bluuebunny/crossref_metadata_2025 huggingface dataset:
PHC service resilience during COVID19 in Brazil’s Northeast
Authors: Vieira-Meyer A , Guimarães JMX , Morais APP , Machado MFAS , orte FDS F , Pequeno AMC , Nascimento E F , Farias S F , Dias MSA , Vasconcelos MIO
Published: October 2023

COVID19 affected health system, including its ability to care for other health issues. Health System Resilience is related to the ability of a health service to continue to offer ongoing care for health issues while under a stressor. Brazil has a public-funded unified health system with a Primary Health Care (PHC) organized by the Family Health Strategy (FHS), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). The CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, and act as liaisons between health units and communities-key informant on the reality faced in the public services during COVID19. Brazil's northeast region is one of the country's poorest regions, with poor social indicators, including low HDI and high illiteracy, utilization of Brazil's conditional cash transfer program and COVID19 mortality. This study evaluated aspects regarding the impact of COVID19 in PHC activities related to diabetes&hypertension, tuberculosis, leprae, pre-natal care, pap smear and oral health care in Brazil's northeast region public service. Questionnaires were applied to CHAs from 8 different cities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed. The data show unequal COVID19 impact in PHC (different impact of COVID19 in the various municipalities and health care services). For 21.3% of CHW, the activities related to pre-natal care diminished during 2021 COVID19 pandemia, this percentage was 25.6%, 30.2%, 41.9%, 79.9% and 79.3% for tuberculosis, leprae, diabetes & hypertension, pap smear and oral health respectively in the PHC. The lack of a unified federal plan, due to a political misleading perspective may have negatively influenced the PHC. Understand how PHC was affected in different scenarios is important to strength the system in a more resilient manner, which is central in the event of other stressful events

Key messages

• There was an unequal impact of COVID19 on different PHC public services, which may be due to political tension and lack of federal guidance of the health system.

• Understand how PHC was affected is important to reorganize the system in a more resilient manner, which is central in the event of another COVID19 wave or other stressful event.
Maternal predictors of timeliness & uptake of Measles, Mumps & Rubella vaccine: A birth cohort study
Authors: Skirrow H , Foley K , Costelloe C , Bedford H , Lewis C , Whittaker E , Saxena S
Published: October 2023

Background

In the United Kingdom (UK) measles, mumps & rubella (MMR) vaccine uptake is below national recommendations. We aimed to identify maternal predictors for missed or late vaccination, including the association with pregnancy pertussis vaccination, added to the UK schedule in 2012.

Methods

We used electronic primary care records from the Clinical Practice Research Datalink to create a UK birth cohort following babies born between 01.01.2000 to 12.12.2020 and linked to their mother's record from birth. We estimated the proportion who received their 1st MMR vaccine by 2 years and 1st & 2nd MMR vaccines by 5 years and examined associated maternal predictors using survival analysis and Cox proportional hazard models. We examined a sub-cohort of babies born from 01.01.2013 to estimate the impact of pregnancy pertussis vaccination on children's subsequent MMR uptake.

Results

Overall, 92.6% (736,495/795,497) children had 1st MMR by 5 years with 89.4% (710,797) by 2 years. Among children still in the cohort when eligible for 2nd MMR, 85.9% had two MMRs by 5 years (478,480/557,050). Lower 1st & 2nd MMR uptake was associated with living in more deprived areas of England, being Black or Black British ethnicity or having mothers aged <20 years (1st MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively). Children of mothers vaccinated in pregnancy were more likely to have 1st & 2nd MMRs after adjusting for ethnicity, deprivation and maternal age (1st & 2nd MMRs by 5 years adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53).

Conclusions

There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics. Mothers vaccinated against pertussis in pregnancy are more likely to have a child vaccinated with MMR. Health professionals should promote pregnancy and childhood vaccinations during pregnancy and consider how families can be supported to access childhood vaccines.

Key messages

• There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics with MMR uptake lower among children living in more deprived areas.

• Maternal vaccination and subsequent childhood vaccination uptake are related; pregnancy offers an opportunity to promote childhood vaccines and ensure families can access childhood vaccine services.
Varying faecal immunochemical test positivity thresholds impacts colorectal cancer detection
Authors: White P , Muraleedharan R , Mooney T , Smith A
Published: October 2023

Background

Colorectal cancer (CRC) is screened for by the faecal immunochemical test (FIT) in Ireland. The FIT positivity threshold in Ireland is 45 micrograms (µg) of haemoglobin per gram (g) of stool. FIT positivity thresholds influence both demand for screening colonoscopies and CRC detection rates through screening. This study aimed to assess the impact of varying FIT positivity thresholds on CRC detection rates through screening in Ireland.

