bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases
Authors: Bal M , Yücel E , Salış E , Dinleyici M , Arslantaş D , Ünsal A
Published: October 2024

Background

Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents.

Methods

This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy.

Results

The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334).

Conclusions

This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school.

Key messages

• Health professionals have a critical role in reducing vaccine hesitancy.

• It would be appropriate to plan face-to-face or online programs with parents.
Implementation as the acid test: International lessons from Universal Health Coverage reforms around the world
Authors: Farsaci L
Published: October 2024

Introduction

Health systems around the world are moving towards Universal Health Coverage, which is included in the Sustainable Development Goals. However, the journey towards UHC began decades ago, with countries in Europe introducing national health services following World War II. This was mirrored in Canada and, more recently, countries in Latin America introduced health reforms as part of broader social movements. Since the millennium, reforms have also taken place in Low and Middle Income Countries as well as High Incomes Countries. However, because the introduction of UHC often necessitates far-reaching reforms, countries face significant challenges along the path of policy implementation.

Methods

A realist review explored international experiences of introducing and implementing UHC. Embase, Medline and Web of Science were searched. Descriptive, inductive and deductive realist analysis aided the development of Context, Mechanism, Outcome Configurations, alongside stakeholder engagement.

Findings

How countries go about establishing UHC depends on their social, political, cultural and economic contexts. For reforms to be facilitated, there must be cohesion and commitment across all systems, as well as the functions of financing, governance and service delivery. This includes political support, often underpinned by legislation framing healthcare as a human right, as well as communication between stakeholders and the development of a strong primary care sector. Conversely, fragmentation across these systems and functions pose significant barriers to reform.

Conclusions

Examining international experiences of UHC reforms supports learning around the factors that facilitate or challenge implementation. These learnings empower policy makers and health system leaders by providing roadmaps for reform implementation. Finally, this research provides insights into health inequities that are rebalanced through the implementation of UHC reforms.
Maternal pre-pregnancy weight and infant spontaneous movement: is there an association?
Authors: De Pasquale L , Palandri L , Marrozzini L , Trevisani V , Scasserra M R , Bertoncelli N , Facchinetti F , Iughetti L , Lucaccioni L , Righi E
Published: October 2024

Introduction

Maternal pre-pregnancy overweight status might create a chronic systemic inflammatory environment for the foetus, impairing neurons development. The Motor Optimality Score-Revised (MOS-R) is an established tool to assess infant spontaneous movement at 3-5 months helping predict later neurodevelopmental outcomes in infants, including language, minor neurological dysfunction or learning difficulties at school age. The aim of our study was to investigate if maternal BMI together with other characteristics were potentially associated with MOS-R score at 3-5 months in a sample of newborns representative of physiologic full-term pregnancies.

Methods

128 mother-children couples were enrolled in the Hospital of Modena, Italy. Mothers’ socio-demographic characteristics and BMI pre and during pregnancy were collected. MOS-R was assessed in infants within 9-18 weeks post term age (Median 13, IQR 12-14). Descriptive statistics, bivariate associations and multivariate analysis were performed.

Results

In our sample, 94.5% of infants (44% females) had a MOS-R≥25 (optimal score), 3.9% a MOS-R between 23-24 and 1.6% a MOS-R<23. In bivariate analyses pre-pregnancy BMI≥25 and weight gain higher than recommended during pregnancy were associated with MOS-R<25 (p < 0.05); being unemployed before and during pregnancy and having pregnancy during COVID lockdown were associated with reduced “age adequate movement repertoire” subcategory (p < 0.05). In multivariate analysis, pre-pregnancy BMI≥25 remained the only factor significantly associated with lower scores (p < 0.05).

Discussion

Our sample of healthy infants showed a typical range of spontaneous movements reflecting neural integrity. However, lower MOS-R scores were associated with pre-pregnancy overweight. This finding reinforce the importance of enhancing public health actions targeted at keeping a weight in the normal range to protect from a large number of unhealthy conditions both the mother and the offspring.

Key messages

• Pre-pregnancy weight appears associated with infant spontaneous movement in 3-5 months infants.

