Intestinal parasitic infections in children from marginalised Roma communities: prevalence and risk factors.

BACKGROUND: Intestinal parasitic infections remain a significant global health issue, particularly affecting poor and marginalised populations. These infections significantly contribute to children's diseases, malnutrition, poor school performance, cognitive disorders, and future economic losses. This study aimed to explore and compare the occurrence of intestinal parasites in early childhood among the group of infants from the Slovak majority population and from marginalised Roma communities (MRCs). Furthermore, it aimed to explore the health complaints of children with and without intestinal parasitic infection in the past month and assess the effect of various risk factors on the occurrence of intestinal parasitic infection in infants from MRCs. METHODS: We obtained cross-sectional data from mothers and stool samples of their children aged 13-21 months using the first wave of the longitudinal RomaREACH study. A total of 181 stools from infants were analysed: 105 infants from the Slovak majority population and 76 from MRCs. RESULTS: Infants from MRCs are significantly more often infected by Ascaris lumbricoides, Trichuris trichiura and Giardia duodenalis than their better-off peers from the majority population. Infection rates are 30% in infants from MRCs vs. 0% in the majority population (p < 0.001). Single and mixed infections were observed in children from MRCs. Infants with intestinal parasitic infections suffer significantly more often from various health complaints, particularly cough, stomach ache, irritability, and diarrhoea. Within MRCs, the risk of parasitic infections in infants is significantly increased by risk factors such as the absence of flushing toilets in households (OR = 4.17, p < 0.05) and contact with un-dewormed animals (OR = 3.61, p < 0.05). Together with the absence of running water in the household, these three factors combined increase the risk more than ten times (p < 0.01). CONCLUSION: Maintaining hygienic standards in conditions of socioeconomic deprivation in MRCs without running water and sewage in the presence of un-dewormed animals is problematic. These living conditions contribute to the higher prevalence of parasitic infections in children from MRCs, causing various health complaints and thus threatening their health and healthy development.

Longitudinal Associations between Different Types of Sexting, Adolescent Mental Health, and Sexual Risk Behaviors: Moderating Effects of Gender, Ethnicity, Disability Status, and Sexual Minority Status.

The present study investigated the moderating effect of adolescent demographic variables in the longitudinal associations among different types of sexting, mental health (i.e., depression, self-harm, subjective health complaints), and sexual risk behaviors. There were 1113 adolescents (ages 14-17 years; Mage = 16.36; SDage = .81; 50% female) from six high schools located in the United States included in this study. Adolescents completed questionnaires on their sexting behaviors, mental health, and sexual risk behaviors during the ninth grade; in tenth grade, they completed questionnaires on mental health and sexual risk behaviors. Non-consensual sexting and pressured sexting were both related positively to each of the mental health variables and sexual risk behaviors. The relationship between non-consensual sexting and depressive symptoms was stronger for girls, ethnic minorities, those adolescents with disabilities, and sexual minorities. Similar patterns were found for pressured sexting, non-suicidal self-harm, and subjective health complaints. The relationships between pressured sexting and sexual risk behaviors were stronger for girls, ethnic minorities, those adolescents with disabilities, and those who identified as sexual minorities. Research focused on the relationships among different types of sexting, mental health, and sexual risk behaviors is important as such research facilitates the development of evidence-based recommendations for sexting harm prevention and sexual education programs.

Psychosomatic complaints are indicative of stress in young individuals: findings from a Swedish national cohort study.

AIMS: Psychosomatic complaints are common in youth and are often assumed to indicate stress. Although several studies have confirmed that a cross-sectional association exists, few have empirically investigated whether or not perceived stress influences psychosomatic complaints. The objective of the present study was to build upon previous research by exploring whether changes in perceived stress over time are associated with corresponding changes in psychosomatic complaints. This analytical approach takes unmeasured time-invariant confounding into account, thereby offering more robust evidence for a causal association between the variables under study. METHODS: Data was derived from the Swedish national cohort study Futura01, with information from 2,708 participants aged 17-18 in 2019 and 20-21 in 2022. Perceived stress was measured by Cohen's Perceived Stress Scale. Psychosomatic complaints were measured by questions on the frequency of stomach aches, headaches and difficulties falling asleep, which were added to an index. Information on gender, parental education, and parental country of birth was derived from registries. Linear regression analyses were conducted and the first difference (FD) approach was used. RESULTS: Perceived stress and psychosomatic complaints exhibited cross-sectional associations at both time points. The FD analyses showed that increases in perceived stress were associated with increases in psychosomatic complaints, and this was the case irrespective of sociodemographic characteristics. CONCLUSIONS: This study provides further empirical support for the assumption that psychosomatic complaints can be partially attributed to stress. Societal efforts aimed at reducing stressors and strengthening coping resources and strategies among young people may help mitigate perceived stress and, consequently, the likelihood of developing psychosomatic complaints.

