bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of COVID-19 on emergency department use among home care recipients
Authors: Peano A , Minutiello E , Politano G , Dalmasso M , Gianino MM
Published: October 2022

Background

The impact of COVID-19 pandemic on Emergency Department (ED) was remarkable throughout Europe. We focused upon ED utilization among integrated home care (IHC) recipients comparing ED between pandemic period with pre-pandemic (February -December 2020 and 2019, respectively) in Piedmont, Italy.

Methods

A retrospective observational study was conducted. All recipients of IHC during the two periods studied were enrolled and all ED visits that occurred among IHC recipients were accounted for. Several variables related to IHC admission, reason of ED visits and demographic characteristics were collected. The average of ED visits in pre-pandemic and pandemic periods were calculated. Analyses were stratified by all variables.

Results

Patients enrolled were 11968 in 2019 and 8938 in 2020. In 2019, 3573 patients had at least one ED visit and 1668 patients in 2020. Number of ED visits was 5503 in 2019 and 2197 in 2020. The average of ED visits in 2020 has reduced in comparison with 2019 (0.464 C.I. [0.44-0.489] and 0.24 C.I. [0.227-0.252], p < 0.001 in 2019 and 2020 respectively). This reduction is regardless of sex, age, duration of IHC, presence of a non-family caregiver or reason for ED visits, except for abdominal pain, cardiac rhythm alteration and gynaecological symptoms. The averages of ED visits were significantly lower for IHC recipients with neoplasm (0.549 C.I. [0.513-0.585] and 0.328 C.I. [0.298-0.358], p < 0.001, and with low level of emergency (1.77 C.I. [1.662-1.877] and 1.397 C.I. [1.348-1.447], p < 0.036), but an increase in mortality rate was not registered.

Conclusions

Our results showed a reduction of ED visits among integrated home care recipients in pandemic period in comparison with pre-pandemic period. If the reduction can be the consequence of an unprepared health service that needs of necessary changes in its organization, these results suggest a great potential of the home care system to reduce the use of the hospital especially for low-risk conditions.

Key messages

• The COVID-19 pandemic overwhelmed health services of all European Countries. A reduced utilization of ED has been shown by literature, especially during the early phase of the COVID-19 pandemic.

• We showed a reduction in IHC recipients and a great decrease in ED visits among IHC patients in 2020 versus 2019, mainly in oncological patients, while an increase in mortality rate was not reported.
Disruptions of cytological screening procedures due to the COVID-19 pandemic in Slovakia
Authors: Melichova J , Marusakova E , Bilikova L , Sivčo P , Plancikova D , Hazerova D , Pham T , Paulik S , Putekova S , Majdan M
Published: October 2022

Background

During the COVID-19 pandemic, most settings experienced healthcare service disruptions. The majority of cytological screening procedures were postponed to focus on assisting patients infected with COVID-19. In this study, we aimed to analyse the impact of the impact of the COVID-19 pandemic on the uptake of cervical cancer screening in Slovakia.

Methods

Data on cytological screening procedures were obtained from two of the three health insurance companies in Slovakia for the years 2019 and 2020, covering the population of women aged 15 and older. All data were calculated stratified for age groups. Rates of cytological screenings were calculated as the number of procedures per women registered in the insurance company in the same age group and rate ratios were calculated as ratios of the rates for the years 2020 and 2019 for the same age group. Incidence rates were calculated as the number of newly diagnosed cervical cancer cases per women registered in the insurance company in the respective year.

Results

Rate ratios of cytological screening procedures revealed that in both examined health insurance companies, the rate of cytological exams was lower in 2020 compared to 2019 (0.95 and 0.89). This was observed across all age groups. The results showed a clear and statistically significant age gradient, indicating that the level of disruption increased with age. The age group 60-69 years had the highest incidence rate of cervical cancer in 2019, at 54.3 per 100 000. In 2020, the highest rate was 48.3 in the age group 50-59 years. The lowest rates were in children and young adults (<20 years).

Conclusions

This study confirms the significant impact of the pandemic on cervical cancer screening uptake in Slovakia, which may have delayed the diagnosis of cervical cancer into later stages of the disease with a worse prognosis. This may lead to increased mortality and years lived with disability due to this disease in Slovakia.

Key messages

• Disruptions in cervical cancer screenings were observed in Slovakia during the COVID-19 pandemic which may result in an increase in cervical cancer incidence and mortality.

