bluuebunny/crossref_metadata_2025 huggingface dataset:
Co-creating an intervention promoting healthy weight development during infancy
Authors: Kierkegaard L , Rothkegel Carlsson R , Ayoe Sparvath Brautsch L , Thørring Bonnesen C
Published: October 2022

Background

Childhood obesity is a major public health challenge, and it is recommended to promote healthy weight development already during infancy. It is important to co-create interventions to maximize the feasibility and thus improve the chances of successful implementation. This paper describes the co-creation process of the Danish Bloom Trial - an early intervention to promote healthy weight development among children of first-time parents.

Methods

Development of the trial is inspired by co-creation frameworks and the Intervention Mapping protocol. The co-creation process comprises three stages: 1) Evidence review, qualitative research with community health nurses (CHNs) and parents, and stakeholder consultations; 2) co-creation of the intervention content including workshops and group meetings with CHNs and other stakeholders and focus group discussions with parents; and 3) prototyping, feasibility- and pilot-testing. Currently, we are in stage 2 and have conducted four workshops with CHNs and one parent group discussion.

Results

During stage 1, we identified the intervention setting; the unique system of CHNs in Danish municipalities. Furthermore, we identified the need for developing intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security to promote healthy child weight development. The main intervention components are a course for CHNs and guidelines on how to talk to parents about behavioral risk factors. The main components for parents are eight home visits and six telephone consultations from CHNs during pregnancy and until the child is 2½ years old and a video library.

Conclusions

The description of the development of the Bloom Trial provides an example of how to co-create an intervention balancing evidence, the practical work of the implementers and the needs of the families. Co-creation with relevant stakeholders increases the chances of producing a relevant, successful, and sustainable intervention.

Key messages

• The co-creation process resulted in development of intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security from pregnancy to child age 2½ years.

• Involving parents and stakeholders in the development of an intervention increases the chances of producing a relevant, successful, and sustainable intervention.
Inflammatory bowel disease at a young age – implications for achieving upper secondary education
Authors: Rasmussen J , Nørgård BM , Nielsen RG , Bøggild H , Qvist N , Brund RBK , Bruun NH , Fonager K
Published: October 2022

Background

The incidence of inflammatory bowel disease (IBD) among children and adolescence is increasing worldwide. Having a chronic condition at a young age may affect educational achievement and later employment and self-support. The study aims to examine the impact of being diagnosed with IBD before 18 years of age on achieving an upper secondary education before 25 years of age.

Methods

Using the Danish National Patient Register (1980-2018) all patients (born 1970-1994) diagnosed with IBD at a young age (<18 years) were identified. The IBD-patients were matched on age and sex with 10 references without IBD at the index date (date of diagnosis of IBD). The outcome was achieving an upper secondary education using data from Danish Education Registers. The association between IBD diagnosis and achieving an upper secondary education was analyzed using Cox regression with robust variance estimation adjusting for parents’ highest educational level. Furthermore, stratified analyses were performed on parental socioeconomic status (education and income).

Results

We identified 3,178 patients with IBD: Crohn’s disease (CD) n = 1,344, Ulcerative colitis (UC) n = 1,834. Reference n = 28,220. The median age at diagnosis was 15.3 years (IQR: [13.0;16.9]). At the age of 25 74.0% (CI: 71.6-76.4) for CD, 75.8% (CI: 73.8-77.8) for UC, and 69.7% (CI: 69.2-70.3) for references had achieved an upper secondary education. The adjusted Hazard ratio (HR) of achieving an upper secondary education was 1.05 (CI: 1.00 -1.11) for CD and 1.09 (CI: 1.04 -1.15) for UC. When stratifying the IBD-patient with the lowest socioeconomic status performed better than their peers.

Conclusions

Being diagnosed with IBD before 18 years of age did not reduce the chance of achieving an upper secondary education. Patients with low socioeconomic status performed better than their peers, however the study gives no explanation of this.

Key messages

• Children diagnosed with IBD before 18 years of age had at least the same chance of achieving an upper secondary education compared to references.

• IBD patients with low social economic status performed better than their peers.
Importance of communication between health care professionals and forced migrant women during birth
Authors: Gaudion M , Engelhardt M , Kamhiye J , Borde T
Published: October 2022

Background

Communication and information are part of the Sexual and Reproductive Health and Rights (SRHR). Various studies show that successful communication between birthing person and health care professionals (HCP) has a positive impact on birth and lowers risk of traumatic birth experience for women. Since information and communication is a major challenge for both forced migrant women (FMW) and health workers during birth, we investigated experiences of both sides in qualitative study.