Physical activity and its relationship to burden and health concerns in family caregivers of people with dementia.

BACKGROUND: Caring for people with dementia (PwD) usually triggers stress and leads to mental and somatic health complaints (SHCs). Physical activity (PA) can provide burden relief in PwD caregivers, but it is not clear whether PA habits would contribute to reducing SHCs. This study aims to analyze the effect of PA on the relationship between burden and SHCs in a sample of family caregivers of PwD. METHODS: One hundred and fifty-seven caregivers of PwD reported their PA habits, and completed the Giessen's Subjective Health Complaints Questionnaire (GBB-8) and the Zarit Burden Interview (ZBI). The relationship between PA habits, burden of care (ZBI), and SHCs (B-GBB-8 scale) was examined. Subsequently, the moderating effect of PA habits on the relationship between burden and SHCs was tested. RESULTS: PA habit was inversely associated with ZBI (rbp = -0.242) and GBB-8 scores (rbp (Gastrointestinal) = -0.174; rbp (Musculoskeletal) = -0.195; rbp (Exhaustion) = -0.247; rbp (Cardiovascular) = -0.250; and rbp (Overall) = -0.257, respectively), whereas moderate positive correlations were found between ZBI and GBB-8 scores (r (Gastrointestinal) = 0.483; r (Musculoskeletal) = 0.536; r (Exhaustion) = 0.542; r (Cardiovascular) = 0.438; and r (Overall) = 0.598, respectively). The interaction effect of PA habit and burden was significant for the overall SHCs (b = -0.11; P < 0.05) and cardiovascular complaints (b = -0.06; P < 0.05). However, the association between burden and SHCs was significant (P < 0.001) only for sedentary caregivers. CONCLUSION: These findings indicate that maintaining an active lifestyle through regular PA could potentially help alleviate the adverse effects of caregiver burden on somatic health among caregivers of PwD. Encouraging and endorsing PA interventions for informal caregivers might yield substantial advantages for their health and general well-being.

Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985-2017.

BACKGROUND AND AIMS: According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints. METHODS: Three decades (1985/1986-2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis. RESULTS AND CONCLUSIONS: With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates.

Accidents, diseases and health complaints among seafarers on German-flagged container ships.

BACKGROUND: For seafarers on the high seas health hazards are various and due to the setting also specific. The spectrum of job-related health impairments and accidents is mainly influenced by the maritime characteristics. The aim of this study is to assess the kind of accidents and the frequency of diseases and health complaints among seafarers on German container ships by evaluating medical log books. METHODS: A systematic analysis of 14,628 medical entries from 95 medical log books of 58 container ships under German flag from 1995 to 2015 was performed. This monocentric retrospective and descriptive study used information on accidents, diseases and health complaints among different occupational groups and medical treatment procedures for the analysis and evaluation. RESULTS: The analysis showed that more than one third of all consultations with the Health Officer on board are related to internal (33.7%) and surgical (31.3%) symptoms. Almost twenty percent of consultations were due to respiratory infections (19.6%) and accidents (17.9%). Accidents represented the most frequent reason for unfitness for sea service (31.2%). Based on occupational categories, most injuries occurred among deck crew (22.5%), followed by ratings working in the engine room (18.9%). In 106 cases, telemedical contact with a physician ashore was necessary. In total, 15 seafarers had to be evacuated from the ship for further medical treatment onshore. Medicine/drug application was the most common therapeutic measure on board, accounting for 77% of all consultations. CONCLUSIONS: The high proportion of health complaints and accidents among seafarers shows that there is a need to optimize medical care at sea and accident prevention, e.g. by standardized treatment algorithms or improving the medical training of Health Officers. The development and introduction of a digital patient file to record medical treatments on the vessels could also improve medical documentation on board.

