bluuebunny/crossref_metadata_2025 huggingface dataset:
Social support and poverty alleviation among asylum-seekers and refugees in Wales
Authors: Wells M , Seage H
Published: October 2022

Background

Wales is working toward being a Nation of Sanctuary for asylum-seekers and refugees and has resettled between 6,000 and 10,000 refugees since 2001. Uprooted social support networks during the period of asylum-seeking process predispose this population to poverty. The aim of this research was to explore the role of social support among asylum-seekers and refugees in alleviating poverty and its adverse impact on their health and wellbeing. Understanding the importance of social support in promoting the health and wellbeing of asylum-seekers and refugees is a critical factor for informing public health interventions and policies to improve outcomes for tackling poverty among this population in Wales.

Methods

A qualitative research method, based on social support framework, was adopted. Semi-structured interviews were utilised to collect data from a purposive sample of 8 participants. All the participants were recruited through a refugee support organisation in Cardiff, Wales and were interviewed in the community hub of this organisation. The interviews were digitally recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

Results

Results show two formal (government, charities) and three informal (family, friends, and peers) sources of social support as the potential pathways that alleviate the impact of poverty on the health and wellbeing of asylum-seekers and refugees. These sources provide access to language courses, education, employment, housing, food, and sense of belonging in the new communities of resettlement.

Conclusions

Enhancing access to formal and informal sources of social support is of vital importance to tackling the pernicious impact of poverty on the health and wellbeing of asylum-seekers and refugees. Providing social support for this population should be given uttermost consideration for public health interventions and policy decisions in an effort to protect and promote their health and wellbeing.

Key messages
Country-level determinants of gender differences in major depression and alcohol use disorder
Authors: Hagen D , Goldmann E , Ompad DC , Bambra C
Published: October 2022

Background

Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disease burden in Europe, with MDD disproportionately affecting women and AUD being more prevalent among men. However, it is unclear how country-level political and socio-cultural characteristics contribute to gender differences in these conditions.

Methods

Data for 30,416 participants from 16 countries were obtained from the 2014 European Social Survey. Depressive symptoms were ascertained using the 8-item CES-D scale, and alcohol use was assessed with items on past-year alcohol use frequency and quantity, as well as frequency of heavy episodic drinking. Country-level data for attitudes to gender equality, needs-adjusted public social expenditure, and other covariates came from the 2012 International Social Survey Programme and the OECD. Modified Poisson and linear regression with log link examined additive and multiplicative interactions of country-level characteristics with gender for MDD, AUD, and their specific symptoms/dimensions.

Results

Public social expenditure was not associated with gender differences in MDD (CES-D>10), but with greater differences in the prevalence of the loneliness and sadness symptoms; support for gender equality was associated with smaller differences in loneliness (p < 0.05). For AUD, there was evidence of increased alcohol use frequency and quantity among women, and decreased frequency and quantity among men associated with support for gender equality, resulting in lower gender differences in predicted probabilities (from 23% to 5% across exposure levels; p < 0.001). Heavy episodic drinking was strongly positively associated with support for gender equality among women (p < 0.001), but not among men.

Conclusions

Country-level characteristics appear to exert differential impact on the prevalence of AUD and certain psychological symptoms of MDD among men and women in Europe. Pending replication, future research should examine underlying mechanisms.

Key messages
The association of loneliness and social isolation with healthcare utilization in Denmark
Authors: Christensen J , Pedersen SS , Andersen CM , Qualter P , Lund R , Lasgaard M
Published: October 2022

Objectives

The present prospective cohort study investigated the association of loneliness and social isolation (SI) with healthcare utilization (HCU) in the general population over time.

Methods

Data from the 2013 Danish “How are you?’ survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and chronic disease.

Results

Loneliness measured at baseline was significantly associated with more GP contacts (incident-rate ratio (IRR) = 1.03, 95% confidence interval (CI) [1.02, 1.04]), more emergency treatments (IRR = 1.06, 95% CI [1.03, 1.10]), more emergency admissions (IRR = 1.06, 95% CI [1.03, 1.06]), and hospital admission days (IRR=1.05, 95% CI [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which SI was associated with fewer planned outpatient treatments (IRR = .97, 95% CI [.94, .99]).

