bluuebunny/crossref_metadata_2025 huggingface dataset:
11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments
Authors:   Organised by: EUPHA-SGMH,   Chair persons: Richard Bränström (EUPHA-SGMH), Arjan van der Star (EUPHA-SGMH)
Published: October 2024

Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health.

Key messages

• Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals.

• Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.
Real-time exposure to negative news media and suicidal ideation intensity among LGBTQ young adults in a high-stigma US state
Authors: Clark K A , Kellerman J K , Argiros A P , Phillips K L , Park E C , Cyperski M , Pachankis J E , Kleiman E
Published: October 2024

Background

With a recent surge in anti-LGBTQ policies and associated news/media coverage worldwide, there is a crucial need to study the role of LGBTQ negative news/media on proximal risk for suicide among LGBTQ youth, especially in high-stigma contexts.

Methods

Using a smartphone-based protocol, participants responded to brief self-report surveys 3x per day for 28 consecutive days. LGBTQ young adults (ages 18-24 years old) residing in Tennessee with recent suicidal ideation were recruited. At each assessment, participants reported real-time exposure to negative news/media, whether the news/media was related to LGBTQ topics, expectations of anti-LGBTQ rejection, and current intensity of passive suicidal ideation, active suicidal ideation, and self-harm ideation. Statistical analyses employed multilevel path analyses with restricted maximum likelihood estimation.

Results

31 participants completed 2189 assessments (90.5% median compliance). Within-person effects showed that real-time exposure to LGBTQ - but not general - negative news/media was positively associated with suicidal ideation intensity. Significant indirect effects were present from exposure to LGBTQ negative news/media to higher suicidal ideation intensity through expectations of rejection. Mediation through expectations of rejection accounted for 25% and 39% of the total effect for active and passive suicidal ideation, respectively.

Conclusions

Findings have important public health implications related to media reporting, policy, and clinical intervention. Interventions targeting media organizations should promote responsible reporting practices and increase awareness of the potential suicidogenic impact of negative LGBTQ news coverage. This study joins numerous others in documenting the potential mental health harms of policies that restrict LGBTQ visibility and rights. Mental health professionals play a vital role in promoting coping in the face of exposure to LGBTQ negative news/media content.
Multilevel Sexual Minority Stigma-Based Experiences and Mental Health Among U.S. Sexual Minority Adults: A Socio-Ecological Longitudinal Moderated Mediation Analysis
Authors: van der Star A , Bos H
Published: October 2024

Background

The current study aimed to longitudinally examine whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes among sexual minority adults, and as a function of two moderators: structural climate and generation.

Methods

Data from 600 sexual minorities across three generations (i.e., ages 18-25, 34-42, 48-55) who completed all three waves of the 2016-2019 Generations Study were merged with census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent and dependent variable combination through two parallel mediators, with both moderators included on each independent-mediator variable pathway.

Results

Greater identity concealment partially explained the effects of perceived external stigma on greater psychological distress and suicidal ideation, but most strongly among older generations. Other mediation was not supported. Reversed sensitivity analyses revealed how identity concealment’s positive effect on suicidal ideation may be suppressed through lower adulthood victimization and, only among younger generations in higher stigma climates, how it’s positive effects on psychological distress and suicidal ideation may be suppressed through lower everyday discrimination.

Conclusions

Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of interpersonal stigma on distress and suicidal ideation. While the longitudinal findings provide some support for the cross-level effects of sexual minority stigma on mental health outcomes, further advanced time-lagged examinations are warranted.
The mental health impacts of othering LGBTQ+ in Rwanda and Kenya: a mixed methods exploration
Authors: Stojanovski K , Otukpa E , Igonya E K , Twahirwa L G
Published: October 2024

Background

Globally lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons experience stigma across at multiple socioecological levels with health-harming impacts. The objectives of this study were to quantify and explore how stigma shapes mental health among LGBTQ+ persons living in Rwanda and Kenya.

Methods

Respondent-driven sampling was used in this mixed methods study of LGBTQ+ persons. In Rwanda, we surveyed 499 and conducted focus groups with 59 persons. In Kenya, we surveyed 1,573 persons, conducted focus groups with 40 persons, and conducted 113 individual interviews. We used thematic analysis for the qualitative data to examine how LGBTQ+ discuss what shapes their mental health.