• Public health actions targeted at keeping female weight in the normal range must be strengthen.
Electromagnetic fields exposure and neuropsychological effects in young people
Authors: Polanska K , Jankowska A , Scieszko M , Politanski P
Published: October 2024

Background

In recent years, there has been a large increase in the use of communication/connected devices and technologies. This raises a question about radiofrequency electromagnetic fields (RF-EMF) exposure levels and neuropsychological effects of RF-EMF in young people. The aim of this study was to assess the pattern of use of communication/connected devices and technologies and its impact on cognition and mental health of early school age children in Poland.

Methods

The study population consists of 293 children from Polish Mother and Child Cohort (REPRO_PL). The study was based on questionnaire data covering type and duration of usage of communication/connected devices and technologies by mothers during pregnancy and children at age of 7 years. The environmental exposure to RF-EMF was also taken into account. Based on such data RF-EMF exposure was assessed. Child emotional and behavioral assessment was done by Strengths and Difficulties Questionnaire whereas IQ and psychomotor development of children was performed by psychologist using Intelligence and Development Scales.

Results

About 75% of young people used smartphones (2% for voice calls and 7% for Internet browsing at least one hour per day). Tablet or laptop use was declared by 59% and 56% of respondents, respectively. More than 10% declared that they use these devices at least one hour a day. The main factors determining the use of new technology devices were parental age and education (p < 0.05) and the age at which youth started school education (p = 0.06). In multivariable regression model higher level of RF-EMF was associated with total difficulties and emotional problems (p < 0.05).

Conclusions

This study presents the pattern of use of new technology devices by early school age children in Poland and the association between the exposure to RF-EMF and child mental health.

Key messages

• The use of communication/connected devices and technologies is common among young people in Poland.

• The exposure to RF-EMF can increase mental health problems among young people.
Reform of the Irish health system towards Universal Health Coverage and the role of the private sector
Authors: O’Donoghue C
Published: October 2024

Introduction

Ireland stands as a compelling case study of a High Income Country setting out on Universal Health Coverage (UHC) reforms. The Irish health system has historically been a two-tier system with a large private sector and a high proportion of the population holding private health insurance (48% in 2023). The reform programme Sláintecare, adopted as a policy direction by all political parties, aims to introduce UHC, strengthen primary care capacity, address inequitable access and decentralise decision-making. The overall aim of this study is to chart the progress of the Sláintecare reforms, from their introduction in May 2017 up to December 2023, and to explore how they have changed throughout implementation.

Methods

A document analysis was undertaken using the READ approach. Department of Health publications, Budget reports, Service Plans, National Development plans, minutes of Health Service Executive committee meetings and transcripts of the Joint Committee of Health sessions in the Irish parliament were uploaded to NVivo and a content analysis was conducted, utilising predetermined themes.

Results

Areas that have made the most significant progress include the expansion of community care and lowering of some out-of-pocket costs. Since implementation began, one approach the government has taken has been to use the private sector to fill capacity gaps in the public system. For example, strategies for reducing waiting lists and using community diagnostics have largely used the private sector. However, through using the private sector, money is taken away from building capacity in the public system, which was the original goal of Sláintecare.

Conclusions

The private sector plays a significant role in providing care in Ireland and leveraging this for the benefit of public patients could play a positive role towards UHC, provided that funding for a purchaser-providers type model for some services from the government could be guaranteed into the future.
Young North African migrants in Europe: exploring their health and the adequacy of health services
Authors: Jackson Y , Rocilla Arachega E , Broers B , Chamay Weber C , Rigumye O , Pinon M
Published: October 2024

Background

Over five million people from North Africa (NA) lived in Europe in 2019, including youth characterized by intense trans-border mobility, precarious living conditions and high-risk behaviours such as prostitution and illegal activities. This population challenges health professionals and institutions ability to deliver medical care and health information remains scarce. This scoping review aims to better understand NA adolescents and young adult (aged 12-25) health status, access to and use of healthcare.

Methods

Following the Arksey and ÓMalley process and based on the Population-Concept-Context framework, we searched the CINAHL, Cochrane, Embase, PubMed, PsycINFO and Web of Science databases for peer-reviewed articles and non-index reports. We systematically tracked references.

