a country variable (0 = USA and 1 = England), which allowed us to quantify between-country inequalities in the trajectories of episodic memory over age across the HRB clusters. This hypothesis was formally tested by examining a quadratic growth curve model with the inclusion of a three-way interaction term (age × HRB clustering × country). RESULTS: We found that within countries, US and English participants within the multi-HRB cluster had higher scores of episodic memory than their counterparts within the inactive and (ex-)smoking clusters. Between countries, among both men and women within each HRB cluster, faster declines in episodic memory were observed in England than in the USA (e.g., b England versus the USA for men: multi-HRB cluster = -0.05, 95%CI: -0.06, -0.03, b England versus the USA for women: ex-smoking cluster = -0.06, 95%CI: -0.07, -0.04). Additionally, the range of mean memory scores was larger in England than in the USA when comparing means between two cluster groups, including the range of means between inactive and multi-HRB cluster for men (b England versus the USA = -0.56, 95%CI: -0.85, -0.27), and between ex-smoking and multi-HRB cluster for women (b England versus the USA = -1.73, 95%CI: -1.97, -1.49). CONCLUSIONS: HRB clustering was associated with trajectories of episodic memory in both the USA and England. The effect of HRB clustering on episodic memory seemed larger in England than in the USA. Our study highlighted the importance of being aware of the interconnections between health behaviours for a better understanding of how these behaviours affect cognitive health. Governments, particularly in England, could pay more attention to the adverse effects of health behaviours on cognitive health in the ageing population.

The Differential Impact of the COVID-19 Crisis on Small-Scale Development Initiatives, a Cross-Country Comparison.

The COVID-19 pandemic presents Northern-based development organisations with unprecedented difficulties. They are challenged in fundraising opportunities in their home countries and in finding ways to continue their work in the Global South. As the first study to present a systematic mixed method, cross-country study of small-scale, voluntary development organisations in four different European countries, this study provides insight into the role of these private development initiatives (PDIs) in the COVID-19 crisis and sheds light on the differential impact of the crisis on these organisations. Whereas most PDIs are involved in long(er)-term development interventions, the COVID-19 crisis was for most organisations their first experience of emergency aid. Overall, we see strong resilience among PDIs and also find that the organisations which relied more exclusively on traditional methods of fundraising (offline) received a greater funding hit than organisations-often with more younger members-that had already moved to online fundraising.

Communicating COVID-19: Analyzing Higher Education Institutional Responses in Canada, China, and the USA.

The study aims to examine how higher education institutions (HEIs) in three countries responded to the challenges of COVID-19 over a six-month period at the outbreak of the global pandemic. Employing document analysis, we examined 732 publicly available communications from 27 HEIs in Canada, China, and the USA. Through theoretical frameworks of crisis management and Situational Crisis Communication Theory (SCCT), we explore how HEIs respond to the pandemic and protect campus stakeholders. The study revealed common patterns in communication strategies during different stages of the pandemic that include accepting responsibility, emotional reassurance, and compensating victims. It also revealed key differences across social contexts and environments and distinct leadership styles. Findings offer insight into how HEIs communicated at the outset of the COVID-19 pandemic and inform the application of SCCT and crisis management theory to institutional behavior in the context of prolonged and intersecting disasters.

Modelling COVID-19 dynamics and potential for herd immunity by vaccination in Austria, Luxembourg and Sweden.

Against the COVID-19 pandemic, non-pharmaceutical interventions have been widely applied and vaccinations have taken off. The upcoming question is how the interplay between vaccinations and social measures will shape infections and hospitalizations. Hence, we extend the Susceptible-Exposed-Infectious-Removed (SEIR) model including these elements. We calibrate it to data of Luxembourg, Austria and Sweden until 15 December 2020. Sweden results having the highest fraction of undetected, Luxembourg of infected and all three being far from herd immunity in December. We quantify the level of social interaction, showing that a level around 1/3 of before the pandemic was still required in December to keep the effective reproduction number Refft below 1, for all three countries. Aiming to vaccinate the whole population within 1 year at constant rate would require on average 1,700 fully vaccinated people/day in Luxembourg, 24,000 in Austria and 28,000 in Sweden, and could lead to herd immunity only by mid summer. Herd immunity might not be reached in 2021 if too slow vaccines rollout speeds are employed. The model thus estimates which vaccination rates are too low to allow reaching herd immunity in 2021, depending on social interactions. Vaccination will considerably, but not immediately, help to curb the infection; thus limiting social interactions remains crucial for the months to come.

