bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in health reforms in the Health System and Policies Monitor network: increasing interaction of primary health care and care coordination
Authors: Polin K , Quentin W
Published: October 2022

Since 2018, the Health System and Policy Monitor (HSPM) network of the European Observatory on Health Systems and Policies has tracked health reform activity in its countries. Top three reforms are identified by national experts yearly and classified across 11 policy clusters. Efforts inform a standardized overview of healthcare development. 337 reforms have been assessed for 31 (mainly EU) countries over 4 years, with clear trends like the converging of PHC and care coordination. Main reform areas were primary/ambulatory care, governance, and hospital care (2018-2019); coordination, governance, and digital health (2020); and care coordination, governance, and insurance coverage/resource generation (2021). For PHC, this suggests a shift from leveraging innovations to support existing delivery mechanisms to transforming PHC. Some PHC reforms in 2018-2019 introduced elements of integrated care, but more focused narrowly on specific levers, e.g., gatekeeping. Early care coordination reforms focused on certain patient groups or care delivery across the system. Separately, PHC and care coordination have long been reform priorities. Since 2020, they are increasingly linked to one another, and to multidisciplinary care. This suggests a recognition that multidisciplinary processes/staffing are key to realizing the promises of PHC-to coordinate the care of patients and ensure comprehensive and continuous care over time for most health needs. This vision is underpinned by the UN SDGs and COVID-19, which highlighted the need for health systems to be set up for and with the resources to respond to crises while maintaining core functions. The overview of HSPM health reforms identifies reform trends and opportunities for cross-country learning. More research is needed for policymakers to benefit fully from reform experiences abroad. Case studies with in-depth analysis of reform design and implementation processes can help inspire or support future health reforms elsewhere.
Storytelling to communicate public health messages during the COVID-19 pandemic; A systematic review
Authors: Paudyal P , Ozkosar S
Published: October 2022

Background

Storytelling has been increasingly used in public health to disseminate health messages in a format that is more understandable and engaging. This project aims to summarize the findings from the studies that used storytelling approach for conveying health messages during the COVID-19 pandemic.

Methods

The protocol for this systematic review is registered in PROSPERO (CRD42021281957). Studies were identified via electronic databases; EMBASE, Ovid MEDLINE and EBSCO using variations of the search terms ‘COVID-19’ and ‘storytelling’. Studies that used storytelling interventions in COVID-19 and published in English after 2020 were eligible for inclusion. Data from eligible full text article was collated in a summary table. Quality of included studies were assessed using Joanna Briggs Institute Checklists.

Results

Of the 4562 studies identified in the electronic search, 11 were eligible for inclusion. Participant numbers in each study varied from 14 to 3746. Eight of the 11 studies included were set online, looking at virtual forms of storytelling. This included online surveys and social media campaigns within hospitals, and online meetings with patients at home. Overall, studies showed that storytelling intervention increased engagement in health communication and has the potential to be used as an effective public health communication tool, for changing health behaviours. Studies were small, six out of 11 were of poor quality.

Conclusions

Storytelling is a widely accepted intervention and has the potential to positively impact communication, empathy and health behaviour. As there is no standardized definition of storytelling, and studies into this area are new, it is important to continually re-evaluate data to enhance understanding and provide standardized guidelines for storytelling in the COVID-19 context.

Key messages

• Storytelling has been increasingly used in public health to disseminate health messages.

• Storytelling has the potential to positively impact communication, empathy and health behaviour.
Semi-Automatic Knowledge Extraction from COVID-19 Scientific Literature: the COKE Project
Authors: Golinelli D , Nuzzolese AG , Sanmarchi F , Bulla L , Mongiovì M , Gangemi A , Rucci P
Published: October 2022

Background

The COVID-19 pandemic highlighted the importance of rapidly updating scientific information. However, the guidelines’ drafting process is highly time- and resource-consuming. The COKE Project aims to accelerate and streamline the extraction and synthesis of scientific evidence. To do so, the Project used deep learning to implement a semi-automated system that enhances the systematic literature review processes. We aim to show some preliminary results on the automatic classification of abstract sentences in papers related to COVID-19.

Methods

The tool is based on Natural Language Processing algorithms to detect and classify PICO elements and medical terms and organize abstracts accordingly. We built a BERT + bi-LSTM language model. The tool was trained on a corpus of 24,668 abstracts unrelated to COVID-19. We assessed the tool performance in a specific topic related to COVID-19 that has not been covered during training. To carry out manual validation, we randomly selected 50 abstracts. Abstract sentences were classified by 2 domain experts into 7 types: Aim (A), Participants (P), Intervention (I), Outcome (O), Method (M), Results (R), and Conclusion (C). The performance of the tool was compared with that of the experts in terms of precision, recall, and F1.