Results

Initial search returned 5319 articles of which we included 13 (2 Spanish, 2 French, 3 German). All reported about observational studies. Nine of 13 papers included males only and 11 focused exclusively on unaccompanied minors. They reported about physical health conditions related to poverty such as dental caries, iron deficiency and dermatological conditions (n = 5) or infectious diseases, notably tuberculosis (n = 7). Trauma-related mental health conditions were frequently reported (n = 7), including post-traumatic stress disorder and alcohol, cannabis or benzodiazepines harmful use with frequent overlapping presentations. Three studies discussed multi-pronged barriers to healthcare, emphasizing the importance of transcultural approaches and attention to social factors.

Conclusions

Embedded into multiple factors of vulnerability, poor physical and mental health is commonly associated with young NA migrants. Evidence is limited in scope and quality notably about females and young adults. There is an important gap about optimal strategies to deliver tailored health services, notably to respond to complex mental health needs.

Key messages

• The complex health needs and barriers to care of young NA migrants in Europe are not adequately documented, understood, and addressed.

• Particular attention should be paid to trauma-related mental health conditions.
An observational study in Roma women in Greece: measuring health factors in an understudied group
Authors: Zota K , Dalma A , Tzirita S , Kouvari M , Katsas K , Zioga E , Drougos N , Karnaki P , Veloudaki A
Published: October 2024

Background

The Roma have always been one of the most vulnerable and at the same time understudied minority groups in Europe, living under difficult conditions and experiencing discrimination. The aim of the present work was to summarize the health and lifestyle profile of Roma women living in various regions of Greece.

Methods

A multi-center, observational study was implemented in April-June 2022, in the context of a national program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach”. Roma women, living in 5 areas of Greece, and health professionals working with Roma groups were considered as eligible to participate. A two-step, methodological approach was followed: a. qualitative study with Focus Groups and b. questionnaire-based survey.

Results

In total, n = 41 participants in FGs, and n = 99 responders in survey were recorded. 40% of participants were smokers (>10-15 cigarettes/day). Main quitting reasons, were “to set a good example and cost’. Increased consumption of ultra-processed foods and beverages, low plant-based foods intake, frequent breakfast omission and eating-out were reported by the vast majority of participants. Only 15% of responders had undergone typical, gynecological, screening tests while 1 in 5 responders used contraception. Regarding vaccinations, even if about 8 in 10 women seemed to comply with the obligatory vaccines for their children, a high vaccination reluctancy in 70% of the study sample was recorded in case of vaccination in adulthood.

Conclusions

This study stands one of the very few that underscore the vulnerability of Roma women in terms of poor health literacy, unhealthy lifestyle behaviours and low motivation to typical preventive measures. Improving access to primary health care services and tailored, culturally sensitive training is crucial.

Key messages

• Social inclusion of the increasing population of Roma women is crucial.

• Health promotion, taking into consideration Roma women’s special needs, shall be a decisive factor of this process.
Health status by time of arrival among Ukrainian refugees in Norway
Authors: Labberton A S , Ozeryansky L , Helland Y , Skogheim T S , Hansen T M
Published: October 2024

Background

Over 75000 refugees from Ukraine have come to Norway since February 2022. Previous studies show that the refugees have poor health for several domains, and reports suggest that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to measure self-reported health in a sample of adult refugees from Ukraine according to month of arrival to Norway in 2022.

Methods

Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22 - 31.01.23. Recruitment was via multiple potential physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of Hopkins Symptom Checklist (HSCL-5).

Results

Among 727 respondents, 82% were female, 65% aged 30-49 years, 69% had higher education and 53% responsibility for children in Norway. 383 arrived February-April (T1), 200 May-August (T2) and 144 September-December (T3). Compared to T1, later periods had higher proportions of males, a younger age distribution and lower proportions with higher education. Proportions reporting poor/very poor overall health, presence of long-term illness, and long-term disability were highest in T3. Oral health and HSCL-5 showed an opposite trend, with lower proportions reporting poorer health in both later periods. Respondents in T3 were still more likely to report poor health and long-term illnesses after adjusting for sex, age and education.

