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Introduction The primary aim of this study is to thoroughly investigate the prevalence and determinants of loneliness among older adults in the Baltic-Nordic region. Utilizing high-quality data sources and employing a methodologically rigorous approach, the study endeavors to enhance our understanding of how loneliness manifests and varies across different cultural and socio-economic contexts within these regions. By identifying key factors influencing loneliness, including demographic, social, and economic variables, the research seeks to contribute significantly to the existing body of knowledge on loneliness and inform targeted public health strategies and interventions tailored to the unique needs of older adults in the Baltic and Nordic countries.Material and methods This research, centered on older adults aged 67 and above within the Baltic-Nordic region, draws upon data from the Survey of Health, Ageing and Retirement in Europe (SHARE), specifically its eighth wave conducted between June and August 2020. The demographic analysis of this study covers a diverse sample of 5,313 participants from the Baltic and Nordic regions. Specifically, the sample includes 2,377 participants from Nordic countries, namely Sweden, Denmark, and Finland, and 2,936 from the Baltic countries of Estonia, Latvia, and Lithuania. The investigation extends to the financial well-being of households, involving an analysis of 3,925 individuals, with 1,748 from Nordic countries and 2,177 from Baltic countries. Although Iceland is categorized as a Nordic country, the analysis within this study is conducted separately due to the unavailability of SHARE data for this region. Instead, the HL20 study, focusing on the health and well-being of the older adult population in Iceland, contributes data for 1,033 respondents. This methodological distinction allows for a comprehensive understanding of regional differences, highlighting the importance of specialized approaches to examine the intricate dy, Corresponding author: Ieva Reine

Intergenerational solidarity in the Baltic states and Nordic countries has gained heightened significance, catalyzed by the COVID-19 pandemic. This research delves into the evolving dynamics of mutual support, care, and respect across generations, emphasizing the role of family values, sociocultural context, and economic factors. Amid global health challenges, intergenerational cooperation emerged as essential, with older individuals’ vulnerabilities underscoring the need for assistance and support from younger generations. By analyzing responses from these regions, the study explores functional and economic exchange, while considering cultural values and historical influences. The pandemic’s impact on assistance patterns and the interplay between COVID-19 restrictions in Baltic and Nordic countries are examined. Ultimately, this research sheds light on the intricate fabric of intergenerational relationships, offering insights into maintaining societal resilience and cohesion during transformative times.

BackgroundMalaria continues to be a public health problem in Kenya, with an estimated 37.2 million people at high risk of the disease. The disease burden is compounded by inequalities in health service availability, housing, socioeconomic conditions, and access to education.ObjectivesWe aimed to determine the status of community-based, health education interventions. Based on the findings, to develop an educational module for medical students to combat malaria in Kenya.MethodsA systematic review was conducted to identify different educational interventions, their successes and limitations, and legal challenges leading to low uptake and adherence to malaria prevention interventions from 2000-2023. Consequently, a 6-week online educational pilot was conducted with healthcare students from Kenya, Japan, the UK, and Cyprus.ResultsDespite developing a national malaria strategy and monitoring and evaluation strategies, Kenya has not been able to meet the incidence reduction targets set by the World Health Organisation, underscoring the need for more work in identifying the barriers to implementing strategies and optimising the distribution of public health interventions. Student teams proposed innovative solutions, including two-tier malaria control strategies, maternal malaria clinical education, community awareness through schools and NGOs, and a 10-year health system strengthening and immunisation plan.ConclusionsPublic education regarding prevention strategies and increasing their adoption remains a key challenge in combating malaria in Kenya. In this regard, digital tools can facilitate international collaborative health education and exchange of best practices, allowing students and faculty to engage across boundaries and prepare them to be future-ready physicians connected to the global community.

IntroductionThe aging population presents both unique challenges and opportunities for societies around the world. To develop an effective healthy aging strategy, a tool for assessing aging process is needed. Numerous attempts to quantify the aging process have been made. However, there is still a challenge in developing and choosing a good enough score that is easy to apply, has a construct of variables that are available in most nationwide surveys for comparable results, and at the same time reflects the aging process of older individuals. The purpose of this study is to present our approach to construct a comparable Healthy Aging Index (HAI).Materials and methodsIn Latvia, data from Wave 8 of the Survey of Health, Aging and Retirement in Europe (SHARE), involving 420 respondents, were used. For comparative analysis, data from a HL20 study on the health and wellbeing of the older adults in Iceland, which included 1,033 respondents, were used.ResultsFor Latvia, 13 items were selected, and for Iceland, nine items were selected. We constructed the HAI with four similar subscales for both countries-"Autonomy," "Health," "Wellbeing," and "Activities," and an additional subscale "Cognitive" for Latvia. We found matching items in all four subscales. For the Autonomy subscale, they were related to difficulties with everyday and daily tasks. In the Health subscale, the only matching item was self-rated physical health. One item related to loneliness was found for the Wellbeing subscale and one item related to social participation for the Activities subscale.DiscussionIn our study, we found evidence for the successful construction of a HAI in two different datasets. The strength of our construct lies in the use of data from one of the largest social science panel studies in Europe (SHARE). As we were able to apply the construct to the Icelandic study, we believe that items presented in our approach are available in other population-based studies as well, and, therefore, can