The role of education and income for cognitive functioning in old age: A cross-country comparison.

OBJECTIVES: Previous studies have shown that higher education promotes cognitive health. This effect, however, is embedded in the living conditions of a particular country. Since it is not clear to what extent the country and its specific living standards are necessary preconditions for the observed effect, we investigated whether the impact of education and income on cognitive functioning differs between countries. METHODS: Analyses were based on harmonized data from the World Health Organization's multi-country Study on global AGEing and adult health, the Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe of over 85,000 individuals aged 50 years and older. Analyses were conducted via multivariate regression analyses and structural equation modeling adjusted for age, gender, marital status, health status, and depression. RESULTS: The effect of education was twice as large as the effect of income on cognitive functioning and indirectly moderated the effect of income on cognitive functioning. The effect sizes varied strongly between countries. The country's gross domestic product per capita seems to influence cognitive functioning. CONCLUSIONS: Our findings indicate that education has a dominant effect on cognitive functioning in people aged 50 years and older, which might even offset the adverse implications of living with low income on cognitive health. Therefore, expanding efforts to achieve universal education are essential to mitigate health disparities due to low income and early life disadvantages, including chances for good cognitive functioning over the life-span.

Variability in the assessment of children's primary healthcare in 30 European countries.

BACKGROUND: The high variability in the types and number of measures adopted to evaluate childcare across European countries makes it necessary to investigate country practices to identify trends in setting national priorities in the assessment of child well-being. OBJECTIVE: This paper intends to investigate country practices under the lens of variability to explore possible trends in setting national priority in the evaluation of childcare. In particular, it analyses variability considering to what extent this depends on the tendency of adopting a broad vision (i.e. selecting measures for a larger variety of aspects) or whether this is influenced by the choice of adopting an in-depth approach (i.e. using more measures to analyse a specific aspect). METHODS: An ad hoc questionnaire was administered to a national expert in each country and yielded 352 measures. To analyse variability, the breadth in the number of aspects considered was explored using a convergence index, while the depth in the distribution of measures in each aspect was investigated by computing a coefficient of variation. Countries were grouped by adopting a hierarchical clustering approach. RESULTS: There is a high variability across countries in the selection of measures that cover different aspects of childcare. Preferences in the distribution of measures are significant even at the domain level and in countries that use a limited number of measures and become more evident at the category and sub-category levels. The statistical analysis clusters countries in four main groups and two outliers. The in-depth distribution of measures focused on a specific aspect shows a homogeneous pattern, with the identification of two main groups of countries. CONCLUSIONS: A limited set of measures are shared across countries hampering a robust comparison of paediatric models. The selection of measures shows that the evaluation is closely related to national priorities as resulting from the number and types of measures adopted. Moreover, a range of a reasonable number of measures can be hypothesized to address the quality of childcare under a multi-dimensional perspective.

Temporal trends in leisure-time sedentary behavior among adolescents aged 12-15 years from 26 countries in Asia, Africa, and the Americas.

BACKGROUND: Multi-country studies examining trends in sedentary behaviors among adolescents have mainly focused on high-income or Western countries, and almost no data exists for the rest of the world. Thus, this study aims to examine temporal trends in adolescents' leisure time sedentary behavior (LTSB) employing nationally representative datasets from 26 countries from five WHO-defined geographical regions. METHODS: Data from the Global School-based Student Health Survey 2003-2017 were analyzed in 17,734 adolescents [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. LTSB was self-reported and included all types of sedentary behaviors, excluding time spent at school or doing homework. The prevalence and 95%CI of high LTSB (i.e., ≥3 h/day) was calculated for the overall sample and by sex for each survey. Crude linear trends in high LTSB were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls. RESULTS: Temporal variations in LTSB substantially diverged across countries, with results showing increasing (6/26 countries), decreasing (4/26) and stable trends. The sharpest increases in LTSB occurred in United Arab Emirates, Kuwait, and Thailand. Some countries did not show an increase in LTSB prevalence over time but had very high levels of LTSB (i.e., > 40%) across multiple years. Most countries showed no differences in LTSB trends between boys and girls. CONCLUSIONS: Data from our study may serve as an important platform for policymakers, as well as local and national stakeholders, to establish country-specific and tailored strategies for reducing LTSB.