Methods

This study used data from BowelScreen - The National Bowel Screening Programme, to retrospectively assess the impact of altering the FIT positivity threshold, adjusting it to correspond with neighbouring European countries, on CRC detection rates through screening in Ireland between 2013 and 2021. All analyses were conducted on Stata 17.

Results

1,552 individuals were diagnosed with CRC in Ireland after a positive FIT performed through BowelScreen between 2013-2021. Adopting the same FIT positivity thresholds as the Netherlands (47µg/g), Scotland (80µg/g), England (120µg/g) and Wales (150µg/g) would have resulted in 21 (1.4%), 262 (17.1%), 458 (29.8%) and 556 (36.2%) fewer diagnoses of CRC through BowelScreen during this period, respectively. Additionally, increasing the positivity threshold to correspond with these countries would have resulted in between 1.7-41.9% fewer stage 1, between 1.0-30.9% fewer stage 2, between 1.4-32.9% fewer stage 3 and between 0-5.6% fewer stage 4 CRCs detected.

Conclusions

Changing the FIT positivity threshold in Ireland to correspond with that of other neighbouring European countries would have reduced the detection of CRC through screening to varying degrees. The detection of stage 1 CRCs would have been most greatly reduced, but up to almost a third of all stage 2 and stage 3 CRCs would not have been detected if some alternative, higher positivity thresholds were adopted.

Key messages

• Increasing the FIT positivity threshold in Ireland will need careful consideration to keep the optimum positive predictive value of a colonoscopy.

• Lower stage 1-3 CRC detection rates may occur as a result.
What are doctors’ strategies to improve care coordination? Results in six Latin-American countries
Authors: Oliver-Anglès A , Vargas I , López-Vázquez J , Samico I , Campaz-Landazábal D , Mogollón-Pérez A S , Eguiguren P , Amarilla D I , Bertolotto F , Vázquez M L
Published: October 2023

Background

Given the problems generated by health care fragmentation, the coordinated provision of health care has become a priority, particularly in Latin America. This communication analyses the strategies for improving clinical coordination proposed by primary and secondary care doctors from public health service networks in six countries of the region (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and their changes between 2015 and 2017.

Methods

Two cross-sectional survey-based studies (2015 and 2017) were analysed with application of the COORDENA questionnaire to a total of 4311 primary and secondary care doctors from two public health service networks in each country. A descriptive analysis was carried out, stratified by country and year, of the suggestions proposed in the open question ‘What do you propose to improve clinical coordination between primary and secondary care doctors in the network?

Results

In all countries, the introduction or improvement of strategies and mechanisms that facilitate interaction and mutual knowledge between professionals at different care levels were highlighted, especially joint meetings, direct communication mechanisms (such as telephone and/or e-mail) and strategies to strengthen the use of the referral and counter-referral sheet. Less frequently, other organisational strategies aimed at strengthening the primary care model, improving access to secondary care and coordinating the management level of the network, were also suggested.

Conclusions

The results contribute to generate recommendations for the improvement of clinical coordination in health systems, based on the suggestions of doctors, a perspective that is not usually considered in the design and implementation of interventions in health services. The need to promote strategies based on mutual feedback in the design of public health policies stands out.

Key messages

• The design of effective interventions aimed at improving coordination requires doctors’ participation.

• Strategies based on mutual feedback and communication should be promoted by healthcare organisations to improve clinical coordination.
Economic management and depression in healthcare workers during the COVID-19 pandemic in Czechia
Authors: Kuklová M , Fryčová B , Kucera M , Pekara J , Wolfová K , Janoušková M , Novák D , Šeblová J , Čermáková P , Seblova D
Published: October 2023

Background

Inequalities in the regional management of healthcare systems can have impact on mental health of healthcare workers. We examined the relationship between regional economic management and depression among healthcare workers during the COVID-19 pandemic in Czechia.

Methods

We conducted cross-sectional analyses of 3 waves (2020 n = 1,282; 2021 n = 1,510 & 2022 n = 956) from the Czech COVID-19 HEalth caRe wOrkErS (HEROES) Study. The cost-to-income ratio for 2019 was used to capture regional healthcare economic management prior to the pandemic. Based on this indicator, regions were grouped into 3 categories (poor, adequate=capital region, good). Depression was defined as ≥ 10 points on the Patient Health Questionnaire. We estimated odds ratio (OR) with 95% confidence interval (CI) for the association of regional healthcare economic management with depression using logistic regression, adjusting for age, sex, and occupation in Model 1 and for self-reported COVID-19 exposure and regional COVID-19 incidence rates in Model 2.