Europe, notably in countries like Lithuania, is facing substantial demographic shifts due to aging, impacting various systems, including the labor market. In this context understanding retirement intentions is crucial. Quality of work is a key determinant of retirement intentions, yet other factors such as financial situation, health, or family pressures also play a role, and a comprehensive understanding of their interactions remains a research gap. Therefore, the aim of this study was to conduct a systematic literature review of research on the relationship between retirement intentions and quality of work, with a specific focus on potential control factors, moderators and mediators of this relationship. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA). Articles were electronically retrieved from Scopus, Web of Science, ScienceDirect, and EBSCO databases. Studies selected were full-text, peer-reviewed articles in English from 2003 to 2023, which used quantitative methodologies and focused on the relationship between retirement intentions and quality of work for workers aged 50+. The quality of the selected publications was assessed using the Appraisal Tool for Cross-Sectional Studies - AXIS tool. Of the initial 776 sources, after removing duplicates and irrelevant articles, 91 were fully screened, and 17 met the criteria for inclusion in the systematic review. This systematic literature review provided further insights into the relationship between retirement intentions and quality of work, highlighting the roles of moderators, mediators, and control factors in this relationship.

Purpose. To explore whether the personal assistance (PA) activities provided by the Swedish Act concerning Support and Service for Persons with Certain Functional Impairment in 2010 and 2015 promote participation in society according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD). Methods. Register data and data from two questionnaires were used (N = 2565). Descriptive statistics and chi-square (McNemar’s test) were used to describe the basic features of the data. Mixed binominal logistic regression was used to examine correlation between gender and hours of PA between 2010 and 2015. Results. Despite an increase in the number of PA hours, more care activities and a reduction of most PA activities representing an active life were found. The result was especially evident for women, older people, and for a particular person category. Conclusions. The results offer evidence of a shift to a medical model and indicate a risk of social exclusion due to fewer activities representing an active life. An increase on average of 16 h of PA over the period studied does not guarantee access to an active life and may indicate a marginal utility. The noted decline of PA for participation in society enhances the importance of monitoring content aspects to fulfil Article 19 of the UNCRPD.

As COVID swept through Europe, and the world, with high rates of illness and death, so did symptoms of anxiety, depression, post-traumatic stress disorder, stress, and psychological distress. This study examines the relationship between gender and psychological distress among Latvians over 50 years old within the first 6 months of the COVID-19 pandemic. Data from Wave 8 COVID-19 data of the Survey of Health, Aging, and Retirement in Europe (SHARE) as an early data version of the SHARE Corona survey conducted between June and August 2020. It features the data collected by telephone (CATI) on topics related to COVID-19 for a large sub-sample of SHARE panel respondents. This study examined a sample of 980 adults over 50 years old in Latvia. Bivariate analysis were performed utilizing the Pearson chi-square test for association to examine differences in symptoms of psychological distress by gender during the first six months of the COVID-19 pandemic. Level of significance was determined by the p-value test statistic. Alpha level was established at .05. A chi-square test for association shows that there were statistically relationships between gender and feeling nervous (X2 (2, N = 976) = 22.11, p < .001), feeling depressed (X2 (3, N = 976) = 10.95, p < .01), and trouble sleeping (X2 (2, N = 976) = 20.40, p < .001). This study rejects the null hypothesis that no differences exist between the genders, as women reported greater psychological distress during the first 6 months of the COVID-19 pandemic. Additional multi-method analysis is consistent with these findings and concludes that this is due to the greater concern women report for family, and the burden which placed limitations on meeting their children and grandchildren.

