bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex differences in the associations of socioeconomic status with stroke in the Turkish Population
Authors: Turunc O , Zwas DR , Calderon-Margalit R , Unal B
Published: October 2021

Background

Low SES status is associated with the risk of stroke, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries. We explored this association in the Turkish population.

Methods

The database of the Chronic Diseases and Risk Factors Survey in Turkey from 2013 and 2019 was used. The education level and employment status of the participants were chosen as a proxy indicator for SES. Cox regression analyses were conducted to assess the effect of SES on incident stroke controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess the multiplicative interaction between sex and SES on the risk of stroke.

Results

The study included 13 975 participants; 7 450 females (53.3%) and 6525 males (46.7%). During 74.2±9.87 months of follow-up, 108 strokes occurred among females (2.34 cases per 1000 person-years) and 81 stroke cases occurred among males (2.01 cases per 1000 person-years). Completion of primary school education was associated with decreased risk of stroke (HR = 0.46, 95%Cl: 0.25-0.84) among males. Education level had a linear protective effect against stroke among females after adjustment for behavioral and biological risk factors (HR = 0.50, 95%Cl: 0.30-0.81; HR = 0.30, 95%Cl: 0.12-0.71; respectively for primary education and secondary or higher education). Employment status did not predict the incident stroke for both sexes. There was no evidence of an interaction between sex and education (p = 0.68).

Conclusions

In this Turkish population, stroke risk was greater in women than in men. Increasing education was associated with a reduced risk of stroke in Turkish women, whereas the only completion of primary education was protective for men, with no further protection at increased educational levels. Further exploration of sex and gender risk differences in moderate-income countries may lead to improved efforts at risk reduction.

Key messages

Education level as a social determinant of health in middle-income countries may affect men and women differently with regards to the risk of stroke Understanding sex differences in the associations of socioeconomic status with stroke may lead to improved efforts at risk reduction of stroke in MICs.
Vaccine Hesitancy and Cognitive Biases: A tailored approach for a better communication
Authors: Casigliani V , Menicagli D , Fornili M , Lippi V , Chinelli A , Stacchini L , Baglietto L , Lopalco PL , Tavoschi L
Published: October 2021

Background

Vaccine hesitancy (VH) remains worldwide a reason of concern. Most of the vaccination education strategies followed a ‘fact-based' approach, based on the assumption that decision making is a rational process, without considering the influence of cognitive biases and heuristics. Our study aimed at identifying factors involved in the parents' vaccination choice to inform and shape communication interventions.

Methods

We conducted an online national survey among parents between November 2020 and April 2021. The questionnaire consisted of 59 items organised in 5 parts: personal information, cognitive biases, risk aversion, conspiracy mentality, and VH. Exploratory factor analysis was conducted to identify latent variables underlying the 19 items related to the 6 cognitive biases. Factors were categorised in quintiles and the corresponding pseudo-continuous variables used as predictors of the VH. Logistic regression model was applied to assess the association of the VH with factors, conspiracy mentality and risk propension. We adjusted for age, gender, economic status, and education levels.

Results

The study included 939 parents, 764 women (81.4%), 69.8% had a degree or higher level of education. Considering cognitive biases, four factors explaining 54% of the total variance were identified and characterised as: fear of the side effects of vaccines (scepticism factor); carelessness of the risk and consequences of infections (denial factor); optimistic attitude (optimistic bias factor); preference for natural products (naturalness bias factor). All factors were positively associated with VH (p < 0.001) as were conspiracy mentality (p = 0.007) and risk propension (p = 0.002).

Conclusions

This study confirmed the need to amplify the model used to analyse the VH considering cognitive biases as an important factor affecting the parents' decision making. These results may be useful to design personalised communication interventions regarding vaccines and vaccination.

Key messages

The model used to analyse the vaccine hesitancy needs to be extended including the evaluation of cognitive biases and heuristics. Communication interventions to promote vaccine acceptance should be tailored and personalized on the basis of the drivers of choice of the parents.
5.H. Skills building seminar: Methodological choices in burden of disease studies: a literature review of European studies
Authors:   Organised by: COST Action CA18218–European Burden of Disease Network,   Chair persons: Brecht Devleesschauwer (Belgium), Juanita Haagsma (Netherlands)
Published: October 2021