• Strategies should be implemented to maintain cancer screening programs during health emergencies to avoid excessive mortality and morbidity.
Re-admission after early discharge from involuntary hospitalization of psychiatric patients
Authors: Mor Z , Shachar C , Shai U , Sheffer R
Published: October 2022

Background

State psychiatrics in Public Health Departments in Israel can involuntary hospitalize patients (IHP) in psychotic status. IHP who are unsatisfied with the involuntary hospitalization can appeal to a Psychiatric Committee (PC) in the institution to ask to shorten their hospitalization. The PC can decide to discharge the patient to ambulatory treatment. This cohort study aimed to assess re-admission of IHP among patients who shortened their involuntary hospitalization in Tel-Aviv.

Methods

IHP whose involuntary hospitalization was shortened by PC (research arm) were compared to IHP patients who completed the entire hospitalization length, as was initially recommended by the psychiatrist (control arm). Re-admission was defined as hospitalization within one year after release by the PC/end of hospitalization.

Results

From 3,160 IHR between 2010 and 2015, 1,338 were re-hospitalized during a year after release, 317 (41.7%) from the research arm and 1,012 (42.6%) from the control arm, p < 0.7. Discharge of IHP by PC during first month of the involuntary hospitalization resulted in a higher re-admission rates than IHR from the control group (58.4% vs. 46.4%, respectively, p < 0.001). Yet, discharge of IHR by the PC after one month of hospitalization (or end of the hospitalization) resulted in lower re-admission rates (14.8% vs. 53.6%, respectively, p < 0.001). Risks factors for re-admission included male gender, Israeli born, single and diagnosis of schizophrenia.

Conclusions

Re-admission rates were higher in IHR who were released by the PC during the first month of hospitalization. The first month is important for mental and therapeutic stabilization of IHP. After 30 days, release of IHP can be re-assessed according to the patients’ situation. Early discharge of males who were diagnosed with schizophrenia should be carefully assessed.

Key messages

• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.

• Early discharge of psychiatric patients from involuntary hospitalization should be assesses only after the first 30 days of hospital admission, especially among young males with schizophrenia.
Educational inequalities in major depressive disorder over the adult life course: a microsimulation
Authors: Lepe A , Hoveling LA , Boissonneault M , de Beer JAA , Reijneveld SA , de Kroon MLA , Liefbroer AC
Published: October 2022

Background

Educational inequalities in major depressive disorder (MDD) pose a major challenge. Tackling this issue requires evidence on the long-term impact of intervening on modifiable factors, e.g. behavioural and psychosocial factors. Therefore, we aim to simulate the development of educational inequalities in MDD across the life course, and to assess the impact of intervening on the modifiable factors that contribute to these inequalities.

Methods

We used data from the prospective Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation allowed us to estimate the development of educational inequalities in MDD with a synthetic cohort of 500,000 individuals followed from ages 18 to 65, and to assess the potential benefit of intervening on quality of social contacts, health literacy, and smoking.

Results

On average, an additional 19.1% of individuals with low education will ever experience MDD between ages 18 and 65 compared to those with high education (32.0% vs 12.9%, respectively). Additionally, individuals with low education generally will develop MDD 0.9 years earlier (35.6 years vs 36.5 years, respectively) and spend 1.2 years more with MDD (6.2 years vs 5 years, respectively), than individuals with high education. Improving the quality of social contacts in individuals with low education would have the largest impact; it would reduce the inequalities in the prevalence, onset, and duration of MDD by an average of 18.4%, 18.3%, and 28.6%, respectively.

Conclusions

Intervening on modifiable factors, especially quality of social contacts, in individuals with low education could help reduce the large estimated educational inequalities in MDD over the life course.

Key messages

• There are large educational inequalities in major depressive disorder (MDD) over the life course, especially with regard to the life course prevalence of MDD.

• Improving quality of social contacts, and to a lesser extent health literacy and smoking behaviours, amongst individuals with low education may help reduce the inequalities in MDD.
Methods of policy monitoring in physical activity promotion: a systematic review across different levels of government
Authors: Messing S , Tcymbal A , Abu-Omar K , Richardson D , Gelius P
Published: October 2022

Background

Even though the importance of policy monitoring in public health has increased in the last decades, there is still a lack of understanding what different approaches of policy monitoring exist and which methodology they employ. In order to address this research gap, this review attempts to provide a comprehensive overview about the methods of policy monitoring in the field of physical activity promotion.

Methods

A systematic search was conducted in five scientific databases, using the terms “physical activity”, “policy” and “monitoring” and their variations. In total, 12.963 studies were identified and, after the elimination of duplicates, screened independently by two reviewers. During full text analysis, information on the methods applied for policy monitoring was extracted and studies were categorized based on their key characteristics (monitoring tool, policy level, and setting).

