The 2018-2019 FoodNet Population Survey: A tool to estimate risks and behaviors associated with enteric infections.

The FoodNet Population Survey is a periodic survey of randomly selected residents in 10 US sites on exposures and behaviors that may be associated with acute diarrheal infections and the health care sought for those infections. This survey is used to estimate the true disease burden of enteric illness in the United States and to estimate rates of exposure to potential sources of illness. Unlike previous FoodNet Population Surveys, this cycle used multiple sampling frames and administration modes, including cell phone and web-based questionnaires, that allowed for additional question topics and a larger sample size. It also oversampled children to increase representation of this population. Analytic modeling adjusted for mode effects when estimating the prevalence estimates of exposures and behaviors. This report describes the design, methodology, challenges, and descriptive results from the 2018-19 FoodNet Population Survey.

The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-Analysis.

OBJECTIVES: This review aims to examine the ceiling effects of EQ-5D-3L (3L) and EQ-5D-5L (5L) in general adult populations and identify the factors influencing these effects. METHODS: We searched 8 databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed. RESULTS: We identified 94 studies from 70 articles, including 4 543 647 adults across 37 countries. The global pooled proportion of individuals reporting full health ("11111") was 56% (95% CI 51%-62%) for 3L and 49% (95% CI 44%-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), whereas pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18%-32%) in 3L and 9% (95% CI -2%-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and 5L dimensions (except for pain/discomfort and anxiety/depression). CONCLUSIONS: This review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.

Population-level norm values by EQ-5D-3L in Hungary - a comparison of survey results from 2022 with those from 2000.

PURPOSE: Although population norms of the EQ-5D-3L instrument had been available in Hungary since 2000, their evaluation was based on a United Kingdom (UK) value set. Our objective was to estimate the population norms for EQ-5D-3L by using the new Hungarian value set available since 2020, to extend the scope to adolescents, and to compare with norms from 2000. METHODS: A cross sectional EQ-5D-3L survey representative of the Hungarian population was conducted in 2022. The EQ-5D-3L dimensional responses were analyzed by age and sex and compared with the survey from 2000, by estimating population frequencies with their 95% confidence intervals; index values were evaluated by both value sets. RESULTS: Altogether, 11,910 respondents, aged 12 or more (578 between 12 and 17), completed the EQ-5D-3L. There was a notable improvement in reporting problems for both sexes (age 35-64) regarding the pain/discomfort and anxiety/depression compared to 2000. Below the age 44, both sexes had an EQ-5D-3L index plateau of 0.98, while above the age 55, men tended to have numerically higher index values compared to women, with the difference increasing with older age. Improvement in dimensional responses were also translated to numerically higher index values for both sexes between ages 18 and 74 compared to 2000. Multivariate regression analysis showed that higher educational attainment, lower age, larger household size, and active occupational status were associated with higher index values. CONCLUSION: Over the past 22 years, there was a large improvement in HRQoL of the middle-aged to elderly men and women in Hungary.

Health states can be described by a combination of statements of health-related quality of life measures. 'Value sets' are numerical expressions of how preferred a health state is. The provision of population-level health-related quality of life estimates (also known as 'population norms') are expected to improve the precision of patient-level clinical decision making, and health economic and public health studies. However, preference towards these health states is influenced by culture, resulting in differences across populations. While responses for the EQ-5D-3L instrument for adults have been available in Hungary since 2000, the evaluation of these responses was based on a 'value set' from the United Kingdom, rather than a Hungarian one.This research, utilizing the newly introduced Hungarian 'value set' (available since 2020) for the EQ-5D-3L instrument, offers a larger sample size, inclusion of adolescents and potentially improved sampling compared to the prior research conducted in 2000. Comparison of the two surveys allows us to estimate changes in both dimensional responses and overall health-related quality of life of the population over a 20-year time horizon, while we also compare the impact of different 'value sets' on health-related quality of life assessment. A large EQ-5D-3L improvement was observed in middle-aged-to-elderly people.