Results

The average depression score was 6.3, which is categorized as mild depression. Additionally, 36% (n = 744) scored as mild, 14% (n = 289) as moderate, 5% (n = 110) as moderately severe, and 2.5% as severe (n = 52). Average scores were the same in Kenya and Rwanda. In regression models, as compared to cisgender males, cisgender females’ depression scores were 2.1 points higher (95% CI 1.5, 2.8), trans male scores were 1.6 points higher (95% CI 0.7, 2.5), trans female scores were 1.9 points higher (95% CI 1.1, 2.7), and gender non-conforming scores were 1.7 points higher (95% CI 1.0, 2.4). As compared to transgender people, lesbian & gay participants had depression scores that were 0.93 points lower and bisexual 1.3 points lower (p < 0.000). In adjusted regression models, we found that for every one-unit increase in discrimination, depression scores increased by 0.44 (95% 0.36, 0.52). Qualitatively, stigma was described as a prominent factor in negatively impacting mental health.

Conclusions

LGBTQ+ people in Rwanda and Kenya experience elevated mental health issues that arise from discrimination due to their stigmatized identity.
The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018–2023
Authors: Schulmann K , Bruen C , Parker S , Siersbaek R , Burke S
Published: October 2024

Background

This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation.

Methods

This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis.

Results

The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors.

Conclusions

Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed
Sleep health across the life cycle: an unmet and neglected public health priority
Authors: Stranges Saverio
Published: October 2024

The presentation will set the stage on the central role of sleep health across the life cycle. Despite the large body of evidence on the importance of poor sleep behaviors as a modifiable risk factor for several adverse health outcomes, sleep health is still an unmet and neglected issue in public health policy, especially in the European context. Sleep problems are widespread and potentially affect everyone, from childhood to adult age. In addition, sleep health disparities represent a major source of health inequities across marginalized and high-risk population subgroups, such us people from low socio-economic status, women, refugees and immigrants, shift workers, people living with physical and mental illness. There is an urgent need to promote evidence-based health promotion and public health policy to enhance sleep health both in the general population and high-risk subgroups.
Cancer prevention over the life course
Authors: Chiolero Arnaud
Published: October 2024

Within a life course epidemiology framework, the etiology and prevention of cancer are informed at different ages from a social, behavioral, and biological perspective (1). Due to population aging, the burden of cancer increases and calls for new cancer prevention and screening strategies. In this introduction, we will discuss the issues of cancer screening among older adults and inequalities in screening uptake, and how vulnerable population preventive strategies can reduce these health inequities.
Monitoring inequities using routine administrative data: a case study of cancer screening in Ontario, Canada
Authors: Stranges Saverio
Published: October 2024

Routine cancer screening is a critical primary care service to reduce cancer morbidity and mortality, through early detection, diagnosis, and treatment. We evaluated longitudinal changes in socioeconomic inequities in cancer screening in Ontario, Canada, by using linked provincial health administrative databases including 15.9 million records eligible for cancer screening. The rate of colorectal cancer screening increased between 2011 and 2020 (54% to 62%) with a reduction in the indices of inequity (slope index, SII: from 0.36 to 0.33; relative index of inequity, RII: from 0.69 to 0.54). However, the rate of cervical cancer screening decreased (from 76% to 68%), particularly in deprived areas (RII increasing from 0.47 to 0.54). Access to cancer screening is a challenge in deprived areas. Understanding the socio-economic determinants in access to screening across the life course can help develop tailored interventions to increase health equity.
2.Y.1. Communication in participatory health research with refugees and migrants
Authors:   Organised by: ICPHR, EUPHA-MIG,   Chair persons: Bernadette Kumar (EUPHA-MIG), Ana Gama (Portugal)
Published: October 2024

Innovative approaches are needed to transform public health research and address health inequities. Participatory Health Research (PHR) is one such approach, which aims to maximize the participation of those whose life or work is the subject of the research in all stages of the research process. PHR has advantages for both research outcomes, including increased relevance, meaningfulness and impact of research, as well as for those involved, in terms of ownership and empowerment to address their health priorities. PHR with migrants has potential to reduce health inequities through the active involvement of migrants in research about their health. In a framework for refugee and migrant health in the WHO European Region, MacFarlane et al. (2022) recommend the research field of migration and health to adopt PHR as the norm, for ethical reasons and to support effective research-policy-practice translation. PHR with migrants is increasingly used but is still rare and adhoc in the field of migration health research. There are also potential practical and ethical challenges that warrant critical reflection. One persistent challenge is communication, where differences in culture, language and knowledge areas need to be considered in multiple ways, for example, in the development of participatory partnerships, in the conduct of data collection that takes place as a result of such participatory partnerships and in dissemination processes. The aim of the workshop is to share different approaches on PHR with migrants and propose solutions to common challenges in communication. The workshop will be structured in a first part where presenters will draw upon their experience in PHR with refugees and migrants covering a broad range of topics relating to communication, and a second part of open discussion with presenters and the audience. The workshop will address two key questions: what challenges have we experienced, and lessons learnt.