Results

The search yielded in a total of 112 studies that were structured into seven categories: Report Cards on Physical Activity for Children and Youth, HEPA Monitoring Framework, HEPA Policy Audit Tool, national policies, subnational policies, school setting, and childcare setting. Across all categories, policy monitoring focused mainly on national level policies in a single country. Differences were identified with regards to the level of government involvement which allowed to differentiate between research-driven approaches (little or no government involvement), government-driven approaches (led by governments), and co-production approaches (strong collaboration between researchers and governments).

Conclusions

Research-driven, government-driven and co-production approaches have different strengths and weaknesses with regards to the monitoring of policies. Awareness needs to be raised regarding the implications of these approaches, and more research is needed to analyse the impact of policy monitoring on policy-making in public health.
Monitoring COVID-19 related changes in population mental health
Authors: Rodríguez-Blázquez C , Aldridge S , Bernal-Delgado E , Dolanski-Aghamanoukjan L , Estupiñán-Romero F , Garriga C , Gissler M , Lyons RA , Sagerschnig S , Tolonen H
Published: October 2022

Background

The COVID-19 pandemic, and its consequences in terms of control measures and restrictions to normal life, has affected the population mental health. One of the four case studies from the Population Health Information Research Infrastructure (PHIRI) for COVID-19 is focused on mental health with the objective to measure changes in incidence of mental health problems associated with the COVID-19 pandemic in several European countries.

Methods

Using electronic health records (EHR), data on new episodes of depression or anxiety, prescription of antidepressants and anxiolytics, and visits to primary care, specialized care or emergency units with an episode of depression/anxiety, were collected by participant data hubs at national/regional level for the period 2017-2021. A common data model to collect the data was defined for all participating data hubs and analysis of status prior and during the COVID-19 pandemic was performed using R.

Results

Data hubs from Austria, Finland, Spain (Aragon), and United Kingdom (Wales) were able to provide aggregated results from raw individual-level data. Preliminary analysis of trends suggests a decrease in new cases of depression and anxiety in the pandemic period (2020-2021) in comparison with previous years. Different trends were observed between data hubs regarding prescription of drugs and the number of primary/specialized care visits due to depression or anxiety. Issues in the access to data in some of the participating data hubs were observed, related to ethical and legal matters, and the lack of centralized registers and of private consultations statistics.

Conclusions

The results of this use case show that EHR for the secondary use can be retrieved in a common way across Europe to analyse and compare the impact of COVID-19 in population mental health in European countries. However, the process is more complicated and time consuming than expected.
Spread of SARS-CoV-2 at school through the pandemic waves: a population-based cohort study in Italy
Authors: Fonzo M , Pistellato I , Calzavara A , Sorrentino P , Selle V , Sbrogiò LG , Bertoncello C
Published: October 2022

Background

To limit SARS-CoV-2 transmission, proactive closure of schools is often believed by policy-makers and public an effective strategy. While evidence on the role of students in the spread is ongoing, effects of closure on children's well-being are well known. The number of secondary cases per class has been considered one of main driving criteria to mandate for distance learning. We aimed to calculate the rate of secondary infections per classroom and to identify factors associated with the development of school clusters.

Methods

We conducted a population-based cohort study between October 2020 and November 2021 in the province of Venice, Italy, a catchment area of 600,000 inhabitants. Primary, middle and high-schools were included.

Results

We identified 1,623 primary cases of SARS-CoV-2 infection in students. Of these, 72.5% did not lead to any secondary case in the school setting, 15.6% to 1, and 11.9% to 2+ contagions. The so-called second wave (Oct-Dec 2020) was associated with a lower occurrence of 2+ contagions (AOR=0.37; 95%CI: 0.24-0.56) than the fourth (Sep-Nov 2021). Both primary (AOR=1.74; 95%CI: 1.16-2.63) and middle schools (AOR=1.76 95%CI: 1,14-2,72) showed higher odds than high schools for cluster generation of 2+ cases. The involvement of 2+ secondary cases was lesser associated with the index case being a student rather than school staff (AOR=0.42; 95%CI: 0.29-0.60). The number of 2+ cases clusters per week followed a time trend in line with the general population incidence.

Conclusions

The school environment does not facilitate viral spread, but rather reflects transmission in the community. Appropriate measures (use of airway protection devices, interpersonal distancing, frequent hand and respiratory hygiene) and timely case tracking make school a safe place. Given the documented negative effects of school closures on children's learning and well-being, maintaining school attendance is as essential as it is desirable.

Key messages

• A SARS-CoV-2 positive student at school does not generate secondary infections in 3 out of 4 cases. The risk of cluster generation is lower when the index case is a student rather than school staff.