Results

In 2020, there was a statistically non-significant trend towards a graded relationship between the regional healthcare economic management and depression with OR 1.8 (95%CI:0.8-4.2) for poor management and OR of 1.3 (95%CI:0.6-2.5) for adequate management, when compared to regions with good management. No substantial differences were apparent (OR for poor=0.9; 95%CI:0.6-1.3 & OR for adequate=0.9; 95%CI:0.6-1.3) in 2021. In 2022 showing an increased chance for depression with adequate management (OR = 1.4; 95%CI:0.6-3.2) but a lower chance of depression for regions with poor management (OR = 0.7; 95%CI:0.4-1.5).

Conclusions

We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers. There was an indication that in regions with poorer management, healthcare workers showed an increased chance of depression in the early phase of the pandemic.

Key messages

• Poorer regional economic healthcare management may play a role for depression of healthcare workers, especially in early phases pandemic or other crisis situations.

• We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers.
Norwegian inmates’ experiences of a shift to self-catering: promoting health through empowerment
Authors: Hervik SEK , Hervik A K , Thoresen T , Thurston M
Published: October 2023

Prisons have been described as important settings for health promotion. Health promotion, in which empowerment is a key process, is challenging in prisons since inmates’ individual choice and control is constrained. Empowerment through increased individual choice and control regarding food could be one way to promote health in prison. The aim of this presentation is to explore how inmates experience a shift from ready meals to self-catering and how they perceive the consequences of this for their health. The context of this study is Bastøy Prison, situated on an island in the Oslofjord. It is Norway's largest low-security prison with a capacity of 115 male inmates. In advance of the study, the canteen had been closed and ready meals were introduced as a substitute. This resulted in protests among inmates, who argued for the possibility to cook their own food. Consequently, the prison shifted to self-catering. In the spring of 2022, 20 individual semi-structured interviews were carried out, with inmates with differing age, social backgrounds, and ethnicity. The interviews were transcribed verbatim and analysed inspired by the principles of framework method. Empowerment through introduction of self-catering was expressed as having several positive consequences for the inmates related to their physical, mental, and social wellbeing. These consequences included, for example, developing food skills such as planning and organizing meals, cooking, and keeping the kitchen clean, eating healthier foods, building and expressing identity and strengthening social relations among inmates. The findings from this study suggest that empowerment through self-catering can have positive ripple effects that may be important for health promotion. Such understandings are important to bear in mind if the aim is to create health-promoting prisons.

Key messages

• Empowerment through increased individual choice and control regarding food could be one way to promote health in prison.

• A shift to self-catering was expressed by inmates as having several positive consequences for their physical, mental, and social wellbeing.
Functional social support and physical activity in community-dwelling older adults: A scoping review
Authors: Steinhoff P , Reiner A
Published: October 2023

Background

Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for healthy ageing, as it can prevent noncommunicable diseases, improve mental health, cognitive functioning and quality of life. However, PA decreases with age. About two-thirds of those aged 65-74 years and three-quarters of those aged 75 or more do not meet PA guidelines. A systematic review from 2017 showed that social support (SOSU) and loneliness are associated with PA in older people. The aim of this scoping review was to update that systematic review by identifying and mapping all of the available knowledge, including results from mixed-methods and qualitative studies, and to explore associations between functional SOSU and PA in older people.

Methods

A scoping review was conducted using the Joanna-Briggs manual. Empirical studies investigating associations between functional SOSU and PA levels in older adults were identified through a systematic search of the electronic databases Web of Science, PubMed, ProQuest, PsycInfo, PSYINDEX, SocINDEX and Scopus up to March 2022, without time or geographic restrictions. After removing duplicates, 17,196 articles were screened for titles and abstracts by two independent researchers. Strict inclusion and exclusion criteria were set in advance.

Results

88 articles matched the inclusion criteria; 71% were quantitative studies and 29% qualitative studies. Most studies used self-reported PA measures, only 13% of the studies used objective-reported PA measures. Most studies showed a significant positive association between functional SOSU and PA. The results were analysed separately for the different SOSU types.

Conclusions

Functional SOSU is positively associated with PA while lack of SOSU is a major barrier to exercise. The study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.

Key messages

• Older adults have lower levels of SOSU and PA.