School and class closures and adolescent mental health during the second and later waves of the COVID-19 pandemic in Finland: a repeated cross-sectional study.

BACKGROUND: Since the start of the COVID-19 pandemic, several studies have shown deterioration of adolescents' mental health when comparing periods before and after the start of the pandemic when there were national school closures. Less is known of the following waves with more variation in school closures and their duration. We study here, if variation in school or class closures was related to adolescents' mental health, if the duration mattered, and if the relationships were gender sensitive. METHODS: All comprehensive schools in Finland were invited to participate. Students (grades 7-9, age 13-16 years) answered digitally in November-December 2020 (n = 41,041) and April-May 2021 (n = 28,501). The responses were given anonymously. Mental health was measured by daily health complaints and moderate/severe anxiety (GAD-7, only in 2021). School and class closures were combined to a variable (yes/no). The duration of a closure was analysed in weeks. Logistic regression analysis was used. RESULTS: In 2020, 14% of pupils reported a school closure and 33% in 2021. The gender-adjusted odds for daily health complaints were higher among those with the school or class closure compared to those without (OR = 1.2 (1.1-1.3) in 2020; OR = 1.3 (1.2-1.3) in 2021). For anxiety, the corresponding OR was 1.3 (1.2-1.4). Girls had higher odds for both measures than boys and the non-binary gender had the highest. A one-week increase in the duration of closure had a small effect on daily health complaints OR = 1.05 (1.02-1.09) in 2020; OR = 1.05 (1.02-1.08) in 2021) and anxiety OR = 1.05 (1.01-1.08). Gender differences in the associations of the school or class closure with mental health were negligible. CONCLUSIONS: A specific negative influence of school or class closures on adolescents' mental health was seen when comparing those who had school/class closure and those who did not during the further waves of the pandemic. The duration of closure had a small effect, too. The non-binary gender had lowest mental health, but the influence of school closure on mental health was mainly similar between the genders. School closures are one of the factors in adolescents' mental health, but not the only one.

An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study.

BACKGROUND: Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents. METHODS: In all, 47 children and adolescents aged 6-16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent's condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences. RESULTS: Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18-30 (47-77%) rated relational empathy in the intervention as "Very good" or "Excellent". Of the parents, 35-39 (92-100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001). CONCLUSIONS: The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.

Helpful elements in a brief work-oriented intervention targeting musculoskeletal and mental health literacy.

Musculoskeletal and mental health complaints are common in the general population and frequent reasons for healthcare utilization and work absence. Illness perceptions, coping expectancies, rumination and self-stigma are important factors in the management of these health complaints and factors closely linked to health literacy (HL). The aims of the study were to identify helpful elements in a brief intervention (BI) targeting HL regarding common musculoskeletal and mental health complaints and to identify patient perceptions of how the intervention was helpful and whether it affected their subsequent coping. Three focus group interviews with 14 patients were conducted. Systematic text condensation was used for the analysis, supported by the health literacy skill (HLS) framework to sharpen the focus on intervention elements related to the acquisition and utilization of HLSs. Results revealed the importance of receiving comprehensible health information and guidance, the use of metaphors to create recognizable narratives and the use of practical examples and exercises. Normalizing the experienced health complaints, together with a safe and accommodating clinical environment, facilitated the change process. The BI initiated processes that contributed to acceptance, resilience and empowerment, aiding work-life balance and return to work. The study presents authentic narratives of value for future focus in BI.

Mercury, silver and selenium in serum before and after removal of amalgam restorations: results from a prospective cohort study in Norway.