Anne MacFarlane presents emerging evidence about music and singing as culturally attuned arts based methods that can create innovative opportunities for communication for partnership building, fieldwork and dissemination. Ana Gama presents on using idea-generation workshops with vignettes representing migrants with diverse health-literacy profiles and its potential to address communication challenges.

Key messages

• Participatory health research with migrants warrants critical reflection around communication, ethics and partnership-building.

• In participatory health research, using innovative and creative methods can create opportunities to overcome communication barriers and build meaningful collaborations.

Speakers/Panelists

Anne MacFarlane

University of Limerick, Limerick, Ireland

Ana Gama

IHMT, Universidade Nova de Lisboa, Lisbon, Portugal
Implementation of the international health regulations – global challenges and the COVID-19 pandemic
Authors: Vasconcelos R , Pulido Valente F , Pinto H , Santos M M , Travassos S , Saldanha Resendes D , Crisóstomo E , Pacheco I , Godinho M , Carvalho J M
Published: October 2024

The International Health Regulations (IHR) govern how 196 countries and the World Health Organization (WHO) collectively manage global disease spread while preserving international travel and commercial trade. The COVID-19 pandemic set an unprecedented challenge to the IHR commitments. To address this gap, two scoping reviews were conducted: one identifying global challenges in IHR implementation and the other analyzing challenges, successes and limitations of the IHR during the COVID-19 pandemic. The scoping reviews followed Arksey and O’Malley’s framework and PRISMA methodology, utilizing the PubMed, Medline, World of Science, SCOPUS, and Google Scholar databases, plus backwards citation chaining. Data selection and analysis were guided by pretest forms. From 128 articles screened, 52 met inclusion criteria for the IHR implementation review. 135 challenges were identified, in these categories: (1) requirement of financial and technical resources, (2) lack of enforcement and accountability mechanisms, (3) need for rules clarification, (4) deterrents to reporting, (5) inadequate governance, (6) insufficient cooperation between countries, (7) sovereignty issues, (8) scarcity of guidance and technical support from WHO, (9) lack of inclusion of roles for relevant non-state actors, (10) conflicts and emergencies. In the COVID-19 review, 15 articles were included. Although the role of the IHR during Health Emergencies was acknowledged, most countries faced limitations in its implementation during the pandemic. Key lessons included reinforcing the global health security strategy, reviewing the IHR to address current challenges and strengthening countries and states’ commitment to resolutions compliance. The ongoing debate over IHR updates confirms the need for its revision to safeguard global health. A more effective response grounded on the IHR is needed to face upcoming and expected events of COVID-19’s magnitude and severity.
3.X.1. Health literacy in Europe: Building a comparative database for shaping public health policy
Authors:   Organised by: Austrian National Public Health Institute (Austria), EUPHA-HL, WHO/Europe, JA PreventNCD,   Chair persons: Robert Griebler (Austria), Christopher Le (Norway)
Published: October 2024

Health literacy (HL) is a key determinant of health and a lever for health equity. It refers to the extent to which individuals are able to deal with health-related information, communicate with health professionals, and navigate the health care system to restore, maintain, protect, and improve their health and well-being. It is the result of an interplay between personal motivation, individual competencies and the health information and service environment. HL is strongly related to health behaviors and issues such as obesity, the social determinants of health, and the use of health systems, which have been under pressure since COVID-19. The development and implementation of targeted public health interventions to promote HL in the European Region require reliable and comparable data on population HL to identify the main HL challenges and the most affected population groups. The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has started monitoring population HL and conducted the first M-POHL Health Literacy Survey (HLS19) in 17 countries in the WHO European Region between 2019 and 2021. In preparation for the 2nd M-POHL Health Literacy Survey (2024-2026; HLS24), the HLS19 instruments were further improved and supplemented by a new measure on mental HL. These instruments are also of interest to the European Joint Action PreventNCD with its specific task on HL and non-communicable diseases (7.4). The workshop will provide insights into the M-POHL HLS24, the largest HL survey in Europe, and the HL instruments used. It consists of four presentations, one describing the M-POHL HLS24 project and three on specific HL instruments used to assess different aspects of HL in the European general population: HLS24-DIGI for digital HL; HLS24-COM-P for communicative HL; HLS24-NAV for navigational HL.

