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This study evaluated the cross-cultural measurement invariance of the Pediatric Quality of Life Inventory version 4.0 (PedsQL™) among adolescents sampled from Bulgaria, Croatia, India, Indonesia, Nigeria, Serbia, and Turkey. The multiple-indicator multiple-cause (MIMIC) model was used, which allowed controlling of demographic variables (i.e., age, gender, and socioeconomic status). Significant effects of country on scores within the PedsQL™ domains were observed, with up to 17 items showing differential item functioning (DIF) across the countries. We did not find support for cross-cultural measurement invariance hypotheses for scores on the PedsQL™ adolescent self-report in this study. Researchers should use caution in making cross-cultural quality of life comparisons while using the PedsQL.

BackgroundInjection drug use is a major public health problem. Oral health problems and the appearance of dental disease among injection drug users (IDUs) are caused by their lifestyle. The aim of the present study was to examine the relations between socioeconomic factors, drug use, and oral hygiene habits on the oral health of heroin drug users.MethodsA cross-sectional survey on oral health was carried out as part of UNICEF’s research on the biological and behaviours survey among injection drug users in Sarajevo, Banja Luka and Zenica in Bosnia and Herzegovina. A sample of 519 IDUs participated in the survey. Respondent Driven Sampling (RDS) was used to obtain the sample. The data were obtained through face–to–face interviews using a structured questionnaire related to socio-demographic characteristics, duration of drug injection, frequency of drug injection in the last month and oral health.ResultsOlder participants (OR = 1.06; 95% CI = 1.02 -1.10), part–time employment (OR = 3.57; 95% CI = 1.02 - 12.20) and unemployment (OR = 3.23; 95% CI = 1.23 - 8.33) in comparison to full-time employment as the referent category, and longer duration of drug injection (OR = 1.06; 95% CI = 1.003 - 1.12) were predictors of bad oral health. A higher level of education (OR = 0.56; 95% CI = 0.39 - 0.79), more frequent tooth brushing (OR = 0.59; 95% CI = 0.49 - 0.71), and regular dental checkups (OR = 3.30; 95% CI = 1.42 - 7.67) were predictors of good oral health.ConclusionsSocioeconomic characteristics of IDUs as well as their lifestyles may contribute to oral health problems. Heroin drug users have specific dental needs, and programmes to improve their oral health should be an integral part of strategies to prevent addictions including treatments and harm reduction programmes.

Aim. The Covid-19 pandemic may be associated with an increase in mental disorders and mental distress. However, there are no representative studies testing the impact of stressors directly related to Covid-19. We aimed to determine whether Covid-19 related stressors were associated with mental disorders and mental distress in the second year of the pandemic.Method. This cross-sectional observational epidemiological survey was conducted from June to October 2021. We interviewed a representative sample of the adult population in Serbia (18-65 years) in the second year of the pandemic, at a time when large parts of the population had been affected by the pandemic in different ways. Multistage probabilistic household sampling of the adult population in 60 municipalities was used. Mental disorders were assessed by in-person interviews using the Mini International Neuropsychiatric Interview and depression and anxiety symptoms were self-rated on the PHQ-9 and GAD-7. Covid-19 related stressors i.e., infection, self-isolation, infection of a close relative, and lack of protective equipment at work, as well as stressors during the pandemic that were not directly Covid-19 related were measured. Associations of potential predictor variables with mental disorders and mental distress were explored through univariable and multivariable regression analyses.Results. In total, 1023 individuals (mean age 43.7±13.6 years, 48.7% male) were interviewed. Most respondents (67.8%) of the sample had already experienced Covid-19 related stressors (20.1% had Covid-19 infection; 43.2% had a close relative member who had Covid-19; 28.1% had to work without appropriate protection; 27.5% had been in quarantine themselves) and about 50% had already been vaccinated. The prevalence of any mental disorder was 15.2% (95% CI 13.2–17.2): mood disorders 4.6%, anxiety disorders 4.3% and substance use disorders 8.0%. Mean levels of distress were: PHQ-9=3.2±3.8; GAD-7=2.1±3.1. A lack of protective equipment was associated with higher levels of any disorder, anxiety disorders, and anxiety symptoms. No other Covid-19 related stressor predicted mental disorders or mental distress.Conclusions. In this study, lack of personal protective equipment for Covid-19 when it would have been appropriate was associated with higher levels of anxiety and a greater frequency of anxiety disorders. Provision of the appropriate equipment at workplaces is likely to prevent lasting increased levels of anxiety. There is no evidence that the prevalence of mental disorders in the second year was elevated.

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