• One way of promoting PA in older age is facilitating high levels of SOSU.
Perspectives of individuals on reducing meat consumption to mitigate climate change: a scoping review
Authors: Moosburger R , Richter A , Manz K , Mensink GBM , Loss J
Published: October 2023

Background

Meat production has negative impacts on climate change which could, along with other factors such as health and animal welfare, motivate individuals to eat less meat. So far, willingness to reduce meat consumption and motives to do so are not sufficiently understood. Therefore, we conducted a scoping review, based on the PRISMA-ScR guidelines.

Methods

The research questions were: What is the evidence regarding (1) the awareness about the link between meat consumption and climate change, (2) the willingness of individuals to reduce meat consumption to mitigate climate change and (3) individuals having reduced meat consumption for the reason of climate protection? We systematically searched multiple databases and included studies from 2015 onwards.

Results

Of 62 identified studies, 50 have been analysed so far. Research in this field increased steadily in the last years, with most studies being cross-sectional and conducted in Europe. Results indicate that the negative influence of meat consumption on climate change is relatively unknown or often being underestimated, yet awareness increased over the last decade. Among persons who think meat reduction is an effective strategy to mitigate climate change, the willingness to reduce consumption is more frequent. Regarding individuals who have reduced meat consumption, climate protection as a motive seems to be gaining importance over time. The results are preliminary.

Conclusions

The climate change mitigation potential of meat reduction should be better communicated, e.g. in health promotion campaigns, to further raise awareness, strengthen willingness to reduce meat consumption and initiate behaviour change. Longitudinal studies are necessary to accompany the whole process, from awareness and intentions to behavioural change.

Key messages

• The scoping review shows to what extent climate protection aspects influence individual willingness to reduce meat consumption.

• Also, research gaps in this field are being identified.
Improving health and scientific literacy in disadvantaged adults: a scoping review of interventions
Authors: Romanova A
Published: October 2023

Background

People with low socioeconomic status face high health risks and poor health literacy. Tailored health education could help reduce these disparities. This scoping review sought to provide an up-to-date overview of approaches to craft and conduct interventions to improve health and scientific literacy in disadvantaged adults.

Methods

7 databases were searched from 2012 to 2022. Data about research design, settings, target groups, topics, skills, theoretical foundations, materials, methodologies, outcomes, and evaluation tools were extracted from the selected articles. Quality assessment was done using the Crowe Critical Appraisal Tool.

Results

The review included 50 studies, most of which were quasi-experimental, involving participants with low income or limited education, ethnic minorities, or immigrants. Frequently theory-driven, these interventions were conducted in community settings and used various interactive methods like discussions and practical exercises. Functional and interactive health literacy dimensions were emphasised more than critical and scientific ones. Many programs highlighted cultural appropriateness and customization. Researchers often involved participants in program development or execution. Evaluations assessed knowledge, health literacy, behavioural and psychological gains using various quantitative and qualitative instruments. Critical appraisal of the studies revealed quality limitations.

Conclusions

Participatory methods, interactivity and culturally appropriate materials are crucial for crafting relevant health education for disadvantaged groups. Greater emphasis should be placed on developing critical and scientific health literacy skills.

Key messages

• This study provides novel findings on the ways to design and evaluate health literacy interventions targeted at vulnerable groups.

• Such guidance can be valuable for health education practitioners.
Mental health of older parents with migrant adult-children in Europe
Authors: Lee H , Kim J , Zrínyi M
Published: October 2023

Background

As migration patterns continue to shift across Europe, an increasing number of older parents are experiencing the departure of their adult children. This phenomenon has been linked to higher levels of stress, isolation, and loneliness among left-behind parents, which may lead to poor mental and physical health. This study aimed to investigate whether adult children's outmigration is associated with the mental health of older parents in different regions of Europe.

Methods

The Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 8 was used to investigate the impact of adult child migration on depression of older parents in four European regions: Western, Northern, Southern, and Central and Eastern Europe.

Results

A total study sample was 23,185 older parents composed of Western (5,458), Central and Eastern (10,397), Southern (4,063), and Scandinavian (3,267) Europe. Preliminary results showed that there was a regional difference in the health effects of adult children outmigration in Europe. From the bivariate analysis, older parents in Central and Eastern (F = 4.756, p = 0.003) and Southern (F = 4.675, p = 0.003) regions showed significant differences according to their adult children's migration status while Western and Northern Europe regions did not show the difference in depression levels. According to a multiple regression model, compared to those having no migrant child or all children lives within 500km, those in Central and Eastern Europe region with all (p < 0.001, β = 0.423) or some (p < 0.001, β = 0.309) of adult children were over 500km away were statistically more depressed even after considering extensive other factors.