Conclusions

Respondents arriving later in 2022 generally reported poorer long-term health, but less psychological distress than those arriving earlier. These findings may help to inform planning of health services to refugees from Ukraine, especially in areas receiving large numbers of refugees.

Key messages

• Refugees from Ukraine arriving earlier to host countries appear to have generally better health compared to those arriving later.

• Refugee health services should plan and scale accordingly when large numbers of refugees are expected as a result of international crises.
Impacts of an interpretation fee on immigrants’ access to healthcare: A Danish survey study
Authors: Nielsen M R , Jervelund S S
Published: October 2024

Background

In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. The fee entails out-of-pocket costs ranging from 26-225 EUR per consultation, outpatient visit, or hospital admission. Little evidence is available on how immigrants experience impacts of the fee on their access to healthcare. The study aims to address this gap.

Methods

Using survey data collected among newly arrived immigrants (n = 486) at 26 cluster-randomly selected language schools in 2021, we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had caused immigrants to refrain from seeking healthcare, using ad hoc interpreters, and trying to learn Danish faster.

Results

In the study population, 19% (95% C.I. 14-26%, n = 95) reported interpretation needs. Refugees and their families (OR: 10.2, 95% C.I. 5.3-19.7) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.9, C.I. 1.2-2.8), low income (OR: 2.6, C.I. 1.6-4.5) or poor self-perceived health (OR: 3.2, C.I. 1.1-9.2), adjusted for gender, age, region of residence, and length of stay. Among immigrants needing interpretation, 42% (C.I. 32-53%, n = 69) reported having refrained from seeking healthcare due to the fee, 73% (C.I. 55-86%, n = 119) using ad hoc interpreters, and 77% (C.I. 59-89%, n = 126) trying to learn Danish faster.

Conclusions

Findings suggest that the policy aim of incentivizing resettlement country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care, especially for vulnerable immigrants. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants’ access to healthcare.

Key messages

• Healthcare interpretation fees appear to be incentivizing acquisition of the resettlement language, but at the same time severely hamper access to care.

• The fee appears to disproportionately affect vulnerable immigrants, including refugees and their families and immigrants with low education, low income, and poor health.
Immigrants and nurses’ perspectives on the barriers in using health promotion services in Finland
Authors: Nekouei ML M , Lindström J , Turunen H
Published: October 2024

Background

The incidence of chronic diseases and health disparities is high among immigrants. Lack of access to health promotion services targeting the needs of the immigrant population was reported. This study aimed to explore the perspectives of immigrants and nurses on the barriers to using health promotion services in Finland.

Methods

A qualitative study with 12 focus group interviews was conducted in various cities across Finland. A total of 69 participants, including 46 adult immigrants and 23 registered nurses, were selected through purposive sampling. A semi-structured interview was used. Interviews were transcribed verbatim and analyzed using content analysis.

Results

The analysis generated four themes: insufficient individual factors (i.e., knowledge, skills), restraining cultural norms (i.e., unhealthy cultural habits, gender disparities), inadequate health promotion services (i.e., lack of resources, structural limitations), and negative environmental impacts on health behavior (i.e., sweet foods and beverages, cold weather).

Conclusions

The findings suggest reinforcing health promotion services to prevent chronic diseases among the immigrant community. Providing health education resources that are culturally tailored helps improve immigrants’ knowledge to make healthier decisions in their own lives after migration. Moreover, it is recommended to introduce the health care system of the host country and healthy habits during the integration process, along with language training.

Key messages

• Improving equity in using health promotion services for immigrants requires reforms.

• More strategies are needed to prevent chronic diseases among immigrants in Finland.
Understanding and addressing the needs of refugee and asylum-seeking children and young people
Authors: Stevens A
Published: October 2024

Issue/problem

Europe is home to an increasing number of refugee and asylum-seeking children at risk of health and wellbeing needs due to their life experiences. They are frequently marginalised, impoverished, and face barriers accessing the healthcare and support they need. Bevan, an English social enterprise providing health and wellbeing services to Inclusion Health populations, carried out a needs assessment of migrant children registered at one of its General Practices to determine challenges and opportunities to ensuring their right to health. The knowledge and learning generated is relevant across sectors; organisations and geographical boundaries.