Conclusions

Our findings suggest that loneliness is a risk factor for certain types of HCU, independent of social isolation, baseline demographics, and chronic disease.

Key messages
Burden of alcohol use disorder in Balkan countries
Authors: Todorovic J , Santric- Milicevic M , Terzic-Supic Z , Stevanovic A , Stamenkovic Z , Terzic N , Scepanovic L , Albreht T , Stoisavljevic S
Published: October 2022

Background

Alcohol use is recognized as an important risk factor for more than 200 different diseases and injuries. In the Diagnostic statistic Manual- 5 (DSM-5) it is defined as ‘impaired control over alcohol consumption with chronic, heavy and often escalating pattern of alcohol use despite significant detrimental consequences to their overall health, the lives of their family members and friends and society in general’. The aim of this study was to describe the disability adjusted life years (DALY) associated with the alcohol use disorder in the Balkan countries in the period between 1990 and 2019.

Methods

The study included the data on age-standardized DALY rate per 100,000 for alcohol use disorder in the period between 1990 and 2019 for ten Balkan countries (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Montenegro, North Macedonia, Romania, Serbia and Slovenia) from the Institute of Health Metrics and Evaluation. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network.

Results

The highest age-standardized DALY rate in 1990 was in Romania 484.03 per 100,000 (95% CI: 394.68-594.99), while the highest age-standardized DALY rate per 100,000 in 2019 was in Slovenia 427.75 (95% CI: 332.28-543.83). Along with Slovenia, only country that recorded the increase in the age-standardized DALY rates in the period between 1990 and 2019 was Albania, but the increase was only marginal (DALY per 100,000 increased from 174.24, 95% CI: 115.07-244.76 to 187.92, 95% CI: 127.26-262.41). The lowest burden measured in age-standardized DALY rates per 100,000 in 1990 was in Albania, and in 2019 was in Greece- 174.68, 95% CI: 113.66-251.34.

Conclusions

In the majority of the Balkan countries the age-standardized DALY rates per 100,000 for alcohol use disorder decreased in the observed period. The increase is observed for Slovenia and Albania, with the more apparent increase in Slovenia.

Key messages
Sexual and Contraceptive Behaviour of Adolescents and Young Adults in Germany
Authors: Scharmanski S , Hessling AH
Published: October 2022

Background

For 40 years the Federal Centre for Health Education in Germany has been analysing the contraception behaviour of young people. The current Survey is the ninth iteration, carried out in 2019. This continuous monitoring generates insights on the sexual and reproductive health of young people in Germany. The survey provides an important basis for the development of sexuality education and family planning measures.

Methods

A total of N = 6032 adolescents and young adults participated in the survey. Date collection was conducted by computer-assisted personal interviewing (CAPI). The current sexual and contraceptive behaviour of adolescents and young adults will be summarized using descriptive results. In addition, the association between contraception non-use and sociodemographic factors, characteristics of sexuality education and situated factors of first sexual intercourse is analysed by multivariate logistic regressions.

Results

A key finding of this iteration is that with regards to the age of the first sexual intercourse, the proportion of adolescents younger than 17 years has been declining for several years. For contraception, adolescents most frequently used condoms, and use of the pill has decreased. 9% of the participants reported non-contraception use at first sexual intercourse. This is significantly associated (p < .01) with unexpected and only unilaterally desired sexual intercourse and the absence of sexuality education in School. In addition, the younger the adolescence were at first sexual intercourse the greater the risk for contraception non-use.

Conclusions

The data from the current iteration indicate safe and responsible contraceptive behaviour among young people in Germany. It is important to maintain the commitment in the field of sexual health promotion and expand prevention measures for young people. This is the only way to ensure the sexual and reproductive health also in the next generation.

Key messages
Social inequalities in multimorbidity patterns in southern Spain: findings from the DEMMOCAD survey
Authors: Carretero-Bravo J , Ortega-Martín ME , Ramos-Fiol B , Suárez-Lledó V , Álvarez-Gálvez J
Published: October 2022

Background

Multimorbidity (MM) is associated with lower quality of life, greater disability, and higher use of health services. It is a complex problem that is difficult to capture due to the broad spectrum of concurrent chronic diseases involved. There is a need to identify and characterize patterns of chronic conditions in the local context of specific population groups. The DEMMOCAD project aims to respond to this knowledge gap by detecting patterns of MM and their inequalities in the province of Cadiz (Spain).