Methods

Qualitative interviews were conducted with 7 maternal HCPs (midwifes, physicians, social workers) and with 7 FMW 1-9 months after the birth of their child in 3 regions in Germany. The refugee sample included new mothers from 6 countries of origins, 14 languages, and an average of three years living in Germany. The interviews were analyzed via framework analysis.

Results

The majority of the interviewed FMW had no or little knowledge about SRHR. Good communication is one of the main factors allowing a safe and trustful environment with the birthing women. If verbal communication is not possible nonverbal communication helps to create and maintain a care relationship with the women is given. However, due to lack of staff, time and interpreters FMW with little German language proficiencies receive hardly any relevant information and had a poorer accompaniment during birth.

Conclusions

To provide for equity and SRHRs in maternal health and care there is an urgent need for reliable professional interpretation and easily accessible information in relevant languages material about giving birth, medical possibilities, procedures and interventions. Additionally, further training on heterogeneous needs and life contexts is necessary, to improve professional care during birth in maternity wards. HCPs 1:1 support is strongly recommended.

Key messages

• Information on SRHR and communication are a fundamental part of birth work and should be made possible for all women including FMW to prevent discrimination and traumatic birth experiences.

• If given, 1:1 support by HCPs during birth can comensate missing communication.
Prospective prediction of alcohol consumption among a Tunisian sample of adolescents
Authors: Zammit N , Ghali H , Ghammam R , Ben Fredj S , Ben Belgacem W , Boujebha S , Ouertani M , Maatouk A , Maatoug J , Ghannem H
Published: October 2022

Background

During adolescence, alcohol consumption represents a new experience with the advantage of facilitating the integration of a peer group. The global overall prevalence of this risk behavior among the 15-19 years old was over 25% in 2018. However, this prevalence varies between countries.

Objectives

To determine the incidence and the predictors of alcohol consumption among high school students in Sousse, Tunisia between 2017/2018 and 2018/2019.

Methods

A prospective longitudinal study was conducted in four high schools in the governorate of Sousse during the 2018-2019 school year. Pre-trained medical doctors used an anonymous self-administered questionnaire to collect data about socio-demographic and educational features, alcohol consumption, tobacco use, illicit substances use and emotional disorders.

Results

Participants accounted for 404. Their average age was 16.4 (±1.1) years. Females represented 68%. The prevalence of alcohol consumption in 2017/2018 was 5.9% while the cumulative incidence during the 2018/2019 school year was 3.5%. Among males, this incidence was of 11.9%. Among females, it was of 3% (p = 0.020). Illicit substance use among friends was the main predictor of becoming alcohol consumer with an adjusted odds ratio of 6.4 (95% CI: 1.9-21.3) on the other hand, having an anxiety trouble predicted less this risk behavior (adjusted odds ratio =0.2 95% CI: 0.1-0.8).

Conclusions

Alcohol consumption is becoming more and more common among the adolescents of Sousse especially among males. The current national strategy against substances use in schools should be reinforced. Implementation of a social skills training among adolescents to improve assertiveness is essential.

Key messages

• Alcohol consumption has an upword trend among the adolescents of Sousse.

• The current prevention programs targetting adolescents in Tunisia should be revised and integrate a comprehensive and multisectoral program.
Erasmus+sport let’s move Europa: learning units for health promotion among children and adolescents
Authors: Masini A , Zanutto G , Longo G , Marini S , Soldà G , Salussolia A , Anastasia A , Sánchez-Oliva D , Ceciliani A , Dallolio L
Published: October 2022

Background

School years are crucial for acquiring life-lasting healthy habits. However, an increasing rate of children and adolescents fail to maintain a healthy lifestyle. European Union has financed the Erasmus+ Sport Let’s Move Europa project to design an innovative digital tool for promoting healthy lifestyles among those age groups. University of Bologna, partner of the project, has developed 30 Learning Units (LUs) about Physical Activity, Sleep and Nutrition to be integrated in the school program by teachers.

Methods

A group of 17 teachers (15 females and 2 males, mean SD age 49,5 ±11,6) from primary and secondary schools located in Bologna province (Italy) took part in semi-structured focus groups (FGs). The investigation focused on facilitators/barriers of the intervention and possible solutions, identifying time frames and locations, suggestions for engaging the different stakeholders (teachers, students and families). All FGs were recorded, transcribed, anonymized, and analyzed through inductive thematic analysis.