Description of the problem

The assessment included a literature review, audit of child new patient health checks, service mapping, multi-agency stakeholder interviews and a consultation event with unaccompanied minors. Findings informed Bevan’s Migrant Children and Young People (CYP) Strategy, local service development and system-wide recommendations.

Results

Key areas of concern identified included mental health; safeguarding; development; nutrition; and inter agency working. Challenges to meeting needs were complex and included national policies, poor provider understanding of rights and entitlements, language and cultural barriers, health service waiting lists, housing and silo-working.

Lessons

Responding to findings Bevan invested in an in-house CYP mental health service and CYP social prescriber, opened a drop-in clinic and wellbeing service for unaccompanied minors, and initiated orientation and health information sessions for new arrivals with peer advocate support. Bevan now hosts a city-wide cross-sector Migrant CYP stakeholder group and collaborates with regional and national partners to develop resources to promote the health of migrant CYP.

Key messages

• The needs assessment enabled development of a responsive integrated service for migrant CYP that meets their health needs and addresses their social determinants of health.

• The Migrant CYP stakeholder group has improved inter-agency working, helped identify service gaps, increased advocacy opportunities, and facilitated co-creation of solutions to meet population needs.
Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy
Authors: Paduano S , La Torre M , Borsari L , Kahfian Z , Incerti F , Carlei A , Liguori A , Bargellini A , Filippini T
Published: October 2024

Background

Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre.

Methods

This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed.

Results

A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR.

Conclusions

The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals.

Key messages

• The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach.

• Clinical data collection will support health policies’ choices to protect vulnerable individuals.
Molecular transmission clusters in newly HIV-1 diagnosed migrants in Portugal from 2014 to 2019
Authors: Pingarilho M , Videira A , Miranda M , Sebastião C ,   BH BEST-HOPE study group, Seabra S , Oliveira Martins M R , Gomes P , Pimentel V , Barroso Abecasis A
Published: October 2024

Background

Portugal has an important HIV burden with a total of 804 diagnosed cases in 2022. Migrants remain a significant source of HIV infections, with 45% of newly reported cases. We aimed to evaluate the characteristics of HIV-1 molecular transmission clusters (MTCs) among migrants followed in Portugal, diagnosed between 2014 and 2019.

Methods

265 migrants, newly HIV-1 diagnosed were included in the BESTHOPE project with clinical, socio-behavioral and genomic data. Pol nucleotide-based phylogenetic analyses were used to infer HIV-1 MTC. Those were constructed using ClusterPickerGUI_1.2.3 considering SH-aLRT higher than 90 of branch support and a pairwise genetic distance of ≤ 4.5. Logistic regression analyses were used to examine the relationship between the sociodemographic and clinical data associated with HIV-1 clustering.

Results

66.8% of the migrants included in the study were males with a median age at diagnosis of 36.0 years old (IQR:29-45). Most migrants were from African countries (50.6%) followed by Brazil (39.6%). Sixty-eight (33%) of the migrants were included in clusters. Being in cluster was significantly associated with region of origin, with individuals from South America more likely to be in cluster (OR = 14.85, 95%CI:1.52-144.79), compared to individuals from Africa; with transmission route, with men who have sex with men (MSM) more likely to be in cluster (OR = 23.52, 95%CI:2.35-235.10), compared to the heterosexuals and with subtype, with subtypes B less likely to be in cluster (OR = 0,017, 95%CI:0,001-0,254) compared with subtype non-B.

Conclusions

Migrants HIV transmission clusters in Portugal are associated with specific health determinants, such as region of origin, transmission route and subtype. Targeted prevention health strategies are needed to mitigate transmission of HIV within this population. Funded by FCT to GHTM - UID/04413/2020 and LA-REAL - LA/P/0117/2020; BESTHOPE (HIVERA:249697); and MARVEL (PTDC/SAU-PUB/4018/2021).

Key messages

• HIV transmission clusters in migrant are associated with their region of origin, transmission route and subtype.

• Targeted prevention health strategies are needed for the migrant population.
Health disparities among in multicultural and non-multicultural families in South Korea
Authors: Song K S , Lee E J , Lee J H
Published: October 2024

South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue.

