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Insufficient sleep and recurrent health complaints may increase the risk of poorer self-reported health in adolescence, yet the relationships between these factors are not well understood. This study aims to explore the association between poor self-reported health and insufficient sleep duration among 11, 13, and 15 years old adolescents in Latvia by assessing the moderation effects of age and gender and by considering the mediating effect of health complaints. Methods: Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n = 4412) were used for statistical analysis. Results: On average, 19.3% reported insufficient sleep duration on schooldays and 4.4% on non-school days. Of those with insufficient sleep duration, 5.8% reported poor self-reported health while this proportion was 2% among those with sufficient sleep. Poor self- reported health was associated insufficient sleep duration on school days (OR = 3.02; 95%CI 2.02-4.49), but not on non-schooldays. The association between insufficient sleep and poor self-reported health changed considerably after adjustment with health complaints (OR = 1.58;95%CI 1.03-2.43), however, it still remained significant. Conclusions: There is significant association between insufficient sleep and poor self-reported health regardless of total burden of health complaints.

In the rapidly progressing world where different sectors become more interconnected, cross-sectoral cooperation in health promotion lacks a specific set of instruments, navigating partners through the cooperation process in project implementation. Cross-sectoral cooperation is an everyday practice in business and has become an integral part of promoting health and wellbeing comprehensively and sustainably. In this paper, we propose a developed Model for cross-sectoral cooperation, which has been designed within the Interreg Baltic Sea Region project “Urban Labs for Better Health for All in the Baltic Sea Region” (Healthy Boost), aiming to boost cross-sectoral cooperation for health and wellbeing in cities and municipalities. The Model is developed based on literature research and self-assessment of cross-sectoral cooperation for health promotion in Healthy Boost partner cities and municipalities in Latvia, Poland, Russia, Finland, Estonia, Lithuania, and Sweden. Composed of five major domains (risk identification, leadership, coordination, communication, and motivation) and four stages of cooperation (mapping, planning, implementation, and assessment), it provides a checklist of helpful questions for identifying solutions effectively and systematically. The Model can be used both as a navigational tool and as an “emergency” tool to manage cross-sectoral cooperation challenges successfully.

Schools and municipalities play an important role in local health promotion. The Institute of Public Health at Rıga Stradiņš University in collaboration with the National Centre of Disease Prevention and Control carried out an online survey for studying the experiences and needs of health-promoting schools and municipalities in Latvia in implementing health promotion interventions. The aim of this study was to explore the context for developing new intervention model for a health behaviour change model within the Interreg BaltCityPrevention project “Innovative Lifestyle-Related Disease Prevention Model in the Baltic Sea Region.” Totally 112 municipalities and 100 schools within the National Health Promoting Networks were targeted. Only schools and municipalities that had previous experiences in health promotion intervention development were included in the analysis. This study showed that school-aged children were the most prevalent target group for the both schools and municipality interventions. The interventions in physical activity and nutrition used to be the most common areas for health behaviour changes. Health promotion schools and municipalities reported several significant differences in experienced difficulties and expected future needs in implementing health promotion interventions, which should be considered for increasing the capacity for better health promotion for both schools and municipalities in Latvia.

Introduction: This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020., Method: We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status-i.e., gross domestic product (GDP) per capita., Results: Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models., Conclusions: The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts., (© 2024. The Author(s).)

Background and Objective: Reducing the affordability of alcoholic beverages by increasing alcohol excise taxation can lead to a reduction in alcohol consumption but the impact on government alcohol excise tax revenue is poorly understood. This study aimed to (a) describe cross-country tax revenue variations and (b) investigate how changes in taxation were related to changes in government tax revenue, using data from Estonia, Germany, Latvia, Lithuania and Poland., Methods: For the population aged 15 years or older, we calculated the annual per capita alcohol excise tax revenue, total tax revenue, gross domestic product and alcohol consumption. In addition to descriptive analyses, joinpoint regressions were performed to identify whether changes in alcohol excise taxation were linked to changes in alcohol excise revenue since 1999., Results: In 2022, the per capita alcohol excise tax revenue was lowest in Germany (€44.2) and highest in Estonia (€218.4). In all countries, the alcohol excise tax revenue was mostly determined by spirit sales (57-72% of total alcohol tax revenue). During 2010-20, inflation-adjusted per capita alcohol excise tax revenues have declined in Germany (- 22.9%), Poland (- 19.1%) and Estonia (- 4.2%) and increased in Latvia (+ 56.8%) and Lithuania (+ 49.3%). In periods of policy non-action, alcohol consumption and tax revenue showed similar trends, but tax level increases were accompanied by increased revenue and stagnant or decreased consumption., Conclusions: Increasing alcohol taxation was not linked to decreased but increased government revenue. Policymakers can increase revenue and reduce alcohol consumption and harm by increasing alcohol taxes., (© 2024. The Author(s).)

Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health., Competing Interests: The authors except J. Manthey and S. Lange declare no competing interests. J. Manthey declares consulting fees, honoraria and travel support from German and international public health agencies, unrelated to the current manuscript. S. Lange declares funding from the National Institutes of Health for conducting the study; and further funding from the Canadian Institutes of Health Research, and consulting fees from the Pan American Health Organization, unrelated to the current manuscript., (© 2023 Published by Elsevier Ltd.)

Objective: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use)., Design, Setting, and Participants: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study., Measurements: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data., Results: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results., Conclusions: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Issues: Latvia has one of the highest alcohol per capita consumption in Europe. This study provides a narrative review of all evidence-based population-level alcohol control policies implemented in Latvia during the past 30 years., Approach: A review of country-level alcohol control policies implemented in Latvia between 1990 and 2020 was conducted. The World Health Organization's "best buys" and other recommended interventions for alcohol control were used to guide the search., Key Findings: Alcohol control policies in Latvia have evolved significantly over the last three decades. The most changes to alcohol control policy occurred in the transitional period between regaining independence in 1991 and joining the European Union in 2004. A number of significant alcohol control policies have been implemented to reduce alcohol availability and affordability, to restrict alcohol marketing and to counter drunk-driving. However, since 2010, when an increasing trend of alcohol consumption was observed, there has been a reluctance to pursue national public health policy actions to reduce alcohol consumption, and few adjustments to legislation to increase alcohol control have been made., Implications: Despite the progress in alcohol control, Latvia still has considerable potential for strengthening alcohol control to reduce the high levels of alcohol consumption., Conclusion: Although several alcohol control policies have been established in Latvia, many of the planned activities to limit alcohol intake and related harm have not been executed. Public health goals rather than political and economic incentives should be prioritised to reduce high levels of alcohol consumption in Latvia., (© 2023 Australasian Professional Society on Alcohol and other Drugs.)

Alcohol consumption in the Baltic countries and Poland is among the highest globally, causing high all-cause mortality rates. Contrary to Poland, the Baltic countries have adopted many alcohol control policies, including the World Health Organization (WHO) "best buys". The aim of this study was to evaluate the impact of these policies, which were implemented between 2001 and 2020, on all-cause mortality. Monthly mortality data for men and women aged 20+ years of age in Estonia, Latvia, Lithuania, and Poland were analysed for 2001 to 2020. A total of 19 alcohol control policies, fulfilling an a-priori defined definition, were implemented between 2001 and 2020 in the countries of interest, and 18 of them could be tested. Interrupted time-series analyses were conducted by employing a generalized additive mixed model (GAMM) for men and women separately. The age-standardized all-cause mortality rate was lowest in Poland and highest in Latvia and had decreased in all countries over the time period. Taxation increases and availability restrictions had short-term effects in all countries, on average reducing the age-standardized all-cause mortality rate among men significantly (a reduction of 2.31% (95% CI 0.71%, 3.93%; p = 0.0045)). All-cause mortality rates among women were not significantly reduced (a reduction of 1.09% (95% CI - 0.02%, 2.20%; p = 0.0554)). In conclusion, the alcohol control policies implemented between 2001 and 2020 reduced all-cause mortality among men 20+ years of age in Baltic countries and Poland, and thus, the practice should be continued., (© 2023. The Author(s).)

Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020., Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed., Results: All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans., Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland)., (© 2022 Society for the Study of Addiction.)

Background: Many population-based alcohol control policies are postulated to work via changes in adult alcohol per capita consumption (APC). However, since APC is usually assessed on a yearly basis, often there are not enough data to conduct interrupted time-series or other controlled analyses. The current dataset, with 21 years of observation from four countries (Estonia, Latvia, Lithuania, and Poland), had sufficient power to test for average effects and potential interactions of the World Health Organization's (WHO) three "best buys" for alcohol control: taxation increases leading to a decrease in affordability; reduced availability (via a decrease in opening hours of at least 20 %); and advertising and marketing restrictions. We postulated that the former two would have immediate effects, while the latter would have mid- to long-term effects., Methods: Linear regression analysis., Results: Taxation increases and availability reductions in all countries were associated with an average reduction in APC of 0.83 litres (ℓ) of pure alcohol per year (95 % confidence interval: -1.21 ℓ, -0.41 ℓ) in the same year, with no significant differences between countries. Restrictions on advertising and/or marketing had no significant immediate associations with APC (average effect 0.04 ℓ per year; 95 % confidence interval: -0.65 ℓ, 0.73 ℓ). Several sensitivity analyses corroborated these main results., Conclusions: The WHO "best buy" alcohol control policies of taxation increases and availability restrictions worked as postulated in these four northeastern European Union countries., Competing Interests: Conflict of interest No conflict declared., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The study's objective was to investigate the associations between workplace conflicts and self-reported sickness presenteeism defined as going to work while being ill. Cross-sectional survey data pooled from four national surveys in years 2006, 2010, 2013 and 2018 with a study sample of 6368 employees (mean age 42.9 years and 52.9% females) were used. Respondents were randomly drawn from different regions and industries; therefore, the sample is representative of the working population of Latvia. The computer-assisted personal interviewing (CAPI) method was used to collect data at respondents' places of residence. The associations between conflicts in the workplace and presenteeism were analyzed by using binomial logistic regression and calculated as odds ratios (ORs) with 95% confidence intervals (CIs) adjusted (aOR) for gender, age, education, and survey year. On average, 11% of respondents reported sickness presenteeism during the last year. The odds of presenteeism significantly increased for all types of workplace conflicts, but most for conflicts with managers (OR = 2.84). The odds of presenteeism doubled for those reporting conflicts with other employees (OR = 2.19) and conflicts with customers (OR = 1.85). The odds of sickness presenteeism were significantly higher if the workplace conflicts occurred often (seven times for conflicts between managers and employees, and four times for conflicts with customers) and with other employees. Presenteeism frequency increased more than three times if respondents had more than two types of conflict at work. The results of this study show that having any type of conflict in the workplace significantly increases the frequency of sickness presenteeism, especially when conflicts are frequent or an employee has more types of conflicts in the workplace. The study results justify the need to implement targeted and effective workplace conflict management measures at the organizational level to decrease sickness presenteeism.