Each presentation will describe the revised item set and results from pretests. We invite the audience to ask questions and to engage in a (cross-cutting) discussion with the presenters. Expected impact: The presentations will provide a comprehensive overview of the advanced family of instruments used in the HLS24 study, their quality, and the expected HL data for Europe. They will provide a deeper understanding of how HL will be measured in the M-POHL HLS24 project.

Key messages

• The advanced family of HL instruments used in the M-POHL HLS24 project enables comprehensive HL monitoring in Europe.

• The data collected in HLS24 will provide a solid database for shaping public health policy to strengthen population HL and promote health equity in Europe.
Measuring digital health literacy in Europe – developing a new tool to capture innovation
Authors: Levin-Zamir D , Arabska Y , Bíró É , Krajnovic D , Le C , Link T , Mancini J , Ochaba R , Schaeffer D , Van den Broucke S
Published: October 2024

Background

Rapid advancement of digital resources for health and healthcare in Europe has widened the scope of opportunities to promote health, but also raises concerns about accessibility and health equity. Measuring digital health literacy (DHL) in populations is critical for assessing digital resource appropriateness in general and specifically among vulnerable populations. The DHL measure used in the M-POHL Health Literacy Survey 2019-2021 (HLS19) in 13 countries showed inadequate DHL in large parts of the population, reflecting a social gradient. As digital resources become increasingly interactive, potentially widening the digital divide, a need to refine the DHL HLS19 tool was evident.

Methods

Building on the HLS19 tool, an additional measure was developed to assess interactive aspects of DHL by representatives from 16 countries in a co-productive way, based on discussions about the diverse digital challenges. The additional scale was to be generic enough to be relevant for all countries, yet specific enough to discern the diverse needs regarding various public health/healthcare service formats across Europe.

Results

The new tool is divided into 2 parts: a scale measuring the skills to access, understand, appraise, and apply digital health information as applied and validated in HLS19, and a new set of items assessing the use and ease of use of interactive digital resources including health promotion apps, digital tools for managing health/medical conditions, navigating the healthcare system, and communicating online with health professionals. The tool has been translated into several languages and is currently undergoing piloting/cognitive testing.

Conclusions

Collaborative work among countries is essential for developing relevant measurement tools on the European level. Just as the technology undergoes rapid change, likewise tools for assessing DHL must be updated acknowledging the diversity of digital resources and needs on country levels.
Measuring navigational health literacy – an extension of the HLS19-NAV scale
Authors: Griese L , Schaeffer D , Arabska Y , Bonaccorsi G , De Gani S M , Guttersrud Ø , Kučera Z , Strassmayr C , Touzani R , Vrbovšek S
Published: October 2024

Background

European healthcare systems are characterized by a high complexity and intransparency. Finding one’s way through the multitude of services requires navigational health literacy (NAV-HL). NAV-HL is defined as the ability to maneuver the healthcare system and deal with information necessary to do so at the system, organizational, and interactive levels. Using a newly developed scale, the European health literacy population survey 2019-2021 (HLS19) measured NAV-HL across multiple countries. To better capture the complexity of the construct and enhance scale validity, the aim was to improve it by generating additional items on the interactive level.

Methods

An international panel of health literacy experts from ten countries generated additional items that specifically covered tasks related to interactions with healthcare professionals. These skills are important for ensuring continuity of healthcare and navigating the healthcare system. The items were generated in an iterative process, translated, and tested in cognitive interviews.

Results

Four items were generated according to the four cognitive domains of the underlying conceptual model. These items concern the proficiency to: a) obtain information from health-care professionals about further healthcare services, b) understand this information and c) assess it in relation to one’s own preferences, and d) use it to make decisions about further healthcare. Using cognitive interviews, the four new items have been found to be meaningful and comprehensible. Only minor adjustments were made.