The Kessler Psychological Distress Scale in Australian adolescents: Analysis of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

INTRODUCTION: The 10-item Kessler Psychological Distress Scale (K10) is used to screen adolescents for mental disorders in Australian clinical practice; however, there are no Australian adolescent normative data. METHODS: Data were drawn from a nationally representative sample (N = 2964) of Australian adolescents (11-17 years). This study had three aims: (1) to examine concurrent validity between the K10 and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms subscale, (2) to establish normative Australian adolescent K10 data and (3) to determine optimal K10 cut-off scores for screening for major depressive disorder (MDD) via receiver operator characteristic curve analysis and stratum-specific likelihood ratios. RESULTS: The K10 and SDQ emotional symptoms scales were moderately correlated (rs = 0.63, p < 0.001). Older female adolescents reported higher total K10 scores compared with younger female adolescents (15-17 years: M = 20.2, standard error [SE] = 0.3; 11-14 years: M = 16.8, SE = 0.3) and male adolescents (11-14 years: M = 16.6, SE = 0.2; 15-17 years: M = 16.0, SE=0.2). K10 scores to optimally discriminate those with and without MDD varied by age and sex and had low specificities. Stratum-specific likelihood ratios indicated adolescents with a K10 score of ≥30 will have a 12.9 (95% confidence interval = [10.2, 16.2]) increased likelihood of MDD. CONCLUSION: The K10 has utility for assessing psychological distress in health care and epidemiological research in Australian adolescents. Adolescents with K10 scores in the 'very high' range are at increased risk of MDD. Further assessment of these young people is indicated to identify those with or at risk of developing MDD.

Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency.

OBJECTIVES: Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS: A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS: PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS: Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.

Religious Differences in Physical and Mental Health among Israeli Jews: Findings from the Global Flourishing Study.

Numerous studies have identified religious correlates of health indicators, but relatively few have been conducted among Jewish populations in Israel or the diaspora. This study investigates the possibility of a religious gradient in physical and mental health and well-being across the familiar categories of Jewish religious identity and observance in Israel: hiloni (secular), masorti lo dati (traditional, non-religious), masorti (traditional), dati (religious or Orthodox), and charedi (ultra-Orthodox). Data are from Jewish respondents aged 18 and over (N = 2916) from the Israeli sample of the new, 22-nation Global Flourishing Study, which used stratified, probability-based sampling and assessed demographic, socioeconomic, political, religious, health-related, and other variables. This analysis investigated religious differences in nine indicators of physical and mental health and well-being among Israeli Jews. Using a strategy of one-way ANOVA and ANCOVA, adjusting for complex sampling design components, a statistically significant "dose-response"-like gradient was found for eight of the outcome measures, validated by additional multiple comparison tests. For four "positively" worded indicators (physical and mental health, happiness, and life satisfaction), scores increased consistently from the hiloni to the charedi categories. For four of five "negatively" worded indicators (bodily pain, depression, anxiety, and suffering), scores decreased across the same categories. Results withstood adjusting for effects of age, sex, education, marital status, urbanicity, income, and nativity (whether born in Israel). Among Israeli Jews, greater religiousness was associated with higher levels of health and well-being and lower levels of somatic and psychological distress.

Bidirectional relationships between cannabis use, anxiety and depressive symptoms in the mediation of the association with psychotic experience: further support for an affective pathway to psychosis.

BACKGROUND: Empirical evidence suggests that people use cannabis to ameliorate anxiety and depressive symptoms, yet cannabis also acutely worsens psychosis and affective symptoms. However, the temporal relationship between cannabis use, anxiety and depressive symptoms and psychotic experiences (PE) in longitudinal studies is unclear. This may be informed by examination of mutually mediating roles of cannabis, anxiety and depressive symptoms in the emergence of PE. METHODS: Data were derived from the second longitudinal Netherlands Mental Health Survey and Incidence Study. Mediation analysis was performed to examine the relationship between cannabis use, anxiety/depressive symptoms and PE, using KHB logit in STATA while adjusting for age, sex and education status. RESULTS: Cannabis use was found to mediate the relationship between preceding anxiety, depressive symptoms and later PE incidence, but the indirect contribution of cannabis use was small (for anxiety: % of total effect attributable to cannabis use = 1.00%; for depression: % of total effect attributable to cannabis use = 1.4%). Interestingly, anxiety and depressive symptoms were found to mediate the relationship between preceding cannabis use and later PE incidence to a greater degree (% of total effect attributable to anxiety = 17%; % of total effect attributable to depression = 37%). CONCLUSION: This first longitudinal cohort study examining the mediational relationship between cannabis use, anxiety/depressive symptoms and PE, shows that there is a bidirectional relationship between cannabis use, anxiety/depressive symptoms and PE. However, the contribution of anxiety/depressive symptoms as a mediator was greater than that of cannabis.

A pilot study to estimate the population size of endangered Galápagos marine iguanas using drones.