Conclusions

The outmigration of adult children can profoundly affect the mental health of older parents left-behind in Central and Eastern Europe, emphasizing the need to recognize left-behind parents as a vulnerable population at risk for developing mental health issues.
Impact of transition to retirement on the risk of depression and suicidality: results from the Survey of Health, Ageing and Retirement in Europe (SHARE)
Authors: Mosconi G , Vigezzi G P , Bertuccio P , Amerio A , Odone A
Published: October 2023

Background

Depression is among the main contributors to older adults’ mental health burden. Retirement, as a major life transition, has been claimed to influence mental health substantially.

Methods

To assess short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe, we conducted a longitudinal study using data from the SHARE, collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalised estimating equation models for repeated measures.

Results

We included 8,998 individuals employed at baseline and retired at follow-up. Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2 years (RR 0.91; 95% CI 0.82-1.00) and after 3 years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). As for suicidality, we reported an increase in risk only 5 years or more after retirement: +30% 5-9 years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98).

Conclusions

Longitudinal data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions.
A wellness intervention to address weight gain in people living with HIV
Authors: Hill J , Skinner D , Nachega J , Kengne A
Published: October 2023

Background

Dolutegravir-based antiretrovirals are the cornerstone of HIV treatment in LMICs but has shown to be associated with excessive (≥10%) weight gain. Increased body mass index combined with fat redistribution poses increased risk for diabetes, hypertension, and cardiovascular disease. The South African Diabetes Prevention Program (SA-DPP) is a lifestyle intervention program, including nutrition education, physical activity, and other risky behaviors and has been adapted to poorly resourced communities in Cape Town. We aimed to adapt the SA-DPP intervention for people living with HIV (PLWH) and assess its acceptability and feasibility.

Methods

PLWH and health staff were drawn from three primary health clinics in Cape Town (n = 35). Purposive sampling was used. Five focus groups (FG) with PLWH; two individual interviews (II) with PLWH; five interviews with health staff, including two II with medical doctors; two with a pair of nurses each and a group of three lay counsellors and three II with experts on diet and exercise lifestyle (n = 6). The FG and interviews explored two parts 1) PLWH experience of HIV treatment, their lifestyle issues, the education and support received from clinics and 2) review, evaluation and perspectives on the current SA-DPP intervention and tools. FG and interviews were transcribed and thematically analyzed.

Results

The SA-DPP curriculum was positively reviewed by PLWH and health staff. This included acceptability of the content and structure of the material. The content was deemed thorough and detailed in relation to nutrition and exercise. “The physical active part here, is something that I need in my life, this is something that I need in my health, the improve your sleep and the stress”. Practical in its approach, gave options within reach, in terms of availability and cost.

Conclusions

The intervention content was deemed accessible and covered all important areas. Experts thought it a resource PLWH could use over time and across illnesses.

Key messages

• This study provides insight into the challenges faced by PLWH in trying to live a healthier lifestyle.

• The result of this study will translate into a healthy lifestyle intervention that can easily be adopted in the current primary health care set up for PLWH.
Health & well-being experiences of patients with pulmonary fibrosis from dancing intervention
Authors: Niranjan V , Tarantino G , Kumar J , Cassidy N , Galvin L , Barnes T , O'Neill F , Cullen M , O’Connor R , O’Regan A
Published: October 2023

Patients with pulmonary fibrosis (PF) are recommended pulmonary rehabilitation which improves health outcomes. Such physical activity (PA) programmes are meant to promote sustainable behavioural change as exercise activities are valued, enjoyed and considered meaningful. Dance is one exercise form, but COVID-19 may have negatively impacted participation and quality of life of vulnerable populations due to lockdown and consequent isolation. This qualitative study aimed to investigate the perspectives of adults living with PF who had participated in a dance intervention. In partnership with the Irish Lung Fibrosis Association (ILFA), A group of 16 patients with PF, members of ILFA, participated in 75 minutes online dance intervention for eight weeks delivered by an experienced choreographer. An exploratory qualitative study using thematic analysis of semi structured interviews was carried out to understand feasibility as well as health and wellbeing impacts of dancing among the participants. Eight participants (6 Female, 2 male; mean age 72.3 years) completed one to one semi-structured qualitative interviews. Four key themes emerged: 1) Dance is fun - we're not exercising 2) Improved sense of wellbeing 3) Positive impact of own online social space 4) Connecting dance impacts to clinical health. Overall, participants mentioned that our virtual dance intervention was acceptable, enjoyable, preferable, and feasible. They strongly perceived health benefits especially breathing efficiency and mental health improvements for managing their day-to-day struggles with PF. Emerging themes could influence the development and evaluation of dance as an alternate form of PA for patients with PF, exploring its benefits and sustainability. As dance is a low-cost activity that can be done at home, dance interventions may be used as an exercise pathway for patients with pulmonary diseases. More organised and continuous events in future may reveal cost-benefit ratio and impact on health outcomes.