Key messages

• Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures.

• Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.
Mortality in migrants with dementia living in the Lazio region, Italy
Authors: Acampora A , Angelici L , Cascini S , Cacciani L , Canevelli M , Cova I , Contoli B , Pomati S , Bellomo G , Bargagli A M
Published: October 2024

Background

Dementia is a major cause of disability and death among older people. Older migrants living in Italy are increasing and the prevalence of dementia is expected to rise in this population. Nevertheless, there is lack of real-world information concerning their health outcomes. The aim of this work was to analyse mortality in migrants with dementia living in Lazio, Italy (IMMIDEM project, GR-2021-12372081)

Methods

In a retrospective cohort study, people with dementia aged ≥50 living in Lazio on 31st December 2018 were selected using Health Information Systems (HIS) and followed-up for 5 years. The migrant status was defined according to the Country of birth as native Italians, people from High Migratory Pressure Countries (HMPC) or Highly Developed Countries (HDC). Age-standardized mortality rate (SMR) was estimated overall and by migrant status. Time to event analysis was performed using Kaplan-Meier curves, log-rank tests, and multivariate Cox regression.

Results

On 31st December 2018, 38,835 individuals with dementia were living in Lazio, 2.1% from HMPC and 0.9% from HDC. Natives and HDC were older than HPMC, while migrants showed a higher proportion of female. The SMR was lower in migrants from HPMC (42.2%; CI95% 37.0%-48.1%) and from HDC (33.2%; CI95% 25.4%-43.4%) than among natives (52.4%; CI95% 50.7%-54.1%). The age-adjusted mortality hazard ratio (HR) was lower in migrants (HDCs HR = 0.76, CI95%:0.66-0.89; HMPC HR = 0.88, CI95%:0.80-0.97) than natives.

Conclusions

The study showed a lower mortality rate among migrants with dementia compared to native Italians. Under-diagnosis, the “salmon bias”, and the “‘healthy migrant effect” could explain this apparent paradox, consistently with available literature. In addition, following-up migrants in the HIS may be difficult and underestimation may occur. Enhancing the comprehension of this phenomenon could allow the formulation of more effective, diversity-sensitive policies and practices for the management of dementia.

Key messages

• The mortality rate among migrants with dementia was found lower than that among native Italians.

• Understanding the morbidity and mortality patterns in migrants with dementia is important to develop practice to adequately respond to their health needs and diversity-sensitive polices.
Validity of the Multigroup Ethnic Identity Measure for Māori, Pacific, Asian & European adolescents
Authors: Neumann D , Yao E , Feng L , Taufa S , Liang R , Kingi T K , Atatoa Carr P , Fenaughty J , Paine S J
Published: October 2024

Background

Ethnic identity is important for positive health and wellbeing outcomes, especially for Indigenous youth and adolescents from minoritised ethnic groups. The Multigroup Ethnic Identity Measure (MEIM) is widely used to examine ethnic identity as a general phenomenon across ethnic groups. However, evidence regarding its validity for adolescents from different ethnic backgrounds is mainly limited to the US context. This study investigated psychometric properties of the MEIM, for the first time, within a large ethnically diverse population-based sample in New Zealand.

Methods

We used data from the Growing Up in New Zealand study. Participants were 4500 12-year-olds and included 22.4% Māori (the Indigenous people of New Zealand), 16.7% Pacific, 14.8% Asian and 51.9% European young people. 45.7% were cisgender boy, 37.4% were cisgender girl, and 16.4% were non-binary, trans or unsure. We conducted factor analysis for the 12-item MEIM.

Results

Confirmatory factor analysis model fit tended to be best for a solution with two factors representing two ethnic identity subcomponents of Exploration and Affirmation/Belonging. A single ‘ethnic identity’ factor showed a slightly weaker model fit. Exploratory factor analysis revealed a 2-factor structure with a slightly different item composition as compared to the original MEIM subscales. The findings were largely comparable across ethnic groups.

