bluuebunny/crossref_metadata_2025 huggingface dataset:
Heat waves effect on daily mortality in districts in Madrid: The effect of sociodemographic factors
Authors: López-Bueno JA , Díaz J , Sáchez-Guevara C , Sánchez-Martínez G , Franco M , Gullón P , Núñez-Peiró M , Linares C
Published: October 2021

Background

Although there is significant scientific evidence on the impact of heat waves, there are few studies that analyze the effects of sociodemographic factors on the impact of heat waves below the municipal level.

Methods

The objective of this study was to analyze the role of income level, percent of the population over age 65, existence of air conditioning units and hectares (Ha) of green zones in districts in Madrid, in the impact of heat on daily mortality between January 1, 2010 and December 31, 2013. Seventeen districts were analyzed, and Generalized Linear (GLM) Poisson Regression Models were used to calculate relative risks (RR) and attributable risks (RA) for the impact of heat waves on mortality due to natural causes (CIEX:A00-R99). The pattern of risks obtained was analyzed using GLM univariates and multivariates of the binomial family (link logit), introducing the socioeconomic and demographic variables mentioned above.

Results

The results indicate that heat wave had an impact in only three of the districts analyzed. In the univariate models, all of the variables were statistically significant, but Ha of green zones lost significance in the multivariate model. Income level, existence of air conditioning units, and percent of the population over age 65 in the district remained as variables that modulate the impact of heat wave on daily mortality in the municipality of Madrid. Income level was the key variable that explained this behavior.

Conclusions

The results obtained in this study show that there are factors below the municipal level (district level) that should be considered as focus areas for health policy in order to decrease the impact of heat and promote the process of adaptation to heat in the context of climate change.

Key messages

There are factors below the municipal level which should be considered for health policy in order to decrease health heat impacts. Privation hamper isolation of ageing people from extreme outdoor temperatures. Therefore, in some cases poverty could become the key risk factor that explain the vulnerability to heat waves.
9.I. Workshop: Health systems performance – making the links between what we do and what we want to achieve
Authors:   Organised by: WHO, UHC2030, European Observatory,   Chair persons: Dheepa Rajan (Switzerland), Marina Karanikolos (UK)
Published: October 2021

In this session, WHO together with the UHC2030 Technical Working Group on Health System Assessment and the European Observatory on Health Systems and Policies discuss the main elements of their joint approach to HSPA. The workshop intends to propose a common and practical framework that links descriptive health system analysis with evaluation, focussing on health system outcomes. The framework's approach to uncovering health system challenges and bottlenecks and the sources of variation will be discussed - showcasing how Health System Performance Assessment can be used as a means to uncover sources of health system inefficiencies and inequities. The workshop intends to identify the links between intermediate and ultimate goals and relate these to specific actions and actors within a health system, thus providing policy makers with an actionable tool to assess performance. The session is structured into two parts. In the first part the process of developing the HSPA framework and the framework itself will be introduced. The presentation will provide insights into the joint framework based on health system functions and emphasise the links to the intermediate and final goals of the HSPA framework. This will be followed by four short case studies pertaining to the four functions - governance, financing, resource generation and service delivery - and linking specific assessment areas to intermediate and final goals. The second part is an interactive discussion, to be kicked off by the input of Kanitsorn Sumriddetchkajorn and moderated by Josep Figueras, to jointly identify the strengths and weaknesses in performance of a given health system.

Key messages

Health Systems Performance Assessments should focus on what health systems do and how well, rather than on what they are. Health System Performance Assessment should focus on performance and use their evaluative angle to get to the root causes of not achieving final health system goals.
How would the HSPA framework play out in practice? ‘Availability of Pharmaceuticals (Resource Generation)'
Authors: Rohrer-Herold Katja
Published: October 2021

A well-functioning health system relies, among other elements, on the ability to ensure safe, effective, good quality and affordable medicines. This presentation examines the relevance of pharmaceutical availability for the attainment of intermediate outcomes and final goals.
How would the HSPA framework play out in practice? ‘Cross-sectoral collaboration (Governance)'
Authors: Rajan Dheepa
Published: October 2021

The presentation will discuss housing as a social determinant of health. It will highlight how housing links to health system performance and thus demonstrate how contextual factors, usually placed outside the health system's boundaries, impact on intermediate outcomes and final goals.
How would the HSPA framework play out in practice? ‘Financial protection (Financing)'
Authors: Cylus Jonathan
Published: October 2021

The presentation will discuss how (ensuring) financial protection, being embedded in the finance function, impacts on intermediate outcomes and final goals. The presentation will therefore highlight the links between the financing sub-functions and the performance of the health system.
Patient safety attitudes in the next generation of healthcare providers. A review of the literature
Authors: Tocco Tussardi I , Benoni R , Moretti F , Tardivo S , Poli A , Wu AW , Rimondini M , Busch IM
Published: October 2021

Background

A comprehensive understanding of the attitudes towards patient safety of the new generation of healthcare workers is fundamental not only for ensuring safe, high-quality care in the present but also for creating a safer healthcare setting in the future. This study aimed to systematically review the literature on patient safety attitudes of health professional students, new graduates, newly registered health professionals, and resident trainees, and to examine potential differences in this population with respect to year of study, specialty, and gender.