Since the first Global Burden of Disease (GBD), the burden of disease (BoD) concept has been widely used to understand patterns of health and the causes of loss of health in populations. In particular, the use of Disability-Adjusted Life Years (DALYs) has become popular as a single numerical index representative of both morbidity and mortality. Over the years, the original GBD methodology has undergone numerous updates, and various weighting and discounting schemes have been used in the reporting of the result. In addition to the GBD estimates (produced by the World Health Organization and the Institute for Health Metrics and Evaluation), many other independent studies have been conducted with considerable variation in the use of discounting, age weighting, disability weights, reference life tables, incidence or prevalence measures, and in the use of methods handling missing or poorly coded mortality data. The European BoD network (COST Action CA18218) strives to integrate and strengthen the capacity and knowledge in BoD assessment across Europe and beyond. Within this context, a series of systematic literature reviews (SLR) was performed to explore key methodological choices and differences of European BoD studies. The reviews aimed to i) identify existing BoD studies; ii) provide an overview of the specific methodological choices for calculating disease burden; and iii) synthesize the current scope and quality of BoD assessments across Europe. The ultimate aim of the literature summary is to develop a checklist for BoD studies that used DALYs. Since the review has been a continuing collaboration with a large group of members who are part of the European BoD network (burden-eu), this workshop represents an opportunity to enlarge that collaboration. Within the workshop, we will first present our aims and objectives and SLR procedures. After having presented some preliminary results, we will offer some starting points for a discussion on the implications of our findings. In particular, the presentations will be structured as follows:

Methods and preliminary results of the SLR focusing on non-communicable diseases, communicable diseases, and injuries; Methods and preliminary results of the SLR focusing risk factors; Discussion on the implications for researchers.

The workshop is meant to be an occasion to share experiences on computational variations within BoD studies and to collect input for the quality and scope evaluation of the studies.

Key messages

Shedding light on methodological approaches and data sources that have been used over the years across European countries should help to evaluate effectively the comparability of the results. The development and use of key standardized guidelines for reporting BoD methodological choices may help decision-makers to draw national-level strategies based on more accessible BoD estimates.
Physical Activity Determinants in Older People: An Analysis of the UK Understanding Society Wave 2
Authors: Ikpeme M , Pang D
Published: October 2021

Background

Ageing leads to inactivity and conditions like heart disease, type II diabetes, and risk of falls. Regular physical activity (PA) helps with a renewed feeling of ability, efficient blood circulation, balance, and coordination. In the UK, physical inactivity is the fourth largest killer of the elderly. This study examines some physical activity determinants in older people.

Methods

A cross-sectional analysis of the UKUS cohort study Wave 2 (2010-12) with participants aged 65 and above was done. The descriptive analyses involved crosstabulations and pictorials in SPSS and Microsoft Office. Data was dichotomised for 2x2 tables in OpenEpi for the univariate analyses. Multivariate analysis was via ordinal logistic regression in SPSS. As Wave 2 had no variable describing PA, a ‘total physical activity' (TPA) score was created. TPA is composed of the addition of the total walking score (TWS), total hobbies/sports score (THSS), ‘total physicality score' (TPS), and total sport frequency (TSF). All five variants were created by indexing available proxy variables unique to each category. Results were reported with odds ratios and 95% confidence intervals.

Results

Univariate analysis with TPA showed an association with some variables like income, OR = 15.25 (8.57-27.12), social interaction, OR = 2.11 (1.46-3.05), family interaction, OR = 2.69(1.45-4.98), wellbeing, OR = 312(157.5-617.9), physical health, OR = 2.84(1.39-5.81) and emotional health, OR = 2.42(1.21-5.07). Multivariable analysis after adjusting for age and sex yielded no significant associations between most PA and predictors. Some significant associations include TWS and social class, AOR= 2.59 (P = 0.013), green food consumption, and TPS, AOR= 1.47 (P < 0.05).

Conclusions

In general, higher income, gross personal income, social class, wellbeing, and green food consumption seemed to produce greater odds of participating in all physical activities.

Key messages

These findings suggest the need for other social determinants to be thoroughly investigated. There is also a need for older adults to be well provided for so these determinants of health can improve their quality of life.
Human rights approach to disability advocacy on sexual health and education
Authors: Önnudóttir Hildur
Published: October 2021

