Health status of people with intellectual disabilities: A systematic literature review

Abstract Background People with intellectual disabilities (ID) have a right to the highest level of health and to non-discrimination in health care. There are an estimated 89,000 people with ID living in Austria. Little is known about their health status and about their health care. We carried out a systematic review with the aim to provide an overview of comparative studies on the health status and health behaviour of people with and without ID. Methods The systematic literature search was conducted in 3 electronic databases for the search period 2008 to March 2020, supplemented by a reference list check and a search of relevant websites. Abstracts and full texts were dually screened, data extraction was performed by one person and checked by a second. Bias risk was assessed by two people using the AXIS tool for cross-sectional studies. Results were summarised narratively. Results A total of 73 publications were included. The literature review reveals a very clear picture: people with ID have a shorter life expectancy, are more affected by illness and health problems, are more likely to have health-related limitations in daily living and are more likely to die from potentially preventable causes of death that could be avoided either through preventive measures or by high-quality medical care. Conclusions To better assess the health situation of people with ID in Austria, Austria-specific data is needed. Furthermore, systematic initiatives in the areas of prevention, health promotion and health care are necessary. People with ID should therefore be systematically considered in all strategies and processes in the health sector. In terms of health literacy, a stronger information policy towards people with ID and towards their relatives and health care professions would be indicated. Key messages People with ID have a shorter life expectancy, more illness and health problems, health-related limitations in daily life and are more likely to die from preventable causes of death. Health data for people with ID is missing in Austria and systematic initiatives in the areas of prevention, health promotion and health care are strongly needed.


Background:
Schistosomiasis is a high-burden parasitic disease and endemic in tropical climates, such as Madagascar. Recently it is emerging in Europe. Chronic infections lead to disabilities including loss in work productivity. Current control strategies focus on school-aged children, thereby systematically excluding adults. The goal to eliminate the disease as a public health problem is aligned with the Sustainable Development Goals agenda, including Universal Health Coverage (UHC). We aim at assessing the distribution of schistosomiasis among adults in Madagascar, in order to promote more targeted public health initiatives against the disease.

Methods:
In a cross-sectional study, 1477 blood samples were collected at three primary health-care centers in Madagascar from 03.21 to 01.22. A semi quantitative PCR assay was used to assess the presence of Schistosoma. Positivity rates with 95% Confidence Intervals (CI) were reported by gender and age groups.

Conclusions:
Our preliminary results provide evidence of high positivity rates of schistosomiasis among adults in a highly endemic country. Differently from many studies, males seem more affected than females. The youngest age group, representing the more active workforce of a population, shows a higher positivity rate. Our data suggests that, in the logic of UHC and health as a human right, public health strategies for schistosomiasis need to be re-addressed towards a universal coverage of affected individuals. Key messages: Inequalities in current control strategies to fight the tropical disease schistosomiasis might hinder the achievement of disease elimination and universal health coverage goals. Further systematically assessment and re-addressing of public health strategies towards universal coverage of affected individuals might help to close gaps in health care and reach the set goals.

Background:
People with intellectual disabilities (ID) have a right to the highest level of health and to non-discrimination in health care. There are an estimated 89,000 people with ID living in Austria. Little is known about their health status and about their health care. We carried out a systematic review with the aim to provide an overview of comparative studies on the health status and health behaviour of people with and without ID.

Methods:
The systematic literature search was conducted in 3 electronic databases for the search period 2008 to March 2020, supplemented by a reference list check and a search of relevant websites. Abstracts and full texts were dually screened, data extraction was performed by one person and checked by a second. Bias risk was assessed by two people using the AXIS tool for cross-sectional studies. Results were summarised narratively.

Results:
A total of 73 publications were included. The literature review reveals a very clear picture: people with ID have a shorter life expectancy, are more affected by illness and health problems, are more likely to have health-related limitations in daily living and are more likely to die from potentially preventable causes of death that could be avoided either through preventive measures or by high-quality medical care.

Conclusions:
To better assess the health situation of people with ID in Austria, Austria-specific data is needed. Furthermore, systematic initiatives in the areas of prevention, health promotion and health care are necessary. People with ID should therefore be systematically considered in all strategies and processes in the health sector. In terms of health literacy, a stronger information policy towards people with ID and towards their relatives

Background:
A differentiated analysis of the structural relationships between social factors and health-related quality of life (HRQOL) in older German adults has not yet been conducted. In this analysis, we aimed to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental HRQOL in older German adults.

Methods:
A community-based postal survey was used to collect crosssectional data from German adults aged 65 and older (n = 1687, 33% response proportion, 52% female). Physical and mental dimensions of HRQOL were assessed using Short Form 36, version 2. Multiple linear regression models were used to analyse the associations between social factors and both physical and mental HRQOL.

Results:
Health locus of control, physical activity, and income were positively associated with both physical HRQOL (Adj. R2 = 0.34, p < 0.001) and mental HRQOL (Adj. R2 = 0.22, p < 0.001), whereas age was negatively associated with both. Alcohol use was positively associated with physical HRQOL, and social support was positively associated with mental HRQOL.

Conclusions:
A differentiated understanding of the relationships between social factors and HRQOL assists in group-specific targeting of health interventions. Demand-oriented interventions should consider underlying social factors to reduce socially determined inequities in HRQOL among older German adults.
Depending on the focus of the intervention, it may be helpful to take specific social conditions into account. The results may be transferable to municipalities in high-income European countries.
Key messages: Sociodemographic, socioeconomic, psychosocial, and behavioural factors are associated with physical and mental health-related quality of life in older German adults. Social conditions should be considered when targeting group-specific interventions to reduce socially determined inequities in health-related quality of life among older adults.
Abstract citation ID: ckac130.034 Tobacco product menthol and flavour bans: their utility for LMIC and lessons from the EU ban

Background:
Flavoured tobacco products increase smoking uptake and create dependence. By June 2020 all cigarettes with a characterising flavour, including menthol were banned across the EU, UK and Moldova but many low and middle income countries (LMIC) are yet to develop and implement bans despite high smoking prevalence. This paper has two objectives: to establish whether (1) flavoured tobacco products are present and marketed in LMIC and (2) the experience of bans in Europe can guide development of legislation elsewhere.

Methods:
Research involved analysis of menthol/flavour market data, review of academic and commercial literature and online media.

Results:
The median menthol/capsule market share of the cigarette market grew significantly in middle income countries (p < 0.05) between 2005 and 2019, both in lower and upper middle-income countries [lower: 2.5% (IQR: 0.5-4.0) to 6.5% (IQR: 3.6-15.9); and upper: 4.0% (IQR: 0.8-9.8) to 12.3% (IQR: 3.5-24.3)]. No market data were available on lowincome countries, but the academic literature suggested high prevalence of menthol use in Zambia. Tobacco industry strategies underpinning growth of menthol/flavoured tobacco use in LMICs included in-store marketing and display, colourful packs and non-conventional flavour names. Tobacco industry attempts to circumvent the EU ban included introducing new flavoured tobacco products and accessories not included in the ban and exploiting the ban on characterising flavour (as opposed to an ingredient ban) by introducing cigarettes with lower levels of menthol.

Conclusions:
Banning flavoured and menthol cigarettes in LMIC would impact a growing proportion of smokers in these countries.