OBJECTIVE: A prospective cohort study on changes of health complaints after removal of amalgam restorations was carried out at the request of the Norwegian Directorate of Health. The aim was to provide and evaluate experimental treatment to patients with health complaints attributed to dental amalgam fillings. METHODS: Patients (n = 32) with medically unexplained physical symptoms (MUPS), which were attributed to dental amalgam restorations had all their amalgam restorations removed and replaced with other dental restorative materials. Samples of blood were collected before and 1 year after removal of the fillings, and concentration of inorganic mercury (I-Hg), methylmercury (MeHg), silver (Ag) and selenium (Se) in serum was determined by inductively coupled plasma-sector field mass spectrometry. The comparison groups (one with MUPS but without attribution to amalgam [n = 28] and one group of healthy individuals [n = 19]) received no treatment. The participants responded to questionnaires at baseline and at follow-up after 1 and 5 years. RESULTS: Concentration of I-Hg and Ag in serum decreased significantly after removal of all amalgam restorations. Concentration of MeHg and Se in serum were not changed. Intensity of health complaints was significantly reduced after amalgam removal, but there were no statistically significant correlations between exposure indicators and health complaints. CONCLUSIONS: Removal of all amalgam restorations is followed by a decrease of concentration of I-Hg and Ag in serum. The results support the hypothesis that exposure to amalgam fillings causes an increase of the daily dose of both I-Hg and Ag. Even though intensity of health complaints decreased after removal of all amalgam restorations there was no clear evidence of a direct relationship between exposure and health complaints. Trial registration: The project is registered at Clinicaltrials.gov (NCT01682278).

Item response theory and differential test functioning analysis of the HBSC-Symptom-Checklist across 46 countries.

BACKGROUND: The Symptom Checklist (SCL) developed by the Health Behaviour in School-aged Children (HBSC) study is a non-clinical measure of psychosomatic complaints (e.g., headache and feeling low) that has been used in numerous studies. Several studies have investigated the psychometric characteristics of this scale; however, some psychometric properties remain unclear, among them especially a) dimensionality, b) adequacy of the Graded Response Model (GRM), and c) measurement invariance across countries. METHODS: Data from 229,906 adolescents aged 11, 13 and 15 from 46 countries that participated in the 2018 HBSC survey were analyzed. Adolescents were selected using representative sampling and surveyed by questionnaire in the classroom. Dimensionality was investigated using exploratory graph analysis. In addition, we investigated whether the GRM provided an adequate description of the data. Reliability over the latent variable continuum and differential test functioning across countries were also examined. RESULTS: Exploratory graph analyses showed that SCL can be considered as one-dimensional in 16 countries. However, a comparison of the unidimensional with a post-hoc bifactor GRM showed that deviation from a hypothesized one-dimensional structure was negligible in most countries. Multigroup invariance analyses supported configural and metric invariance, but not scalar invariance across 32 countries. Alignment analysis showed non-invariance especially for the items irritability, feeling nervous/bad temper and feeling low. CONCLUSION: HBSC-SCL appears to represent a consistent and reliable unidimensional instrument across most countries. This bodes well for population health analyses that rely on this scale as an early indicator of mental health status.

Development of health-related quality of life and subjective health complaints in adults born extremely preterm: a longitudinal cohort study.

PURPOSE: To study development trajectories to 34 years of age of health-related quality of life (HRQoL) and subjective health complaints in extremely preterm (EP) born subjects with and without disability, and to compare with term-born controls. METHODS: A Norwegian longitudinal population-based cohort of subjects born in 1982-85 at gestational age ≤ 28 weeks or with birth weight ≤ 1000 g and matched term-born controls completed the Norwegian version of the Short Form Health Survey-36 at ages 24 and 34 and the Health Behaviour in School-aged Children-Symptom Checklist at ages 17, 24 and 34 years. Data were analysed by unadjusted and adjusted mixed effects analyses with time by subject group as interaction term. RESULTS: A total of 35/49 (73%) surviving EP-born and 36/46 (78%) term-born controls participated at this third follow-up. EP-born subjects with severe disability reported clinical significant lower mean score in all domains compared to the term-born controls. Healthy EP-born subjects reported significantly lower mean scores for vitality, role emotional and mental health, and significantly higher mean score for total and psychological health complaints compared to term-born controls. There were no significant interactions with age regarding HRQoL and somatic health complaints, while there were significant differences in psychological health complaints; the EP-born scored higher at age 24 and lower at age 34. CONCLUSIONS: EP-born adults at age 34 reported inferior HRQoL versus term-born peers, especially in the mental health domains, indicating that the negative differences observed at 24 years remained unchanged.

Subjective health complaints in early adolescence reflect stress: A study among adolescents in Western Sweden.