Methods

A cross-sectional study was carried out by means of telephone interviews with people over 50 years of age. The final sample was 1592 individuals with MM. A latent class analysis was carried out to identify patterns of MM from 31 chronic conditions. First, the appropriate number of classes was established, considering model fit indices, class size, and clinical interpretability. Subsequently, covariates were introduced into the model using the three-step approach, a technique that minimizes biases in the multinomial regression model.

Results

Preliminary analyses of the goodness-of-fit indices of the model derived five MM patterns (entropy = 0.727): (C1) mild MM; (C2) cardiovascular; (C3) musculoskeletal; (C4) musculoskeletal plus mental; and (C5) complex MM. Compared with class C1, persons in class C5 were significantly older and less educated, class C4 had a lower income, class C3 was smokers and disabled, and class C2 was characteristic among older males. All four classes also showed lower scores on mental and physical dimensions of the SF12 scale compared to class C1.

Conclusions

In addition to providing an adjusted characterization of the population of the area analyzed, these initial findings highlight the existence of social inequalities in multimorbidity at the local level that should be addressed by implementing policies targeting the most vulnerable groups in Cadiz (low socioeconomic status groups, people with disabilities, and the elderly).

Key messages
An analysis of RMNCH data quality on technological applications and methods to improve it
Authors: Harhini H , Sidh P Nath
Published: October 2022

Background

Health information management systems (HIMS) are used by most countries to record data on the coverage of reproductive, maternal, newborn and child health services (RMNCH). The HIMS in India manually collects data from primary health care facilities. Low and middle income countries (LMIC) are shifting to technological applications (apps) to improve reporting and real time tracking of RMNCH services. This study found high disparity of data between different sources. Yet governments and other stakeholders continue to use poorly reported data for daily monitoring, review and decision making. This study shares insight on the high degree of data variation, and proposes process and policy changes to improve it.

Methods

To quantify the extent of data variation, critical RMNCH indicators from apps and HIMS are compared for a given geography and time period. Workshops with the primary health workers and their supervisors were conducted to understand the challenges in reporting, based on which solutions to improve the efficiency of apps are proposed.

Results

Preliminary analysis in the state of Madhya Pradesh shows, in the year 2020-2021 live births, neonatal deaths and Infant deaths were 93%, 91% and 71% less respectively on apps as compared to HIMS. Major challenges of reporting on technological applications by primary health workers

Conclusions

Online data quality must be governed by policies that focus on implementing mechanisms to analyze and validate data from different sources and remove blockages to quality reporting. Online public health reports need to be demystified by building capacities of primary health workers and their supervisors to use data to reflect on their performance and plan for improvement.

Key messages
Trends in working years lost due to different types of work disability and unemployment
Authors: Leinonen T , Viikari-Juntura E , Solovieva S
Published: October 2022

Background

Little is known about working years lost (WYL) due to work disability and unemployment by industrial sector. This information would help in directing interventions promoting healthy working careers, knowing that the sectors have been differently affected by economic fluctuations and other changes in the labour market. We examined trends in WYL in the general Finnish population and by industrial sector in the period after the 2008 financial crisis with a particular focus on different types of work disability.

Methods

Utilising register data on the Finnish working-age population and the Sullivan method, we calculated expected WYL due to sickness absence, other temporary work disability, partial disability retirement, full disability retirement, unemployment and other reasons in years 2010, 2013 and 2016 for the general male and female populations and by industrial sector.

Results

In 2010, a 30-year-old person was expected to have around two-and-a-half to three WYL due to full disability retirement and unemployment until reaching age 65, depending on gender and the reason. By 2016, WYL due to full disability retirement decreased to less than two years and that due to unemployment increased to around four years among both genders. WYL due to sickness absence, other temporary work disability, partial disability retirement and other reasons remained relatively stable. The total WYL increased between 2010 and 2016 particularly among women. The differences by industrial sector in WYL were attributable more to unemployment than to the different work disability statuses.

Conclusions

After the financial crisis unemployment appears to have replaced disability retirement as the most important reason for WYL. Furthermore, as individuals with a defined industrial sector are initially employed, sectoral differences in WYL are not largely attributable to disability retirement, disability pensioners typically having been outside the labour market for a long time.