Results

30 LUs were created based on the latest scientific evidence and the FGs output. Each LU addresses a specific topic and is tailored differently for primary and secondary school. The layout includes an investigation on the topic, classroom activities, and a section about “healthy homework” or “challenges” to be accomplished at home, engaging families in the construction of a healthy routine. All the activities were designed to be feasible and sustainable. Each LU includes a discussion phase to understand students’ feedback about proposed homework and learning content.

Conclusions

FGs have proven crucial to tailoring LUs on the needs of different stakeholders and co-designing an effective intervention. “Healthy homework” and “Challenges” encourage students to pursue healthy habits also outside the school setting, involving families. Feedback on the activity provides an insight into the progression and effectiveness of the intervention.

Key messages

• The EUmove project integrates knowledge about sleeping, nutritional and physical activity habits into the school curriculum to promote healthy lifestyles among students and their families.

• Thanks to the FGs, LUs are designed to suit the target audience. LUs integration into school curricula is therefore a feasible intervention, not requiring specialized personnel to be implemented.
Self-reported strengths and difficulties among Swedish adolescents: presence, continuity and change
Authors: Grigoryan K , Östberg V , Raninen J , Åhlén J , Låftman S B
Published: October 2022

Background

The Strengths and Difficulties Questionnaire (SDQ) is a screening instrument for emotional and behavioural problems. Swedish reference values based on large-scale national data are lacking for mid- and late adolescents. Also, there is a scarcity of longitudinal studies about the development of strengths and difficulties from middle to late adolescence. The study aims were 1) to report on Swedish adolescents’ assessment of their strengths and difficulties and to present joint and gender-specific reference values for identifying risk groups; 2) to examine the continuity and change of strengths and difficulties and to what extent this differs by gender.

Methods

Data was based on a national Swedish sample of adolescents aged 15-16 years in 2017 (n = 5338) who were surveyed again in 2019 (n = 3973). Mean values and reference values for “close to average” (0th-80th percentile), “slightly raised” (>80th-90th percentile) and “high” (>90th percentile) SDQ scores were calculated. Comparison in SDQ scores by gender and across time was approached using inferential statistics.

Results

Girls reported higher levels of emotional problems (p = <0.001), whereas boys showed higher levels of conduct problems (p = <0.001) at t1 and t2. Hyperactivity slightly prevailed in girls (p = 0.007), and peer problems were slightly higher in boys (p = 0.027) at t2. Prosocial behaviour was higher in girls than boys (p = <0.001) at t1 and t2. Changes in SDQ scores across time were in general small. Yet, analyses focusing on risk groups showed that among those who scored >80th or > 90th percentile at t1 about half scored above the same threshold at t2.

Conclusions

This study provided joint and gender-specific reference values for mid- and late adolescents in Sweden, and found some gender differences in SDQ scores and degree of change. Reported national gender-specific reference values may facilitate identifying adolescents at risk and potentially increasing timely mental health intervention measures.

Key messages

• Among the subscales indicating difficulties, the highest was level of emotional problems in girls and hyperactivity in boys; the largest increase over time was in emotional problems for both genders.

• Analyses of changes in SDQ mean scores showed only minor changes between t1 and t2, while analyses of movement between categories defined by cutoffs presented a more noticeable degree of change.
Correlates of mental health in the Swiss Household Panel – a network analysis
Authors: Gondek D , McElroy E , Bernardi L
Published: October 2022

Background

Firstly, we aim to describe any differences in the mean levels of correlates and indicators of mental health and wellbeing between young (25-39 years) and middle-aged adults (40-55 years). Secondly, we aim to compare the network models depicting interrelations between correlates and indicators of mental health and wellbeing among these age groups.

Methods

This paper draws on longitudinal data from 6 waves (2013-2018) of the Swiss Household Panel (SHP) study, with a total sample of 5,315 individuals, including 2,044 young (25-39 years) and 3,271 middle-aged (40-55 years) participants. We used network analysis to examine and present complex relationships between the correlates and the indicators of mental health and wellbeing.

Results

Middle-aged individuals had worse mental health and wellbeing on all indicators but energy and optimism, which did not differ across groups. The effect sizes (according to Cohen’s d) were small, reaching the maximum of 0.20 for sadness. Despite higher household income and financial satisfaction, perceived job insecurity and work strain were higher in midlife, with socioeconomic prestige being lower. Moreover, middle-aged individuals had lower social support, relationships satisfaction, and health satisfaction. The network was denser in midlife, with two direct interrelations being stronger in this age group: health satisfaction and energy/optimism as well as accommodation satisfaction and life satisfaction. There were also several other differences in indirect interrelations between correlates and indicators of mental health and wellbeing, including a potentially more important role of self-mastery in midlife in bridging socioeconomic indicators, wellbeing and mental health.