• The school environment does not facilitate viral spread, but rather reflects transmission in the community. School attendance is essential considering the effects on children’s learning and wellbeing.
5.D. Workshop: Challenges and opportunities for health systems in the era of multi-morbidity
Authors:   Organised by: Western University (Canada),   Chair persons: Saverio Stranges (EUPHA-CHR), Arnaud Chiolero (Switzerland)
Published: October 2022

Multimorbidity, defined as the co-existence of two or more chronic conditions in the same individual, is affecting increasing segments of the population across both high-income and low-resource settings. The workshop will provide a comprehensive and global perspective on the clinical and public health burden of multimorbidity from a health system perspective, including presentations and speakers from Europe, Africa and North America. Current research and policy initiatives are still primarily focused on the clinical management of multimorbidity after it occurs as well as on the prevention of adverse events in those individuals who are already living with multimorbidity. There is still a significant need to develop and establish effective and equitable primary prevention strategies in order to avoid the occurrence of multimorbidity across populations. Also, health systems around the world will need to implement context-specific initiatives and changes to tackle the growing burden of multimorbidity in ageing populations, which will be constrained by available resources, societal and political priorities and values. Any potential health system transformations will need to reconcile the concomitant burden imposed by multimorbidity and other major public health priorities, including the current pandemic, the health impact of climate change and widening health disparities across marginalized populations.

Key messages

• There is a significant need to develop effective and equitable primary prevention strategies in order to avoid the occurrence of multimorbidity.

• Health systems around the world will need to implement context-specific initiatives and changes, which will be constrained by available resources, societal and political priorities and values.
Association between functional limitation and quality of life among older adults with multimorbidity in Luxembourg
Authors: Wilk P , Ruiz-Castell M , Bohn T , Fagherazzi G , Nicholson K , Moran V , Makovski TT , Pi Alperin MN , Stranges S , Samouda H
Published: October 2022

Introduction

Multimorbidity, defined as the co-existence of two or more chronic conditions, is affecting an increasing number of Europeans, leading to poorer quality of life (QoL). This study assessed how functional limitation affects the QoL trajectories in a cohort of older individuals having multimorbidity, and whether there are any gender differences in these effects.

Methods

We used a longitudinal cohort of 906 multimorbid respondents 50 years of age or older from Luxembourg who participated in four waves of the Survey of Health, Ageing, and Retirement in Europe (2013-2020). We used the Control, Autonomy, Self-Realization, and Pleasure scale (CASP-12) to assess QoL and the Global Activity Limitation Indicator (GALI) to measure functional limitation. Multigroup latent growth curve (LGC) modeling techniques were employed to assess how the measures of functional limitation over time are related to QoL trajectories and whether or not these effects are different by sex.

Results

In 2013, over 60% of older residents of Luxembourg were affected by multimorbidity. The results from the LGC models suggest that both men and women with multimorbidity experienced a statistically significant decline in QoL between 2013 and 2020 at a constant rate; there were no significant differences in the rate of this change between men and women. The level of QoL at baseline and over time was significantly lower for individuals reporting functional limitation. However, functional limitation had no significant impact on the rate of decline in QoL for both men and women.

Discussion and conclusions

As an increasing number of individuals in Europe are becoming vulnerable to more years lived with multiple chronic conditions, there is a growing need to identify factors that may lead to improvements in QoL among people affected by multimorbidity. Gaining more knowledge on the role of functional limitation may be particularly important for planning comprehensive care for patients with multimorbidity.
Factors associated with the perception that eHealth facilitates access to healthcare
Authors: Kainiemi E , Virtanen L , Saukkonen P , Vehko T , Aalto AM , Kaihlanen AM
Published: October 2022

Background

The provision of eHealth has increased in the COVID-19 era with the aim of improving access to care without the risk of infection. Perceiving eHealth beneficial may affect the use. This study examined which patient-related factors are associated with the perception that eHealth facilitates access to care.

Methods

A nationwide survey was sent to 61,600 Finnish residents during the COVID-19 pandemic (September 2020-February 2021). Binary logistic regression analysis was used to examine whether the service needs (self-rated health, met service needs, challenges accessing traditional care) and eHealth experience (e-visits, need for guidance, data security concerns) were associated with perceiving that eHealth facilitates access to care. The model was adjusted for age, gender and education.

Results

The study included 21,409 respondents who had used healthcare services in the past 12 months (55.0% female, mean age 52.88, SE .18). The majority (63.8%) agreed with the benefit that eHealth facilitates access to care. Patients in good health (OR 1.24, 95% CI 1.13-1.37), whose service needs were met (OR 1.34, 95% CI 1.19-1.52) and who had no challenges in accessing traditional care (OR 1.18, 95% CI 1.02-1.36) had greater odds of perceiving the benefit compared to their counterparts. Patients with experience of e-visits (OR 2.60, 95% CI 2.28-2.96) and without need for guidance (OR 1.71, 95% CI 1.52-1.91) had greater odds of perceiving the benefit compared to their counterparts.