BACKGROUND: Large-scale species monitoring remains a significant conservation challenge. Given the ongoing biodiversity crisis, the need for reliable and efficient methods has never been greater. Drone-based techniques have much to offer in this regard: they allow access to otherwise unreachable areas and enable the rapid collection of non-invasive field data. Herein, we describe the development of a drone-based method for the estimation of population size in Galápagos marine iguanas, Amblyrhynchus cristatus. As a large-bodied lizard that occurs in open coastal terrain, this endemic species is an ideal candidate for drone surveys. Almost all Amblyrhynchus subspecies are Endangered or Critically Endangered according to the IUCN yet since several colonies are inaccessible by foot, ground- based methods are unable to address the critical need for better census data. In order to establish a drone-based approach to estimate population size of marine iguanas, we surveyed in January 2021 four colonies on three focal islands (San Cristobal, Santa Fe and Espanola) using three techniques: simple counts (the standard method currently used by conservation managers), capture mark-resight (CMR), and drone-based counts. The surveys were performed within a 4-day window under similar ambient conditions. We then compared the approaches in terms of feasibility, outcome and effort. RESULTS: The highest population-size estimates were obtained using CMR, and drone-based counts were on average 14% closer to CMR estimates-and 17-35% higher-than those obtained by simple counts. In terms of field-time, drone-surveys can be faster than simple counts, but image analyses were highly time consuming. CONCLUSION: Though CMR likely produces superior estimates, it cannot be performed in most cases due to lack of access and knowledge regarding colonies. Drone-based surveys outperformed ground-based simple counts in terms of outcome and this approach is therefore suitable for use across the range of the species. Moreover, the aerial approach is currently the only credible solution for accessing and surveying marine iguanas at highly remote colonies. The application of citizen science and other aids such as machine learning will alleviate the issue regarding time needed to analyze the images.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019.

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

Awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among sexually active adults in Malawi: results from the 2020 Malawi population-based HIV impact assessment.

BACKGROUND: The World Health Organization recommends Pre-Exposure Prophylaxis (PrEP) for all populations at substantial risk of HIV infection. Understanding PrEP awareness and interest is crucial for designing PrEP programs; however, data are lacking in sub-Saharan Africa. In Malawi, oral PrEP was introduced in 2018. We analyzed data from the 2020 Malawi Population-based HIV Impact Assessment (MPHIA) to assess PrEP awareness and factors associated with PrEP interest in Malawi. METHODS: MPHIA 2020 was a national cross-sectional household-based survey targeting adults aged 15 + years. Oral PrEP was first described to the survey participants as taking a daily pill to reduce the chance of getting HIV. To assess awareness, participants were asked if they had ever heard of PrEP and to assess interest, were asked if they would take PrEP to prevent HIV, regardless of previous PrEP knowledge. Only sexually active HIV-negative participants are included in this analysis. We used multivariable logistic regression to assess sociodemographic factors and behaviors associated with PrEP interest. All results were weighted. RESULTS: We included 13,995 HIV-negative sexually active participants; median age was 29 years old. Overall, 15.0%, 95% confidence interval (CI): 14.2-15.9% of participants were aware of PrEP. More males (adjusted odds ratio (aOR): 1.3, 95% CI: 1.2-1.5), those with secondary (aOR: 1.5, 95% CI: 1.2-2.0) or post-secondary (aOR: 3.4, 95% CI: 2.4-4.9) education and the wealthiest (aOR: 1.6, 95% CI: 1.2-2.0) were aware of PrEP than female, those without education and least wealthy participants, respectively. Overall, 73.0% (95% CI: 71.8-74.1%) of participants were willing to use PrEP. Being male (aOR: 1.2; 95% CI: 1.1-1.3) and having more than one sexual partner (aOR: 1.7 95% CI: 1.4-1.9), were associated higher willingness to use PrEP. CONCLUSIONS: In this survey, prior PrEP knowledge and use were low while PrEP interest was high. High risk sexual behavior was associated with willingness to use PrEP. Strategies to increase PrEP awareness and universal access, may reduce HIV transmission.

COVID-19 vaccination status and related process of care outcomes among U.S. adults with active epilepsy-National Health Interview Survey, United States, 2021.