Results

The classifier proved to have a 76% overall accuracy. Precision, recall, and F1 were above 75% for all types of sentences except I, M, and P.

Conclusions

The results indicate a promising ability of the semi-automated classifier to predict expert-validated labels on abstracts of different topics. Our proposed tool is expected to significantly reduce the effort for producing medical guidelines and therefore have a strong, positive impact, particularly in emergency scenarios. The COKE Project also represents a call-to-action for similar initiatives, aimed at enhancing the information extraction process in medicine.

Key messages

• A rapidly changing healthcare requires fast decisions supported by scientific evidence. This is not compatible with the human limits in cognitive skills that reduce the ability to extract information.

• The COKE Project aims to speed up the creation of healthcare guidelines, semi-automating parts of the workflow, and supporting the human-performed process of extracting and analyzing contents.
PHIRI Rapid Exchange Forum (REF): A key tool for cross-country exchange in times of crisis
Authors: Habl C , Pries C
Published: October 2022

The COVID-19 pandemic demanded a quick exchange between experts and institutions supporting national governments in the crisis response literally from the first day onward to provide evidence-based information. There was no such regular cross-country forum established in the field of population health in the beginning of the crisis. Thus, devoted members of the Joint Action on Health Information started already in April 2020 to meet regularly online to foster cross-country exchange. In these meetings, partners could approach each other for questions and shared views in a trusted environment. The European Commission recognized this achievement and supported this exchange as part of the Population Health Research Infrastructure (www.phiri.eu), allowing a quick exchange of data, indicators, good practices and experiences in the COVID-19 crisis response in an efficient manner. Till May 2022 34 REF meetings have taken place, involving project partners, national advisors to ministers/heads of agency, representatives of expert networks (e.g. Healthy Cloud), EU services (ECDC, JRC) and different health stakeholders (e.g. ELIXIR). The bi-weekly 1 hour online meetings cover in a moderated, structured format pre-agreed COVID-19-topics that are proposed by the participating countries and chosen via a survey ex-ante to each meeting). Responses by the countries (backed up by national reports, andguidelines that are briefly presented in the meetings) are compiled and shared immediately after the meeting via the Corona-Corner of the Health Information Portal (www.healthinformationportal.eu/rapid-exchange-forum). Topics covered reach from a discussion on suitable non-pharmaceutical interventions and their application especially prior to the availability of vaccines to child vaccination strategies and overall testing regimes to the most suitable communication tools. In average, 25 to 30 delegates from different, mainly EU member states attend each exchange.

Key messages

• The PHIRI Rapid Exchange Forum demonstrated its importance for regular decision making in the field of population health not only in times of crisis.

• The Rapid Exchange Forum is an integral part of the European Health Information Portal (www.healthinformationportal.eu) which shall be transformed into a sustainable infrastructure.
Health facilities readiness to provide primary cardiometabolic healthcare in Burkina Faso, 2012-2018
Authors: Cissé K , Kirakoya F
Published: October 2022

Background

Cardiovascular diseases (CVD) and diabetes, referred to as “cardiometabolic diseases” (CMD), are a growing health issue in developing countries like Burkina Faso. As the first contact point with the national health system, primary health care must play a crucial role in CMD prevention and control. This study aimed to analyse the primary health care (PHC) system readiness for CMD prevention and treatment in Burkina Faso from 2012 to 2018.

Methods

We performed repeated cross-sectional data analysis from health facility-based surveys, conducted in 2012, 2014, 2016, and 2018. These surveys were conducted using the World Health Organisation (WHO) Service Availability and Readiness Assessment (SARA) tool. The readiness of PHC for CMD was defined according to the SARA manual.

Results

A total of 586 healthcare facilities were included in 2012, 659 in 2014, 567 in 2016, and 653 in 2018. Between 2012 and 2018, the percentage of healthcare facilities providing CMD specific care significantly increased (66.2% to 92.0% for CVD and 39.4% to 46.6% for diabetes). However, the mean readiness index of the PHC system to manage CVD decreased from 26.0% to 21.6% (p for trend<0.001). For diabetes, the overall readiness index increased significantly (from 34.2% to 37.5%, p = 0.005). The readiness index of PHC for CVD significantly decreased in all health regions particularly in the Sahel region (from 31.7% to 20.8%, p < 0.001). While, for diabetes, it increased in all the health regions excepted the Centre-Sud region (from 37.8% to 32.2%, p < 0.001).

Conclusions

There is a low level of preparedness of PHC system to provide CMD in Burkina Faso. Although improvements for diabetes, this is not enough (80% availability of affordable basic technologies and essential medicines recommended by the WHO). Strengthening of the primary healthcare system considering the geographical disparities is urgently required for early detection and management of CMD.

Key messages

• There is a low level of readiness of PHC system to provide cardiometabolic healthcare in Burkina Faso.