The association between depressive symptoms and self-rated health among university students: a cross-sectional study in France and Japan.

BACKGROUND: Depressive disorders in University students have risen dramatically in the past few decades to the extent that students' mental health has become a current global public health priority. Obtaining information from University students about their mental health is challenging because of potential embarrassment of disclosing one's concerns and fear of stigmatization. Self-rated health might be a good solution to evaluate mental health state by a simple and neutral indicator. The aim of the study is to investigate the association between depressive symptoms and self-rated health by sex among University students in France and Japan. METHODS: A cross-sectional study was conducted by using two large cohorts of students aged ≥18 years (n = 5655 in Bordeaux, France and n = 17,148 in Kyoto, Japan). Depressive symptoms (PHQ-2 scale), Likert scale of self-rated health, socio-demographic characteristics and health habits were collected through self-administered questionnaires. Multivariate logistic regression models were performed to describe the association between depressive symptoms and other variables including self-rated health, stratified by sex. RESULTS: A high score of PHQ-2 (high depressive symptoms) was associated with poor self-rated health in both cohorts independently of all other variables (OR 2.82, 95%CI 1.99-4.01 in France, OR 7.10, 95%CI 5.76-8.74 in Japan). Although the prevalence of depressive symptoms between sexes was different in French students (males 15.4%, females 25.0%, p < 0.001), it was similar in Japanese students (males 3.5%, females 3.3%, p = 0.466), who reported less depressive symptoms than French students. The association between depressive symptoms and poor self-rated health was greater in Japanese females (OR 12.40, 95%CI 7.74-20.00) than in males (OR 6.30, 95%CI 4.99-7.95), whereas the strength of the association was almost similar in French students (OR 2.17, 95%CI 0.86-5.47 in males, OR 2.98, 95%CI 2.03-4.38 in females). CONCLUSIONS: Depressive symptoms were associated with self-rated health among University students in both countries with slightly differences in sex. Self-rated health would be a simple, reliable and universal indicator for healthcare professionals and University staff to identify students at risk of depression.

Comparison of psychotropic medication use in the Baltic countries.

Purpose: While the pivotal role of pharmacotherapy in psychiatry is universal, significant regional differences exist in drug use patterns. Herewith we compare the use of ATC psychotropic drugs (N05, psycholeptics and N06A, antidepressants) in 2010-2015 in the three Baltic Countries with reference to the Nordic Countries.Methods: Data were obtained from the national authorities on medicines as expressed in DDD per 1000 inhabitants per day. A semi-structured questionnaire was used for expert statements on the rationale of current use of medicines.Results: During the observation period the use of antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants steadily increased, while the growth in use of anxiolytics stagnated in the more recent years. Antipsychotic use was the largest in Lithuania and the lowest in Estonia. The use on anxiolytics in Lithuania was more than twice of that in Estonia and Latvia. Conversely, the use of hypnotics and sedatives was about three times higher in Estonia than in Latvia or Lithuania. Antidepressant use was dominated by the selective serotonin reuptake inhibitors in all three countries, but overall was much lower in Latvia as compared to Lithuania and Estonia. As compared to the Nordic Countries in 2015, antidepressants are used at much lower level throughout Baltics, probably reflecting underdiagnostics of depression and anxiety disorders.Conclusion: While the health-care expenditures in Estonia, Latvia and Lithuania are largely similar, as is the cultural and recent political background of these EU member countries, the extent and the pattern of psychotropic drug use is remarkably variable.

Effects of COVID-19 Misinformation on Information Seeking, Avoidance, and Processing: A Multicountry Comparative Study.

We examined the implications of exposure to misinformation about COVID-19 in the United States, South Korea, and Singapore in the early stages of the global pandemic. The online survey results showed that misinformation exposure reduced information insufficiency, which subsequently led to greater information avoidance and heuristic processing, as well as less systematic processing of COVID-19 information. Indirect effects differ by country and were stronger in the U.S. sample than in the Singapore sample. This study highlights negative consequences of misinformation during a global pandemic and addresses possible cultural and situational differences in how people interpret and respond to misinformation.