Conclusions

Patients in good health, with met service needs and with easy access to traditional care appear to perceive eHealth more beneficial than their counterparts, which might exacerbate the already existing inequalities in healthcare access and health outcomes. Promotion of eHealth skills might increase equitable opportunities to benefit from eHealth for those patients whose service needs could be met without traditional face-to-face encounter.

Key messages

• Patients in good health, with met service needs and without difficulties accessing traditional healthcare appear to find eHealth more beneficial than their underprivileged counterparts.

• Promotion of eHealth skills might increase equitable opportunities to benefit from eHealth for those patients whose service needs could be met without traditional face-to-face encounter.
Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19
Authors: Alboksmaty A , Beaney T , Elkin S , Clarke J , Darzi A , Aylin P , Neves AL
Published: October 2022

Context

A surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration.

Description of the problem

We need an indicator to enable remote monitoring of COVID patients at home that can be measured by a handy tool; pulse oximetry which measures peripheral blood oxygen saturation (SpO2). Evidence shows that SpO2 is a reliable indicator of deterioration among COVID patients. The UK initiated a national programme (COVID Oximetry @ Home (CO@H)) to assess the theory. The concept can be potentially applied in other countries in various settings. As part of CO@H, we conducted a systematic review of the evidence on the safety and effectiveness of pulse oximetry in remote monitoring of COVID patients.

Results

Our review confirms the safety and potential effectiveness of pulse oximetry in remote home monitoring among COVID patients. We identified 13 research projects involving 2,908 participants that assessed the proposed strategy. Evidence shows the need to monitor at-rest and post-exertional SpO2. At-rest SpO2 of ≤ 92% or a decrease of 5% or more in post-exertional SpO2 should indicate care escalation. The recommended method for measuring at-rest SpO2 is after 5-10 min of rest, and assessing post-exertional SpO2 is after conducting a 1-min sit-to-stand test. We could not find explicit evidence on the impact on health service use compared with other models of care.

Lessons

Remote monitoring of COVID patients could alleviate the pressure on health systems and save hospital resources. Monitoring SpO2 by pulse oximetry can be widely applied, including in resource-limited settings, as the tool is affordable, reliable, and easy to use.

Key messages

• Adopting relevant health technologies in remote patient monitoring is critical to combat the pandemic.

• Pulse oximetry is an affordable, easy to use and widely available tool to monitor patients with COVID-19 at home.
The characteristics of women not-attending screening and their barriers to attendance in Czechia
Authors: Altová A , Lustigová M , Kulhánová I
Published: October 2022

Background

Cervical screening is one of the most important tools to reduce the incidence and mortality of cervical cancer, but uptake is still insufficient in many European countries with implemented population screening programs. In this study, we analyze the sociodemographic characteristics of women who do not attend cervical screening and describe the barriers that these women may have to attend cervical screening using Czechia as an example.

Methods

In the representative sample of 902 Czech women, we first employed binary logistic regression to identify groups of women that have higher chances of being non-attendees. Second, we described the reasons non-attendees declared as barriers to attendance. Third, we analyzed whether there were differences in women's characteristics according to the declared barriers.

Results

In the study sample, 36.7% of the women were considered non-attendees. Women with lower education (primary compared to university education, OR = 2.2, 95%CI 1.2-3.9) single women (compared to married/partnered, OR = 3.6, 95%CI 2.0-5.1), or older women, had a higher chance of not attending the screening. The most frequently declared reasons for not attending were ‘not experiencing any symptoms’ (36.3%), ‘fear of cancer diagnosis’ (23.0%), and ‘fear of the examination procedure’ (20.2%). In most of these barriers, women declaring these reasons did not differ from the other non-attendees.

Conclusions

Identifying sociodemographic determinants of cervical screening non-attendance and the barriers women have to attend are crucial for improving cervical cancer prevention. Based on this knowledge, public health policies should minimize screening hesitancy by targeting psychological factors and improving screening literacy among women. Although this research is a case study for Czechia, we believe that the results may be applicable in other countries.

Key messages

• Cervical screening promotion should be targeted on women at higher risk of non-attendance.Those are women with lover education, single women or older women.

• Understanding the specific barriers to cervical screenin attendance could help develop strategies to improve the communication of prevention.
Pain and mental health - separate and joint associations with sickness absence among young employees
Authors: Fagerlund P , Shiri R , Suur-Uski J , Kaartinen S , Rahkonen O , Lallukka T
Published: October 2022

Background

Both pain and mental illness associate with work disability. However, few studies have examined the association of concurrent pain and mental distress with sickness absence (SA). We examined separate and joint associations of chronic pain, multisite pain, and mental distress with total and long-term all-cause SA among young and midlife municipal employees.