Key messages
Job resources do not mitigate the impact of job demands for workers with depression
Authors: Ots P , Keller AC , Altrock E , van Zon SKR , Brouwer S
Published: October 2022

Introduction

Jobs characterized by low to moderate job demands and high job resources are associated with better work outcomes among healthy workers, yet it remains unclear whether this is the case for workers with depression. This study examined whether depression moderates the relationship between job demands, job resources, and maintaining employment.

Methods

Data from the longitudinal population-based Lifelines cohort study were matched with register data on employment status from Statistics Netherlands (n = 55,950). The two-way interaction between job demands and depression and the three-way interaction between job demands, job resources and depression were examined in a zero-inflated Poisson regression model with path 1 including a binary employment outcome and path 2 a count variable including months out of employment.

Results

The interaction effect of job demands and depression on being employed was significant (b=-0.22, 95% CI: -0.44; 0.01), showing that workers without depression were more likely to be employed whereas workers with depression were less likely to be employed if they had high job demands. The three-way interaction between job demands, job resources, and depression was significant for months out of employment (b = 0.15, 95% CI: 0.01; 0.29), indicating that workers with depression had more months out of employment when reporting high job demands and high job resources compared to workers without depression.

Discussion

Although increasing resources to prevent negative work outcomes may be beneficial for workers without depression, this approach might be limited for the vulnerable subgroup of workers with depression.

Key messages
Determinants influencing municipal decision-makers in Germany regarding community health promotion
Authors: Paulsen L , Benz L , Müller C , Wallmann-Sperlich B , Bucksch J
Published: October 2022

Background

Community health promotion should be based on theoretical behavioural and environmental approaches. Especially changes in the physical environment require administrative and political decisions. This study aims to identify determinants that influence decision-makers from local politics and administrations on decisions so that health promotion can be placed on the agenda of communities as a prerequisite of intervention implementation.

Methods

We used the methods of qualitative guided interviews and a quantitative survey. First, decision-makers from local politics and administrations in both urban and rural areas in Germany were interviewed in the period from July to November 2020. The interviews were analysed using qualitative content analysis according to Kuckartz and MAXQDA. Second, a nationwide online survey was conducted using Limesurvey. We used descriptive analyses. In both surveys, decision-makers reported the determinants for decision-making processes and their decision-making behaviour.

Results

22 interviews were conducted (women n = 7), and 415 participants (women n = 118) responded to the online survey. The decision-making behaviour of local decision-makers can be differentiated on different levels, following socio-ecological models: individual, socio-cultural, institutional, municipal and political. Each of these levels comprises a multitude of determinants that are essential for successful persuasion toward community health promotion. At the individual level, we identified determinants like attitudes, outcome expectations or emotions towards a topic.

Conclusions

The identification and understanding of determinants for local decision-making are essential for a tailored and theory-based intervention approach to place health promotion on the agenda of communities and to implement interventions. Further research is needed to replicate the importance of potential determinants and to develop effective intervention methods and techniques.

Key messages
Hand hygiene and HAI transmission in Piedmont, Italy: an observational study, 2017-2019
Authors: Russotto A , Vicentini C , Zotti CM
Published: October 2022

Background

Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections (HAIs). Several indicators have been proposed to measure HH practices, including alcohol-based handrub consumption (AHC). The objective of this study was to evaluate whether AHC is associated with HAI transmission.

Methods

All 25 public hospitals/trusts of Piedmont, in Northern Italy, are required to provide data each year concerning HAIs and infection prevention and control (IPC) activities, as part of a mandatory regional indicator system. Data on AHC and HAIs were extracted from reports provided concerning the years 2017-2019. The mean annual AHC for each facility was expressed as liters per patient-day. The rate of hospital-wide Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) infections was calculated per 1000 patient-days (pd). Mean ventilation-associated infections (VAP) for 1000 days of ventilation (vd) and mean catheter-related bloodstream infections (CR-BSI) for 1000 days of catheterization (cd) were calculated for intensive care units (ICUs). Spearman's correlational analysis was conducted between AHC and HAIs: hospital-level, ICU-level.