Key messages

• Dance – More favourable, higher adherence rate, better health and wellbeing outcomes and achieve higher targets of recommended PA levels in the community.

• Social prescribing – Creating and promoting alternative exercise forms which patient’s can and should enjoy an activity of their choice and have a choice.
Social capital as an element of impact on public health: a gender gap analysis for Spain
Authors: Valbuena-Portillo H , García-Prieto C , Gómez-Costilla P
Published: October 2023

The recent COVID-19 pandemic highlighted the importance of health, not only for physical but also mental well-being. The isolation to which the population was subjected in many countries drastically reduced social interaction at that time and emphasized the relevance of social capital. The aim of this article is to study the importance of social capital in health, and its impact in gender inequalities, in order to provide guidance on social policy that contributes to the reduction of the gender health gap.

We used the Spanish data from the European Survey on Living Conditions (EU-SILC). Spain is a representative country of Southern Europe, where there are strong gender inequalities in health, especially among the elderly. The selected sample includes the population aged 25 years and over. In total, 25,054 individuals were considered, of whom 47% were men and 53% were women. Self-rated health was used as a general indicator of health status. Different sociodemographic variables and various social capital variables, such as satisfaction with social relationships or meeting with family and friends, were included in the analysis. In order to carry out this analysis, several multivariate logistic estimations were performed. In our results, social capital variables were highly significant and positively associated with perceived health. In the case of women, there is a strong positive association, especially relevant for older women (over 75) and those with lower levels of education (no education or primary education). In both cases, these are the most vulnerable women, who report a poorer health status, with a gender gap in health particularly intense in our estimations for older women. In conclusion, social policies supporting elderly women, promoting participation in group activities and facilitating relationships with others, constitute a strategy of great impact on their perception of health.

Key messages

• Social capital variables were highly significant and positively associated with perceived health, especially relevant for older women and those with lower levels of education.

• Social policies supporting elderly women, promoting participation in group activities and facilitating relationships with others, constitute a strategy of great impact on their perception of health.
Are diet and exercise associated with depression in rheumatoid arthritis patients?
Authors: Husivargova A , Timkova V , Macejova Z , Kotradyova Z , Breznoscakova D , Sanderman R , Nagyova I
Published: October 2023

Background

Although depression is a common comorbidity of rheumatoid arthritis (RA), little is known about a potential treatment strategy. Current studies of dietary improvement for depression have recently emerged in the general population, but have hardly any coverage in RA. Also, less exercise increases the number of people experiencing depression, and current studies showed that most RA patients are physically inactive. Thus, our study aimed to identify the potential factors associated with depression in RA patients.

Methods

We included 157 RA patients (84.7% female; mean age 56.43±13.9 years; mean disease duration 19.53±9.54 years). All participants completed the General Health Questionnaire - 28, the Visual Analogue Scale Pain, the 36-item Short Form Health Survey, the Physical Activity Scale, and the Food Frequency Questionnaire. Correlations and multiple linear regressions were used to analyse the data.

Results

Bivariate analyses showed a significant association between disease activity (.25; p ≤ 0.01), functional disability (.22; p ≤ 0.01), pain (.35; p ≤ 0.001), fatigue (-.45; p ≤ 0.001), physical inactivity (-.19; p ≤ 0.05), frequent consumption of fried foods (-.22; p ≤ 0.01) and depression. No other foods were associated with depression in RA. The multiple regression analyses showed that disease activity, fatigue, and fried foods consumption were significantly associated with depression in the final model. However, the association between physical activity and depression was no longer significant using multivariate models. Explained variance in the final regression model was 27.6%.

Conclusions

It appears that frequent consumption of fried foods is associated with depression in RA when controlled for sociodemographic and clinical variables. Further research on specific dietary habits and underlying mechanisms in the gut-brain axis may help to develop treatment options for the prevention of psychological distress in RA. (Grant: VEGA: 1/0748/22; APVV-15-0719)

Key messages

• Non-pharmacological intervention for reducing depression should target the patient's diet.