Methods

We searched four databases (i.e., PubMed, Web of Science, Scopus, and PsycInfo) up to 20/02/2020 and screened also additional sources, including weekly, automatic e-mailed search alerts up to 18/10/2020. Two reviewers independently performed all methodological steps (i.e., search, study selection, quality appraisal, data extraction and formal narrative synthesis), including a third reviewer in case of disagreement.

Results

We identified 6606 records, assessed 188 full-texts, and included 31 articles. Across studies, healthcare students and young professionals reported more positive patient safety attitudes in certain domains (e.g., teamwork climate, error inevitability, received patient safety training) but showed more negative attitudes in other areas (e.g., management support, safety climate, disclosure responsibility). Women and persons with more years of study and training demonstrated more positive attitudes towards patient safety.

Conclusions

Healthcare students should receive early curricular education in patient safety to build a solid foundation for the development of a strong and healthy safety culture. Understanding the differences in attitudes between aspiring healthcare providers from different areas is important to tailor teaching and training to the specific needs of certain populations.

Key messages

According to the reviewed literature, young healthcare students and professionals’ attitudes towards patient safety differed across domains. Institutions should increase education and training on patient safety for aspiring healthcare professionals, tailor them to the specific needs of this population, and monitor attitudes over time.
Respite service for informal caregivers: evaluation of simulation-training based education program
Authors: Loeffler K , Jerusalem A , Goldgruber J , Weidinger L
Published: October 2021

Background

Currently, the care for elderly people is provided mainly on an informal basis by relatives. This is often associated with psychological and physical stress. Caregiving relatives usually take over the role unprepared and they lack both knowledge and skills to fulfil the tasks. Therefore, arrangements must be made to provide respite for family carers. Simulation training is a validated experiential learning tool traditionally incorporated in health professional education but has not been commonly used in the hands-on training of informal caregivers. This study tried to measure whether participation in a special simulation training affects the trust in one's own ability to care, the quality of life and the stress perception of caring relatives.

Methods

98 caring relatives participated in the prospective, controlled (non-randomized) intervention study. The intervention involved an eight-month educational program in a simulation-training center in Graz (Austria). The program is either Manikin-based or Standardized Patient simulation trainings and take place in a show apartment. The impact on the caregiving competence, the quality of life and the burden-of-care was measured at the beginning (T1), after four months (T2) and after eight months (T3) using validated questionnaires (Self-Efficacy Scale, EQ-5D-5L and HPS).

Results

The results show a significant influence of the education program on self-efficacy (p 0.0018) and the increase in knowledge (p 0.04) of the participants. With regard to the subjective quality of life and the perception of stress no significant effects were shown.

Conclusions

The results show that the participation of family carers at the education program has different influence on the defined parameters. Not only the stable quality of life of the intervention group but also the short-term significant reduction in subjective stress perception directly after the training can be emphasized as positive indicators for the program.

Key messages

The results show that informal caregivers benefit from simulation training, since they can apply at home what they have learned during the training. Simulation training for informal caregivers significant influence their self-efficacy and the increase in knowledge.
Capacity building primary care responses to domestic violence in Brazil: designing a training model
Authors: Lucchesi V , Signorelli M , Priotto E , Hooker L , Taft A , Hegarty K
Published: October 2021

Background

Violence against women (VAW) is a public health challenge in Brazil. The country ranks 6th globally for femicide, with a high prevalence of domestic violence, amplified by the pandemic. Primary healthcare (PHC) workers can play a significant role caring for survivors, but their training on how to identify and respond to survivors is a major gap. This study aimed to investigate frontline PHC workers' needs and concerns in the care of VAW survivors, aiming to co-design a participatory model of capacity building to be implemented in the Brazilian PHC.

Methods

This study is based on participatory action-research (PAR) through participant observation and in-depth interviews with an interdisciplinary team of 13 PHC workers from Paranaguá, South of Brazil. Data were collected between Aug/2020-Jan/2021, transcribed, coded and synthetized through thematic analysis.