Development of a novel benchmark method to identify and characterize best practices in home care across six European countries: design, baseline, and rationale of the IBenC project.

BACKGROUND: Europe's ageing society leads to an increased demand for long-term care, thereby putting a strain on the sustainability of health care systems. The 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care' (IBenC) project aims to develop a new benchmark methodology based on quality of care and cost of care utilization to identify best practices in home care. The study's baseline data, methodology, and rationale are reported. METHODS: Home care organizations in Belgium, Finland, Germany, Iceland, Italy, and the Netherlands, home care clients of 65 years and over receiving home care, and professionals working in these organizations were included. Client data were collected according to a prospective longitudinal design with the interRAI Home Care instrument. Assessments were performed at baseline, after six and 12 months by trained (research) nurses. Characteristics of home care organizations and professionals were collected cross-sectionally with online surveys. RESULTS: Thirty-eight home care organizations, 2884 home care clients, and 1067 professionals were enrolled. Home care clients were mainly female (66.9%), on average 82.9 years (± 7.3). Extensive support in activities of daily living was needed for 41.6% of the sample, and 17.6% suffered cognitive decline. Care professionals were mainly female (93.4%), and over 45 years (52.8%). Considerable country differences were found. CONCLUSION: A unique, international, comprehensive database is established, containing in-depth information on home care organizations, their clients and staff members. The variety of data enables the development of a novel cost-quality benchmark method, based on interRAI-HC data. This benchmark can be used to explore relevant links between organizational efficiency and organizational and staff characteristics.

Gender-based tobacco policies in Bangladesh and India: A prerequisite to counter the smokeless tobacco epidemic.

This study examined gender differences in patterns of smokeless tobacco (SLT) use among various socioeconomic and demographic segments in Bangladesh and India, which are home to 80 percent of global SLT users and share similar sociocultural milieus. The objective was to provide evidence of whether gender-focused interventions and policies might be helpful for SLT cessation programs. Data from the Global Adult Tobacco Survey were used for the analysis. In Bangladesh, data were collected between July and August 2009, and 9,629 individuals were successfully interviewed. In India, data were collected from June 2009 to January 2010, and 69,296 individuals were interviewed. Tests of proportions revealed that the prevalence of SLT use was highest among women in Bangladesh (27.9 percent) and among men (32.9 percent) in India. Logistic regression models revealed that the odds of SLT use was lower among Bangladeshi females in the highest age category. However, in India, a similar observation was made only for females with rural residences. In addition, the odds of SLT use was less among those with a higher level of education and wealth, irrespective of the sex or country. The present findings suggest a need for gender-specific policies and interventions for SLT control.

How to understand informal caregiving patterns in Europe? The role of formal long-term care provisions and family care norms.

AIMS: Motivated by ageing populations, healthcare policies increasingly emphasize the role of informal care. This study examines how prevalence rates of informal caregivers and intensive caregivers (i.e. those who provide informal care for at least 11 hours a week) vary between European countries, and to what extent informal caregiving and intensive caregiving relate to countries' formal long-term care provisions and family care norms. METHODS: Multilevel logistic regression analyses on data from the European Social Survey Round 7 ( n = 32,894 respondents in n = 19 countries) were used to test (a) contradicting hypotheses regarding the role of formal long-term care provisions based on crowding-out, crowding-in and specialization arguments and (b) the hypothesis that strong family care norms are positively related to (intensive) informal caregiving. RESULTS: Prevalence rates of informal caregiving varied between European countries, from 20% to 44%. Intensive caregiving ranged from 4% to 11%. Opposite patterns regarding the role of formal long-term care provisions were revealed: generous long-term care provisions in a country were related to a higher likelihood of providing informal care, but a lower likelihood of providing intensive care. Moreover, intensive caregiving was more likely when family care norms in a country were strong. CONCLUSIONS: This study provided support for the specialization argument by showing that generous formal long-term care provisions crowded-out intensive caregiving, but also encouraged more people to provide (some) informal care. Because especially intensive caregiving is burdensome, low levels of formal long-term care provisions might bring risks to caregivers' well-being and healthcare systems' sustainability.