Background: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases., Methods: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis., Results: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths., Conclusions: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients., (© 2022. The Author(s).)

Background: The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians' experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia., Methods: A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection., Results: During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge., Conclusions: During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted., (© 2022. The Author(s).)

Background: Previous research has linked adolescents' participation in organised leisure-time activities (OLTAs) to better health and well-being. It remains unclear whether these associations can be observed consistently across social and socioeconomic strata and countries., Methods: The present study used nine nationally representative samples of adolescents aged 11, 13 and 15 years (total n=55 429) from the 2017/2018 Health Behaviour in School-aged Children survey from Europe and Canada. Regression models with mixed effects to account for nested nature of data were applied to estimate: (1) the associations of social and socioeconomic factors with OLTA participation; (2) strengths of the associations between breadth and pattern of OLTA participation with health and well-being indicators, after adjustment for the social and socioeconomic factors., Results: Rates of OLTA participation varied by age, sex and country of adolescents. Participants from lower socioeconomic classes and non-nuclear families were less likely to participate in OLTAs across each of the nine countries. Moreover, breadth of OLTA participation was associated with higher well-being independent of socioeconomic status or family structure. All of the participation patterns were associated with higher life satisfaction, but sports (either alone or in combination with a non-sport OLTA) were also associated with fewer psychological complaints and excellent self-rated health., Conclusion: Adolescents' engagement in OLTAs was associated with adolescents' subjective well-being regardless of country, age, sex and variance in social and socioeconomic factors. Policies aimed at increasing adolescents' subjective well-being and OLTA participation should focus on adolescents from low socioeconomic classes and non-nuclear families., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sickness absence is one of the most important working population health indicators. It is a complex phenomenon that is investigated by health care and occupational health specialists, economists, and work psychologists. Sickness absence is used as a predictor for morbidity and mortality, but besides the health status of an individual, sickness absence is influenced by demographic, socio-economic factors, and work environment factors. Conflicts at work are a common psychosocial risk factor that can affect sickness absence. The aim of the study was to investigate the association between different types of workplace conflict and self-reported medically certified sickness absence using cross-sectional survey data pooled from four periodic national surveys-Work conditions and risks in Latvia (2006-2018). The sample is representative of the working population of Latvia, as respondents were randomly drawn from different regions and industries. In total, the study sample ( n = 8557) consisted of employees between 16 and 80 years old (average 42.8 +/- 12.6) of which 46.2% were males and 53.8% were females. Researchers used the computer-assisted personal interviewing (CAPI) method for collecting data. The association between workplace conflicts and sickness absence was analysed by using binomial logistic regression and calculated as odds ratios (OR) with 95% confidence intervals (CI), with adjustment for gender, age, education and survey year. The risk of sickness absence was higher among women (OR = 1.24, CI 1.13-1.35), employees aged 25-44 years old and employees with higher income. Controlling for socio-demographic factors and survey year, the odds of sickness absence increased significantly for all types of workplace conflict analysed. The strongest association with sickness absence was related to conflicts between managers and employees (OR = 1.51, CI 1.37-1.66) and conflicts between groups of employees (OR = 1.45, CI 1.31-1.61). Conflicts between employees and with customers also increased the odds of sickness absence (OR = 1.39, CI 1.27-1.52 and OR = 1.11, CI 1.01-1.23, respectively). Our findings suggest that tailored interventions at a company level for reducing workplace conflicts as risk factors of sickness absence are required. Those should focus on the improvement of managers' leadership and human resource management skills.