Objectives: Chronic pain in children and adolescents (CPCA) is widespread with an increasing prevalence. It is associated with a decreased quality of life and an increased parental work loss. Accordingly, CPCA may pose a substantial economic burden for patients, health care payers, and society. Therefore, this systematic review aimed to synthesize (1) the results of existing cost-of-illness studies (COIs) for CPCA and (2) the evidence of economic evaluations (EEs) of interventions for CPCA. Methods: The systematic literature search was conducted in EMBASE, MEDLINE, PsycINFO, NHS EED, and HTA Database until February 2023. Title, abstract, and full-text screening were conducted by 2 researchers. Original articles reporting costs related to CPCA published in English or German were included. Study characteristics, cost components, and costs were extracted. The quality of studies was assessed using standardized tools. All costs were adjusted to 2020 purchasing power parity US dollars (PPP-USD). Results: Fifteen COIs and 10 EEs were included. The mean annual direct costs of CPCA ranged from PPP-USD 603 to PPP-USD 16,271, with outpatient services accounting for the largest share. The mean annual indirect costs ranged from PPP-USD 92 to PPP-USD 12,721. All EEs reported a decrease in overall costs in treated patients. Discussion: The methodology across studies was heterogeneous limiting the comparability. However, it is concluded that CPCA is associated with high overall costs, which were reduced in all EEs. From a health-economic perspective, efforts should address the prevention and early detection of CPCA followed by specialized pain treatment.

The aim of the present study was to develop a pictorial questionnaire for the assessment of health-related quality of life (PictoQOL) and to examine its content validity and usability across three exemplary population groups of different origin residing in Germany (non-migrants, Turkish migrants and Arabic-speaking migrants). A mixed-methods design combining qualitative and quantitative methods was used, comprising 6 focus group discussions with a total of 17 participants, 37 cognitive interviews and a quantitative pretest with 15 individuals. The PictoQOL consists of a pictorial representation of a total of 15 different situations. Using a visual Likert scale, respondents indicate how much each situation applies to them. Some representations proved to be culturally sensitive and were adapted. Respondents found the use of an additional graphic layer in the form of symbols in addition to pictures helpful for interpretation. The PictoQOL is considered to allow a more accessible assessment and better comparability of HRQOL across different population groups regardless of their literacy level. It is therefore considered to be superior to existing instruments for routine use in health research and practice. Future studies need to examine its convergent and factorial validity.

In most European countries, migrant women have lower rates of cervical cancer screening utilization than non-migrant women. While studies have illustrated that disparities can be partially explained by social determinants, they usually did not take into account the heterogeneity of the migrant population in terms of cultural background or country of origin. Applying an intersectional approach and using 2019 data from a representative survey from Austria on 6228 women aged 20–69 years, the present study examines differences in the utilization of cervical cancer screening in the five largest migrant groups (i.e., individuals with a nationality from or born in a Yugoslav successor state, Turkey, Romania, Hungary, or Germany) residing in Austria. By means of a multivariable analysis, amongst others adjusted for socioeconomic and health-related determinants, it is illustrated that particularly Turkish migrant women have a lower utilization than the Austrian majority population (adjusted odds ratio (OR) = 0.60; 95% confidential interval (CI): 0.40–0.91), while no significant differences between the majority population and other groups of migrants became evident. The findings are indicative of the heterogeneity of migrants and likely result from different obstacles some groups of migrants encounter in the health system. This heterogeneity must be taken into account in order to support informed decision-making and to ensure adequate preventive care.

Colorectal cancer screening can contribute to reducing colorectal cancer incidence and mortality. Findings on disparities in the utilization of colorectal cancer screening between migrants and non-migrants have been inconsistent, with some studies reporting lower, and some higher utilization among migrants. The aim of the present study was to examine potential disparities in fecal occult blood testing and colonoscopy among migrants in Germany. Data from a population survey on 11,757 men and women aged ≥50 years is used. Using multivariable logistic regression, the utilization of fecal occult blood testing and colonoscopy was compared between non-migrants, migrants from EU countries and migrants from non-EU countries, adjusting for socio-economic factors and also taking into account intersectional differences by sex and age. The study shows that migrants from the EU (adjusted OR = 0.73; 95%-CI: 0.57, 0.94) and from non-EU countries (adjusted OR = 0.39; 95%-CI: 0.31, 0.50) were less likely to utilize fecal occult blood testing than non-migrants. No disparities for the use of colonoscopy were observed. The findings are in line with studies from other countries and can be indicative of different barriers migrants encounter in the health system. Adequate strategies taking into account the diversity of migrants are needed to support informed decision-making among this population group.

Family caregivers can be overwhelmed by the care they provide within the family without external support. The development of self-management skills and the associated ability to actively and responsibly manage one’s own health or illness situation therefore plays a vital role in the home care of people living with dementia. As part of an individualized intervention for family caregivers of people of Turkish origin with dementia, existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving and in interviewees’ own practices to maintain their health. Ten caregivers of Turkish origin who were responsible for family members living with dementia were interviewed using problem-centered interviews. We found that the target group has very heterogeneous self-management competencies, which are based, on the one hand, on existing supportive resources and, on the other hand, on diverse care-specific, psychosocial and life-world challenges in intrafamily care that have not been overcome. Self-management skills in family caregivers are influenced by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic combination of resources and challenges results in varying levels of self-management ability among family caregivers. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies. There is great need for action in promoting self-management skills among Turkish caregivers of people living with dementia in home care. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity.

Mammography can reduce breast cancer incidence and mortality. Studies on the utilization of mammography among migrant and non-migrant women are inconsistent. Many of these studies do not take the heterogeneity of migrants in terms of ethnicity and country of origin into account. The aim of the present study was to examine disparities in the use of mammography between non-migrant women and the five largest migrant groups in Austria. The study used data from a nationwide population-based survey of 5118 women aged 45 years and older and analyzed the participation in mammography as a dependent variable. Multivariable logistic regression was used to compare mammography uptake between the aforementioned groups of women, while adjusting for socioeconomic and health variables. The study shows that all migrant groups involved tended to use mammography less frequently than non-migrant women; statistically significant differences, however, were only observed for Hungarian migrant women (adjusted OR = 0.36; 95%-CI: 0.13, 0.95; p = 0.038) and women from a Yugoslavian successor state (adjusted OR = 0.55; 95%-CI: 0.31, 0.99; p = 0.044). These findings are consistent with other studies in Europe and beyond, highlighting the heterogeneity of migrant populations and emphasizing the need for a diversity-sensitive approach to health care.