Results

Hospital-level: mean AHC was 15.4 liters/pd; mean HAI rate was 39.6/1000 pd (MRSA) and 18.5/1000 pd (CRE). No significant correlation was found. ICU-level: mean AHC was 39.6 liters/pd; mean HAI rate was 1.7/1000 cd (CR-BSI) and 8.2/1000 vd (VAP). A moderate correlation was found between AHC and CR-BSI rate (Spearman's ρ -0.55, p 0.022). Concerning AHC and VAP, higher AHC was reported from facilities with lower VAP rates, however no significant correlation was found (Spearman's ρ -0.203, p 0.451).

Conclusions

Results of this study support the validity of AHC as an indicator of IPC practices in ICUs. The hospital-level analysis could have been affected by important differences in AHC among ward types.

Key messages
Impact of lockdown on football players’ injuries
Authors: Falcone V , Romani D , Nante N , Cocchi F , Messina G
Published: October 2022

Background

The global outbreak of COVID-19 has resulted in the closure of stadiums and the interruption of Serie A for three months. Many studies have evaluated the effects of COVID on population health, but few have evaluated the effects of containment measures on the health of football players. With this study, we evaluated the impact of this break on Serie A football players.

Methods

This cross-sectional study was conducted considering a timespan of three Serie A seasons (2018-19; 2019-20; 2020-21). The information was obtained from the German website Transfermarkt. All the players who had played at least one match during each of the Serie A season were identified. For each of the players, data concerning the number of days lost due to injury, both before and after the stop in the championship due to Covid, were collected. Statistical analysis was performed using Stata 17 Software.

Results

According to the selection criteria, 264 players were selected. This group was subsequently skimmed to 256 players after eliminating all players who did not suffer physical injuries over the timespan considered (non-purely orthopedic surgery; COVID; Intestinal problems; Infections). 256 players were analysed, 228 had skipped at least one day for pre-lockdown due to physical injury (median=37,5), while 227 missed a day for post-lockdown (median=27). Wilcoxon signed-rank test between days lost due to injuries before and after lockdown highlighted significant differences (p < 0.05).

Conclusions

Comparing pre-lockdown and post-lockdown periods, we noticed that there were fewer days skipped due to physical injury post lockdown. Statistical evidence suggests that the same players were more susceptible to suffer physical injuries in the pre-lockdown period. This is probably because some players have worked with home coaching by spending more time in the gym and less time on the field. Also tapis roulant and cyclettes were often delivered to football players’ homes.

Key messages
Parental perception about the pandemic impact on mental health of children: a cross-sectional study
Authors: Pinto S , Lo Moro G , Bert F , Rolfini E , Scaioli G , Siliquini R
Published: October 2022

Background

The pandemic may increase mental issues among children. This study aimed to explore parental perceptions on the pandemic impact on the health status of their children, with a focus on mental health.

Methods

An online nationwide cross-sectional study has been conducted amongst Italian parents (from April 2022-ongoing). The survey included: Strength and Difficulties Questionnaire (SDQ), Kessler-6 (K6) for parent's psychological distress, and pandemic-related items. The outcomes were: child's SDQ above the clinical cut-off and perceived child's worsening of sleep, appetite, physical and mental health during the pandemic. Multivariable regressions were run (p < 0.05 as significant).

Results

Up to date, participants were 333 (88% female). Mean age was 40.7 years (SD = 6.7). Considering their children, 52.9% were female and mean age was 6.62 (SD = 4.3). A total of 12.6% of children passed the SDQ cut-off. Having parents who are healthcare workers (adjOR=4.1), having parents positive for K6 (adjOR=4.0) and having a poor economic situation (adjOR=3.9) were significantly associated with a higher probability of passing the cut-off. Considering the pandemic, 15.4% declared their child had worse sleep, 12.2% lower appetite, 6.6% more physical issues, and 22.9% more mental issues. Using electronic devices more than before the pandemic was significantly associated with worsening of sleep (adjOR=2.9) and appetite (adjOR=6.9). Having parents who are healthcare workers was significantly associated with worsening of sleep (adjOR=2.3) and mental health (adjOR=2.4). Having parents positive for K6 was significantly associated with worsening of mental health (adjOR=5.3).