Results

Major needs and concerns were: 1) unanimous need of capacity building for all PHC workers and managers; 2) training ideally should be face-to-face, and more than one day, based in practical cases (not just in theory); 3) clarifying the role of the cross-sectoral network and referral options; 4) contents needs to address confidentiality, qualified listening, empathy and respect, with practical guidance on how to approach survivors. Other issues included: integrating VAW approaches with violence against children and adolescents; ensuring PHC units have a private room to care for survivors; and electing a key professional in each unit, with more specialized knowledge, to support survivors and staff.

Conclusions

This PAR revealed key issues to collaboratively design a capacity building model for PHC in Brazil, tailored to local needs. The next step will be applying for funding to implement a pilot training.

Key messages

Frontline PHC workers routinely attend cases of VAW, therefore their insights are essential to design capacity building to care for survivors in PHC settings. Training healthcare workers to care for survivors of violence needs to address local concerns, targeting knowledge, skills and competences.
Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: a web-based cross-sectional survey
Authors: Villani L , Pastorino R , Molinari E , Anelli F , Ricciardi W , Graffigna G , Boccia S
Published: October 2021

Background

Italy was the first European country to implement a national lockdown because of the COVID-19 pandemic. Worldwide, this pandemic had a huge impact on the mental health of people in many countries causing similar reaction in terms of emotions and concerns at the population level. Our study investigated the impact of the COVID-19 pandemic on psychological well-being in a cohort of Italian university students.

Methods

We conducted a cross-sectional survey in the period immediately after the first lockdown through the administration of a questionnaire on the personal websites of students attending their undergraduate courses at the Università Cattolica del Sacro Cuore. We used the Patient-Health-Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-Scale to assess engagement, anxiety symptoms, and depression symptoms of our sample.

Results

The sample size was 501 subjects, of which 35.33% were classified as anxious and 72.93% as depressed. Over 90% of respondents had good understanding of the preventive measures despite over 70% suffered from the impossibility of physically seeing friends and partners. Around 55% of students would have been willing to contribute much more to face the pandemic. An increase in the occurrences of anxiety was associated with being female, being student of the Rome campus, suffering from the impossibility of attending university, being distant from colleagues, and being unable of physically seeing one's partner. Performing physical activity reduced this likelihood.

Conclusions

University students are at risk of psychological distress in the case of traumatic events. The evolution of the pandemic is uncertain and may have long-term effects on mental health. Therefore, it is crucial to study the most effective interventions to identify vulnerable subgroups and to plan for acute and long-term psychological services to control and reduce the burden of psychological problems.
Acculturation strategies and their impact on the mental health of migrant populations
Authors: Choy B , Arunachalam K , Gupta S , Taylor M , Lee A
Published: October 2021

Objectives

This systematic review examined the correlation between the different types of migrant acculturation strategies according to Berry's model of acculturation (integration, assimilation, separation, marginalisation) and their effects on mental health.

Methods

Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of terms to identify relevant articles. Search terms included relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were filtered using inclusion and exclusion criteria. Common mental health conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse were analysed.

Results

21 primary studies were examined, which assessed 61,885 migrants in total. Of these, 7 were cohort studies and 14 were cross-sectional studies. Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms. Marginalisation triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold. Our study has also identified 16 factors that negatively impact level of migrant acculturation, 19 factors that adversely impact general mental health of migrants, and 22 factors that increases risks of depressive symptoms in migrants.

Conclusions

Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study also established multiple factors associated with low levels of acculturation and poor mental health in migrants. Given the problem of limited public resources, governments can identify at-risk individuals using factors highlighted and channel these scarce resources to develop targeted mental health interventions for them.

Key messages

Our review found out that marginalisation had the worst effects on migrant mental health while integration had the most positive effects. The study identified factors associated with low levels of acculturation and poor mental health in migrants. Governments can develop targeted mental health interventions for these at-risk individuals.
Improving refugees’ health literacy: An assessment of the Swedish ‘teach-back’ method at group level
Authors: Wångdahl J , Drebold H
Published: October 2021

Background

Refugees report lower levels of self-assessed health and underutilize healthcare services compared to host populations. In Sweden, a course in civic orientation is offered to all refugees to facilitate their establishment and help them make informed health choices. However, an evaluation of the civic orientation indicates that refugees with lower health literacy levels do not benefit from the orientation to the same extent. To address this, the ‘teach-back' method has been taught to about 200 cultural mediators participating in the EU project ‘MILSA training platform for civic and health communication'. This study investigated perceptions of the communicators in implementing a Swedish version of the ‘teach-back' method at group level for improved health information recall called Förstå Mig Rätt (FMR).