Conclusions

We suggest further exploring the workplace as an avenue to improving population mental health and wellbeing, with a particular focus on the role of self-mastery.

Key messages

• Middle-aged individuals appear to have worse mental health and lower wellbeing than young adults.

• Health satisfaction is not only lower in midlife, but it seems of greater importance for mental health and wellbeing.
Anxiety among students during the pandemic - Results from the C-19 German Student Well-being Study
Authors: Heumann E , Helmer SM , Busse H , Negash S , Pischke CR , Trümmler J , Niephaus Y , Stock C
Published: October 2022

Background

Anxiety is widespread among university students. The COVID-19 pandemic af-fected students’ mental health negatively. Given the long duration of the pandemic monitoring mental health remains important. This study aims to determine to which extent anxiety is preva-lent among students (1), what factors are associated with it (2) and which student groups are mostly affected (3).

Methods

The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) sur-veyed mental health and well-being of students at five universities in Germany from 27.10.-14.11.21. Anxiety was assessed using the GAD-2. Associations between anxiety and sociodem-ographic, socioeconomic/social support factors as well as health- and COVID-19-related factors were determined using multiple binary logistic regression models.

Results

The mean age of students was 24.1 years (SD = 4.9), 67% were women and 31% men. The prevalence of anxiety was 32% and diverse gender (OR = 3.98, 95% CI: 1.71-9.23), a com-plicated relationship status (OR = 1.66, 95% CI: 1.06-2.60), the lack of a confidant (OR = 2.50, 95% CI: 1.80-3.46), and financial difficulties (e.g., being able to cover monthly expenses; OR = 1.76, 95% CI: 1.36-2.29) were associated with anxiety. Participants who were worried about (re)infection with COVID-19 had a 1.28-times higher chance (OR, 95% CI: 1.03-1.59) for anxie-ty. Students who were (rather) not worried that a relative would become severely ill with COVID-19 had a lower chance to experience anxiety (OR = 0.72, 95% CI: 0.53-0.98) as well as those who were confident receiving medical care in case of an infection with COVID-19 (OR = 0.80, 95% CI: 0.65-0.98).

Conclusions

Concepts for prevention and counselling in terms of mental health problems in students should be developed considering specific stressors due to the pandemic.

Key messages

• This study shows that anxiety is widespread among university students and associated with a variety of stressors.

• The findings can help to develop specific concepts for prevention and counselling.
Stress, anxiety, and depression among healthcare workers during the COVID-19 pandemic in Kosovo
Authors: Arenliu Qosaj F , Merrill Weine S , Sejdiu P , Hasani F , Statovci S , Behluli V , Arenliu A
Published: October 2022

Background

The COVID-19 pandemic has created a very large workload burden on health systems worldwide, Kosovo is no exception to this trend. A pandemic may have a negative impact on health care workers’ (HCWs) mental health. In this cross-sectional study, we assessed the self-reported prevalence of stress, anxiety, and depression and identified their predictive factors among HCWs in Kosovo.

Methods

Data were collected on sociodemographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) online questionnaire. Descriptive statistics, t-tests, and linear logistic regression were used to analyze the data.

Results

Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining respondents were nurses, midwives, and other health professionals (22%). The prevalence rates for moderate to extremely high levels of stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. Nurses reported significantly higher mean scores for depression and anxiety than physicians (P < 0.05). Being married, having poor health, not exercising, and reporting ‘burnout’ from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (P < 0.05).

Conclusions

HCWs require specific national mental health intervention programs that will, among other effects, help raise awareness of the early recognition of symptoms related to stress, anxiety, depression, and burnout due to workload as well as the importance of regular physical exercise. These programs should be part of the national emergency preparedness, emergency response, and health sector strategy, aiming to build and sustain a resilient health system.

Key messages

• During COVID-19 pandemic, certain factors predicted higher levels of mental health burden among HCWs.