Growing research has examined the effects of the COVID-19 pandemic on people with epilepsy. There are no published national estimates of COVID-19 vaccination status among U.S. adults with active epilepsy. The purpose of this study is to use 2021 National Health Interview Survey (NHIS) data to examine select COVID-19-related outcomes by epilepsy status in a nationally representative sample of US adults. The study sample met the criteria for operationalization of epilepsy status (i.e., active epilepsy vs. no epilepsy history) and select questions related to COVID-19 testing, vaccination, delays in care, or experience with virtual care during the COVID-19 pandemic. All analyses accounted for the NHIS complex sample design and response sampling weights. Our study found that in 2021 receipt of one COVID-19 vaccination among U.S. adults with active epilepsy was generally similar to that among adults without a history of epilepsy. By age, adults aged 18-44 years with active epilepsy (27.0%) were significantly less likely to have reported receiving two COVID-19 vaccinations compared with their peers with no epilepsy history (39.1%). Compared to adults with no epilepsy history, adults with active epilepsy reported similar experiences and outcomes regarding COVID-19 testing and obtaining health care during the COVID-19 pandemic. This study provides baseline estimates of select COVID-19 outcomes among US adults with active epilepsy to guide interventions and additional studies.

Active epilepsy prevalence among U.S. adults is 1.1% and differs by educational level-National Health Interview Survey, United States, 2021.

This study used the most recent national data from the 2021 National Health Interview Survey (NHIS) to provide updated estimates of the prevalence of active epilepsy (self-reported doctor-diagnosed epilepsy, currently under treatment with antiseizure medicines or had at least 1 seizure in the past 12 months, or both) and inactive epilepsy (self-reported doctor-diagnosed history of epilepsy, not under treatment with antiseizure medicines and with no seizures in the past 12 months) overall and by sex, age groups, race/ethnicity, education level, and health insurance status. In 2021, 1.1% of U.S. adults, (approximately 2,865,000 adults) reported active epilepsy; 0.6% (approximately 1,637,000 adults) reported inactive epilepsy. The prevalence of active epilepsy and inactive epilepsy did not differ by age or sex. Active and inactive epilepsy prevalence differed by educational level. Weighted population estimates are reported for each subgroup (e.g., women; non-Hispanic Blacks) for program or policy development. Although active epilepsy prevalence has remained relatively stable over the past decade, this study shows that more than half of U.S. adults with active epilepsy have ≤high school diploma/GED, which can inform the development and implementation of interventions. Additional monitoring is necessary to examine population trends in active prevalence overall and in subgroups.

A cross-sectional study of the relationship between injuries and quality of life, psychological distress, sleeping problems, and global subjective health in adults from three Norwegian counties.

BACKGROUND: Studies examining associations between injuries and outcomes like quality of life and psychological distress are important to understand a broader range of possible consequences of injuries for population health. AIMS: The aim of this study was to examine associations between self-reported injury and quality of life, psychological distress, sleeping problems, and global subjective health. METHODS: The sample was drawn from the Norwegian National Population Register. Data were collected among the general adult populations in three Norwegian counties in 2019-2020 (response rate 45.3%, n = 74,030). Exposure variables were being injured during the last 12 months, cause of injury (if more than one, the most serious one), and functional impairment due to injuries. Outcome variables included measures of total quality of life, global quality of life, positive affect, negative affect, positive social relations, social capital (trust, belongingness, feeling safe), psychological distress, sleep problems, loneliness, and global subjective health. Data were analysed with General Linear Modelling in SPSS Complex. RESULTS: Reporting to have been injured once during the last 12 months was associated with slightly elevated levels of psychological distress, sleeping problems, and loneliness, and lower mean scores on quality-of-life indicators and global subjective health. Reporting being injured twice or more showed more pronounced contrasts to the reference group on the same outcomes, with Cohen's d-values (absolute numbers) ranging from 0.17 to 0.54. For having been victim to violence, d-values ranged from 0.30 to 1.01. Moderate functional impairment due to injuries was associated with less favourable scores on all outcomes (d ranging from 0.15 to 0.71). For strong functional impairment d-values ranged from 0.35 to 1.17. CONCLUSIONS: Elevated levels of distress and reduced levels of quality of life are particularly associated with multiple injuries, being victim to violence, and functional impairment due to injuries. Prospective, longitudinal studies with high quality instruments and large samples, allowing adjustment for baseline values of outcome variables, and utilization of state-of-the-art statistical techniques, would bring this research closer to examining causality.

Comparison of three health-related quality of life instruments in relation to visual acuity: EQ-5D, 15D, and EUROHIS-QOL8.