Methods

The data was collected through semi-structured interviews and analyzed by content analysis. Deriving from a holistic view of health, Sørensen's integrated model for health literacy guided the discussion in examining how FMR contributed to health literacy.

Results

Three themes emerged: (i) Appreciating the impact of FMR; (ii) valuing the role of a communicator and; (iii) practical challenges of implementing FMR. The findings demonstrated an overall appreciation for FMR as it empowered the communicators with the ability to discover misunderstandings easier. Nevertheless, it was sometimes perceived as challenging to ask the refugees to retell information and some refugees even expressed feelings of insult. Lack of time and struggle to adapt the information to fit all also generated concerns.

Conclusions

FMR makes its largest contribution to health literacy improvements in the second competence outlined by Sørensen's model (understanding). However, for optimal utilization, groups should be adjusted for participant educational level while further clarification on when the second and third phase of the teach-back concept should transpire, is recommended.

Key messages

FMR (a Swedish version of the method ‘teach-back’) can be used for health communication on group level. The use of FMR makes it easier to detect misunderstandings when communicating.
Reliability and Validity of the Perception of Stigma due to COVID-19 in Physicians
Authors: Oktar D , Aydogan Gedik S , Sungur S , Onsuz MF , Metintas S , Kosger F , Altinoz AE
Published: October 2021

Background

Thinking that they are being stigmatized can negatively affect the mental health of healthcare workers, whose workload has already increased during the epidemic. The aim of the study was to develop the ‘Perception of Stigma due to COVID-19 in Physicians' (PSCP) and to conduct a validity and reliability study.

Methods

A 5-point Likert-type 23-item question pool was created. In order to evaluate the content validity, CGI and CGO were calculated by taking expert opinions and 18 items were selected. It was tested with 303 physicians in Turkey to determine the psychometric properties. In order to evaluate the reliability of the scale, internal consistency (Cronbach's alpha) analyzes, item analysis and test-retest reliability analysis were performed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for construct validity.

Results

Of the participants 59.1% were female. After analysis, the scale consisted of 10 items and 2 sub-dimensions. The Cronbach's alpha coefficient was 0.87 for the environmental stigmatization sub-dimension, 0.76 for the perception of personal stigmatization, and 0.88 for the whole scale. Scale items explained 61.56% of the total variance and factor loads varied between 0.66 and 0.85. Scale fit and fit index were found to be acceptable as a result of CFA. Pearson correlation coefficient calculated for test-retest reliability was 0.63, and intraclass correlation coefficient was 0.70 (95% CI 0.38-0.86, p: 0.001). In the final, the total score that can be taken from the scale was between 0-50. The mean total score obtained from the scale was 24.3 ± 7.9. Of the physicians 46.9% scored above the average. It was accepted that as the score obtained from the scale increased, the level of perception of stigma caused by COVID-19 increased in physicians.

Conclusions

PSCP is a valid and reliable tool for assessing perception of COVID-19-induced stigma in healthcare workers.

Key messages

The scale developed is a tool that can be used in studies aimed at evaluating the stigma perceptions caused by COVID-19 in physicians. During the COVID-19 pandemic, physicians' level of stigma perception obtained with the PSCP scale was high.
Psychological Resilience Training Effectiveness in Emergency Healthcare Workers in Pandemics
Authors: Caliskan Pala S , Metintas S , Ozakın E , Pala VG
Published: October 2021

Background

In the struggle with COVID-19 pandemic, Pre-Hospital Emergency Healthcare Workers(PHE-HCW) are faced with a lot of problems. It is known that people with good psychological resilience(PR) levels could successfully cope with the problems. The study was aimed to evaluate the effectiveness of the psychological resilience training program in PHE-HCW.

Objectives

This intervention study conducted on PHE-HCW. In the study, when type 1 error(α) was taken as 5% and type 2 error(1-β) was taken as 95% and the effect size was accepted as 0.5, it was calculated that there should be at least 47 HCW in the groups.To minimizing the differences between groups, two groups were selected as intervention(n = 51) and control(n = 49) by applying propensity score matching analysis, taking into age, gender, occupation and working time. The questionnaire included questions of sociodemographic characteristics and the PR Scale(PRS).The questionnaire was applied to the both groups before the program and after four weeks of follow-up. The PRS consists of six subdimensions(structural style, future perception, family cohesion, personal strenghts, social competence, social resources), and it was accepted that psychological resilience increased as the score increased. The intervention group received video training on PR(self-awareness, hopefulness, optimism, etc.) whereas online classical training was applied to the control group.