• Public health policy makers must pay more attention to strengthening of the primary healthcare system to address the rising burden of CMD.
Sexual orientation and mental health disparities in US pre-teens: A longitudinal mediation study
Authors: Feinstein BA , van der Star A , Dorrell KD , Blashill AJ
Published: October 2022

Background

Sexual minority children are at increased risk for psychopathology compared to their heterosexual peers, but longitudinal studies are needed to determine whether sexual minority identification precedes (rather than co-occurs with) mental health disparities and what may drive these disparities during childhood. The current study examined the longitudinal associations between sexual orientation and mental health over two years in a cohort of U.S. pre-teens with two potential mediators (increased social problems and decreased perceived school safety).

Methods

We used data from Waves 1-3 (2016-2020) of the U.S. Adolescent Brain Cognitive Development study. Multiple linear regression and auto-regressive cross-lagged mediation models were used to examine longitudinal associations and mediation. Analyses accounted for customized sampling weights to correct for attrition and missing data.

Results

The analytic sample included 5,574 children (46.0% assigned female at birth, 55.1% non-Hispanic White). Across waves, beginning to identify as gay/bisexual (0.6-2.7% of sample) was associated with increased internalizing and externalizing problems, and consistently identifying as gay/bisexual (3.4-5.0% of sample) with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, the widening disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety.

Conclusions

The health disparities affecting sexual minority children include internalizing and externalizing problems, and are partially explained by increased social problems and decreased perceived school safety. These findings demonstrate that sexual minority identification precedes increases in mental health problems relative to heterosexual children, driven by peer difficulties and feelings of unsafety at school experienced by sexual minority children.
Sexual attraction-based disparities in adolescent mental health: The role of school norms
Authors: Kiekens WJ , Baams L , Stevens GWJM
Published: October 2022

Purpose

Few researchers have explained disparities in mental health between sexual minority and heterosexual adolescents by focusing on structural forms of stigma as, for instance, heterosexist school or classroom norms. Addressing this gap, our paper aimed to study disparities in life satisfaction, psychosomatic complaints, and emotional problems between sexual minority and heterosexual adolescents and examine the moderating role of heterosexist norms in the classroom and school.

Methods

We used data from the 2013 and 2017 Dutch Health and Behaviour in School-Aged Children (HBSC) study (N = 12,756; M age = 14.02; SD = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated.

Results

Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints (not for unsure adolescents), and more emotional problems than their other-sex attracted peers. Stronger school-level heterosexist norms were associated with higher life satisfaction and fewer psychosomatic complaints and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with less emotional problems. Few moderating effects of classroom and school-level heterosexist norms were found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents decreased when classroom-level heterosexist norms were stronger.

Conclusions

Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school- and classroom-level hardly contributed to these health disparities.
Envisioning supportive and safe learning environments: A dialogical study with LGBTQ+ adolescents living with chronic conditions or diagnoses
Authors: Cantarero Arevalo L , Skov Nielsen A , Slyngbord L
Published: October 2022

Background

LGBTQ+ adolescents living with mental conditions are affected by stigma based on their health status, sexual orientation, and/or gender identity/expression (SOGIE), especially when navigating their learning environments. Our aim is to gain detailed insights into how LGBTQ+ adolescents living with mental conditions vision their learning environments so that they can feel safe and supported enough to freely disclose their SOGIE and health status, and hence thrive.

Methods

Aware of the participants’ vulnerabilities, a dialogical narrative-based approach was used to gather thick descriptions and deep insight, while applying the “seven C's”: conversation, curiosity, context, complexity, challenge, caution, and care (Frank, 2019). Recruitment was done through LGBTQ+ Denmark and via networks of networks. Two LGBTQ+ young adults living with chronic conditions held the dialogues. Mode of communication was chosen by the participants (either face-to-face, via internet or via telephone). Data analysis was conducted via the “analysis grid” (Roest et al. 2021).

Results

Nine dialogues lasting from 20 to 50 minutes were held with youth from 14 to 24 years old during spring 2022. According to their narratives, supportive and safe learning environments would: respect for change of names and pronouns, update learning materials, allow for flipped classrooms (hybrid teaching tested under COVID lockdowns), have separate neutral change rooms/bathrooms and create safe private spaces to take medications. They would also permit higher absenteeism rates for those living with chronic conditions or getting hormonal treatments, allow for more breaks/slower version of the pensum, and show proactive healthy curiosity and respect for “invisible diseases”, fluid SOGIEs and neurodiversity/neurodivergent profiles.