Methods

As part of the Young Helsinki Health study, baseline data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥3 months) pain, multisite (≥2 body sites) pain and mental distress (RAND-36 emotional wellbeing subscale below median) were reported by 3911 respondents. Register data on total (>1 day) and long-term ((>11 workdays) SA for the following year were obtained from the employer and the Social Insurance Institute of Finland with respondents’ informed consent. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. The interaction of gender was examined.

Results

Chronic pain, multisite pain, and mental distress were associated with total SA. Chronic multisite pain was associated with long-term SA (rate ratio [RR] 2.51, 95% CI 1.17-5.42), and chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) with long-term SA among those with mental distress. For women, there was a synergistic interaction of multisite pain to the association with total SA (synergy index 1.80, 95% CI 1.27-2.54).

Conclusions

Chronic and multisite pain associate with SA among young and midlife employees. The associations are generally stronger among women and particularly among those with concurrent mental distress. Interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence.

Key messages

• Chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress.

• Interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services.
Work after cancer-sickness absence. Barriers and facilitators from survivors’ perspective
Authors: Ayala A , Serra L , Rodriguez-Arjona D , Benavides FG
Published: October 2022

People who have suffered from cancer find it difficult to return to work after a sickness absence (SA). Previous evidence indicates that people who survive a cancer have a higher risk than general population of leaving the labor market prematurely or being unemployed due to sequelae of both treatment and disease. Our objective is to identify barriers and facilitators associated with the return and permanence in the workplace of salaried workers after a SA due to cancer in Catalonia. The research used a descriptive qualitative approach with socio-constructivist perspective. A theoretical sampling was carried out until saturation. Three discussion groups (7 people/group) were conducted with people who had suffered a SA due to cancer in Catalonia. The sessions were held virtually and were recorded, transcribed verbatim, and analyzed using thematic analysis and mixed coding with Atlas.ti. Most of the people had returned to work after SA or were looking for a job that was suitable for their health status. Among the barriers to reincorporation to their job detected: (1) coping with the same workload they had before the SA, (2) sequelae associated with cancer treatment that affected their ability to work (stress, low ability to concentrate, chronic fatigue, mobility limitations), (3) having jobs with a high physical load, (4) expectations of colleagues and bosses. Among the facilitating factors: (1) sessions with psycho-oncologists, (2) availability of holidays to adapt their return after SA, (3) teleworking, and (4) job adaptation. Regarding proposals to improve this process, the most outstanding were the implementation of policies that allow a gradual return to work adjusted to the people who want to adhere to it and generalize the possibility of doing psycho-oncological therapy. End of SA after cancer is a key moment for people who go through it, they suffer many difficulties during the process that could be prevented with measures such as a gradual return to work.

Key messages

• Workers who suffer a SA due to cancer face difficulties on their return to work.

• Initiatives of adaptation and gradual reincorporation to the workplace could improve return to work process after a SA due to cancer.
Covid-19 impacts on unemployment on the migration-gender intersections in Spain, a multilevel study
Authors: Pedrós Barnils N
Published: October 2022

Background

The covid-19 pandemic has led to several socioeconomic consequences, which ultimately affect individuals’ health status. This study aims to assess and explore the short-term impacts of the pandemic on the labour market in Spain, through the intersectional and multilevel analysis of unemployment rates.

Methods

Cross-sectional study using data from the Spanish Labour Force Survey from the three quarters before and after the outbreak of covid-19 (N = 922,074). Multilevel logistic regressions were used to calculate the odds of being unemployed for the intersectional positions on gender and migration background, nested within 7 educational levels.

Results

Before (pre) and after (post) the covid-19 outbreak, women had higher odds (ORnw-pre=1.974; p-value<0.001; ORmw-pre=2.202; p-value<0.001) of being unemployed than men (ORmm-pre= 0.887; p-value<0.001). However, the pandemic affected women's employment unequally. Migrant women experienced an increase in the risk of being unemployed 6 times larger than native women (48.67% (ORmw-post=2.688; p-value<0.001) v 8.78% (ORnw-post=2.062; p-value<0.001)). Moreover, in the post-covid 19 scenario, individual characteristics of migrant women (ORmw-post=2.688; p-value<0.001) played a larger role in the risk of being unemployed than their educational level (MOR=2.537).

Conclusions

Migrant women are disproportionately bearing the short-term economic consequences of the pandemic by means of higher unemployment rates, underpinning experiences of racism and gender discrimination. Increasingly attention needs to be placed on discriminated groups in society. Targeted protective policies that foster labour market integration and increase social protection are needed to mitigate and decrease existing economic, social, and health inequalities.