Results

There was no difference in PR score between the intervention and control groups before the intervention(p > 0.05).The mean PR score±SD increased in both groups, for the intervention group from (67.2±18.2) to (80.3±12.4) and for the control group from (64.2±19.3) to (77.7±9.5).After the follow-up, positive changes were found in all subdimensions in the intervention group and in subdimensions except structural style and social competence in the control group(p < 0.05).

Conclusions

Psychological resilience training is effective in PHE-HCW during the pandemic period.

Key messages

Pre-hospital emergency healthcare workers need psychological resilience training during the pandemic process and this training program provides a positive change in healthcare workers. Psychological resilience training programs should be developed according to the needs of healthcare workers and added to in-service training.
Trends in uptake of Pap test in Estonia: results from cross-sectional studies in 2004–2020
Authors: Suurna M , Pärna K
Published: October 2021

Background

In 2006, Estonia started organized nationwide cervical cancer (CC) screening program, but in 2020 incidence of CC in was still second highest in Europe. An estimated 80% of women have done Pap tests outside the organized screening program. The aim of this study was (1) to describe the trend in lifetime uptake of Pap test and (2) to explore trends in lifetime uptake of Pap test by age group, nationality and education among 25-64-years-old women in Estonia based on data from 2004 to 2020.

Methods

Data of 6685 women aged 25-64 years who participated in population-based cross-sectional surveys of Health Behavior among Estonian Adult Population in 2004-2020 was analyzed. Uptake of Pap test was determined by asking women whether they have ever had a Pap test. The proportion of women who reported taking a Pap test was calculated for each study year. Chi-square test for trend was used to evaluate statistically significant changes (p < 0.05) in the uptake of Pap test over the study period. Join point regression analysis was used to estimate annual percentage changes for the Pap test uptake trends.

Results

Proportion of women who reported ever having a Pap test increased from 51.1% in 2004 to 86.8% in 2020 (p < 0.001). Annual percentage change was 2.8% per year (95% CI 0.5 to 5.1%). Uptake of Pap test increased significantly in all age groups, among Estonians as well non-Estonians and across all education levels (p < 0.001).

Conclusions

Although self-reported uptake of Pap test has increased significantly during 2004-2020, particular attention should be paid to determinants of Pap test uptake to better target CC prevention activities and improve effectiveness of interventions with the further aim to reduce prevalence and mortality of CC in Estonia.

Key messages

Uptake of Pap test has increased significantly in Estonia according to data from 2004–2020. More research is needed to explore why prevalence of CC is increasing despite of high uptake of Pap test.
Stroke as an Antecedent Risk Factor for Depression among Post-Menopausal Women
Authors: Banerjee S , Huth J , Burkholder G
Published: October 2021

Background

As many as one out of every three individuals develop depression after stroke. Numerous studies have also shown a link between depression and increased rates of mortality after stroke. Additionally, the risk factors and characteristics of stroke are different between men and women. However, the association between stroke and depression has not been investigated in postmenopausal women in a nationally representative sample.

Methods

The association between currently active depression [score ≥ 10 on a Patient Health Questionnaire (PHQ)-9 scale] and self-reported history of stroke were assessed among participants from the 2005-2010 National Health and Nutrition Examination Survey (NHANES). All post-menopausal women from the nationally representative NHANES study were included in the analysis. Multivariable complex samples logistic regression was used to calculate multivariate-adjusted odds ratios (ORs) of depression.

Results

Out of the 3,636 (representative sample=44,110,822) postmenopausal women, the mean age was 62.6 ± 0.33. The ethnic distribution was 77.3% non-Hispanic Whites, 10.9% non-Hispanic Blacks, 7.5% Hispanics, and 4.3% other nationalities. In age-adjusted analysis, individuals with a history of stroke had 2.5-fold higher odds of active depression than those without a history of stroke (OR 2.57, 95% CI 1.57-4.19, p < .001). Controlling for vascular risk factors (diabetes, hypertension, C-reactive protein, and BMI) of depression and socio-demographic risk factors (age, ethnicity, and income level) attenuated the effect (OR 2.16, 95% CI 1.17-3.99, p < .05).

Conclusions

A significant association between previous stroke and current depression was found in this population, independent of vascular disease risk measures among post-menopausal women. These findings highlight the possible importance of screening for and treating depression among stroke survivors. Longitudinal studies need to be conducted assessing the mental health impact of stroke.