Aims: Mental health problems are common among Swedish adolescents and are sometimes referred to as 'stress-related'. The overall aim of this study is to do an analysis of subjective health complaints (SHCs) and perceived general stress among adolescents in Sweden, both their prevalence and association, by gender, migration background, family structure and socioeconomic conditions. Methods: Data from the baseline (comprising 2283 adolescents aged 13) of the STudy of Adolescence Resilience and Stress (STARS) study in Västra Götaland in Sweden were used. SHCs were measured by the Psychosomatic Problems Scale (PSP-scale) and self-reported stress was measured by Cohen's Perceived Stress Scale (PSS-10). Socioeconomic conditions were measured with the Family Affluence Scale (FAS) and the MacArthur Scale of Subjective Social Status (SSS). Statistical analyses included Student's t-tests and ANOVAs of means, linear and logistic regression analyses and Pearson's correlations. Results: Social inequalities in both SHCs and self-reported stress were found; levels were higher among girls, adolescents living with one parent or in families with less favourable socioeconomic conditions. Self-reported stress and SHCs were found to be strongly correlated (r=0.70). Correlations with self-reported stress were stronger for psychological complaints (r=0.71) than for somatic complaints (r=0.52). Correlations did not vary with socioeconomic conditions of the family. Conclusions: SHCs do reflect general stress among adolescents, and it is appropriate to address the complaints as 'stress-related'. Measures to improve adolescents' mental health by reducing levels of SHCs should pay special attention to stressors in adolescents' daily lives and strengthening adolescent's coping resources and strategies.

The role of perceived loneliness and sociodemographic factors in association with subjective mental and physical health and well-being in Norwegian adolescents.

AIMS: Adolescence is a particularly salient period for understanding the role of perceived loneliness for subjective health and well-being. This study investigated sociodemographic differences (sex, age, self-reported socio-economic status (SES)) in loneliness and associations between sociodemographic factors, loneliness and self-rated health (SRH), subjective health symptoms, symptoms of depression/anxiety and mental well-being (MWB) in a sample of Norwegian adolescents. METHODS: The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. The participants reported scores on an 11-item scale assessing subjective health complaints (SHC), one item each assessing SRH and loneliness, the 10-item version of the Hopkins Symptom Checklist and the seven-item version of the Warwick-Edinburgh Mental Well-Being Scale. SES was assessed using perceived family economy and parents' education. Data were analysed with descriptive, comparative and multiple linear regression analyses. RESULTS: The multivariate results showed that boys scored significantly higher on MWB than girls did, whereas girls scored significantly higher on loneliness, depression/anxiety and SHC. Perceptions of poorer family finances were significantly associated with higher levels of SHC and depression/anxiety, lower levels of MWB and more negative SRH. Loneliness showed significant positive associations with depression/anxiety and SHC, and significant negative associations with MWB and SRH. A significant moderation effect of sex by loneliness was found in association with depression/anxiety, with stronger associations for girls. CONCLUSIONS: The findings in this study support the significant roles of sex, perceptions of family finances and loneliness in association with adolescent's subjective mental and physical health and well-being, especially mental health.

Pre-adolescents with multiple health complaints redeem more prescriptions: A follow-up study in the Danish National Birth Cohort.

Aims: This study aimed to examine the association between multiple health complaints (MHC) in pre-adolescence and prescription redemption in adolescence. Methods: This was a nationwide population-based study based on the Danish National Birth Cohort for an average of 6.9 years (2010-2018). A total of 96,382 children were invited at the age of 11. A modified version of the Health Behaviour in School Children Symptom Checklist was dichotomised into the World Health Organization's definition of MHC (⩾2 complaints, each with a frequency of at least weekly, yes/no). The number of prescriptions was retrieved from Danish registries. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Prescription redemption was further stratified by psychiatric/somatic medication and into subtypes of prescriptions. Results: A total of 47,365 (49.1%) children participated (Mage=11.2 years, 52% girls). MHC were reported by 10.3%. The unadjusted IRR (MHC vs. no MHC) of all types of redemptions was 1.57 (95% confidence interval (CI) 1.49-1.64). Results were robust to adjustment for socio-demographic variables and somatic/psychiatric morbidity at baseline (IRR=1.47; 95% CI 1.40-1.54). Associations were especially strong for psychiatric medication (adjusted IRR=3.88; 95% CI 3.43-4.40) and were modified by neither sex nor maternal education. Conclusions: MHC in pre-adolescents predict prescription redemption. This implies that changes in MHC might be indicative of changes in public health. This requires further study, as the cause of a change in reporting of symptoms might also cause a change in treatment response. The latter determines whether prescriptions are treating ill-being or needlessly medicalising subjective symptoms.