Key messages

• Migrant women have disproportionately carried the economic impact of the covid-19 pandemic in Spain. Targeted protective policies are needed to mitigate existing socioeconomic and health inequalities.

• Migrant women’s gender and migration background play a greater role than their education in the risk of being unemployed, underpinning experiences of racism and gender discrimination.
Digital health literacy and health behaviors of eighth and ninth graders from Germany
Authors: Dadaczynski K , Rathmann K , Schricker J , Bilz L , Sudeck G , Fischer S , Janiczek O , Quilling E
Published: October 2022

Background

Due to the high availability and use of digital media, health-related information is increasingly shifting into the digital space. While there are increasing empirical findings on general health literacy (HL), there is a lack of evidence on digital HL in adolescence and its association with health behavior.

Methods

A cross-sectional study of 490 secondary school students (grades eight and nine) from the federal state of Hesse was conducted from October 2019 to February 2020. Digital HL was assessed using five subscales of the Digital Health Literacy Instrument (DHLI), while consumption of fruits, vegetables, soft drinks, and weekly physical activity were used as indicators of health behavior. In addition to gender and grade level, subjective social status (SSS) was used as a social characteristic. Univariate, bivariate, and multivariate analyses were performed, with binary-logistic regression adjusted for gender and SSS.

Results

Across all items, the percentage of adolescents reporting difficulties in acquiring and dealing with digital health information ranges from 15.3 % to 37.5 %. Stratified by social characteristics, gender and socioeconomic differences were found with girls and respondents reporting a lower SSS more often showing a limited digital HL. Adolescents with moderate and low digital HL report higher levels of low physical activity, non-daily fruit and daily soft drink consumption. Depending on the health behavior, different relationship patterns can be observed for the dimensions of digital HL.

Conclusions

The findings suggest a need for interventions to promote digital HL among adolescents, particularly for those of low SSS. In this context, the differential relationship patterns with health behaviors provide an avenue for the development of specific interventions.
Health workforce needs of small medical specialties: findings from rheumatology in Germany
Authors: Kuhlmann E , Hoeper K , Witte T , Ernst D , Dopfer-Jablonka A
Published: October 2022

Background

Small medical specialties may be more vulnerable to workforce shortage and the COVID-19 pandemic and this may directly impact in the provision of care for chronically-ill patients. This study aims to explore health workforce development and new needs, using rheumatology in Germany as a case study.

Methods

An explorative multi-methods approach was applied, combining health labour market assessment of rheumatology physicians (public statistics 2000-2019) and a questionnaire-based online survey conducted in early 2021 (n = 101 respondents; rheumatology physicians and residents). Main selected topics: work hours, workload, mental health issues, discrimination and sexual harassment experiences, impact of COVID-19. Descriptive statistical analysis was performed and qualitative content analysis for free-text information.

Results

Health labour market analysis showed that the numbers of rheumatologists increased markedly between 2000 and 2019 in the groups aged +50 years, but only 9% in younger groups under 50 years; since 2010 the group 40-50 years showed decreases. In 2019, the absolute number of rheumatologists working in healthcare after retirement-age exceeded those aged 40 and under. Survey data revealed a strong mismatch between actual and desired work hours for women and men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress with major stressors being digitalisation and increased demand for communication and patient education.

Conclusions

Decreasing health workforce capacities in German rheumatology combine with negative perceptions of work and workplace conditions, threatening both retention and service delivery.

Key messages

• Small medical specialties, like rheumatology, face severe shortage that threaten healthcare for chronically-ill patients and need greater attention.

• COVID-19 has reinforced rheumatologists’ workload and stressors, thus worsing mental health and retention.
Mixed-methods study to assess an intervention for healthier lifestyles in primary healthcare
Authors: Bytyci Katanolli A , Merten S , Kwiatkowski M , Obas K , Gerold J , Zahorka M , Jerliu N , Ramadani Q , Fota N
Published: October 2022

Background

Smoking, physical inactivity, low fruit and vegetable consumption, and obesity are common in Kosovo. The Accessible Quality Healthcare project is implementing a primary healthcare intervention that entails nurse-guided motivational counselling to facilitate lifestyle behaviour change. This study assesses the uptake of counselling and the impact on health behaviours and participants’ stages of health behaviour change as well as describes experiences and perceived benefits of motivational counselling.

Methods

Study participants (n = 907) were recruited from 12 municipalities participating in the Kosovo Non-Communicable Disease Cohort study. For the quantitative study, data on lifestyle behaviours, use of counselling, and stages for behavioural change were used. For the qualitative study, in-depth interviews were conducted with 26 cohort participants who had undergone motivational counselling.