In this part of the workshop we will present an example of best practices in advocacy for CSE for children and young people with disabilities. The International Federation for Spina Bifida and Hydrocephalus (IF) represents individuals with spina bifida and/or hydrocephalus (SBH) and their families globally. IF's mission is to protect and advance the rights of individuals with SBH and as a part of that mission IF installed a formal international youth group to inform IF's advocacy on issues related to youth with spina bifida and/hydrocephalus (SBH) where sexuality, sexual health and the taboos and stigmas surrounding these topics was identified as a high priority topic for advocacy. IF will present the work of IF and its youth group, the implementation and findings of activities such as the survey on SBH and sexuality, focus group discussions and the 2020 IF event on disability rights and sexual health. With an emphasis on the role of young people in advocacy and how they were supported and empowered to address this important topic. How strong leadership from persons with SBH helped to open discussions about the challenges faced by young people with disabilities and how disability specific issues (such as incontinence) are often left unaddressed due to stigma and societal taboos. These discussions help to address the barriers to CSE for children and young people with disabilities. IF bases all of its work on the UN Convention on the Rights of Persons with Disabilities and as such meaningful participation by persons with lived experiences, inclusion and non-discrimination guide IF's work on sexuality. IF will present how those principles elevated the discussions and the outputs produced by the activities. In addition, IF will present how this was achieved in collaboration with other representative organisations for persons with disabilities and the wider impact of IF's advocacy for individuals with SBH on the disability community as well as for health and social care professionals.
An introductory course on social identities and their importance in public health
Authors: Wandschneider L , Namer Y , Siepmann I , Khutan R , Otok R , Middleton J , Razum O , Selig S
Published: October 2021

Background

Social identities - e.g., sex/gender, ethnicity, ability, sexual orientation - and their intersections shape health inequalities in societies. Yet, a systematic, critical integration into public health curricula is lacking, especially in the European region. To address this gap, we developed a curriculum on social identities and their importance in public health in collaboration with ASPHER.

Objectives

The curriculum enables students to identify mechanisms of privilege and oppression related to social identities, and to learn how to determine biases within public health structures (and oneself). Moreover, it equips them with tools and skills to address and change biases in their practices to ultimately reduce health inequities.

Results

We conceptualized the curriculum in an iterative and participatory process in a group of students, young professionals and senior researchers from different countries in Western Europe and North America. The curriculum covers three core elements: 1) the introduction of concepts and terminology on diversity, equity and social identities in relation to health inequalities, 2) the reflection on the role of public health professionals and their responsibility within this system; and 3) spotlights on specific social identities, e.g., sex/gender or social class. In addition, it provides guidance on teaching methods to empower a broad range of public health professionals to engage with the course materials more easily.

Conclusions

The curriculum has the potential to strengthen the capacities of future public health professionals to acknowledge the relevance of social identities and how to respond effectively to contribute to health equity. After piloting and revisions, the course will be made available on an open access platform.
Reflections on the presentations from the rapid Health Impact Assessment perspective
Authors: Green Liz
Published: October 2021

Liz Green is Consultant in Public Health, Policy and International Health / Programme Director for Health Impact Assessment at Public Health Wales. She co-authored a HIA report on the potential impacts from home and agile working on public health. https://whiasu.publichealthnetwork.cymru/en/hia-reports/
Mental health services use for depression: socioeconomic status, needs perception and affordability
Authors: Roxo L , Perelman J
Published: October 2021

Objectives

There is no clear evidence about the association between socioeconomic status (SES) and mental health services (MHS) use. Those with lower SES may be less prone to recognize they need MHS, but they may access free health services. This study aims to assess the link between SES, needs perception and affordability of MHS, among depressed persons.

Methods

Data from the 2019 Portuguese National Health Survey were used. Among those depressed (N = 3,807; Personal Health Questionnaire-8 ≥ 5), we used gender-stratified logistic regressions to model perception of need and affordability (unfulfilled MHS needs due to financial constraints), as a function of education and income quintile, adjusting for age group and marital status. Health insurance was used as a mediation variable.

Results

Compared to low education, high-educated men lad lower perception of need (17.2%, OR = 0.46, 95%CI=0.44-0.47) and high-educated women had higher (31.3%, OR = 1.06, 95%CI=1.04-1.07). Men in the first income quintile were more likely to recognize need (34.2%, OR = 1.26, 95%CI=1.23-1.29). Among those with self-reported needs, affordability constraints were more likely among men with higher education (61.9%, OR = 16.9, 95%CI=16.0-18.0), and less-likely among high-educated women (24.2%, OR = 0.88, 95%CI=0.86-0.91). Those in the poorest income quintile were more likely to report affordability concerns (66.5%, OR = 16.3, 95%CI=15.4-17.3 among men; 51.5%, OR = 4.66, 95%CI=4.51-4.81 among women). After adjusting for health insurance, the disadvantage of those in the poorest income quintile decreased among men (OR = 14.9, 95%CI=14.1-15.8) and increased among women (OR = 5.00, 95%CI=4.84-5.17).