Conclusions

This study suggested a perceived substantial worsening of children's health, especially considering mental health. Exploring how parents recognize their children's health and how the COVID-19 has changed daily habits should be considered as a public health priority in Europe.

Key messages
Community Perceptions of Facilitators and Barriers to Post Natal Care access in Rural Laos
Authors: Mayangitan JC , Poudel B , Gulliver H , Stephenson C
Published: October 2022

Background

The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic. Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project. This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming.

Methods

From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted. Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province. Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD. Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders.

Results

Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC. Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice. Economic, road conditions, and transport challenges were also identified as significant barriers.

Conclusions

Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care. Thus, quality outreach with home visits are critical. Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access.

Key messages
Health professionals’ communication and Italian pregnant women’s attitudes to the Covid-19 vaccine
Authors: Fiammenghi C , Mbaye NA , Pelleri D , Gelatti U , Covolo L
Published: October 2022

Background

Pregnancy is a risk condition for hospitalization and severe illness from Covid-19, with an increased risk of maternal mortality and serious neonatal complications. The study examines Italian pregnant women's attitudes about the Covid-19 vaccine, the role of healthcare professionals’ (HP) communication, the reasons and potential predictors for non-adherence to vaccination.

Methods

An online survey was developed by LimeSurvey software and spread through social media between August 2021 and January 2022 to pregnant women of age living in Italy. Participants were asked to indicate their sources of information and to rate the support received from their HP; their health literacy (HL) was assessed using the HLS-EU-Q6 tool. Multivariate linear regression analysis was performed. Open-ended questions were analysed using MaxQDA 2022.

Results

1594 total survey responses were obtained (median age 31.5±4.94); 48% of the participants had a university degree. Only 17% of women had sufficient HL. Most (52%) of them refused to be vaccinated against Covid-19 while pregnant, 27% were unsure and 26% disagreed about the safety of the vaccine during pregnancy. Most of them did not deem the information received by HP complete (56%), clear (52%), and reliable (46%); 49% of them did not feel supported in their decision to vaccinate. This variable was the main predictor of vaccine hesitancy in addition to concern about vaccine safety in the multivariate model. Among women who felt unsatisfied 57% had an inadequate HL compared to 40% of those who had sufficient HL (p<.0001). The analysis of the open-ended questions also revealed a pervasive feeling of uncertainty.

Conclusions

The study highlights how the lack of adequate communication and support by HP had a strong impact in the adherence to Covid-19 vaccination among pregnant women.

Key messages
Colorectal Cancer Prevention in Eastern European (EaP) Countries: A Policy Analysis
Authors: Nonikashvili M , Kereselidze M , Beruchashvili T
Published: October 2022

Background

Colorectal cancer (CRC) is a critical public health issue in Central and Eastern European Countries, where it is the second leading cause of female cancer deaths. In this study, we aimed to identify the presence of CRC policies in EaP Countries and analyze the content of CRC policies for comprehensiveness.

Methods

We conducted a scoping review based on the methodological framework suggested by Arksey and O'Malley. We searched for publicly-available policy documents from Armenia, Azerbaijan, Belarus, Georgia, Moldova and Ukraine. We outline each country’s prevention approaches and activities based on World Health Organization (WHO) guidelines for CRC screening.

Results

Most countries had at least one policy addressing some aspect of colorectal cancer prevention. Primary and secondary prevention were most commonly addressed, and certain details such as healthy lifestyle campaigns, target age and screening method (gFOBT, FIT or colonoscopy) were frequently mentioned in these policies. Policies to implement or pilot population-based CRC screening program have been adopted only by Georgia. Our analysis revealed the urgent need to improve the availability and use of colorectal cancer screening among those countries.

Conclusions

These country experiences suggest that while prevention approaches can promote the best strategies to carry out screening programs, there is no standardized approach to screening for CRC.

Key messages

• Further research is urgently needed to better understand CRC screening needs of adults in EaP.

• Necessity of CRC screening irrespective of need will help make shift from curative to preventive cancer care.
Person-centred care to prevent hospitalisation - a focus group study with primary care providers
Authors: Nørby Lyhne C , Bjerrum M , Johansson Jørgensen M
Published: October 2022

Background

The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. The aim was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care.

Methods

Five focus group interviews were conducted with 27 primary healthcare providers. Interviews were transcribed, and analysed with qualitative content analysis.