Key messages

Occurrence of stroke may lead to an increased likelihood of depression, especially among post-menopausal women. Due to the global COVID-19 pandemic, surveillance efforts should include mental health complication including those related to stroke.
Health sector engagement on the implementation of SDGs in Turkey
Authors: Gacal F , Çağlayan Ç , Yavuz M , Yavuz M
Published: October 2021

Turkey is a country with major environmental and climate threats, so implementing the SDGs offers significant potential to improve people's health and well-being. The Turkish government aims to take a voluntary approach to SDGs. In Turkey's 2019 report, SDG-3 on Good Health and Well-being, which is coordinated by the Ministry of Health, was promoted as one of the goals with the most progress. Non-communicable diseases (NCD) have become the main cause of death; in Turkey, the share of NCDs in total disease burden was 69.7% in 2002, and rose to 82% in 2017. In the light of the latest Lancet findings, it is clear that the NCDs burden will increase further with climate change, thus the link between health and climate should be strengthened in SDG implementation. Turkey's latest Climate Change Action Plan 2011-2023 offers an opportunity for the health sector to do so (and thus also advancing the implementation of SDG-13). To strengthen the Turkish health sector's capacity to engage on the implementation of SDGs and other relevant climate and environment policies, HEAL, HASUDER (the Association Of Public Health Specialists) and Kocaeli University, Department of Public Health launched a network in April 2020, called “Health Collaboration on Climate Change and Environment Project (CISIP)”. The project, which is financed by the EU, will organise a range of webinars, trainings, materials and facilitate exchanges for better evidence-based and health promoting policy-making. So far, these three organisations/institutions have engaged with more than 30+ different health organisations that are keen to work on the environment, climate and health intersections. The presentation will share some lessons learnt from recent CISIP activities and discuss the opportunities and challenges for the implementation of SDGs 3 and 13 in Turkey.
Continuum beliefs and mental illness stigma: A systematic review and meta-analysis of correlation and Intervention studies
Authors: Peter L-J , Schindler S , Sander C , Schmidt S , Muehlan H , McLaren T , Tomczyk S , Speerforck S , Schomerus G
Published: October 2021

Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. In a systematic review and meta-analysis, we examined whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma. We searched three electronic databases (PubMed, Web of Science and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness and stigma. Of these, 13 studies were included in meta-analysis. Continuum beliefs are consistently associated with lower stigma. Interventions were effective in manipulating continuum beliefs but differ in their effects on stigmatizing attitudes. We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of “us” and a process of identification with the person with mental illness. We discuss implications for the design of future interventions using the example of our current online anti-stigma intervention, which was developed on the basis of these considerations, containing gamified elements with the purpose of identification and involvement.
Validity of self-reported data to assess the prevalence of overweight, hypertension and cholesterol
Authors: Pelgrims I , Devleesschauwer B , Doggen K , Vandevijvere S , M De Clerq E , Vansteelandt S , Van der Heyden J
Published: October 2021

Background

Accurate data on the risk factors of non-communicable diseases is essential to build evidence-based prevention programs. In Belgium, this is assessed through self-reported (SR) data from the Belgian health interview surveys (BHIS) in a wide population sample or through objective measures from small-scale surveys (such as the Belgian health examination survey [BHES]). It has been shown, however, that relying on SR data leads to a prevalence underestimation. The objective of this study is to assess the agreement between SR and measured overweight, hypertension and high cholesterol and to provide information to do a valid correction for measurement error.

Methods

The BHIS/BHES 2018 database was used (n = 1184). Kappa coefficient was used to assess the agreement between SR and measured hypertension (systolic BP > 140 mmHg, diastolic BP > 90 mmHg, or reported use of medication for hypertension) and ICC was used to assess the agreement between SR and measured BMI. SR high cholesterol was compared to a measured total serum cholesterol >190 mg/dl.

Results

Risk factor prevalence based on SR data is severely underestimated. The agreement between SR and measured data is high for BMI (ICC: 0.92), moderate for hypertension (Kappa: 0.49) and poor for cholesterol (Kappa: 0.05). Using SR data, 45% of the people with a measured hypertension and 22% of the people with a measured high cholesterol are detected. With regressions based on the SR risk factor, age, sex and education, the measured BMI and hypertension can be predicted with a good accuracy (BMI: R2: 87%, HBP: AUC: 86%). A lower accuracy is observed for the cholesterol model (AUC: 65%). Using predicted values instead of SR data yields higher estimates of people suffering from overweight (+8% relative increase), obesity (+12%), hypertension (+24%) and cholesterol (+36%).