Conclusions

The differing participants’ narratives provide innovative ways to create safe and supportive inclusive learning environment that embrace and enhance diversity.
10.P. Round table: Public health of the future: innovations in surveillance, communication and knowledge translation
Authors:   Organised by: SESPAS, EUPHA-PHPP, ASPHER,   Chair persons: Enrique Bernal-Delgado (Spain), Gabriela Barbaglia (Spain)
Published: October 2022

The social, ecological, economic and health crises exacerbated by COVID-19 pandemic are challenges of extraordinary magnitude and complexity for global public health. Moreover, the context in which the pandemic emerged was characterized by underinvestment in public health and growing distrust in institutions. Public health responses were often fragmented and failed to make use of existing resources and expertise. Nearly 3 years after the start of the COVID-19 pandemic much has been learned and much is still to be learned. Accordingly, European national public health agencies have been pushed to their limits and currently face an urgent need to be renovated incorporating innovations in surveillance, communication and knowledge translation. National agencies should network and collaborate at the EU level. EUPHA may play an important role in this effort.

On the one hand, there is the need of improving surveillance of harmful effects of the pandemic, specifically the health inequalities aggravated at local, national and global levels; and, on the other, to improve the availability of this knowledge to policymakers. Public Health communication needs to be further developed as it has been a crucial piece of national and international efforts to protect and promote health in the pandemic and so will be in the future. With this workshop proposal, we would like to bring up for discussion how could we further improve surveillance, communication and knowledge translation to policy makers and citizens in our European national public health agencies. Innovative and updated public health agencies will help regaining trust and strengthening public health institutions. National and European Public Health further development is essential and should be strengthened to protect and promote European populatiońs health.

The objectives of the workshop are:

– To discuss key innovations to implement in national public health agencies to improve surveillance, communication and knowledge transfer to policy makers and citizens.

– To reflect on supranational European coordination mechanisms that would allow for efficient surveillance and a rapid and adequate response to different public health challenges, including social inequalities in health.

– To manage public health intelligence in the European Health Data Space and the role of public health in this data lake design.

Key messages

• COVID19 pandemic has revealed the challenges of creating strong trustworthy national public health institutions to ensure the integrity of public health science and information dissemination.

• Structures to facilitate timely and efficient monitoring requires national and supranational coordination mechanisms, including data and experience sharing.

Speakers/Panellists

Robert Otok

ASPHER, Brussels, Belgium

Sofia Ribeiro

EUPHA-PHPP

Manuel Franco

University of Alcalá, Madrid, Spain
Urban places and Mental Health challenges (lessons learned from Covid-19 crisis)
Authors: Jevtic M , Matkovic V , Kusturica MP , Bouland C
Published: October 2022

Nature deprivation under COVID-19 lead to reduced well-being. Urban design interventions were also identified as an important contributor to the restoration of community confidence, choice, and safety. Factors related to sociodemographic, housing and lockdown were linked to changes in exposure to nature during the pandemic lockdown. Changes in exposure to nature and mental health outcomes during the COVID-19 lockdown were strongly linked. Especially young people had an increased number of mental health problems. Children and youth were more bored and worried in comparison with the pre-pandemic period. The educational institutions worldwide were closed or changed to online education during the pandemic, leading to great disturbance in students’ education and outdoor events. All “green infrastructure” (GI) resources (including parks, gardens etc.) received great attention as “essential infrastructure” supporting well-being. But, the quality, functionality and position of GI in urban areas showed inequality in distribution. Frequently, societies with greater ethnic diversity, lower income and larger health inequality suffered from unsatisfactory or lack of access. GI is important in decision-making to address inequality. This work will also present an open-air activity for all generations: A reflective walk through the oldest part of Novi Sad (EU Capital of Culture 2022), as a part of Project Reflective citizens in Novi Sad. This walking tour was led by pupils from primary school - where all generations spend useful time in open space and a safe atmosphere walking tour, learning and listening about the cultural history of the oldest part of the city. It is vital to enhance urban planning and design practices in making healthier and more resilient communities. It is necessary to underline the importance of planning green spaces that need time to form in urban areas, and which have proven to be very important for mental health in the midst of the pandemic crisis.
Digital health literacy and well-being of university students in Austria during the pandemic
Authors: Reitegger F , Wright M , Gasteiger-Klicpera B
Published: October 2022

Background

Previous findings suggest that depressive and anxiety-related symptoms have doubled among students since the beginning of the pandemic. Digital health literacy can act as a protective resource to strengthen well-being.

Objectives

This paper analyzes the relationship between digital health literacy, socioeconomic status and well-being and future-anxiety among students in Austria.

Methods

480 students from Austrian higher education institutions were surveyed via online questionnaire during the second wave of the Corona pandemic. Sociodemographic data, students’ self-assessments of well-being, fears regarding future development and perspectives, and digital health literacy were collected. Variance and regression analyses were used for the evaluation.

Results

About 50% of the students reported low scores in well-being and distinct fears about the future. A higher socioeconomic status correlated with higher well-being as well as lower fears about the future.Regarding digital health literacy, the ability to assess the relevance of information showed the highest correlation with well-being.