• Addressing these factors require policy recommendations with concrete systemic interventions.
Mental health of migrants during the COVID-19 pandemic: additional stressors, increased inequalities
Authors: Marques MJ , Gama A , Pedro AR , Magano R , Tiessen C , Hollanders P , Dias S
Published: October 2022

The COVID-19 pandemic has resulted in an unprecedent range of negative mental health outcomes across populations worldwide. Such effects are increasingly being documented, however an evidence gap persists on the consequences on most vulnerable groups, as certain subgroups of migrants. These populations already suffer from increased psychological burden, and the pandemic effects may potentially exacerbate adverse experiences and outcomes. This study aims to uncover the perceived impact of the COVID-19 pandemic on the mental health of migrants in Portugal and the associated sociodemographic aspects. A survey was conducted with a community-based sample of 1126 adult migrants in Portugal, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on mental health. Association between sociodemographics and mental health indicators was measured through bivariable analysis. In total, 1126 adult migrants were surveyed: 53.4% female, mean age of 35.8 years (range 18-77), 48.9% from African countries, 29.5% from Middle East/Asian countries, 21.6% from Brazil. Most participants (80%) reported feelings of agitation, anxiety or sadness during the pandemic period with 26.4% experiencing these feelings most days. The pandemic had a disproportionate impact on women (86.9% reported negative impact compared to 72.5% of men, p < 0.05), those undocumented (83.3% vs 75.4%, p < 0.05), those whose financial situation got worse since the pandemic (82.8% vs. 77.3%, p < 0.05) and those who had increased food shortages (84.4% vs 79%, p < 0.05). Migrants perceived an elevated deterioration of their mental health during the COVID-19 pandemic. In addition, particular groups such as women and those with a more insecure income or residence status are particularly susceptible to experiencing negative mental health outcomes.

Key messages

• There is a need to recognize the detrimental mental health impact of the COVID-19 pandemic on particular migrant groups and to develop interventions that target their unique needs.

• Investigating sociodemographic and migration aspects could help identifying migrants at a higher risk of experiencing mental health distress.
Up to the TASG: a participatory study on sexual health of trans and non-binary persons in Germany
Authors: Koppe U , Spurgat C , knoop JM , Hahne A , Appenroth MN , Pöge K , Hamm J
Published: October 2022

Problem

Comprehensive data on the sexual health of trans and non-binary people are not available due to lacking focus on these groups and inappropriate study designs that often fail to capture the lived realities of these communities.

Description of the practice

A participatory study was developed with trans and non-binary representatives with a qualitative part involving single and group interviews as well as the development and roll-out of a quantitative online questionnaire. After securing funding, we started the study in 2020 ensuring community involvement in as many parts as possible.

Results

A crucial component is the advisory board including people representing a broad spectrum of trans and non-binary communities, organizations, who are also representing a variety of intersectional perspectives, e.g. BIPoC and neurodiverse people. The advisory board provides crucial input to the design and conduct of the study components. For the qualitative part, a unique study design was developed using sexual health & empowerment workshops for trans and non-binary people in a trustful peer setting combined with qualitative data collection. This way, participants of the study truly benefit from participation and the data quality is improved. The quantitative study was created together with >20 community representatives. Items on gender identity, transition, and experiences of discrimination were developed using online workshops and written feedback. The questionnaire was checked by community members to ensure appropriate language. Through diverse community channels and social media, we recruited 58 participants for the qualitative part and more than 2000 participants for the online questionnaire. The results are expected in late 2022.

Lessons

Involvement of community representatives and the participatory study design ensured strong community support. This enables the capture of meaningful information on the sexual health of trans and non-binary people.

Key messages

• Using a participatory study design was crucial to the success of this study.

• We were able to conduct a study capturing meaningful data on the sexual health of trans and non-binary communities.
Psychiatric and somatic health of homeless individuals in the context of their migration history
Authors: Bertram F , Hajek A , König H-H , Wulff B , Ondruschka B , Püschel K , Heinrich F
Published: October 2022

Background

Descriptions of homeless individuals’ somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access.

Methods

A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status.

Results

306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals.

Conclusions

Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system.

Key messages

• Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants.

• Our data underline the need for specific care services for homeless individuals.
Substance use prevention among migrant children in Serbia- challenges and opportunities
Authors: Kilibarda B , Simonovic P , Medarevic A , Jovanovic V , Vasic M , Misic I , Zajeganovic-Jakovljevic J
Published: October 2022

Among almost millions of children asylum seekers registered in the EU in 2015-2017, there were one-fifth unaccompanied children. These children are facing many challenges, including substance use while at the same time the recommendations for prevention are underdeveloped in many countries. To address the issue of substance use among migrant children in Serbia, the Institute of Public Health of Serbia with the support of the UNICEF and in cooperation with other partners developed recommendations for preventive activities in 2022 based on the migrant needs and country-specific situation. In the first phase of development, a desk review of current legislation and available relevant data was done. In the second phase, in order to gain in-depth view of the challenges and opportunities, workshops were conducted in two migrant centers with medical and other staff. Based on the findings and consultation process, feasible, evidence-based interventions were recommended. Several barriers to the implementation of evidence-based prevention activities in migrant centers were identified. To address the knowledge gap on the management of acute intoxication and the current referral system, guidelines were developed. The diversity of professional backgrounds of staff in migrant centers was identified as a barrier and recommendations for further training were made. There are several barriers that need further action and solutions such as short periods of stay in centers that hinder the provision of structured programs, language barriers, and ethical issues for minors, especially unaccompanied children. Prevention activities in migrant centers need to consider the specific needs of migrants, such as language barrier, capacities, and relevant knowledge of available staff and country-specific situations. The development of guidelines and a flowchart for a referral system for migrants at risk for substance abuse and dependence can be a useful tool for staff in migrant centers.