PURPOSE: To compare three health-related quality of life (HRQoL) instruments in detecting the effect of distance visual acuity (VA) on generic HRQoL in an adult population. METHODS: We used cross-sectional, population-based data from a nationwide health survey conducted in Finland in 2011-2012. It included three self-reported HRQoL instruments, EuroQol-5 Dimension (EQ-5D), 15D, and EUROHIS-QOL8, and a health examination in which habitual distance VA was measured binocularly. We assessed 3764 survey participants aged 30 years and older with information available on these parameters. The comparability and sensitivity of the instruments were evaluated using Pearson correlation coefficients and multivariable linear regression in different VA groups. RESULTS: EQ-5D and 15D index scores showed strong positive correlation (0.65-0.74) with each other regardless of distance VA, whereas EUROHIS-QOL8 index score showed moderate-to-strong correlation (0.46-0.79) with EQ-5D and 15D. All three instruments showed a negative trend with deteriorating VA, although EQ-5D and 15D showed better sensitivity than EUROHIS-QOL8. When adjusted for age, gender, and co-morbidities, adequate vision (VA 0.63-0.8), weak vision (VA 0.32-0.5), and impaired vision or worse (VA ≤ 0.25) were independently associated with declined EQ-5D and 15D, whereas declined EUROHIS-QOL8 was associated only with adequate and weak vision. CONCLUSION: All three instruments can be viable tools in evaluating the relation between vision and HRQoL. While 15D is preferred due to its wide coverage of dimensions, EQ-5D can be an equal alternative, as it has less respondent burden. The feasibility of EUROHIS-QOL8 on detecting differences between lower VA levels may require further evidence.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

OBJECTIVE: This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. DESIGN: This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SETTING: SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. PARTICIPANTS: Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. RESULTS: The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. CONCLUSIONS: The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

Socioeconomic inequalities in sexual victimisation in a nationally representative sample of the Swedish population.

AIMS: Sexual victimisation is a key public health concern because of its physical, psychological and social consequences. Nationally representative studies exploring sexual victimisation and re-victimisation are still scarce. The aim of the current study was to explore associations of sexual victimisation with sociodemographic factors including sexual orientation in Sweden. METHODS: We used Swedish data from a national population survey linked to nationwide registers. The sample consisted of 3349 individuals aged 30-44 years, (2021 women and 1328 men). With a latent class analysis we identified groups of individuals with distinctly different experiences of sexual victimisation. Multinomial logistic regression was used to explore how common characteristics could explain latent class membership classes. RESULTS: Experiences of sexual victimisation were common: 48% of women and 13% of men had experienced sexual harassment, 47% of women and 12% of women sexual assault, 11% of women and 1% of men attempted intercourse and 8% of women and 1% of men rape. Among women four groups were identified who had distinctly different experiences of exposure to sexual victimisation such as low victimisation, sexually harassed and assaulted several times, highly sexually victimised with low re-victimisation and finally high victimisation. Both women and men who were highly sexually victimised had to a higher extent a non-heterosexual sexual identity. CONCLUSIONS: Non-heterosexual orientation is a robust indicator of a high level of sexual victimisation as well as re-victimisation among both male and female adults.

The Danish National Survey of Diet and Physical Activity (DANSDA) 1995-2011-2013: Study design, study participants, participation rate and underreporting.

AIM: This study describes the study design, study participants, participation rate and underreporting in the Danish National Surveys of Diet and Physical Activity (DANSDA) from 1995 to 2011-2013. METHODS: DANSDA are government-funded surveys of food and nutrient intake, physical activity and lifestyle, undertaken to support nutritional policy, risk assessment and public health research. The surveys are cross-sectional based on primarily simple random samples (ages 1-80 years in 1995, 4-75 years in 2000-2013) drawn from the Danish Civil Registration System. Approximately 4800 individuals in 1995, 8200 in 2000-2002, 8400 in 2003-2008 and 7300 in 2011-2013 were invited to participate. Participants completed a seven-day food diary, a physical activity questionnaire (2000-2008), a step diary (2011-2013) and a face-to-face interview. Self-reported anthropometrics (1995-2013) were supplemented with device-based measures (2011-2013). Pedometers were included in 2011-2013. RESULTS: The number of participants included per survey round was 3100-4400. Participant rates decreased from 66% (1995) to 54% (2011-2013). Non-participation was primarily refusal. Ages 18-30 years, 61-75 years (2000-2013), 61-80 years (1995) and low educated and individuals living alone were underrepresented. Underreporting of energy intake among adults ranged from 14% (1995) to 26% (2008). CONCLUSIONS: The methods in DANSDA have been developed to include device-based measures on physical activity and anthropometrics. This has improved the applicability of the results of the survey. The participation rate has fallen, which has affected sample representativity, and underreporting has increased. Future DANSDA surveys should explore and consider new initiatives to counteract non-response and underreporting, with the aim of enhancing data representativeness and applicability.