Conclusions

Individual factors such as gender or the study-program are relevant for the interaction between well-being and digital health literacy. The assessment of the relevance of information and its connection with one's own life reality seems to be important factors in promoting well-being.
Global decline in vaccine coverage; COVID-19 Vaccine Hesitancy
Authors: Laaser U
Published: October 2022

Vaccine hesitancy is a relatively new concept, developed by WHO's Strategic Advisory Group of Experts (SAGE) on Immunization in 2014 as a response to the growing awareness of the decline in global confidence in vaccination. Vaccine hesitancy is a context-specific behavioural phenomenon whose occurrence ranges between full acceptance and complete refusal of vaccines. Several studies have explored factors that influence people's decision to get vaccinated and in 2018 WHO and UNICEF conducted a joint study to explore the reasons for vaccine hesitancy. The study aimed to determine the reported rate of vaccine hesitancy across the globe and the reasons for hesitancy. In most studies three top reasons were identified. 1) vaccine safety concerns, 2) lack of knowledge and awareness of vaccine importance, and 3) religion, culture, gender and socio-economic issues regarding vaccines. Other factors contributing are negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent socio-demographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, lived in a rural area, and self-identified as a racial/ethnic minority. Vaccine hesitancy is associated with the global crisis of trust in science and institutions, namely lack of political trust, which can be defined as public judgment that the system and its representatives are responsive and reliable. Furthermore, distrust in one institution is related to distrust in other, indicating the unidimensional phenomenon. This kind of distrust is exemplified by the appearance of infodemic - an overabundance of information. In addition, support for conspiracy theories related to COVID-19 which correlates with the scepticism towards vaccination has significantly higher rates among Balkans’ populations.
Co-creation of a school-based sexual health education intervention in Italy
Authors: Chinelli A , Farinella M , Rancilio L , Salfa MC , Cellini A , Ubbiali M , Torri E , Camposeragna A , Martinelli D
Published: October 2022

Introduction

School-based sexuality education (SBSE) is the most effective way to positively impact young people's behaviour and attitude towards sexuality. This study describes the development of a SBSE pilot activity targeting lower secondary schools (LSS) within the context of EduforIST project funded by the Italian Ministry of Health.

Methods

A desk review was carried out to collect information about national policies, international literature and guidelines on SE and STIs prevention. An online survey was developed to collect information on SBSE activities implemented in Italy during 2016-2020. Focus groups among project partners and open consultations with a multisectorial expert advisory board were organised. SBSE pilot activity was developed by an interdisciplinary team of pedagogists, public health and SE experts, educators.

Results and discussion

The SBSE was structured in: a) 5 interactive interventions of 2 hours each with students (4 theoretical and practical modules; 1 final intervention for students-led discussion and evaluation); b) introductory and closing meetings with teachers and with parents. The modules addressed the following dimensions: changes in adolescence; emotions and relationships; sexual identities and diversity; sexual consent, STIs/pregnancy prevention, sexual health services. Additional materials were developed: a. pre/post evaluation tools for educators and students; b. pre-implementation checklist for schools; c. materials for teachers’ and parents’ engagement before/after the SBSE activity.

Conclusions

This pilot activity represented a first step towards the development of a standardised, evidence-based and comprehensive approach to SBSE, for future implementation across the country.
Anxiety and depression symptoms during the COVID-19 pandemic in European countries and Australia
Authors: Gemes K , Bergström J , Sijbrandij M , Pinucci I , Quero S , van der Waerden J , Burchert S , Bryant RA , Mittendorfer-Rutz E
Published: October 2022

Background

Studies on mental health changes during the COVID-19 pandemic report no change or increasing prevalence of mental health problems in general, but less is known on changes in potentially disadvantaged groups over time. We investigated changes in anxiety and depression symptoms during the first year of the pandemic in France, Germany, Italy, the Netherlands, Spain, Sweden, and Australia by prior mental disorders and migration status.

Methods

Overall, 4,674 adults answered a web-based survey in May-June 2020 and were followed by three repeated surveys up to February 2021 in these countries. Information on socio-demographic, living conditions, psychosocial factors, diagnosis of mental disorders before, depression and anxiety symptoms during the pandemic and migration status (being a resident or not) was collected. Weighted general estimation equations modelling was used to investigate the association between prior mental disorders, migration status, and symptoms over time.

Results

Most participants were <40 years old (48%), women (78%), and highly educated (62%) with some variations across countries. The baseline prevalence of depressive and anxiety symptoms ranged between 19%-45% and 13%-35% respectively. In most countries, prevalence remained unchanged throughout the pandemic and was higher among people with prior mental disorder than without even after adjustment for socioeconomic, psychosocial, living and health factors. We observed interactions between previous mental disorders and symptoms of anxiety or depression over time in Germany (p = 0.01) and in Spain (p = 0.04). No prevalence difference was noted by migration status.