During Covid-19 social isolation has become more common worldwide, however, some groups, especially elderly people, might have experienced dramatically limited communication due to the lack of skills and access to digital technologies. In this paper, we examined if education was associated with the use of digital technologies to maintain contacts with a family, friends, other social networks and services. The survey was conducted in June-August 2020 by doing 1089 computer-assisted telephone interviews. The questions examined how people aged 50 years and older coped with socioeconomic and health-related impact of COVID-19.We used logistic regression analysis to study the association between the use of digital technologies and the level of education by gender and age. The higher the education was, the more it strongly associated with the use of digital technologies (OR 5.85; 95% CI 3.78-9.03). As expected, age was a strong explanatory factor, however, we did not find consistent age and gender differences. Among those who used digital technologies, analyses showed that overcoming social isolation was related to the education level. The conclusion of the study is that education has inevitable impact on the use of digital technologies and social contacts, however high education level is not crucial for the acquisition of information. It seems that digital technologies are important tools to prevent social isolation and are related to education that includes digital access and competencies.

The COVID-19 pandemic brought significant changes to the usual rhythm of life. Reduced opportunities to meet with family members and friends in a situation of heightened stress leads to increased feelings of loneliness and social isolation, as well as increases the risk of mental health problems. The aim of this paper is to evaluate the effect of social contacts on the changes in psychoemotional states in the elderly population in Latvia during the crisis caused by the COVID-19 pandemic. The analysis draws upon quantitative data collected by the Survey of Health, Ageing and Retirement in Europe within Wave 8 in Latvia (n=1207). Measurements of the frequency of social contacts were used to construct social isolation indexes. Changes of psychoemotional state, characterized by sleeping problems, nervousness, frustration during the pandemic were included as dependent variables in multinomial logistic regression models that were run to identify the effect of social isolation on psychoemotional health in the context of other factors: age, gender, perceived health status, affluence and feelings of loneliness. The results show that in the group of those aged 50+, close to one-fifth of respondents experienced the effect of the COVID-19 crisis on their mental health. The link between reduced social contacts and changes in psychoemotional states proved to be statistically significant. In the group with the highest level of social isolation, irregularities in psychoemotional health are three times higher compared to other groups.

One of the first areas severely hit by the Covid-19 pandemic was international travel. In March/April, with commercial flights coming to a near halt, the governments were struggling to help their stranded citizens to return home. Extra flights and ferry trips were organised, and the opportunity to return was used by many emigrants worried about the uncertainty and the possible future development of the pandemic. This paper containing both data collected through survey and in-depth interviews with people aged 50+ in Latvia, is the first to explore the reactions of the society to repatriation policy implemented by the government of Latvia, and to explore how the Covid-19 situation has affected the attitudes towards return migrants in general. Importantly, it demonstrates how education moderates these attitudes. The results show that most of the population consider returning migrants as a significant source of infections, and many had doubts if they follow self-isolation and other rules responsibly. Those with the higher education were in general more supportive of the repatriation policy demonstrating the importance of education and explaining difficult decisions in order to reduce tension and fear.

The coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on March 11, 2020, due to its high infection rate, which caused thousands of deaths worldwide and expanding. The evolving outbreak of COVID-19 requires health-protective behavior that can alleviate the severity of an epidemic. Therefore, recognizing the underlying drivers of health-protective behavior against COVID-19 is urgently needed to form policy responses. The purpose of this study was to investigate the individual-level underlying drivers affecting the formation of knowledge, attitudes, and COVID-19-related health-protective behavior among individuals aged 50 and older who are more vulnerable to complications of infection because of their age. The factors making individuals more vulnerable are also associated with the ability to access and understand information, make well-informed decisions, and take health-protective and promoting actions, especially when information itself is not timely, trusted, consistent, or actionable. The researchers used data from a representative population sample consisting of 50-80-year-old individuals, obtained from in-depth, semi-structured telephone interviews during July – August 2020, between the first and second waves of COVID-19. For conducting qualitative data analyses, the Grounded Theory (GT) approach for developing code structure was used.

According to the WHO, healthy ageing is characterized by such interrelated determinants as intrinsic capacity, functional ability and environment. An individual's intrinsic capacity is a powerful predictor of the future ageing process and includes 5 areas - cognitive, psychological, sensory, locomotion and vitality. Exploration of these areas can provide necessary information for therapeutic and preventive actions that can be tailored to an individual's needs, priorities and values to support participation and quality of life. The objective of this study was to evaluate and compare healthy ageing determinants of older individuals in the Baltic States. The research was based on the sample of older individuals (50 years and older) from wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) during the period from November 2019 to March 2020. The obtained results indicate a low level/poor results in such determinants as locomotion, sensory, vitality and functional ability (more than 50% of the respondents among the Baltic countries has poor health, various long-term illnesses, limitations in daily activities, suffer from moderate or severe pain, requires help to meet daily needs, etc.), has various behavioral risks, however has higher assessment of cognitive and psychological determinants.