Conclusions

The MEIM appears to be a valid measure for Māori, Pacific, Asian and European young people. However, nuances may exist due to unique contexts including structural factors, societal norms and challenges, opportunities and access to cultural engagement. Ethnic identity is strongly linked to health and wellbeing including quality of life, self-esteem and life satisfaction. Therefore, we recommend acknowledging nuances of ethnic identity during an important time of development within diverse cultural contexts, by applying subscales and subgroup analyses where possible.

Key messages

• The Multigroup Ethnic Identity Measure is valid and appropriate to use at age 12-years among diverse ethnic groups including Māori, Pacific, Asian and European.

• Nuances of ethnic identity should be acknowledged as an important factor for health and wellbeing, especially during critical times of transition for adolescents within diverse cultural contexts.
Promoting vaccination for newly arrived migrants: a multistakeholder collaboration pilot
Authors: Russo M L , Tosti M E , Marchetti G , Bellini A , Ferrari C , Napoli P A , Trani F , Coraci B , Rusi E , Declich S
Published: October 2024

Access to vaccinations for Newly Arrived Migrants (NAMs) is a critical public health issue. In the context of the project ‘Increased Access for Newly Arrived Migrants-AcToVax4NAM’ (Grant No. 101018349, 3rd EU Health Program), DPHID-SAP and GLOB-ISS conducted a pilot aimed at developing and testing a system pathway to promote and vaccinate NAMs. The pilot began with the creation of a team between researchers from DPHID-SAP and GLOB-ISS, professionals from two services of the Local Health Authority and from a first reception centre (CAS) in Rome area. An integrated knowledge translation approach was used, which facilitated the collaborative development of strategies and actions of the pilot. The team then reached out to other ‘professionals FOR health’ involved in the vaccination process of NAMs, i.e. physicians from Temporarily Present Foreigners (STP) outpatient clinics, General Practitioners and Pediatricians. Between July 2023 and April 2024, four actions were developed. 1) analysis of the current access of NAMs to vaccination services and the subsequent development of a contextualized pathway to facilitate vaccinations for NAMs, including catch-up strategies; 2) identification of informed consent and other materials needed to be included in the pathway; subsequently, translated in 10 languages; 3) implementation of vaccine literacy session for CAS staff and NAMs; 4) improvement of immunization information flows to enable assessment of vaccination coverage of NAMs. To evaluate the pilot, the vaccination rate observed during the pilot (January-April 2024) was compared to that occurring in 2023, showing a 36.5-fold increase in the vaccination rate (4 x 100 person-year in 2023 and 155 x 100 p/y in 2024; RR = 36.5 (95%CI 14.6-117.6). The pilot highlighted that a research collaborative approach among various actors facilitated the access to vaccination for NAMs and was an opportunity to turn knowledge into action.

Key messages

• It is essential to ensure equitable vaccination coverage to reduce under-immunized groups.

• Access to vaccination is a key element of the right to health and for collective health protection and it should be a shared responsibility.
Ethnic disparities in clinical severity of COVID-19 as predictor of long COVID
Authors: Goldschmidt M , Benfield T , Nørredam M
Published: October 2024

Background

Recent studies from Europe have shown a higher incidence of long COVID among ethnic minorities compared to the majority population. Little is known of these disparities, but they might be related to factors such as COVID-19 disease severity, barriers in access to health and individual factors such as working and living conditions. This study will elucidate possible predictors of long COVID related to COVID-19 disease severity in an ethnic diverse hospitalised cohort.

Methods

A retrospective cohort study of 1648 patients admitted with COVID-19 at three hospitals in Copenhagen, Denmark, between 1st February 2020 and 31st May 2022. Clinical data was extracted from health care records, and subsequently linked to data from Statistics Denmark on long COVID diagnosis (ICD-10 “DB948A”) as well as migration status.

Results

1361 patients were discharged alive and of those, 113 (8,3%) patients got a long COVID diagnosis. Preliminary analyses show no excess risk of getting a long COVID diagnosis as a migrant compared to patients of Danish origin (RR = 1,20, p = 0,35). Some ethnic disparities are seen in disease severity among all patients discharged alive. Patients with migrant background were admitted to the hospital later (6,8 vs 5,6 days, p < 0,0001), and at a greater risk of needing high flow oxygen administration upon admission (RR = 1,46, p = 0,0012) compared to patients of Danish origin. Furthermore, a higher degree of systemic inflammation is seen among migrants with regards to lactate dehydrogenase (LDH) compared to patients of Danish origin (349,7 vs 317,2 U/L, p = 0,0014). No significant differences in c-reactive protein (CRP) levels (92,8 vs 85,9 mg/L, p = 0,11).