Conclusions

Depression and anxiety symptoms were worse among individuals with prior mental disorders than without, but there was no clear trend of mental health worsening in the observed groups during the first year of the pandemic. Still, monitoring mental health should be continued in the long-term, with special focus on vulnerable groups.

Key messages

• Depression and anxiety symptoms were higher in individuals with prior mental disorders during the first year of the pandemic in an international sample of six European countries and Australia.

• There were no clear trends of mental health worsening in any of the observed groups in neither of the countries between May-June 2020 and February 2021.
The effect of financial support on depression among young adults during the COVID-19 pandemic
Authors: Coulaud P , Salway T , Jesson J , Bolduc N , Ferlatte O , Bertrand K , Desgrées du Loû A , Jenkins E , Jauffret-Roustide M , Knight R
Published: October 2022

Background

To mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments provided financial support (e.g., emergency aid funds) as well as family via personal assistance. This study aims to assess the moderating effect of financial support from the government or from family on the association between income loss and depression among young adults.

Methods

Two online cross-sectional surveys among young adults (18-29) living in Canada and France were conducted in October-December 2020 (n = 4511) and July-December 2021 (n = 3329). Depressive symptoms were measured using PHQ-9 score+10. Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family modeled separately), controlling for demographics (e.g., country, age, gender, income, living conditions).

Results

In the total sample, half reported depressive symptoms (2020/2021: 53%/46%), and over a third lost income (2020/2021: 10%/12% all income, 38%/22% some income). In 2020, 41% received government financial support (2021: 18%) while family/friends support was constant (12%). In both surveys, among those who received government support, income loss was associated with depression, whether participants lost all income (2020: AOR 1.75 [1.29-2.44]; 2021: AOR 2.17 [1.36-3.44]), or some income (2020: AOR 1.31 [1.17-1.81]; 2021: AOR 1.46 [0.99-2.16]). However, among those who received family support, income loss was no longer significantly associated with depression, whether participants lost all income (2020: AOR 1.37 [0.78-2.40]; 2021: AOR 1.51 [0.88-2.56]), or some income (2020: AOR 1.31 [0.86-1.99]; 2021: AOR 1.10 [0.67-1.81]).

Conclusions

Association between income loss and depression was moderated by receipt of family financial support but not by receipt of government support. Financial support may help to mitigate the negative effects of income loss on young adults mental health during public health crisis.

Key messages

• Financial support may help to minimize risk of depressive symptoms among youth who lost income related to the COVID-19 pandemic.

• Financial support through personal assistance (e.g., family, friends) appears to have a greater impact on youth mental health than COVID-specific government assistance funds.
Longitudinal rate of change in depression symptoms from pre- to post-COVID-19 onset among US mothers
Authors: Kapp J , Coble D , Kemner A , Hall B
Published: October 2022

Background

The extent of the psychological impact of the pandemic is still unfolding. Despite existing literature, most studies lack rigor. We assessed the longitudinal rate of intra-individual change in maternal depression symptoms from before to after COVID-19 onset among US mothers enrolled in a home visiting program with robust adjustment for family contextual factors. We hypothesize that the rate of change in maternal depression symptoms increased after the pandemic onset.

Methods

Eligibility included mothers with ≥1 depression assessment both prior to and after March 16, 2020; thresholds of ≥ 13 on the Edinburgh Postnatal Depression Scale and ≥10 on the Patient Health Questionnaire-9 identified probable depression. We used a generalized linear mixed effects longitudinal model with a random intercept and random slope for time (years) to analyze probable depression (event=‘Yes') pre- and post-COVID. Covariates for model estimation were based on the literature and theory.

Results

Our cohort of 3,431 mothers included 43% non-Hispanic White, 21% non-Hispanic Black, and 31% Hispanic races/ethnicities; 58% from rural/small towns, 18% Spanish-speaking, 63% with one child, median age of 29 and median 2 years follow-up. Households included: 82% low income, 24% low education, 10% insecure housing, 29% single parents, 21% mental illness, 10% substance abuse, and 8% domestic violence. Fourteen percent screened positive for depression pre-COVID, and 10% post-COVID. Depression was significantly higher pre- versus post-COVID, with no significant difference in the rate of change over time. Significant variables (p < 0.05) associated with depression included race/ethnicity, region of the country, number of home visits, mental illness, substance abuse, and domestic violence.

Conclusions

After controlling for family contextual factors, we did not find a significant increase in maternal depression post-COVID-19. Additional research is needed to examine subgroups and the timing of events.

Key messages

• The extent of the psychological impact from the pandemic is still unfolding.