Conclusions

High-educated men seem more likely to report low perceived need and affordability concerns. Low-income individuals' concerns about affordability question universal mental healthcare and may contribute to wider health inequalities.

Key messages

High-educated men seem more likely to report low perceived need and affordability concerns. Affordability concerns are more likely among low-income men and women. That questions universal mental healthcare and may contribute to wider health inequalities.
Gender differences in depressive symptoms and perception of need of mental health services
Authors: Roxo L , Perelman J
Published: October 2021

Background

Women are more likely than men to use mental health services use (MHS) when depressed. Gendered presentations of depression may contribute to explain this gender gap. This study aims to identify depression symptom profiles among men and women and to understand their relationship with perception of MHS need.

Methods

We used data from the 6th Portuguese National Health Survey, with 3,807 participants fulfilling criteria for mild, moderate or severe depression (scoring 5 or more in Personal Health Questionnaire-8). We used latent-class analysis to identify classes of depressive symptoms (using 8 symptoms from PHQ), separately for men and women. Afterwards, we characterized the needs perception (during previous year), by latent class.

Results

Latent classes identified among men were “Mood and somatic symptoms” (50.6%), “Severe depression” (32.9%), and “Somatic symptoms” (16.5%). Perception of need was low among those with more prominent somatic symptoms (8.1%), and higher for those with severe depression (42.4%). Among women, latent classes were “Mood and somatic symptoms with low self-esteem” (47.8%), “Severe depression” (26.9%), and “Somatic symptoms” (25.3%), and. Less than half (43%) of those with severe depression reported need of MHS, compared to 25.5% of those with mood, somatic and self-esteem struggles and 11.2% with somatic symptoms.

Conclusions

Less than half severely depressed men and women recognized the need for MHS. Somatic symptoms were less associated to needs perception, particularly among men. The need perception is generally low, even in case of severe depression, while gendered symptom profiles may impact MHS help-seeking behaviours.

Key messages

Depression is presented differently among men and women and that may impact mental health service help-seeking behaviours. While the need perception for mental health services is generally low, somatic symptoms were less associated to needs perception, especially among men.
Health promotion through digital means: Refugee women using video and social media in times of COVID-19
Authors: Mohammadi M , Wächter-Raquet M , Odukoya DQ
Published: October 2021

Background

Forced migration is particularly hard on women and families. On arrival in host countries, living conditions (e. g. accommodation in camps) and various restrictions connected with the process of seeking asylum severely restrict women's abilities to care for themselves and their families. Gender-based violence is just one of many problems. These problems are exacerbated during the COVID-19 pandemic.

Methods

As part of the EMPOW project at the study site in Hannover, Germany, community partners who are female refugees themselves, are committed to improving the health of other refugee women and families. To pursue this aim, a digital network was established using social media. Short videos were created in Farsi and Arabic addressing various aspects relevant to the health of refugee women and families. These include: a) information on hygiene and how to wear a mask to reduce the spread of Corona, b) activities during COVID related lockdown phases (e.g. games to play with children indoors and gymnastics and sports for adults), and c) further questions and answers on general health and health care.

Results

More than 80 women have joined the digital network within a few months. The videos are distributed and discussed using WhatsApp groups. The community partners collect health related questions from the participating refugee women, which are then answered by a medical doctor in Farsi. The groups provide an opportunity for mutual exchange and advice regarding women's health and the wellbeing of families.

Conclusions

Digital means including short, self-made videos and social media such as WhatsApp groups are valuable means for participatory health promotion with refugee women. Limitations of the digital format are discussed.

Main messages

Refugee women can be reached via social media messages and short video clips. Peer-based health promotion holds great value for women and families affected by forced migration.
Health Information Portal - One-stop-shop for health information
Authors: Tolonen H , Zaletel M
Published: October 2021

Background

A vast amount of health information in the form of data sources, experts, research networks, and tools related to collection, use and knowledge transfer of health information exists in EU Member States (MSs) but this information is scattered around and often difficult to find. Researchers and policy makers don't have a centralized place where information could be easily obtained. This hampers effective use of existing information and materials for research and evidence informed policy making.

Methods

There is a need for a centralized place where different components of health information can be easily found. Information should be described in structured, standardized format to allow comparisons and searchability.

Results

InfAct and PHIRI have established the Health Information Portal (HIP, healthinformationportal.eu), a one-stop-shop for health information. This portal brings together health information from different EU MSs and research networks and projects as well as from international organizations. HIP has catalogues on health information data sources, research networks, national nodes, health information initiatives and projects, health information related publications and guidelines including legal and ethical guidelines, and available capacity building activities. These catalogues are searchable and support open and fair access to the health information.