Conclusions

The HLS19-NAV scale has already been successfully applied and validated in eight countries of the HLS19. The new items capturing the interactive level enhance the validity of the existing HLS19-NAV scale. The psychometric properties of the new (sub)scale will be explored.
Statistics on disability pensioners is important for assessing injury burden
Authors: Lund J
Published: October 2024

Introduction

We have little information about long term effects of injuries resulting in disability. In addition to human suffering and reduced quality of life, these consequences of injuries inflict a heavy burden on the national economy. All persons in Norway aged 16 - 66 years are entitled to disability pension benefits from the National Insurance Administration (NIA) if their working capacity is permanently reduced by at least 50 % due to disease, injury or defect. The burden of injuries in terms of “New disability pensioners” (NDP) related to traffic injuries was assessed in a study for the years 1992-97 and in a follow up study for 2005-12.

Methods

Each year, a number of persons will be registered as NDP in the Disability register of NIA. Between 1992 and 2012 accident types were classified by an additional code, one of them denoting traffic injury. To calculate rates, the number of NDP are related to the number of persons in Norway on the 1st of January minus the number of persons holding a disability pension at that time (risk population) and are shown as NDP pr 100 000 of the risk population.

Results

The rates for NDP due to traffic injuries increased from 16.8 in 1992 to 23.0 in 1997, an average annual increase of 7.4 %. These rates were compared with the mortality rates in the age group 15-64 years due to traffic injuries from 1988-1993. The average time lag between an injury and getting a disability pension is 4 years. These rates were 9.3 in 1988 and 6.4 in 1993, an average annual decrease of 6.2 %. The follow up study for 2005-2017 confirmed more or less this increasing trend in NDP due to traffic injuries.

Conclusions

The rate of NDP due to traffic injuries is increasing while mortality rates for same age group is decreasing. This might reflect that our emergency medicine now saves more and more lives, however many of them ending up as disabled. We need to get valid statistics on disability enabling us to describe the burden of traffic injuries.
4.X.1. Health literacy policies – how can they be developed and implemented?
Authors:   Organised by: Austrian National Public Health Institute (Austria), M-POHL,   Chair persons: Christina Dietscher (Austria), Angelika Schlacher (Austria)
Published: October 2024

In Europe and beyond, there is political recognition of health literacy being an important factor for good health and well-being. As health literacy is considered critical to achieving health and as limited health literacy is still a widespread phenomenon, the topic is steadily attracting more attention among policy and decision makers. To meet growing demand from decision makers, a policy guide was initiated by M POHL, the World Health Organization (WHO) Action Network on Measuring Population and Organizational Health Literacy. The guide aims to support awareness-raising, the building of commitment and the implementation of effective policies to improve health literacy. It mainly addresses decision-makers in health policy and administration, but may also inspire researchers and other relevant stakeholders in the health literacy area.

Objectives of the workshop

This skills building seminar seeks to contribute to capacity building and to offer time for exchange and discussion on health literacy policy work. More specifically, the objectives of the workshop are to: - provide an overview on national health literacy policy implementation; - increase the knowledge of participants on what countries are doing already and identify needs for further support; - support participants in reflecting, initiating, developing and implementing effective measures to improve population and organizational health literacy.

Methods of the workshop

The workshop will start off by a presentation introducing the guide “Health literacy policies - how can they be developed and implemented?’ and sharing some national experiences in implementing health literacy policies, strategies, and interventions. After these impulses attendees will be divided into groups to enable exchange. A checklist for self-assessment will be provided as a tool to guide the discussion and to identify and address potential challenges in implementing health literacy policies and interventions. The input and identified needs will be captured. They will support M-POHL’s continuing efforts to support policy makers and administrators in their work.

Key messages

• Health literacy is steadily gaining more interest from policy- and decision-makers.

• In this seminar, participants will learn on how evidence-informed policies and practice can be supported.
A guide for policy and decision makers on health literacy policies
Authors: Schlacher A
Published: October 2024

Supported by supranational organizations such as the WHO or the European Union, governments across the world have begun to work systematically on developing and implementing action plans, strategies and policies to improve the health literacy of their citizens and the health literacy friendliness/responsiveness of health organizations. In 2023, a first project on evidence-based policies and practices was initiated by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and financially supported by the Swiss Ministry of Health. In this project a guide on how health literacy policies can be developed and implemented was developed by an international working group. This guide brings together insights from existing literature on national health literacy strategies, action plans and interventions, including an expert snowball search within the M-POHL network and among other partners, experiences and case examples collected from M-POHL members and other countries. Feedback on the guide was collected in interactive webinars with policy representatives and decision-makers and addressed. The structure of the guide follows an adapted version of the Public Health Action Cycle model, assisting step-by-step action on health literacy policy development: situation analysis; agenda setting; developing policies, strategies and interventions; implementation; evaluation and monitoring. Each phase is described, and best practices and recommendations provided. The guide closes with a checklist for self-assessment which follows the structure of this document. It supports reflection on the state of policies in a country. This innovative guide contributes to supporting evidence-informed policies and practice. This can be of interest to experts and practitioners who have data on challenges relating to the health literacy levels of population groups and who wish to develop or adjust their policies, services and communications accordingly.
Improving RCCE-IM for LGBTQ+ migrants: Lessons learned from COVID-19 Pandemic
Authors: Gato J
Published: October 2024