[A literature review on the relationship between questionnaires for assessing minor health complaints and health status indices among Japanese people].

Objectives　Minor health complaints related to stress, mental health, sleep, and fatigue are closely associated with each other, and their deterioration may cause lifestyle diseases. The health status of people can be predicted through a questionnaire by exploring the relationship between their state of minor health complaints and objective health status indices. Therefore, we conducted a systematic review of the relationship between a questionnaire on the state of minor health complaints and health status indices among Japanese people who have a high level of stress, which they experience on a daily basis, using epidemiological literature. Additionally, we considered items for the questionnaire which were necessary for an index development.Methods　The PubMed database was searched for papers on "autonomic nervous system," "sleep disorders," "mental health and stress," and "fatigue," using keywords mentioned in previous studies on minor health complaints.　The extracted research papers were screened according to the following inclusion criteria: 1) the participants were healthy Japanese people; 2) descriptions included characteristics of the target population; 3) use of analytic epidemiological study design, intervention studies, and systematic reviews; 4) minor health complaints assessed by a questionnaire; 5) evaluation of the relationship between the questionnaires for minor health complaints and the health index; and 6) written in Japanese or English. Based on this, ten papers were adopted.Results　Of the 10 papers collected, one was a cohort study, three were case-control studies, and six were cross-sectional studies. The participants in five of them were working adults. Reports on three out of six questionnaires on stress, four out of seven on sleep, and all two on comprehensive health status showed significant associations between minor health complaints assessed by the questionnaires and the index for health status. The increase in responses about work-related stress from the questionnaire was associated with an increase in the "risk of developing depression" [odds ratio 2.96 (confidence interval: 1.04-8.42)]. Poor sleep quality was associated with an increase in "changes in autonomic index," "number of comorbidities and the rate of depression," and the "risk of work-related injuries." Moreover, the health score was associated with the "autonomic nervous system index".Conclusion　These results suggest that a questionnaire evaluating minor health complaints should include questions about "stress," "sleep quality," and "comprehensive health status." Since studies that appropriately adopted for risk of bias were limited, it is necessary to further examine these relationships by applying prospective studies such as cohort studies and intervention studies.

Socioeconomic inequalities in adolescent health complaints: A multilevel latent class analysis in 45 countries.

Our study evaluated the relationship between adolescent health complaints and socioeconomic position in 45 countries. Data are from the 2017/2018 international Health Behaviour in School-aged Children survey which used proportionate sampling among adolescents aged 11 to 15 years old (n=228,979). Multilevel, multinomial regression analysis assessed the association between the multilevel latent classes with socioeconomic status (SES; at the household and country level). Three distinct latent classes were identified: No Complaints, Psychological Complaints, and a Physical and Psychological Complaints class; where, low household SES was highest for the physical and psychological complaints class. The findings suggest that health promotion policies and interventions among adolescents should consider the specific needs of adolescents living with low household SES as they report more subjective health complaints.

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life.

OBJECTIVES: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN: Cross-sectional. SETTING: US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

Sexual jokes at school and psychological complaints: Student- and class-level associations.

Background: Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is also stressful for those who are not directly targeted, with potential negative effects on well-being for all students. Aim: The aim was to examine whether exposure to sexual jokes at the student level and at the class level was associated with students' psychological complaints, and if these associations differed by gender. Method: Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (N=3720 distributed across 209 classes). Psychological health complaints were constructed as an index based on four items. Exposure to sexual jokes at the student level was measured by one item, and at the class level as the class proportion of students exposed to sexual jokes, in per cent. Two-level linear regression analyses were performed.Results: Students who had been exposed to sexual jokes at school reported higher levels of psychological complaints, especially boys. Furthermore, the class proportion of students who had been exposed to sexual jokes was also associated with psychological complaints, even when adjusting for student-level exposure to sexual jokes, gender, grade and class size. Conclusions: Sexual jokes seem to be harmful for those who are directly exposed, but may also affect indirectly exposed students negatively. Thus, a school climate free from sexual jokes may profit all students.

Trends in the utilization of youth primary healthcare services and psychological distress.

BACKGROUND: Psychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need. METHODS: This study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13-19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time. RESULTS: We found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend. CONCLUSIONS: Our findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people.