Key messages

• Substance use prevention among migrants should be evidence-based and in line with migrant needs and country-specific situations.

• Guidelines for prevention should be available to migrant centers’ staff.
COVID-19 among migrants, refugees, and IDPs: a synthesis of the global empirical literature
Authors: Hintermeier M , Gottlieb N , Oppenberg J , Mohsenpour A , Flores S , Rohleder S , Pernitez-Agan S , Lopez J , Wickramage K , Bozorgmehr K
Published: October 2022

Background

The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health.

Methods

Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included.

Results

A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we expect to find a higher risk of infection in migrants and their disproportionate share among COVID-19 cases, and consolidate the (mental) health impacts of pandemic control measures. Our preliminary findings indicate a vast knowledge gap on vaccination coverage among migrant groups.

Conclusions

Two years into the syndemic, this review summarizes the global empirical evidence on the impact of the COVID-19 syndemic on migrant populations. With health systems often lacking related data, the review provides an important evidence base for the consideration of migrants in future pandemic preparedness policies.

Key messages

• The systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 among diverse migrant populations globally.

• Knowledge on vaccination coverage in migrants remains patchy.
Structural intervention proposals and the delegitimization of the institutions involved
Authors: van Meurs T , Oude Groeniger J , de Koster W , van der Waal J
Published: October 2022

Improving citizens’ nutritional intake is crucial to combat obesity. Especially structural interventions are effective; likely due to bypassing issues of individual agency. However, such restrictive interventions have low public acceptance, and pushback may create a negative feedback loop, adversely impacting the perceived legitimacy of the institutions involved. This may be especially so among less-educated individuals, as they consider health promotion institutions less legitimate. Recent theorizing argues this may be due to the cultural distance perceived towards those populating the institutions. As structural interventions mainly target behavior more prevalent among less-educated individuals - e.g. sugar-sweetened beverage (SSB) consumption - this perceived distance may be enhanced. With a preregistered survey-experiment among a high-quality representative sample, fielded in February ‘22, we test if proposed structural interventions affect perceived legitimacy of health promotion institutions, and if this differs between educational groups. We used the strategically selected case of interventions to reduce SSB consumption in the Netherlands - currently not tackled by official interventions. This allowed us to confront citizens with a potential - rather than implemented - intervention, singling out its effects more clearly. Respondents were randomized into i) a control group presented with an explanation of the institutions and their information provision approach; or a treatment group with this information, plus ii) a proposed sugar tax or iii) a proposed regulated decrease of sugar content. Results indicate that institutions are perceived as less legitimate when citizens are confronted with structural intervention proposals, but little evidence for a moderating role of education is found. These results can improve awareness among policymakers regarding interventions effects besides health outcomes, and their risk for delegitimizing health institutions.

Key messages

• Proposals for structural interventions decrease the perceived legitimacy of involved health promotion institutions across society.

• Less-educated citizens perceive health promotion institutions as less legitimate at baseline; structural intervention proposals maintain and occasionally increase this gap.
Patients’ migration for orthopaedic intensive rehabilitation among Italian Regions
Authors: Guarducci G , Urbani A , Carbone S , Moirano F , Messina G , Nante N
Published: October 2022

Background

Interregional patients’ migration, according to Italian Law, can be considered an expression of the (inviolable?) right to health and freedom of choice regarding place of care. It contributing, albeit perversely, to guaranteeing equity in the Italian National Health Service allowing citizens to overcome territorial inequalities in the distribution of healthcare services. The aim of our study was to analyze fulfilment of needs for orthopaedic intensive rehabilitation hospital services on site and interregional patients’ migration trends.

Methods

We conducted an observational cross sectional study on Hospital Discharge Cards provided by the Ministry of Health, upon specific request, from 2011 to 2019. The study of interregional patients’ migration, for orthopaedic intensive rehabilitation, relative to single Italian regions was carried out from data of Residents, Attractions and Escapes, which were graphically developed through Gandy’s Nomogram. Trend analysis (Cuzick’s Test) was performed through STATA. Were considered statistically significant at level of 95% (p < 0.05).