Background

To foster equity during a pandemic event, public health practitioners must be mindful of social and political circumstances that inform poor health. This is especially true for populations who are exposed to several factors that structure health inequity, such as lesbian, gay, bisexual, transgender, or otherwise queer identifying (LGBTQ+) populations. We aim to report on the specific challenges of LGBTQ+ people, including those who belong to the migrant communities, during the COVID-19 pandemic and find out their needs in risk communication (RC), community engagement (CE) and infodemic management (IM).

Methods

We will first review findings of studies conducted in Portugal, UK, Italy, Brazil, Chile, and Sweden, between 2020-2023, in the context of “Project Global Queerantine”, then report on the additional challenges that LGBTQ+ people faced when living in migrant communities.

Results

LGBTQ+ individuals perceived their psychological wellbeing to have been greatly affected by the pandemic. Stressors included fear of the disease itself, and fear of spreading the virus, as well as the negative consequences of adhering to the recommendations of social distancing, which constantly interplayed with the marginalized position of being a LGBTQ+ person. Limited access to the LGBTQ+ community was a common stressor for trans individuals who faced prolonged waiting times for “gender dysphoria” assessment and hormone treatment. The intersectionality of vulnerability mechanisms experienced by LGBTQ+ migrants exacerbated all these issues, as did challenges in accessing and comprehending COVID-19-related information.

Conclusions

During health crises, it is critical for RCCE-IM efforts to consider the increased mental health issues and disruption of social support networks that LGBTQ+ people may face. Strategies and examples of good practices for RCCE-IM that are specifically tailored to LGBTQ+ migrants will be developed in collaboration with the workshop participants.
Sources and determinants of exposure to indoor air pollutants in schools and hospitals: a review
Authors: Teófilo V , Clemente M , Viegas S , Martins C
Published: October 2024

Background

Indoor Air Quality (IAQ) is an important determinant of health. This study aimed to review the available scientific evidence about indoor pollutants and determinants of exposure in several settings, in the scope of the K-HEALTHinAIR project.

Methods

The systematic review was performed for the sources, concentrations, and determinants of pollutants in schools in the European region for 2013-2023. Articles were selected for data extraction if they were epidemiological studies, reported primary data for indoor air and pollutant levels, and, identified sources and determinants of exposure.

Results

The main pollutants affecting IAQ in schools and hospitals were carbon dioxide, volatile organic compounds (e.g., formaldehyde, terpenes), particulate matter, nitrogen dioxide, radon, ozone, and carbon monoxide. Besides the outdoor environment, several important indoor sources of emissions were identified such as occupancy, resuspension, cleaning products. Ventilation was the main determinant influencing the indoor levels of pollutants, stressing the importance of good planning, installation, and maintenance of mechanical ventilation systems in buildings. Other determinants were the number of occupants and their activities, and the building characteristics (e.g., type of floor, location, etc).

Conclusions

Results revealed indoor air quality as a public health concern since several pollutants are present in indoor settings. The identification of sources and determinants of exposure is fundamental for determining preventive measures in a public health perspective.

Acknowledgments: K-HEALTHinAIR team for screening and data extraction: Mariana Corda, Jose Fermoso, Alicia Aguado, Sandra Rodriguez, Hanns Moshammer, Mireia Ferri, Belén Costa, Leticia Pérez, Wojciech Hanke, Artur Badyda, Piotr Kepa, Katarzyna Affek, Nina Doskocz, Laura Martín, Oguz Mulayim, Cesar Mediavilla Martinez, Alba Gómez, Ruben González, Isaac Cano, Josep Roca, Simon de Leede.
5.Y.1. Refugees and mental health
Authors:   Organised by: EUPHA-MIG,   Chair persons: Jutta Lindert (EUPHA-PMH), Sonia Dias (Portugal)
Published: October 2024