Conclusions

Using SR data yields to an underestimation of the prevalence of obesity, hypertension and high cholesterol in Belgium

Key messages

Relying on SR data to assess the prevalence of overweight, hypertension and high cholesterol requires a correction for measurement error. Using the predicted values from regression models based on the SR risk factor, age, sex and education, yields higher estimates of people suffering from overweight, hypertension and cholesterol.
Understanding the factors that contribute to the similarities and differences in SARS-CoV-2 testing strategies across Europe
Authors: Kamga S , Voordouw B , Koopmans M , Timen A
Published: October 2021

Background

Since the beginning of the COVID-19 outbreak, the importance of testing suspected cases has been stressed by various governments and international organizations. Early in the pandemic, the WHO's Secretary General emphasized the need to ‘test, test, test'. Nonetheless, there were some evident differences between European Member States' testing strategies. In order to get an understanding of why and how these differences developed we conducted a mixed methods study in several EU member states.

Methods

We conducted semi-structured interviews with 11 professionals with expertise in public health, laboratory diagnostics and policymaking in 8 European countries, namely Croatia, Italy, Latvia, Malta, the Netherlands, Spain, Latvia, Italy, Slovenia. Based on interview results, a questionnaire is developed to quantify to which degree a larger audience of public health, laboratory and policy-making professionals believe identified factors played a role in the national SARS-CoV-2 testing strategy.

Preliminary results

3 factors seem to play an important role in the diagnostic capacity and testing strategy. Firstly, differences in the countries' available stockpile and their ability to efficiently procure diagnostic equipment influenced testing strategies. Secondly, the variation in institutions that took ownership of the issues of developing, executing and developing the policies led to differences in the testing strategies. Lastly, all countries aimed to follow international advice and guidelines, which led to the convergence of testing strategies over time.

Conclusions

In order to be prepared for a pandemic of COVID-19's scale and make necessary adjustments in capacity building, it is important that Member States understand the factors that play an important role in both their own and other European countries' diagnostic preparedness strategies.
Competences in the management of health regions: Germany, Poland and Spain
Authors: Romaniuk P , Behrens Y , Morales I , Kaczmarek K , Cassens M , Rodríguez López C
Published: October 2021

Background

Germany has a comprehensive and diverse network of health regions, Spain has partial health regions and in Poland this model is not yet present. The purpose of this study is to summarize and compare the experiences of Spain and Germany in terms of health network managers activity, along with a potential and conditioning for the existence of similar structures in Poland, to determine what competences they need in each country and what are the similarities and differences between them.

Methods

In the three countries, 18 in total qualitative interviews were conducted with experts and stakeholders from the health sector, public administration, the health economy and health regions. The interviews focused on the current state of the health systems as well as the required competences of a regional health network manager. They were analysed for content. The following categories were created: Health, management, social skills and other competences.

Results and discussion

There is an overlap in the required competences in the three countries. A knowledge in the field of public health, the organisation and assessment of health services as well as communication and management skills are of importance. In addition, there are competences in fund raising and legal matters. Country-specific competencies and areas must be taken into account, e.g. in Germany addressing people with a migration background is a more central issue than in Poland, while in the latter country high pressure has been put on the soft skills.

Conclusions

European competence profile for managers of regional health networks is possible, which harmonizes with and complements the competence profile of public health specialists. Nonetheless, national profiles require to highlight different critical competences adapted to local conditions.

Main message

The competences of a regional health network manager are predominantly cross-national.
Support Asylum and Vulnerabilities through e-health: SAVe as a healthcare continuity tool
Authors: Diodati A , Sisti LG , Cammilli M , Fazioli C , Cimarra D , Mirisola C , Costanzo G
Published: October 2021

Issue

Migrants and refugees (M&Rs) could present different vulnerabilities and health conditions. The high geographical and setting mobility of migrants within the reception system as well as the legal and administrative variability can impact negatively the continuity of care of eventual vulnerabilities and diseases.

Description of the practice

The Italian National Institute for Health Migration and Poverty developed an IC platform to take care of migrant's health over its migration pathway in the hosting country. SAVe guarantees both the health assessment at the border and the following steps of clinical care. It offers specialized tools guiding health professionals to evaluate M&Rs' vulnerabilities as well as infectious and chronic diseases. The electronic system is compliant with the EU-GDPR and includes validated tools such as the WHO (Five) WBI, the EASO tool for special needs identification, the Italian guidelines on Border health checks and the Italian protocol for the unaccompanied minors' age assessment.

Results

The system is being implemented in 4 Italian Regions, where over 28,000 migrants are hosted in reception structures and is expected to be used in the whole Italian reception system. The migrant person is also given the opportunity to save, store and use his health records even in case of relocation to another country.