Conclusions

The Health Information Portal will facilitate secondary use of existing health information data for research and evidence informed policy making. Through HIP, researchers can find experts from different domains of health information as well as existing tools for data collection, analysis and knowledge transfer. It also facilitates health information capacity building within the EU. Aim is to support a more effective, also more cost-effective, health research environment which can enhance population health and healthcare in the EU, and through that productivity and European economy.
COVID-19 vaccine hesitancy among university students: how worrying is it? An Italian survey
Authors: Baccolini V , Migliara G , Renzi E , Isonne C , Massimi A , De Vito C , Marzuillo C , Villari P
Published: October 2021

Background

With the availability of COVID-19 vaccines, vaccine hesitancy (VH) poses a great challenge to achieving herd immunity. Since young adults are usually asymptomatic, they may be less inclined to follow social distancing and mask-wearing guidelines. This study aimed at (i) quantifying VH among university students and (ii) investigating its determinants to identify barriers and predisposing factors to COVID-19 vaccination.

Methods

Students physically attending Sapienza University of Rome during April 2021 were invited to take part in an online survey. The questionnaire explored sociodemographic variables, COVID-19 experience, attitude towards preventive measures, and COVID-19 vaccination. Hesitancy was measured as the complement to 10 of students' intention to get vaccinated and was modeled through zero-inflated negative binomial regression analysis.

Results

Overall, 1949 students were surveyed. Most were females (59.9%) and aged 23.8±4.9 years on average. A great proportion reported no (76.8%) or slight hesitancy (15.7%). At multivariable analysis, in the count part, being more scared for the pandemic (IRR=0.94, 95%CI: 0.89-0.98), rating COVID-19 as more severe (IRR=0.93, 95%CI: 0.89-0.98) and being Italian rather than non-Italian (IRR=0.68, 95%CI: 0.54-0.85) were associated with lower VH, but no influence was found for age, sex, self-perceived risk of infection, and being a medical student. In the logit part, rating the vaccines as safe (b: 0.92, 95%CI: 0.75-1.10) or effective (b: 0.30, 95%CI: 0.14-0.45) decreased the likelihood of being hesitant.

Conclusions

A few factors seemed to influence the intention to get vaccinated against COVID-19, including vaccine safety and effectiveness. Hence, attention should be given to planning effective communication about the vaccine profile in order to maintain and improve the public's confidence. Also, partnerships should be established among the stakeholders to ensure coordinated information sharing and dissemination.

Key messages

Almost one-quarter of the surveyed students reported VH to some extent, and a few factors seemed to play a role in the vaccination decision-making process. Among others, the perceived vaccine safety and effectiveness seemed to influence VH. Attention should be given to planning effective communication about the vaccines’ profile.
The Road to eHealth in Estonia: Lessons Learned and Future Opportunities and Challenges
Authors: Tiik M
Published: October 2021

Estonia has one of the leading eHealth solutions in Europe. Since its inception in 2008, it has been further developed to include new services, integrate private sector partners and Blockchain technology for system access and data integrity. This presentation will discuss the extensive progress and current developments in relation to eHealth and information sharing in Estonia, the factors that have been fundamental in achieving strategic goals in relation to eHealth, and future opportunities and challenges for eHealth in Estonia and across Europe. Strong national leadership that coordinates the actions of various stakeholders and finds a balance between patient autonomy and personal data use and societal benefits has been essential. Patient engagement and trust building was a core component from the beginning. There has been a specific focus on addressing digital literacy concerns and implementing strict legislation for data misuse to build trust. Realising the potential benefits of eHealth depends on the completeness and quality of the data. Continued engagement with healthcare professionals and organisations are needed to understand and address their concerns in relation to design and functionality, financial cost, and sharing information with patients. The implementation of eHealth systems internationally paves the way for the creation of a unique international health account number. Artificial intelligence offers a potential solution of addressing the complexity of healthcare and may contribute to a more efficient and effective patient experience. Careful consideration is needed in relation to consent management and developing appropriate and transferable standards.
Changes in food-related practices among families in Ireland as a consequence of COVID-19
Authors: Vaughan E , Spyreli E , Woodside J , McKinley M , Kelly C
Published: October 2021

Introduction

The COVID-19 pandemic has had an inordinate influence on people's lives, including impacts on food behaviours. This study explored the impacts of the COVID-19 crisis and ensuing public health restrictions on food-related practices of families living on a tight budget on the Island of Ireland.