Research suggests an elevated risk of mental health conditions (depression, posttraumatic stress disorder, anxiety) among refugees, due to exposure to trauma, displacement, and the challenges of adapting to new environments. Children and adolescents with refugee background face additional challenges, including family disruptions, education interruptions, and uncertain futures. However, the data are heterogeneous and more detailed data are needed. To address this gap, we present data on refugee’s mental health and resilience. First, data on resilience and mental health from Germany are presented. These data are adjusted for demographics and suggest that in case data are adjusted to the living situation in the host country the migrant status is less relevant. The second study presents the mental health of refugee adolescents and children in Greece. The third study presents results based on a Portuguese prospective cohort study Perinatal Health in Migrants: Barriers, Incentives, and Outcomes (baMBINO). This study investigates postpartum depression among refugee women in Portugal highlighting the need for access to care. Last, a systematic review and meta-analysis provides data on depression, anxiety and stress of 62,522 refugees from more than 30 countries. This data suggests that life experiences are critical for refugees’ mental health. Based on the presentations the audience will be engaged in discussion on how to better early prevent mental health conditions in refugees.

Key messages

• Mental health of refugees is a Public Health challenge.

• Pre- and post migration experiences impact refugees and migrants mental health conditions.
Depression, posttraumatic stress of migrants and refugees in Germany – a cross -sectional study
Authors: Sisenop F , Lindert J
Published: October 2024

Background

Research shows associations between migration status and mental health conditions (e.g., depression). Yet, few representative data on migrants’ health are available. We aim to provide representative data on depression, and posttraumatic stress (PTSD) among migrants in a representative sample in Northwestern Germany.

Methods

We conducted a longitudinal study with two measurement points using a standardized assessment instrument in a representative sample of 18-65 years olds in Germany. Here we report on the baseline data. To assess socio-demographic characteristics (gender, age, marital status employment status, household income and migration status) we developed a standardized instrument. To assess depression, we used the Patient Health Questionnaire (PHQ-9), to assess PTSD we used the Harvard Trauma Questionnaire (HTQ-5). To investigate associations of migrant status with depression, and PTSD we estimated linear regression models.

Results

The analytical sample for this study includes n = 437 (male: n = 181, female: n = 256) individuals (age: M = 44.48, range: 18-65). In the total sample 15.1% (n = 66) showed symptoms of depression, and 6.5% showed PTSD (n = 26). Depression was more frequent in migrants than in non-migrants (22.1% vs. 13.4%, p = 0.043; 66.7). Crude linear regression models showed statistically significant associations between migration status and depression (B = 1.998, 95% CI: 0.831; 3.165, p < 0.001), and PTSD (B = 0.204, 95% CI: 0.085; 0.333, p = 0.002). However, models adjusted for gender, age, marital status employment status, household income and migration status suggested significant associations between migration status and PTSD (B = 0.136, 95% CI: 0.009; 0.263, p = 0.036), but not for depression.

Conclusions

Longitudinal data are needed to better understand trajectories between mental health conditions, PTSD and migration status. Living situation after the migration is of critical importance for mental health of migrants.
Migration and mental health: the case of postpartum depressive symptoms in Portugal
Authors: Barros H
Published: October 2024

Background

Postpartum depression (PPD) affects about 17% of healthy mothers within one year of childbirth. The etiology remains unknown, but PPD is influenced by a combination of genetic, physical, psychosocial, and obstetric factors, migration could influence the risk.

Methods

We analyzed data collected within the scope of baMBINO (Perinatal Health in Migrants: Barriers, Incentives, and Outcomes), a Portuguese prospective cohort study, aimed to investigate the maternity experiences and outcomes of migrant women, defined as foreign-born women, and compared to native women. Among the 5431 women enrolled at delivery, 3006 (55%) were considered eligible for this study and interviewed in their preferred language, within six months of recruitment. The Edinburgh Postnatal Depression Scale (EPDS) was administered during this interview, along with the Migrant-Friendly Maternity Care Questionnaire (MFMCQ).

Results

2890 (96%) women were included in the analytical sample for this study. Among women included, 1475 (51%) were migrants or refugees. The proportions of women having EPDS scores ≥ 10 were overall greater among migrants than among native women (7.2% vs. 12.4%, p < 0.001) and the risk remained higher after multiple adjustment models.