• Frequent consumption of fried food may influence depression more significantly than physical inactivity.
Intergenerational transmission of health behaviors: A population-based study in Germany
Authors: Rau S , Shojaa M , Montano D , Schmitz N
Published: October 2023

Background

Intergenerational transmission has been identified for many chronic diseases and behavioral factors. Long-term prospective studies are needed that examine different generations within families and determine the expression of specific biological and psychosocial characteristics using a standardized measurement protocol. At present, there are no prospective cohort studies in Germany that have examined the association between the health behavior of parents and children.

Methods

The ongoing pilot study is the first phase of a population-based longitudinal study on the health behavior of the generations. A random sample of 230 community members aged 70-85 years in Germany was recruited. A face-to-face interview with standardized questionnaires was conducted to collect information on health outcomes, including lifestyle, medical, social, and psychological factors in participants’ lives. Blood and saliva samples were also collected to determine some specific biomarkers. Online questionnaires will be used for younger generations.

Results

Data collection for the first generation has been completed and recruitment for the second and third generations is expected to be completed by June 2023. Written informed consent has been obtained from all participants. Results from the current study will be presented at the conference.

Conclusions

Parental health behaviors may influence the onset of risky health behaviors in their offspring. Thus, in order to promote healthy behaviors, it is important to examine these factors to understand whether the transmission from one generation to the next is due to high-risk lifestyles, the direct transmission, or both.

Key messages

• This pilot study will provide information needed to design a larger population study, i.e., sample size will depend on response rates and associations between psychosocial and biological factors.

• Intergenerational transmission may provide an important framework for health promoting interventions leading to healthy aging.
Organizational Health Literacy in cancer care: the patients’ perspective
Authors: Jeitani C , Van den Broucke S
Published: October 2023

Introduction

While earlier views of health literacy focused on patients’ skills, recent conceptualizations put the emphasis on matching individuals’ functional, communicative and critical skills to the information requirements of the health system. This paradigm shift has given rise to the concept of health-literate organizations. Yet while this concept is becoming better known, the barriers and facilitators to its implementation remain understudied. This study aims at understanding patients’ perspective of how their health literacy levels are being attended to by the healthcare system and enable their decision-making process.

Methods

The study took place at the oncology-hematology departments in two sites of a Brussels-based hospital, serving two different patient populations. The perceptions of 20 patients on existing health literacy policies and procedures were evaluated through semi-structured interviews based on the Enliven Organisational Health Literacy Self-Assessment Resource, CDC's attributes of a health-literate organization, and the International Self-Assessment Tool for Organizational Health Literacy Responsiveness of Hospitals. The models underlying these tools were used for the analysis of the results alongside the WHO health literacy policy model.

Results

Preliminary results revealed a weak understanding of the term health literacy and poor comprehension of the impact and importance of health literacy. The information given through oral or written measures was considered sufficient but poorly adapted to cultural and linguistic needs. Little or no involvement was perceived in patient-related approach strategies. Coordinating nurses were considered as the main source of information.

Conclusions

The weak ability of patients to understand the importance of health literacy and its impact calls for a health literate organization approach that allows the patient an accessible and level-adapted environment that caters to all HL levels.

Key messages

• Weak ability for patients to understand HL and it's importance shows how perception of adapted Health Literate approaches are impacted.

• The need for health literate organizations through the creation of interventions that cater the needs of patients, health care staff and the organization.
Changes of physical and emotional wellbeing of public health workers during the Covid-19 pandemic
Authors: Lingiene R , Buckus R , Stukas R
Published: October 2023

Background

During the Covid-19 pandemic, healthcare workers’ mental health was affected by enormous challenges in work environment. The study aimed to analyze the physical and emotional wellbeing of the Lithuanian National Public Health Center (NPHC) workers before and during the COVID-19 pandemic. It assesses the relationship between self-assessed well-being and sociodemographic factors.

Methods

An online questionnaire including 8 statements on health and physical and 13 statements on emotional wellbeing was distributed to all 396 NPHC workers. Answers to the statements were provided on a 5-point Likert scale. Wilcoxon Signed Ranks Test, Mann-Whitney Test and Sperman's rank correlation were used for assessment on relationships.