Lessons

SAVe is turning out as an innovative tool to evaluate vulnerabilities and health of M&Rs who are present in Italy. The use of validated and evidence-based tools improves the confidence of doctors in detecting vulnerabilities and social determinants of health. Its spread at National level is expected to guarantee the continuity of care. Further, the interoperation between SAVe and the National Health File would allow health data collection from the first arrival of migrant until its full integration in the country.

Key messages

SAVe is designed to evaluate comprehensively the health of M&Rs, increase the continuity of care and optimize the healthcare resources. Its socio-health and evidence based approach encourages the use as a benchmark for health data collection and health information sharing.
Barriers and facilitators to genetic testing amongst Black African women in the UK
Authors: Kabeya V , Puthussery S , Furmanski A
Published: October 2021

Background

Black African women have the lowest attendance of genetic testing services and the highest mortality rate of breast and ovarian cancer amongst women from ethnic minority groups in the UK. Therefore, this study aimed to identify the barriers and facilitators to genetic testing to enable these women to make informed choices if found eligible.

Methods

A qualitative approach was used to explore the perceptions surrounding genetic testing amongst Twenty-four women aged 23-57 Black African women in Luton. Purposive sampling combined with snowballing sampling was used as a recruitment technique.

Results

The findings revealed that most of the participants had no awareness or knowledge of genetic testing and limited knowledge of their family medical history for eligibility to attend genetic testing services. Facilitators including family member's health, funding by the National Health services and accessibility and awareness and education on genetic testing were identified.

Conclusions

This study sought to explore the perceptions of Black African women on barriers and facilitators to genetic testing to enable researchers to implement efficient intervention that would increase genetic testing attendance whilst addressing the other barriers and facilitators to alter Black African's women health seeking behaviours.

Key messages

Identify barriers and facilitators to genetic testing amongst Black African women in the UK. This study highlights the need for further research into health seeking behaviour among Black women that could contribute to the low uptake of genetic testing.
11.B. Workshop: COPERS - an international longitudinal study on coping and resilience during the COVID-19 pandemic
Authors:   Organised by: EUPHA-PMH,   Chair persons: Ledia Lazeri (Hungary), Jutta Lindert (EUPHA-PMH)
Published: October 2021

Background

Mental health and resilience during the COVID-19 pandemic is a challenge for all indivduals. While evidence is emerging that the COVID pandemic has affected mental health of everybody, at this point, no comparable data about the extent of the COVID-19 pandemic impact on mental health and resilience on citizens in Europe are available. We aim to fill this gap in knowledge.

Methods

We conducted a longitudinal study in eight European countries including 18+ year old individuals using mixed methods sampling (e.g. convenience sampling, panel data sampling). Main outcomes were depression, anxiety, post-traumatic symptoms and resilience. Depression was assessed with the PHQ-9, anxiety with the GAD-7, substance use with the Audit, resilience with the BRS and the CD-RISK, stress symptoms with the Impact of Event Scale (IES-R). We assessed as potentially influencing factors socio-demographic factors (location, age, gender, education, profession, living situation), and COVID-19 specific factors, furthermore we investigated social support, social capital, loneliness, and domestic violence and alcohol consumption (AUDIT). We analyze every measurement point, starting from the baseline data, cross-sectional and longitudinally. For the longitudinal analyses, multiple linear regression analyses, simple logistic regression analyses, and multinomial logistic regression analyses are conducted to examine resilience trajectories. Furthermore, to simultaneously control for many variables that potentially confound the relationship between a mental health and resilience, propensity score matching is applied.

Results

In total as of 30. April. 2,442 individuals participated (female: n = 1,582 (64.8%), male: n = 672 (27.5%), diverse: n = 5 (0.2%), missing: n = 183 (7.5%) as well as an age bias (Median=33, Mean=36.30, SD = 14,46, age range=18years-80 years. Mental health outcomes varied widely within and between countries. In this panel European and country specific data will be presented and discussed. We present the data on behalf of the COPERS consortium, other members of the consortium will be present at the discussion.

Speakers/Panelists

Jutta Lindert Hochschule Emden-Leer, Emden, Germany Marija Jakubauskiene Vilnius University, Vilnius, Lithuania Marija Jevtic Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia Edvaldo Begotaraj Department of Social and Developmental Psychology, Sapienza University, Rome, Italy Alessandro Morganti Politecnico di Milano, Milano, Italy

Key messages

To the best of our knowledge, no comparable multinational data about the impact of the COVID-19 pandemic impact on mental conditions and resilience on citizens in Europe are available. Scope and extent of mental conditions during the COVID pandemic vary; country specific most vulnerbale groups are identified.