Conclusions

Migration status, poor experience with maternal care and language proficiency increased the risk of PPDS and should be carefully addressed as part of perinatal care.
Characteristics of adolescents with acute alcohol intoxication accessing emergency care in The Netherlands
Authors: Pigeaud L , de Veld L , van der Lely N
Published: October 2024

Background

Prevent alcohol consumption amongst minors is a major concern for national governments. Collecting comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Therefore, the aim of this study is to give an overview of demographic and clinical characteristics of adolescents with an acute alcohol intoxication in the Netherlands.

Methods

This study was conducted using a cohort of adolescents aged 14-17 years presenting with acute alcohol intoxication symptoms at the emergency department from 2015-2023. Data were collected at the Reinier de Graaf Gasthuis in Delft in order to monitor trends in admissions for acute alcohol intoxication. Data on patients age, blood alcohol concentration, sex, combined drug use and reason of admission were collected.

Results

A total of 505 patients who presented themselves with symptoms of acute alcohol intoxication at the Reinier de Graaf Gasthuis were included. The mean age of patients was 15.7 years old. The mean blood alcohol concentration was 2.0‰. During the COVID-lockdown period there were statistically significant less admissions with alcohol intoxication. The distribution of sex was nearly equal with 50.3% females and 49.7% males. Combined drug use was present in 13.4% of all cases, with cannabis as the most frequent type of drugs found. The most common known reason for admission was ‘reduced consciousness’ (35.9%).

Conclusions

These findings are relevant for both the central government’s ongoing prevention initiatives and treatment strategies within hospitals. In the future, more countries should evaluate data on adolescent drinking patterns.
Difference in long COVID prevalence due to different definitions and long COVID related risk factors
Authors: Coste J , Delpierre C , Tebeka S , Lemogne C , Robineau O , Steichen O , Rushyizekera M , van den Akker M , Makovski T T
Published: October 2024

Several definitions of long COVID are used in research and practice what challenges epidemiological investigations. Here we present differences in long COVID prevalence accounting for several definitions and concordance between the definitions, as well as the risk factors associated with long COVID. Definitions considered were WHO post-COVID19 condition (PCC) definition with several thresholds (at least low - standard definition, moderate or strong impact on daily activities), NICE1 and NICE2 definitions (reported at least one or at least two symptoms), United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions and perceived long COVID. Prevalence of long COVID among French adult population (N = 10 615) in autumn 2022 ranged from 1.2% to 13.4%, conditional of the definition. The concordance between the definitions was at best moderate. Next, on a smaller representative sample of a French adult population (N = 1 813) eight potential risk factors groups for long COVID were assessed in a systematic epidemiological investigation, following a conceptual model. Fifteen factors from seven groups were associated with long COVID including early-defined sociodemographic characteristics, pre-existing chronic conditions, short-term work-related factors, current socioeconomic position, health behaviours, infection-related factors, and perception of COVID-19 severity and long COVID. The likelihood of long COVID was higher for individuals with higher number of diseases and for nineteen out of twenty-six most prevalent dyads and a triad. A more standardized definition would facilitate research and surveillance of long COVID. Furthermore, long COVID should be observed as an interplay of social, medical and contextual factors rather than a mere complication of SARS-COV-2 infection, while patients with multimorbidity may present some of the particularly vulnerable population groups.
Long Covid autonomic syndrome and his impact on workability: results of observational prospective study and 1-year FU in patients admitted to hospital with COVID19
Authors: Barbic F , Rinaldi L , Rigo S , Furlan R , Riboli E , Stranges S
Published: October 2024

Long-COVID19 has been recently associated with long-sick leave and unemployment. We will present recent data obtained by a prospective observational study conducted during the 2nd wave of the pandemic in Italy to assess the time course of Long-COVID19 autonomic syndrome in working age population and its impact on patient’s work ability. The patients were consecutively enrolled at the time of their hospital discharge and were followed-up for 1 year. Clinical data and work ability have been collected at 1, 6, and 12 months after hospital discharge in our out-patient clinic. Data on Long-COVID19 autonomic syndrome occurrence in working-age and the effects on work ability will be presented and discussed. Long-COVID19 autonomic syndrome occurred in one in three working-age people and was still evident 6 and 12 months after the acute infection resolution. This was associated with a significant reduction in the work ability. Timely recognition of long-COVID19 autonomic syndrome and its potential impact on work ability represents important steps in the prevention of long-term disabilities among active working adults.