Methods

Photovoice and creative mapping methods were used whereby parents were requested to take photos of factors influencing food-related decisions and draw maps of their food environments. These items were then used during qualitative interviews with 28 parents from across the Island of Ireland as a reference for discussions around the food environment and food decision-making processes of economically disadvantaged parents. Data were analysed using deductive thematic analysis.

Results

The findings were situated in Bronfenbrenner's Social Ecological Theoretical framework, conceptualising the COVID-19 crisis as an exogenous socio-historical factor that exerted significant influence on the food-related practices of families in Ireland. The pandemic and responses to it altered patterns of food purchasing, preparation, decision-making and consumption. Changes to practices included increased unhealthy snacking and grazing and consuming fewer meals outside the home. Participants on particularly low incomes relied more on benefits and subsidised food sources and consumed more cheap, processed and frozen foods.

Conclusions

This study provides insight into the impacts of the COVID-19 crisis on dietary habits. The observed changes to food practices may compound food insecurity and already high levels of obesity, particularly among children and young people, and have future implications on prevalence of nutrition-related conditions. This highlights the need for healthcare professionals and policy-makers to be cognisant of the mounting health issues that will need to be addressed in the wake of COVID-19.

Key messages

The COVID-19 crisis significantly impacted on family food related behaviours in Ireland. Post-COVID health promoters should re-focus efforts on healthy eating initiatives.
6.M. Workshop: Moral distress and moral injury in the public health community in times of COVID-19
Authors:   Organised by: EUPHA-PMH,   Chair persons: Dineke Zeegers Paget (EUPHA), Jutta Lindert (EUPHA-PMH)
Published: October 2021

During the COVID-19 pandemic, many health professionals endured moral distress and moral injury. Whereas many stories about moral distress in hospitals and care facilities were shared, little is known about moral injury among health care personnel and among public health professionals. This workshop wants to offer an opportunity to open a conversation about moral injury in general, in health care personnel and in in public health experts. The public health community should not shy away from openly discussing moral injury and moral distress due to the the Covid-19 pandemic. It is necessary to collect the stories about the situations where members of the public health community were hindered in doing what was the ethically appropriate action due to circumstances beyond their control.

Objectives of this workshop are:

Clarifying the concept of moral injury and moral distress Understanding what ‘ethically appropriate actions' are in times of a pandemic Offering a platform for sharing stories of moral distress

Key messages

Moral distress and moral injury are potential modifiable mental conditions in times of disaster and stress Identifying determinants of moral distress and moral injury is necessary to optimize Public health responses to disasters
Moral injury and moral distress
Authors: Lindert J
Published: October 2021

Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as “moral injuries.” Despite interest, there is no consensus definition of moral injury. Research about moral injury, especially among military personnel, veterans, has proliferated. The scientific study of moral injury began 2009 with the definition that moral injurious events are those that entail “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations”. These events include betrayal. Moral injury can have impact on symptoms of symptoms such as mental distress, posttraumatic symptoms, suicidal behavior, substance abuse, demoralization and hopelessness and interpersonal problems and loss of trust. For this study, conceptualize moral injury as both, the extent to which individuals appraise themselves as having committed moral violations and b) the extent to which individuals appraise themselves as victims of other betrayal or transgressive behavior. We reviewed scientific research about moral injury among healthcare personnel and the general public during the COVID - pandemic. Moral injury among healthcare personnel was related to exposure to severely ill patients and lack of support. Moral injury among the general public needs more research. To support healing in the aftermath of the COVID -19 pandemic it will be necessary to clearly define moral injury and identify potentially morally injuries events during the pandemic.
Theory and conceptual frameworks: blame and credit/centralization and decentralization
Authors: Jarman H , Williams N
Published: October 2021

In this presentation we will introduce the politics of blame-avoidance and credit taking. We will also conceptualize centralization between and within governments and lay out the conceptual frameworks which have guided this research. It is almost axiomatic in political science that politicians seek credit and avoid blame. If there is something that will be popular, they try to take credit for it; and if there is something unpopular, they will try to avoid blame and, if possible, cast blame for it onto opponents. If good or bad outcomes cannot be traced to their actions, they will try to change the subject and opt for ‘position-taking' in which they declare their fidelity to what they see as popular positions. This was the strategy adopted by many politicians of the populist radical right around the world during the pandemic, though as the pandemic wore on the ones out of power increasingly focused on blaming incumbent governments for public health measures. Centralization between governments means an increase in the power of the central government vis-a-vis other ‘subnational' governments such as regions, states, provinces, or municipalities. ‘Command and control' is a common recommendation in public health emergencies and central governments do often take powers over or away from subnational governments in crises. This is most politically contentious in federal states such Spain, Canada, or Germany, but can happen even in countries where there is a history of only local government (such as Ireland, Portugal, or the Nordic states).
How to promote maternal mental well-being in refugee mothers through home visiting: the Danish experience
Authors: Marti Castaner M , Villadsen SF , Poulsen V , Nørredam M
Published: October 2021