Results

Three categories emerged: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions.

Conclusions

By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately prevent some hospitalisations. The findings have clear implications for person-centred care and health system quality, and they highlight the need for involving stakeholders at all levels and for informing about the relevance of social and mental conditions, as they may influence the general health state and the risk of hospitalisation. The study supplements existing knowledge by providing valuable insight into the views of key primary healthcare providers.

Key messages

• Healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation highlighting the importance of care that considers the whole person.

• The development and sustainable implementation of person-centred care in local primary care settings may be supported by evidence-based practices and co-production trajectories.
Interorganisational collaboration to improve accessibility of diagnostic evaluations for children
Authors: Cloet E , Jansen A , Leys M
Published: October 2022

Background

Children with a suspected developmental disability need early diagnostic evaluations and support, to maximize developmental opportunities. Accessibility to diagnostic settings in Flanders, Belgium, is poor, with waiting periods up to two years. Interorganisational coordination of activities using a public health and needs of the population perspective is needed to strengthen the system. This study aims to evaluate current practices and opportunities for interorganisational collaboration of organisations active in the field of diagnostics.

Methods

It concerns a qualitative, policy-support research project. 6 homogeneous focus groups were organised for the 6 types of organisations subsidized by the government to perform diagnostic evaluations of children with a (suspected) developmental disorders. Data were thematically analysed and categorized in a process of researcher and data-triangulation. A member check validation was done.

Results

59 persons participated. We classified the hampering and facilitating factors for collaboration Current interorganisational collaboration is mostly limited to referral. Organisational differences in vision and goals, working processes and quality requirements, regulations and financial support criteria, a problem of accessibility and communication problems are hampering factors. Knowledge of mutual expertise and working processes, personal contacts and open communication are facilitating factors.

Conclusions

A population public health based organisation of the field of multidisciplinary diagnostic evaluations for children with a developmental disorder, with interorganisational collaboration and coordination of activities in mandated networks, sharing experience and knowledge, would increase the accessibility for all children and strenghten the health system. The implementation of interorganisational networks would benefit from a functional and institutional analysis of organisations.

Key messages

• Coordination of activities and interorganisational collaboration in mandated networks, could potentially improve the accessibility of diagnostic evaluations for children with a developmental disorder.

• Implementation of interorganisational networks would benefit from a functional and institutional analysis of organisations.
Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions
Authors: Fitzpatrick P , Bhardwaj N , Syed S , Fox P , Frazer K , Niranjan V , Lyons A , McCann A , Brennan S , Guerin S
Published: October 2022

Background

The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs).

Methods

Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis.

Results

Four key themes emerged:

(1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge.

(2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels.

(3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC.

(4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy.

Conclusions

Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients.

Key messages

• Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients.

• Tailored SC support should be an integral part of comprehensive cancer care.
Smart Brain Care – A novel approach to health care of mild cognitive impairment and mild dementia
Authors: Schwientek A-K , Wolski L , Riedl L , Grimmer T
Published: October 2022

Background

Dementia is a huge burden. Trends for the aging European nations indicate a significant increase of people with dementia. Prevention and early detection are the key elements to reduce risk factors and to treat reversible causes. In addition, identifying people at the beginning of the disease process is crucial when disease-modifying therapy becomes available.

Methods

We aim to develop a complex intervention to improve the identification, diagnosis, and treatment of people with mild cognitive impairment (MCI) and mild dementia syndromes. Our goal is to reduce the time to diagnosis, raising awareness for MCI and increase patient involvement. First, barriers in pathways of care are determined in a systematic review and refined by conducting focus groups and interviews with primary care physicians (PCPs), specialists and experts in the field. A first theory about intervention components and how they interact are developed and will be further tested and adapted through development phase, feasibility and piloting.

Results

The first blueprint of Smart Brain Care addresses three identified key barriers for an improved care of MCI and mild dementia syndromes (communication, skills and awareness) by three interventions (1-3), all linked and accessible through an e-database: An online platform (1) for exchange between PCPs, specialists and experts, (2) a screening tool, diagnosis-algorithm and training for PCPs as well as (3) information materials (e.g., fact sheets, short videos) separately accessible for patients.