Results

Motivational counselling was received by only 22% of the eligible participants in the intervention municipalities. Unhealthy behaviours remain high even in persons who underwent counselling (of whom 13% are smokers; 86% are physically inactive; 93% with inadequate fruit and vegetable consumption; 61% are obese). According to the qualitative study results, the participants that received counselling were very satisfied with the services but requested additional services such as group physical activity sessions and specialized services for smoking cessation.

Conclusions

More tailored and additional primary healthcare approaches in accordance with patients’ views need to be considered for the motivational counselling intervention to reach patients and efficiently facilitate lifestyle behaviour change.

Key messages

• The following tailored approaches are suggested: a) strengthened referral mechanism b) specialized services for smoking cessation; c) delivery of group physical activity sessions.

• More tailored and additional primary health care approaches in accordance with patients’ views need to be considered for the motivational counselling intervention.
5.N. Workshop: Children first: do health systems pay enough attention to their youngest constituents?
Authors:   Organised by: European Observatory on Health Systems and Policies,   Chair persons: Ewout Van Ginneken (Germany), Dimitra Panteli (Belgium)
Published: October 2022

This workshop aims to bring together a range of insights on how health systems have dealt with child health and health care, highlighting both successes and challenges. For children, access to health care is vital. It impacts their physical and emotional health and wellbeing and largely determines whether they can reach their full potential as adults, which is also important to their families and society at large. Consequently, it comes as no surprise that he 1989 UN Convention on the Rights of the Child, which was ratified by all European countries, guarantees a fundamental right to healthcare for all children. However, various national governments do not fully comply with the Convention, and evidence exists that children may not always enjoy the necessary access to meet their needs. In 2021, Doctors of the World (DoW) concluded that there are urgent questions about the welfare and health of vulnerable children across Europe, based on the increase in children seeking healthcare from DoW clinics instead of the national health system. This concerning trend is not captured well enough in available statistics. What is more, the COVID-19 pandemic and the Ukrainian refugee crisis raise additional concerns as to how health systems will deal with the observed increases in related paediatric sequelae and mental health needs. The aims of this workshop are therefore to stimulate discussion around better understanding children's access to health care and how it relates to health system performance, and provide impetus for new initiatives that can improve health care for children. The workshop will take a hybrid format, kicking off with three short presentations followed by a round table discussion and engagement with the audience. The presentations will cover the regulatory framework for children's access to health care in European countries; identified bottlenecks of health system performance specific to child services from a range of countries around the world; and the impact of COVID-19 on hospital care for children based on the example of one European country.

Key messages

• Ensuring children’s access to health care is now more important than ever; a lot more can and should be done at all levels.

• More and better data about children’s health and health care access is necessary to enable effective policies; collecting it should become a health system priority.
Gender and occupational differences in post-terrorist mental health outcomes among emergency responders with and without crisis intervention
Authors: Wesemann U , Mahnke M , Polk S , Bühler A , Willmund G
Published: October 2022

Introduction

After the Berlin terrorist attack at Breitscheidplatz, the gender-specific evaluation of emergency responders (ER) revealed higher perceived levels of paranoid ideation among females. The occupation-specific evaluation revealed higher hostility among police officers and a lower quality of life among firefighters. The aim of this study was to examine the outcome of crisis intervention (CI) provided for ER deployed to this terrorist attack.

Methods

In total, N = 55 ER were included (n = 37 with and n = 18 w/o CI). Stress, quality of life, post-traumatic stress disorder, and current psychological stress were assessed 4 months after the attack.

Results

ER with and w/o CI were compared. Participants with CI showed lower quality of life in psychological health (t(53)=2.01, p=.050) and higher depressive symptomatology (t(44) = 2.51, p=.016). Females with CI showed lower quality of life in social relationships (t(12)=2.46, p=.030), whereas males showed more posttraumatic stress symptoms (t(39)= .32, p=.026). Emergency responders from NGOs with CI had higher phobic anxiety (t(9.2)=2.72, p=.023). Emergency medical technicians with CI showed more somatic (t(7.5)=2.52, p=.037) and depressive (t(8)=2.30, p=.050) symptoms.

Conclusions

This study provides evidence for differences in the mental health burden for ER with and w/o CI, in general and for subgroups of gender and occupation. There is no conclusive explanation for why ER with CI score worse on certain measures. It is possible that CI had a harmful influence due to the reinforcement of negative emotions in some parts of measures like the Critical Incident Stress Debriefing (CISD). While it is known that ERs are vulnerable to develop mental problems, and appropriate and timely help is recommended, it is important to critical evaluate the methods used and to take also into account the identified gender and occupational differences. Further research is needed to better understand the interaction of risk factors.