Telecommuting-related health outcomes during the COVID-19 pandemic in South Korea: a national population-based cross-sectional study.

BACKGROUND: Telecommuting has expanded greatly during the COVID-19 pandemic. Since the advent of remote working from home, there has been an ongoing controversy about the positive or negative health-related impact of telecommuting. This study aimed to investigate change in the occupational health risk in South Korean workers involved in telecommuting during the pandemic period compared to daily commuters. METHODS: A population-based cross-sectional study of South Korean workers using the secondary data from the 6th Korean Working Conditions Survey (2020-2021) was designed. A total of 12,354 white-collar wage employees were selected as the study sample. Telecommuting, depression, anxiety, insomnia, fatigue, musculoskeletal pain, headache-eye strain, absenteeism, and presenteeism were measured by self-reported data. Multiple logistic regression models, including gender stratification analysis, were used to estimate the adjusted odds ratio (AOR) with a 95% confidence interval (CI) for the health outcomes of telecommuters. RESULTS: Among the study population, 338 males and 318 females were reported to be telecommuters. The entirely adjusted regression model showed a positive association between telecommuting and anxiety (AOR = 2.82; 95% CI, 1.93-4.10), insomnia (AOR = 1.93; 95% CI, 1.27-2.92), fatigue (AOR = 1.76; 95% CI, 1.30-2.37), musculoskeletal pain (AOR = 1,76; 95% CI, 1.33-2.32), headache-eye strain (AOR = 1.94; 95% CI, 1.48-2.54), presenteeism (AOR = 1.66; 95% CI, 1.20-2.28) respectively. Gender difference was identified in that only female telecommuters had a higher risk of depression (AOR = 1.62; 95% CI, 1.04-2.53) and insomnia (AOR = 2.07; 95% CI, 1.26-3.41) than daily commuters in the adjusted model. CONCLUSION: Telecommuting was significantly associated with an increased risk of various health problems among South Korean workers and females were identified as a more vulnerable group. Although further research is required to ascertain the causal relationship, public health intervention should be considered to prevent the negative effects of telecommuting.

Validation of a short version of the Lee fatigue scale in adults living in Norway: a cross-sectional population survey.

BACKGROUND: Due to the nature of fatigue, a brief reliable measure of fatigue severity is needed. Thus, the aim of our study was to evaluate a short version of the Lee Fatigue Scale (LFS) in the Norwegian general population. METHODS: This cross-sectional survey consists of a representative sample from the Norwegian population drawn by The National Population Register in Norway. The study is part of a larger study (NORPOP) aimed at collecting normative data from several questionnaires focused on health in adults living in Norway. Registered citizens between 18 and 94 years of age were randomly selected stratified by age, sex and geographic region. Of the 4971 respondents eligible for the study, 1792 (36%) responded to the survey. In addition to age and sex, we collected responses on a 5-item version of the LFS measuring current fatige severity. The psychometric properties focusing on internal structure and precision of the LFS items were analyzed by a Rasch rating scale model. RESULTS: Complete LFS scores for analyses were available for 1767 adults. Women had higher LFS-scores than men, and adults < 55 years old had higher scores than older respondents. Our analysis of the LFS showed that the average category on each item advanced monotonically. Two of the five items demonstrated misfit, while the three other items demonstrated goodness-of-fit to the model and uni-dimensionality. Items #1 and #4 (tired and fatigue respectively) showed differential item functioning (DIF) by sex, but no items showed DIFs in relation to age. The separation index of the LFS 3-item scale showed that the sample could be separated into three different groups according to the respondents' fatigue levels. The LFS-3 raw scores correlated strongly with the Rasch measure from the three items. The core dimensions in these individual items were very similarly expressed in the Norwegian language version and this may be a threat to the cultural-related or language validity of a short version of the LFS using these particular items. CONCLUSIONS: The study provides validation of a short LFS 3-item version for estimating fatigue in the general population.

Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014-2015.

BACKGROUND: The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI. METHODS: We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday. RESULTS: Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI. CONCLUSION: Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.