Refugee women are at increased risk to develop perinatal mental health problems, including postpartum depression. The fact that refugee and immigrant women suffering PPD are more likely to be exposed to poverty, lack of social support, or restricted working opportunities suggest that a comprehensive approach that addresses the broader social determinants of health is suited to effectively support their perinatal mental health needs. However, public health programs with such a comprehensive approach are scarce in most European countries. We will present qualitative findings from ‘Health nurses strengthen integration', a universal home visiting program aimed to strengthen the integration of refugee families in Denmark. The program includes a minimum of five 2-h meetings including a mind-mapping of families' psychosocial needs, a focus on parenting in a new culture, and support to connect with social and health services. Nurses are trained in cultural competencies and are provided with interpreters. We conducted 3 focus groups (n = 11) and 2 interviews with health visitors (HV) and 9 interviews with refugee mothers to identify what aspects of a comprehensive approach that foster families' integration can support the mental well-being of refugee mothers after birth. Using thematic network analysis we found how the structure, extra time, and training in cultural competence facilitated HV to use critical self-reflection and cultural sensitivity, use respectful curiosity, create a safe space for sharing, and ‘hand-hold' families in interactions with other services. These practices permitted HV understand the complex needs of families, build trust, and facilitate interactions with others services. Interviews with families illustrated how 1) feeling that someone cared ‘like family', 2) and build-bridging with services (doctor, school, job center) reduced families daily stress. Using the family stress and adaptation theory we will discuss program and policy implications.
Strategies to challenge discrimination and foster inclusivity for LGBT+Q+ youth in workplaces: a qualitative exploratory study in six European countries
Authors: Seiler-Ramadas R , Markovic L , Llop Medina L , Baros S , Bajkusa M , Horvat M , Smith L , McDermott D , Grabovac I
Published: October 2021

Background

Lesbian, gay, bisexual, trans and queer (LGBT+Q+) youth are highly vulnerable to work-based discrimination, which correlates with poor social, physical and mental health. The European Union funded WE-Project aims to empower LGBT+Q+ youth in Europe through work-based educational interventions. The first leg focused on exploring barriers and facilitators to workplace equality in Austria, Croatia, Serbia, Slovakia, Spain and the United Kingdom, gathering experiences of LGBT+Q+ youth and stakeholders.

Methods

Self-identifying LGBT+Q+ 15-26 year-olds were recruited via social media and diverse organisations for semi-structured interviews, while stakeholders from various institutions were invited to participate in focus group discussions based on standardised interview and discussion guidelines. Transcriptions were coded, categorised and thematically analysed, revealing five themes: societal discrimination influencing work-life, experiences of workplace discrimination, barriers to resolve discrimination, facilitators to overcome discrimination and creation of inclusive strategies.

Results

Overall 56 LGBT+Q+ youth interviewees and 38 stakeholders from 6 European countries were recruited. Facilitators overcoming workplace discrimination and inclusive strategies towards work-based equality for LGBT+Q+ youth were varyingly emphasised and included: clear policies, open communication, staff involvement and inclusive infrastructure, LGBT+Q+ quotas as well as education on diversity in schools and increasing visibility, legal recognition of partnerships, implementing youth centres, and access to counselling.

Conclusions

Results indicate several strategies to consider when designing interventions challenging work-based discrimination of LGBT+Q+ youth. Participating countries differ in social acceptance and legal protections of LGBT+Q+ youth, but experiences and voiced issues are similar, necessitating relevant anti-discrimination interventions throughout Europe.
Looking for a healthy breath - the importance and potential of urban green spaces in the city: Case study of Novi Sad, Vojvodina Province, Serbia
Authors: Jevtic M , Zoric M , Orlovic S , Bouland C
Published: October 2021