Purpose: To examine how the right to participation according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD) is promoted by personal assistance use in Sweden across age, gender and eligible person categories. Method: Register data and data from a questionnaire were used (N¼15,289). Principal component analysis was performed and the internal consistency was tested. Descriptive statistics (v2 test) were used across age, gender and eligible person categories and components. Results: An uneven distribution of personal assistance across the components Health and Care; Home, Leisure and Social Interaction; and Daily Occupation was found. Significant differences in personal assistance reported were found between children and adults, men and women and between the three eligible person categories. Conclusions: The discrepancy between reported and expected outcome of personal assistance indicates that Article 19 of the UNCRPD has not been met. The unequal access to participation across age, gender and eligible person categories would seem to further signify that the Act concerning Support and Service for Persons with Certain Functional Impairments is promoting activities of a caring nature rather than fulfilling Article 19 of the UNCRPD, i.e. ensuring full participation in society., Avhandlingsarbete; Att styra rättigheter rättsäkert: Har socialförsäkringens implementering av personlig assistans uppfyllt LSS värdegrund för goda levnadsvillkor?

Supplement: 1This meeting abstract has two posts in Web of Science. The Accession numbers are 000398600404162 and 000398600403255, Socialförsäkringens betydelse för kvinnor och män med statlig personlig assistans i uppfyllandet av de nationella folkhälsomålen

People with severe disabilities usually have less capacity to achieve a long-lasting disposable income as their participation in the labor market is often limited. Various laws have been implemented to strengthen the individual autonomy in order to facilitate equality and participation in the society. However, people with disabilities are expected to adhere to a traditional role as a deviant and not fully included in societal normality of adults. The aim of the study was to analyze whether there are differences in marital status among people with severe disabilities, receiving personal assistance to work. The study consists of a quantitative cross-sectional analysis based on data from the Swedish Social Insurance Agency as well as data from a questionnaire survey of a sample of people with severe disabilities who were entitled to personal assistance (total of 15,515) conducted in 2010. The number of responses (10,200) corresponds to a response rate of 67 %. The results showed that among those being active in the labor market men were overrepresented compared to women disregard their marital status. The wish to work, however, was generally stronger among women who did not receive assistance allowance for participation in the labor market. The study showed that the image of disability may be intensified by gender - for women it seemed to be the intensified passivity and helplessness. Although men often experience constraints on their sexual access and wider social participation, women with disabilities seemed to be questioned not only through their ability to reproduce, but also to produce, thus providing less assistance benefits for women's active participation in the labor market., Forte 2012-0921

Introduction: People with severe disabilities usually have less capacity to achieve a long-lasting disposable income as their participation in the labor market is often limited. Various laws have been implemented to strengthen the individual autonomy in order to facilitate equality and participation in the society. However, people with disabilities are expected to adhere to a traditional role as a deviant and are not fully included in society normality of adults. The aim of the study was to analyze whether there are differences in marital status among people with severe disabilities, receiving personal assistance to work. Methods: The study consists of a quantitative cross-sectional analysis based on data from the Swedish Social Insurance Agency as well as data from a questionnaire survey of a sample of people with severe disabilities who were entitled to personal assistance (total of 15,515) conducted in 2010. The number of responses (10,200) corresponds to a response rate of 67 %. Results: Among those being active in the labor market, men were considerably overrepresented compared to women disregard marital status, i.e. there were no considerable differences whether a person was married, divorced, single, a widow/-er etc. The wish to work, however, was generally stronger among women who did not receive assistance for engaging in the labor market. Discussion: The study showed that the image of disability may be intensified by gender - for women it seemed to be the intensified passivity and helplessness. Although men often experience constraints on their sexual access and wider social participation, women with disabilities seemed to be questioned not only through their ability to reproduce, but also to produce, thus providing less assistance benefits for womens active participation in the labor market.