Results

In our studied period, Gandy’s Nomogram showed that only Piedmont, Lombardy, A.P. of Trento, E. Romagna, Umbria and Abruzzo had a good public hospital planning for orthopaedic intensive rehabilitation. Attractions increased significantly for Lombardy, A.P. of Trento, Veneto and Basilicata, while they decreased significantly for A.P. of Bolzano, Veneto, F.V. Giulia, Abruzzo, Calabria and Sicily. Escapes increased significantly for Veneto, F.V. Giulia, E. Romagna, Tuscany, Molise, Puglia and Basilicata, while they decreased significantly for Piedmont, Aosta Valley, A.P. of Trento, Umbria, Abruzzo and Sicily.

Conclusions

Only six regions (4 in the North, 1 in the Centre and 1 in the South) satisfied care needs of their Residents, with an Attractions minus Escapes positive balance. Only A.P. of Trento appears to have been able to reduce Escapes and increase Attractions at the same time.

Key messages

• Studying patients’ migration by type of health benefit makes it possible to identify specific situations of lack of supply.

• Patients’ migration is an indirect Index of a region’s health policy.
Viral hepatitis C – a challenge for the public health
Authors: Pakov I , Terzieva K , Kunchev M , Shalamanov D , Karcheva M , Gancheva G
Published: October 2022

Background

Viral hepatitis C (VH C) is a global health problem with overall prevalence in 3-5% of the human population. This study provides the relevance of viral genome characterization in clinical settings.

Methods

Retrospective study was conducted upon epidemiological, demographic, clinical, laboratory and viral characteristics in fifty cases of VH C confirmed with positive anti-HCV, evaluated by ELISA. Thirty eight of cases were hospitalized in different clinics of the University Hospital “Dr Georgi Stranski” - Pleven (2017-2018) and remainders were blood-donors registered in Regional Center of Transfusion Hematology - Pleven. The viral load and genotype of HCV had been investigated by Real-Time PCR in Laboratory of Virology at Military Medical Academy - Sofia.

Results

The prevalence of cases was equal and highest in age groups 30-39 years and 60-69 years (24%, respectively). Males were 69.81% (p < 0.05). Surgical interventions (26.32%), blood infusions (23.68%) and hemodialysis (15.79%) were at highest risk for VHC (p > 0.05). Thirty hospital patients were with chronic VH C (78.95%) (p < 0.05). Clinical symptoms suggestive viral hepatitis were adynamia (39.47%; OR 5.25), anorexia (28.95%; OR 2.16), heaviness in the abdomen (21.05%; OR 23.33), and 52.63% of patients were asymptomatic (p < 0.0005). Laboratory investigations revealed slightly or moderately elevated total bilirubin (mean 53.27±37.38 µmol/L; 95% CI 18.48-88.06) and transaminases - ASAT (mean 231.36±155.82 IU/L; 95% CI 79.91-382.80) and ALAT (mean 294.48±196.26 IU/L; 95% CI 96.37-492.59) (p > 0.05). Investigation of viral load of HCV revealed 22 samples with detectable viral load (range 683-673 720 copies/ml). All isolates of HCV had been proved to be genotype 1b.

Conclusions

VH C is mostly asymptomatic. Screening for anti-HCV in risk groups and genotyping of HCV will improve surveillance, reduce nosocomial HCV-infections, facilitate therapeutic management and prevent complications of infected individuals.

Key messages

• Screening for anti-HCV in risk groups and genotyping of HCV improves surveillance and reduces nosocomial HCV-infections.

• Screening for anti-HCV facilitates therapeutic management and prevents complications of infected individuals.
A matter of freedom? Right-wing populist frames of Austria’s smoke-free policy
Authors: Andreas M
Published: October 2022

Background

Even though right-wing populist parties (RWPP) are increasingly influential in Europe, their position on public health has hardly been researched. I aimed to fill this research gap by focusing on the case of the FPÖ (Freiheitliche Partei Österreichs) and its opposition to Austriás smoke-free policy. Understanding RWWP positions on health policy can help to prevent detrimental influences on health policy making. Therefore, this project aimed to investigate how the FPÖ framed Austria’s smoke-free policy and whether newspaper articles reflect these frames.

Methods

Online archives of the three most-read Austrian newspapers (Standard, Kurier, Kronenzeitung) were searched for articles on the policy published in November 2019, when the policy was implemented. Furthermore, speeches by FPÖ politicians in the parliamentary debate on the policy in June 2019 were identified via the parliamentary archive. Drawing on 4 speeches by FPÖ politicians and 29 newspaper articles, I used frame analysis to answer the research question.