Results

Our final sample included 343 (86,6%) NPHC workers. The self-assessment of health and physical wellbeing of the total 8 statements determined that 81.5% of respondents rated it worse during the pandemic (p < 0.001). The self-assessment of the emotional wellbeing of the total 13 statements showed that 84.7% of respondents rated it worse during the pandemic (p < 0.001). There were statistically significant relationships between self-assessment scores during the pandemic and public health workers’ age and work specificity. University degree workers showed significantly higher negative changes both in health and physical wellbeing (p < 0.001) and in emotional wellbeing (p = 0.001) compared with non-university degree workers.

Conclusions

The health and physical and emotional wellbeing of the workers of NPHC during the Covid-19 pandemic have significantly deteriorated. It suggests, that measures ensuring public health workers remain physically and mentally healthy during future crises such as COVID-19, are necessary.

Key messages

• Health and physical and emotional wellbeing of public health workers during the Covid-19 have deteriorated.

• Measures that ensure public health workers remain healthy during future crisis are necessary.
'I became the nurse I dreamed to be': Posttraumatic growth of hospital nurses during COVID-19
Authors: Inchi L , Admi H , Bord S , Sharabani S
Published: October 2023

Background

The unexpected COVID-19 pandemic outbreak has shaken the personal and professional lives of people worldwide. Nurses, as the largest healthcare workforce and in the closest proximity to patients, are at high risk of being infected, facing life-threatening situations while being exposed to secondary traumatic stress from direct care of others who are also experiencing traumatic events.

Aim

To explore the lived experiences of frontline hospital nurses as direct caregivers of COVID-19 patients, during four waves of the pandemic.

Methods

The grounded theory approach was employed to generate a theory of nurses’ lived experiences during four waves of the pandemic using the constant comparative method of analysis. Semi-structured interviews were conducted with 23 nurses from nine tertiary hospitals in Israel, between August and September 2021. Interviews were video recorded and transcribed verbatim. Criteria for establishing trustworthiness were applied.

Results

Nurses experienced the COVID-19 pandemic as (1) A direct and secondary threatening event; unexpected, uncertain with poor conditions and resources; (2) Paradoxical negative and positive changes were experienced such as threats to life vs. valuing life; social distancing vs. improved relations; and professional challenges vs. growth; (3) Nurses gained meaningful professional growth such as awareness of their professional strengths and limitations; choosing the optimal career path, and restructuring their nursing identity and image.

Conclusions

This study shed some light on nurses’ positive experiences during their struggle during the COVID-19 pandemic without neglecting the impact of adverse experiences on nurses. The phenomenon of secondary traumatization in nursing is still undervalued and needs to be explored and addressed. The pandemic provided nurses with a rare opportunity to redefine the meaning of being a nurse and experience professional growth.

Key messages

• Nursing leadership should consider nurses’ emotional needs and include affective-cognitive processing of traumatic events as part of the professional curricula in nursing education and at workplace.

• Public recognition of the added value of nurses strengthened nurses’ professional identity and image. This process of developing the future state of the nursing image must be continued internationally.
Beyond one-sided expectations of integration: Rethinking international nurse migration to Germany
Authors: Peppler L , Feißt M , Schneider A , Apelt M , Schenk L
Published: October 2023

Background

Like most countries, Germany is currently recruiting international nurses due to staff shortages. While these are mostly academic, the academisation of nursing in Germany has only just begun. This allows for a broader look at the participation of migrant nurses: How do care teams deal with the fact that immigrant colleagues are theoretically more highly qualified than long-established colleagues?

Methods

Case studies were conducted in four inpatient care teams of two hospitals in 2022. Qualitative data include 26 observation protocols, 4 group discussions and 17 guided interviews. These were analysed using the documentary method and validated intersubjectively.

Results

Due to current academisation efforts in Germany and the immigration of academised nursing staff from abroad, the areas of activity and responsibility of nursing in Germany are under negotiating pressure. This concerns basic care for example, which in Germany is provided by skilled workers, but in other countries is mostly provided by assistants or relatives. The question of who should provide basic care, whether all nurses or only nursing assistants, documents the struggle between an established and a new understanding of care. In this context, the knowledge and skills of migrant and academicised care workers become a crucial aspect in the struggle for a new professional identity for care in Germany.

Conclusions

The specific situation in Germany makes it possible to show the potential for change that international care migration can constitute for destination countries. The far-reaching process of change of German nursing is given a further dimension not only by its academization, but by the immigration of international and academically trained nursing staff, where inclusive or exclusive effects can already be observed.

Key messages

• The increasing proportion of migrant nurses accelerates the current discussion on nursing in Germany.

• Conflict areas show up in everyday work of care teams and must be addressed there.