Background In 1994, the personal assistance reform that gives support to people with substantial and durable disabilities, took effect in Sweden. Today, two decades later, we can conclude that differences in the number of hours of assistance granted regionally and between various subgroups remain. This indicates that the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS) is not implemented equally and that there is a lot of uncertainty to what extent the law’s intent of equal rights for men and women, different age groups and certain diagnoses, etc. is met. A central question is what contributes to inequalities in granted assistance between persons with disabilities. The aim of this study was to analyze, which factors are associated with a large number of hours of attendance allowance. Methods The study consists of a quantitative cross-sectional analysis based on data from the Swedish Social Insurance Agency as well as data from a questionnaire survey of a sample of people entitled to personal assistance (total of 15,515) conducted in 2010. The number of responses (10,200) corresponds to a response rate of 67 %. The main outcome was a large number of hours, defined at median, and was analyzed by multivariate logistic regression, involving three empirical models. Results The results showed that double assistance had the strongest association with a large number of hours (OR = 3.98, 95% CI = 3.26-4.36), but that the strength of the associations varied by both county and gender. There was also a strong association between a large number of hours and the use of assistants who were not family members, as well as the type of the assistance provider. Help by a trustee or legal guardian during the application process was related to a large number of hours. The same held true when a family member helped a male client with the application. According to the results, an acquired disability was associated with a smaller number of hours. Conc, I samarbete med Fösäkringskassan., Socialförsäkringens betydelse för kvinnor och män med statlig personlig assistans i uppfyllandet av de nationella folkhälsomålen.

I samarbete med Försäkringskassan, Socialförsäkringens betydelse för kvinnor och män med statlig personlig assistans i uppfyllandet av de nationella folkhälsomålen.

Swedish Survey of People Entitled to Assistance Allowance. Ever since the personal assistance reform took effect in 1994, people with a substantial and durable disability have been entitled to personal assistance. To qualify for government attendance allowance, a person must belong to one of the groups predefined in the Act concerning Support and Service for Persons with Certain Functional Impairments and require personal assistance with their basic daily needs for more than 20 hours a week. In 2010 the Swedish Social Insurance Agency carried out a survey to all people (n=15,515) entitled to assistance allowance. A total of 10,200, or 67 per cent, of the responses were valid. The percentage was very high considering the potential difficulties involved for this population. The aim of this study was to gather more comprehensive knowledge about the population that receives assistance allowance. The study was based on cross-sectional analysis involving both registry and survey data. It describes the respondents’ need for assistance, their attitude towards the assistance provider, what kind of living arrangements they have and the tasks that assistants perform. The study includes even questions about service, thoughtfulness and support on the part of assistants, as well as discrimination, financial considerations, participation and psychological variables. A higher percentage of men are entitled to personal assistance than women, and the majority has durable physical or mental disabilities that are evidently not caused by normal ageing. Eight out of ten people entitled to personal assistance have a physical disability. Multiple disabilities are also common. More than half of the respondents had acquired their disability during their lifetime and had it for an average of approximately 18 years. The results also showed that personal assistance is experienced by users and proxies as a valuable support that largely meets Sweden’s obligations pursuant to the UN Convention on, I samarbete med Försäkringskassan., Socialförsäkringens betydelse för kvinnor och män med statlig personlig assistans i uppfyllandet av de nationella folkhälsomålen.

Background In Sweden, people with a substantial and permanent disability have been entitled to personal assistance since the personal assistance reform took effect in 1994. To qualify for government attendance allowance, a person must belong to one of the groups predefined in the Act Concerning Support and Service for Persons with Certain Functional Impairments and require personal assistance with their basic daily needs for more than 20 hours a week. Attendance allowance may be granted to people who have not turned 65. Compensation for almost 93 million hours of assistance was paid for a total of 15,877 clients in 2010. The average number of hours has increased by 73 percent between 1994 and 2010. Two and a half times as many people received attendance allowance in 2010 as in 1994. The aim of this study was to investigate if attendance allowance provides the prerequisites for people with personal assistance to engage in meaningful activities and participate in the labor market. Methods The report consists of a quantitative cross-sectional analysis based on data from the Swedish Social Insurance Agency as well as data from a questionnaire survey of a sample of people entitled to personal assistance (total of 15,515) conducted in 2010. The number of responses (10,200) corresponds to a response rate of 67 % which is very high considering the potential difficulties involved for this population. Results The results shed light on the extent to which personal assistance enables people to live normal lives. More men than women believe that attendance allowance is a prerequisite for their ability to work or study. Eight of ten clients reported that assistance contributed to the ability to have a meaningful employment. Nine of ten people, including small children, reported that assistance promoted opportunities for social contact and activities. Nevertheless, a relatively large percentage (ca 60%) of respondents expressed uneasiness about the future. Conclusions The results, I samarbete med Fösäkringskassan., Socialförsäkringens betydelse för kvinnor och män med statlig personlig assistans i uppfyllandet av de nationella folkhälsomålen.

Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami., Original included in thesis in manuscript form.