Results

The analysis yielded that FPÖ politicians used authoritarian, populist, and libertarian frames to argue against the implementation of the smoke-free policy. Thus, the policy was portrayed as not being in the interest of the people, restricting personal and economic freedom, and as elitist. These frames were not reflected in newspaper reports that mainly focused on the practical aspects of the policy implementation. However, in contrast to politicians supporting the policy, FPÖ politicians were overrepresented in newspaper reports representing 47% of political actors cited in newspaper articles.

Conclusions

Authoritarian, populist, and libertarian frames were used by the FPÖ in opposition to the smoke-free policy. While these frames were not replicated by Austrian newspapers, RWP politicians were overrepresented in articles on the policy. These findings illustrate the importance of effective counter-framing by health advocates.

Key messages

• RWPP used authoritarian, populist, and libertarian frames to oppose Austria’s smoke-free policy.

• Even though RWPP frames were not replicated in newspaper articles, RWPP politicians were overrepresented in reports on the policy.
Citizen participation in healthcare: a field perspective
Authors: Timans R , de Jong J , Brabers A , Horsselenberg M , Damen L
Published: October 2022

Background

Many nations are faced with challenges regarding the sustainability of their healthcare systems. Rising costs and limited financial and human resources mean that difficult decisions regarding the provision of healthcare are imminent. Which care should be provided, when and where? These decisions will affect all current and future users of healthcare. This has given rise to calls from policy makers and others to include citizens in the decision making process. The question is how this can be done. What are viable ways of citizen participation in healthcare? What are critical issues to take into account? And how do citizens themselves want to participate?

Methods

We use results from a literature review, six interviews with organizations in the field and the results of two citizen platforms to map the challenges and opportunities for citizen participation in healthcare. We study the case of the Netherlands, a country with a long and singular tradition of participatory policies.

Results

Preliminary findings indicate there are six key decision variables that are instrumental in shaping citizen participation in the field of healthcare. Among those are the kinds of knowledge that participants possess and the valuation of these kinds of knowledge by agents in the field of healthcare.

Conclusions

We interpret the results using a Bourdieusian conceptual framework, which emphasizes the contextual framing of participation. Citizen participation can be understood as an intervention in the field of healthcare. Participation is structured by the different forms of knowledge of participants as capitals. This highlights power differences that must be understood in order to design fruitful participatory processes.

Key messages

• Citizen participation in healthcare understood as an intervention in the field of healthcare.

• Understanding power differences is crucial for designing and implementing this intervention.
Harnessing the potential of digital data for infectious disease surveillance in sub-Saharan Africa
Authors: Boenecke J , Brinkel J , Belau M , Himmel M , Ströbele J
Published: October 2022

Despite efforts by the WHO to support local surveillance strategies in developing countries, there is a lack of robust public health surveillance frameworks. As a result, early infectious disease outbreak detection and response remain a significant challenge for local health systems in low-resource settings such as sub-Saharan African countries. In contrast, the growing digital infrastructure, especially in the mobile phone sector, and the global availability of extensive digital data offer promising solutions to enhance and strengthen epidemiological surveillance. Yet, there is little insight into concepts of utilisation and transfer into local public health practice. Using Tanzania as an example, a novel electronic surveillance and early outbreak alert framework is being developed that links signals on emerging diseases with relevant contextual Open Data for rapid outbreak risk assessment. The concept focuses on haemorrhagic fever diseases, specifically dengue virus disease, which is increasingly spreading in sub-Saharan Africa. A data stack framework forms the core of the system, which augments electronic information on the occurrence of acute haemorrhagic fever syndrome, e.g., collected via mobile phone-based surveillance tools, with openly available socio-ecological context data specific to dengue. Preliminary results on the data and information flow within the surveillance framework are presented and strategies for an automated indicator-based risk assessment for dengue outbreaks will be discussed, supplemented by an agent-based simulation framework to model possible short-term outbreak scenarios. In addition, adequate data inputs, identified through an appraisal of various data sources available for Tanzania, are outlined. The framework could serve as a blueprint for designing locally implementable early warning and decision support systems integrated with existing digital surveillance infrastructure.

Key messages

• Digital health surveillance and Open Data offer great potential for early outbreak detection and supporting health decisions but require tailored solutions to benefit low-resource settings.

• Building on existing digital surveillance infrastructure, the framework may serve as a blueprint for designing an enhanced surveillance and decision support system for infectious disease outbreaks.