Urban Green Spaces (UGS) are providing multiple health related ecosystem services (ES) to Public Health by improving quality of life (QoL) and well-being. The aim of research is to provide an insight of UGS in Novi Sad, and its potential to support public health, using publicly available data. Novi Sad, as the capital of Vojvodina Province (Republic of Serbia), region with the lowest percentage of forests, needs to provide enough UGS for healthy living. The best example for this goal is one of the greenest urban areas- Brussels with 79.00km2 of UGS. The results showed that City of Novi Sad has 39.02km2 of UGS, while lowest percentage of green areas is found in the city center core, and highest in family-oriented city blocks, which is characteristic even for green cities such as Brussels. Although the distribution and positioning of UGS in Novi Sad is well planned, additional actions for improvement of the amount, quality accessibility is needed, which is supported by the City Council for green spaces of Novi Sad. Considering the lack of the green spaces in the core center of Novi Sad, the potential for creation of new green areas in such urbanized environment lies in roof and vertical greening, and community-based gardens. In light of the biodiversity loss and the climate change, the importance of various policies that include sustainable development and growth as well as preserving nature and biodiversity (SDG8, SDG11, Green Deal, etc.) is rising. It is important to define natural, sustainable, and unobtrusive methods for public health, well-being and QoL improvement, which is also important in the circumstances of Covid pandemic. The introduction of more green areas and community-based gardening in cities would improve the ES of UGS. These actions would have indirect and direct positive effect on public and individual health of local population, as well as the potential to decrease the loss of biodiversity and the effects of climate change on microscale.
An analytical framework for assessing data for health services research
Authors: Webb E , Polin K
Published: October 2021

This presentation will provide an overview of the conceptual framework we used as a basis for the analysis of the case studies. The framework distinguishes between data sets with care-relevant data i) at the individual level (i.e. microdata) and ii) at the non-individual level, and iii) from three or four large content blocks (health data, health care data, socio-demographic or economic data, environmental data). Using health data as an example, individual-level health data includes individual patient data, such as laboratory and clinical results, vital signs (body temperature, pulse rate, and respiration date), as well as diagnoses and health behavior. Non-individual level data includes aggregated data in areas such as life expectancy, years of life lost (YLL), years lost to disability (YLD), disability-adjusted life years (DALY), as well as population characteristics such as prevalence of risk factors and chronic illness. The framework we have developed shows linking possibilities that are available by either storing the data in common databases (e.g., based on an electronic health record) or by linking them via a unique personal characteristic (e.g., patient identifier). The country case studies selected in the research - largely within the European region but also Australia, Canada, the Republic of Korea, New Zealand, and the United States - are all evaluated using the same conceptual framework.
Mental health among people in prison at the time of COVID-19: all bad news?
Authors: Plugge E
Published: October 2021

Introduction

Institutional changes in prisons in response to the COVID-19 pandemic have affected the mental health of those who live and work in prisons. Infection prevention and control (IPC) measures have been implemented in prisons throughout the world to protect imprisoned people from COVID-19 and minimise harm to them and the communities in which they are situated. These efforts have been focused on minimising the risk of infection with an emphasis on individual's physical health. The current international evidence on the broader aspects of imprisoned people's wellbeing during the pandemic mostly comprises opinion pieces. These emphasise the likely negative effects of isolating imprisoned people; the picture however is likely to be more nuanced.

Methods

One national study across England used quantitative and qualitative methods to examine rates of self-harm in prisons and understand some of the underlying reasons. Another national study measured mental wellbeing, using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), in staff and imprisoned people during the pandemic.

Results and discussion

Self-harm rates have varied across the prison estate with the most notable differences seen between men and women's prisons and this is explained by several factors, including perceived safety and support networks. There are notable differences between the mental wellbeing of prison residents and staff.

Conclusions

The implementation of IPC measures has been essential to control the spread of infection in prisons and so minimise morbidity and mortality. However, for many (but not all) imprisoned people, these measures have resulted in isolation for much of the day with negative impacts on wellbeing. In future it will be important to ensure mental wellbeing is maintained and to involve the imprisoned people themselves in the development of effective interventions.
How structural and individual factors help explain socioeconomic inequalities in health behaviors
Authors: Mudd AL , van Lenthe FJ , Verra SE , Bal M , Kamphuis CBM
Published: October 2021

Socioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex pathways through which these factors influence inequalities requires more research. We examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors. Dutch adults 25 and older self-reported socioeconomic position (SEP) (educational level); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three waves (2004, 2011, 2014) of the longitudinal GLOBE study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders like baseline health behavior. Educational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed. Time orientation followed by material conditions may help explain socioeconomic inequalities in certain health behaviors, providing empirical support for the interplay between structural and individual factors. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.

Key messages

Socioeconomic inequalities in certain health behaviors were mediated by time orientation followed by material conditions, showing the importance of considering both structural and individual factors. Policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.