• It is difficult to fully articulate its effects without rigorous, longitudinal research designs.
11.P. Workshop: Tobacco control policy strategies to contribute to the EU’s tobacco-free generation goal
Authors:   Organised by: Tilburg University, Amsterdam UMC, University of Amsterdam (Netherlands),   Chair persons: Andrea Rozema (Netherlands), Mirte Kuipers (Netherlands)
Published: October 2022

In 2021, the European Union's (EU) ‘Europe's Beating Cancer Plan’ set the goal to achieve a tobacco-free generation in Europe by 2040, which means that less than 5% of people will use tobacco. The EU proposed policies to address internationally relevant issues such as tobacco taxation, cross-border purchases, packaging, flavours, and online advertising. However, many tobacco control policies need to be adopted and implemented at the national or local level. It is therefore important to exchange research findings and insights on national tobacco control policies. In this workshop we present results mainly from the Netherlands. With a 21% smoking prevalence and scores 53 out of 100 points on the Tobacco Control Scale, it may therefore be considered an average European country in terms of its tobacco control. However, the Netherlands has progressed its tobacco control policies in recent years, in part due to the 2018 National Prevention Agreement. This Agreement included the same goal as the European tobacco-free generation goal. Achieving a tobacco-free generation requires the prevention of smoking initiation among young people, but also smoking cessation among those who already smoke. This is especially important among lower socioeconomic groups, as the smoking prevalence in these groups is higher both in adults and adolescents. Therefore, smoking and tobacco products need to be less visible and available in the environment, and easily accessible smoking cessation support needs to be provided. With this workshop, we cluster very recent evidence on the EU's tobacco-free generation goal. We will present evidence on four policy strategies for the smoke-free generation, in which their potential impact and challenges in implementation will be discussed. These presentations will be followed by a plenary discussion on the implications and the relevance of the four strategies taking into account differences between international settings.

The presentations will focus on four policy areas:

• Policies to reduce smoke-exposure in and around sport clubs

• Policies to reduce availability of tobacco products in the retail environment

• Policies to reduce smoke-exposure in hospitality venues and homes

• Policies to increase access to smoking cessation

The objectives of the workshop are:

1. Present evidence of four tobacco control policies strategies

2. Discussion of the international relevance and implications of the results

Key messages

• We present on multiple settings that can be further capitalised on to achieve a non-smoking norm, including sports clubs, retail outlets, hospitality venues, and the home environment.

• The majority of European countries currently does not have strong tobacco control policies in the presented settings, and the potential of such policies throughout Europe will be discussed.
Improve service coordination and delivery in community hubs serving homeless and at-risk populations
Authors: Shamaa H , Sun W , Peters V , Martignetti L , Valant E , Sparks D
Published: October 2022

Background

Two community hubs are currently located in Durham Region, Ontario, Canada, to provide a single point of access to a wide range of support services for individuals experiencing homelessness and other at-risk populations. The community hub in Oshawa is formally known as the Back Door Mission for the Relief of Poverty and the community hub in Ajax is formally known as the Ajax Hygiene Hub. It is unclear if these two community hubs are effective in addressing the needs of individuals experiencing homelessness and how the COVID-19 pandemic continues to impact these services amongst this population. This study was conducted to identify gaps and barriers within the community hub models as well as provide recommendations to improve the coordination and delivery of services serving individuals experiencing homelessness and other at-risk populations.

Methods

A mixed methods approach was utilized in this study, which included surveys for individuals experiencing homelessness, through open-ended and close-ended questions to assess their experiences at either one of the two community hubs. A total of 75 surveys were completed by the study participants (40 surveys in Oshawa and 35 in Ajax). Thematic analysis was performed for all the open-ended survey responses. A literature review was also conducted to evaluate the community hub models as well as best practices for the implementation locally, nationally, and internationally.

Results

Data analysis for the open-ended survey responses revealed the need for housing support, increased resources for medical services, and the expansion of programs provided by the community hubs.

Conclusions

Homelessness is a major public health issue however community hubs play a pivotal role in addressing this concern in Durham Region. The equitable access to a diverse range of services that are co-located in a community hub is imperative for individuals experiencing homelessness, especially during the COVID-19 pandemic.

Key messages
Screening intimate partner violence in the healthcare services during Covid-19 lockdowns in Israel
Authors: Agronsky B Pekar , Daoud N
Published: October 2022

Background

Studies have shown increased rates of intimate partner violence (IPV) during the Covid-19 lockdowns. Healthcare services (HCS) have an important role in detection and screening of women victims of IPV. These women tend to visit the HCS more frequently, which creates an opportunity to detect, screen, and inform them about relevant support services.

Methods

We conducted an online survey during Israel's 2nd and 3rd lockdowns (October 2020-February 2021). A self-administrated structured questionnaire was distributed in Arabic and Hebrew via social media. Eligibility criteria included women >18 years old. 519 women completed the questionnaire: Palestinian-Arab=73; non-immigrant Jew=319; and immigrant Jew=127. We asked women whether they were ever screened (ES) for IPV or received information (RI) on support services in the HCS.