Conclusions

There is still low awareness about MCI under health care providers and the general population. A lack of knowledge, cooperation strategies and guidance seem to play an important role for the management of MCI and mild dementia syndromes.

Key messages

• We need to increase focusing on the identification of people with MCI and mild dementia syndromes.

• Call for a structured diagnosis and treatment regimen to support primary care physicians as key players in the management of MCI and mild dementia syndromes.
Five-hub General Conceptual Framework to improve the vaccination coverage for newly arrived migrants
Authors: Tosti ME , Marchetti G , Scarso S , D'Angelo F , Russo ML , Marceca M , Karnaki P , Papaevgeniou N , Declich S
Published: October 2022

Background

Within the Project “Increased Access for Newly Arrived Migrants-AcToVax4NAM” (Grant n 101018349, 3rd EU Health Programme), a General Conceptual Framework (GCF) was developed for understanding how to improve vaccination coverage for Newly Arrived Migrants (NAM), by characterizing and critically analysing system barriers and possible solutions to increase vaccination

Methods

A logical pathway was hypothesized based on conceptual hubs in the immunization process. The identification of barriers and solutions was carried on by: a) non-systematic revision of scientific and grey literature, institutions and relevant websites, and documents suggested by Consortium Partners; b) qualitative research conducted in each Consortium Country. The GCF was used as a guide for the above mentioned activities and organize results into the GCF itself to enrich it with content

Results

5 conceptual hubs were identified: ENTITLEMENT to vaccination, REACHABILITY of people to be vaccinated, ADHERENCE to vaccination, ACHIEVEMENT of vaccination, EVALUATION of the intervention. All hubs are linked sequentially, starting with Entitlement without which the process cannot take place. Hubs are connected: if vaccination does not take place, it’s important to go back to the previous hubs to understand the barriers. Reachability-Adherence-Achievement are closely related because some approaches are cross-cutting, such as proximity interventions which, in addition to allowing the system to approach NAM, promote adherence and thus possibility of completing the process. Other strategies may be implemented with different purposes: training aims to foster a culturally competent approach to facilitate adherence and avoid vaccination hesitancy, but also to improve competence in the entire process and lead to vaccination completion

Conclusions

The proposed GCF facilitates identification of barriers and possible solutions to the effective achievement of immunization, at all stages of the process

Key messages

• The GCF can be the basis for the creation of country-specific flow-charts through which to test strategies aimed at increasing immunization coverage in NAM.

• The GCF will be useful at EU level, to facilitate both the harmonisation of approaches and interventions and the evaluation of comparable approaches.
The impact of four dominating variants and vaccine coverage on Covid-19 mortality: the Malta case
Authors: Cuschieri S
Published: October 2022

Background

Disease burden can be quantified by mortality. The European Islands of Malta experienced a seesaw of Covid-19 surges in mortality and cases across the pandemic. The study aims to assess the impact of Covid-19 mortality across the four phases dominated by different variants while considering the vaccination coverage among the Malta population.

Methods

Covid-19 epidemiological data was obtained up till end of February 2022 from the websites of the Malta Ministry of Health and the European Centre for Disease Prevention and Control. Data was categorised into the four periods according to reported dominant Covid-19 variant. The Years of life lost (YLL) and Case-Fatality-Ratio (CFR) for each period were estimated. Correlations were performed between mortality and vaccinated age-groups.

Results

The original Covid-19 period (54 weeks) had the highest YLL (6633.53), followed by the Omicron variant period (12 weeks; 2,692.17). The Alpha variant period (7 weeks) had the highest CFR (1.89) followed by the Original Covid-19 (1.37). A significant negative correlation was present between two dose vaccination and the 60-69 years (p = 0.01), 70-79 years (p = <0.01), and 80+ years (p = <0.01) age groups, while a positive correlation was present between the booster dose and the 60-69 years (p = 0.01) age group.

Conclusions

Covid-19 variant’s infectivity, transmissibility, and the effectiveness of the vaccine against the variant play an important role in the ultimate outcome. Reducing mortality by embracing mass vaccination that targets current variants along with other non-pharmaceutical interventions remains paramount.

Key messages

• Mortality is an indicator for assessing the burden of an emerging variant within a population.

• The effectiveness of vaccination against emerging variants plays a role in reducing mortality rates.