Conclusions

Preliminary analyses indicates possible ethnic disparities in COVID-19 disease severity among patients discharged alive possibly playing a role as predictors of long COVID. Low health literacy or language barriers might partly explain this. Further analyses are needed.

Key messages

• In preliminary analyses of 1381 patients previously admitted with COVID-19, we find no excess risk of a long COVID diagnosis (DB 948B) among patients with migrant background.

• Preliminary analyses show some ethnic disparities in COVID-19 disease severity that might act as possible predictors of long COVID.
Digital Literacy Among Migrants in Portugal: Access, Usage, and Trust in Health Information
Authors: Hamwi S , Marques M J , Dias S
Published: October 2024

Background

Digital literacy is crucial for effective utilization of health-related services and information. This study evaluates digital literacy among migrants in Portugal, focusing on three key components: access to digital services, usage of these services for health information, and trust in online health resources.

Methods

A cross-sectional survey was conducted to assess migrants’ access to digital devices such as smartphones and computers, their ability to use these devices for health-related purposes, and their perceptions of the credibility of online health information. Data were analyzed across various sociodemographic and migration-related factors.

Results

1,048 migrants were included, of which 90.3% had access to digital services, and 64.9% reported ease in using these services to obtain health information. Despite widespread access and usability, about 45.6% of migrants doubted the reliability of online health information. Access and usage varied significantly with age, education, income, employment status, and region of origin. Older, less educated, lower-income, and African migrants faced more significant challenges in access and usage. Additionally, trust issues were predominantly reported by females, those with lower education levels, recent arrivals, and non-Portuguese speakers.

Conclusions

The study highlights significant disparities in digital literacy among migrants, influenced by socio-economic and demographic factors. While access to digital tools is high, challenges in usage and trust present barriers to effective health communication.

Key messages

• High access to digital services among migrants, yet significant disparities affect older, less educated, and lower-income groups.

• Usage difficulties combined with low trust in online health info highlight the need for targeted digital literacy interventions.
Are post-communist countries paying increased healthcare costs because of risky behaviour?
Authors: Zimmermannova J , Helman K , Hajek M
Published: October 2024

Background

Based on the annual Country Health Profiles, we can see the difference in population behaviour across EU countries and the associated health risks. At first glance, the so-called post-communist countries are characterised by above-average per-capita harmful consumption of sin goods, alcohol and tobacco. Is this harmful consumption associated with increased healthcare costs?

Methods

The idea of the study is based on balanced panel-data published in Country Health Profiles. The member countries were divided into groups based on their health risk scores - high risk (above average), and low risk (below average). The group of countries with high risk is mostly composed of post-communist countries. The detailed per-capita annual data for the period 2013-2021 was collected, such as GDP, consumption of sin goods, alcohol, and tobacco. The analysis is based on fixed-effects linear regression models, following recent recommendations on suppressing the excessive role of statistical-inference tools.

Results

We built various models for different groups of countries, and in this abstract, we present results for the group of post-communist countries - a simple model of harmful consumption (sin goods, GDP) and a more complex model (alcohol, tobacco, GDP). The results show that in the case of the post-communist countries group, for a fixed level of GDP per capita, higher consumption of sin goods by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 0.244 per capita. For a fixed level of GDP per capita and tobacco consumption per capita, higher consumption of alcohol by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 1.367 per capita.

Conclusions

Harmful consumption has a multiplier effect in the health sector; besides direct impact, it influences an increase in healthcare expenditures. More emphasis should be placed on prevention and awareness of consumers to reduce harmful consumption.

Key messages

• For fixed GDP per capita, higher harmful consumption corresponds with higher healthcare costs in post-communist countries.

• For fixed GDP per capita and tobacco consumption per capita, a €1 higher alcohol consumption corresponds with more than €1 higher healthcare expenditure in the post-communist countries.