Results

37.2% of the women reported any IPV; Palestinian-Arab women reported higher rates of IPV (49.3%) compared to non-immigrant Jew (34.2%) and immigrant Jew (37.8%). Prevalence of ES and RI on support services were low among the total study sample (21.8%, 47% respectively). Only 12.1% reported on both (ES and RI). Among women who reported IPV, only 26.9% reported that they had been ES, 39.4% RI, and 13.5% both. Whilst Palestinian-Arab women victims of IPV reported higher ES and a lower RI (30.6%,25% respectively) non-immigrant and immigrant Jew reported the opposite -higher prevalence of RI and less ES (non-immigrant Jew 45%,25.7%. Immigrant Jew 37.5%,27%, respectively). In the multivariate analysis after adjusts, Palestinian-Arab women were less likely to RI regarding support services (OR = 0.33,90%CI=0.19-0.57), while immigrant Jew women had a greater chance to be ES in HCS (OR = 4.29, 90% CI=1.43-12.80).

Conclusions

To increase IPV detection in the HCS, there is a need for interventions on screening and providing information on support services specifically during emergencies where IPV is likely to increase.

Key messages
Barriers to HIV testing among transgender women and men who have sex with men in sub-Saharan Africa
Authors: Tewogbola OT , Thapa S
Published: October 2022

Background

Accessing HIV testing services is a challenge for transgender women and men who have sex with men (MSM) in sub-Saharan Africa. Only a little about this issue has been understood and discussed. No systematic review exists that discusses barriers to HIV testing among transgender women and MSM on the regional level.

Methods

We systematically searched databases namely MEDLINE, CINAHL, and Google Scholar to identify qualitative studies that reported decision-making and/or experiences with HIV testing uptake among transgender women or MSM and that were conducted in sub-Saharan Africa between January 2005 and March 2020. Two independent authors performed the selection, extraction, and thematic analysis of data.

Results

Twelve out of 794 studies were found eligible and included for synthesis. The synthesis led to the development of a framework illustrating multi-level, inter-related barriers to HIV testing. Couple-based HIV testing policies, criminalizing same-sex behaviors, and (health) governance being influenced by traditional religious (Islamic or Christianity) belief systems were the barriers at the regional level. Discriminatory practices in the communities and health institutions were the community-specific barriers. Interpersonal barriers included interactions with healthcare providers leading to forced disclosure and/or discrimination, and individual level barriers included fears and depressive thoughts, and poor healthcare access.

Conclusions

We identified policies and practices at the regional and country levels that hindered HIV testing practices among transgender women and MSM, which should be reconsidered while providing HIV prevention services to people of gender-minority backgrounds. We also think that countries from the global west do have a responsibility to question the sovereignty of some African countries for their inability to provide optimal health care to gender minority populations.

Key messages
Youth HIV services in the context of COVID-19 pandemic in Sofala Province, Mozambique
Authors: Casigliani V , Ronzoni N , Merolle A , Chenene F , Cinturao V , Putoto G
Published: October 2022

Background

After the first COVID-19 case in Mozambique, the government established a state of emergency in period April - September 2020. To reduce exposure for people living with HIV (PLWHIV), the Ministry of Health modified service delivery guidance, interrupting community activities, and revising patient flow within health facilities. The study aimed to measure the impact of the COVID-19 pandemic on HIV testing and treatment services in Sofala Province, Mozambique.

Methods

The study analysed the activities in 9 youth HIV services called SAAJs (Serviço amigo do adolescente e jovem) supported by Doctors with Africa CUAMM in 2020 and 2021. The following data were gathered and analysed: number of counselling sessions, number of HIV tests performed, number of people who tested positive and therefore started the antiretroviral treatment (ART), number of PLHIV on ART. Data were disaggregated by sex and age.

Results

In 2020 and 2021 85466 and 141844 counselling sessions were performed, respectively. A decrease of 41% was observed in the second trimester of 2020 compared with the previous one. The number of counselling sessions came back at pre-pandemic levels in the 2nd trimester of 2021. People aged 20-24 accessed more in 2020, while those aged 15-19 in 2021. In 2020 people tested for HIV were 22753, while the number was twice in 2021: the increase was higher among males(p<.05). In 2020 females were more likely to be tested, while in 2021 it was the opposite(p<.05). The positivity rate was 2.5% and 1.5%, respectively; in both years males were more likely to be tested positive(p<.05). In 2020 86.1% of people tested positive started the ART, in 2021 98%. Males were more at risk of not starting the ART(p<.05). The number of PLWHIV on ART did not decrease over time.

Conclusions

ART provision was generally maintained during the COVID-19 pandemic, while other services were heavily impacted. The difference observed among sex was significant and may inform future interventions.

Key messages