bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing pharmacy student injection training with the CARD™ system
Authors: Bucci L , Crown N , Gudzak V , Logeman C , Taddio A
Published: October 2023

Background

Immunization stress-related responses (ISRR) such as fear, pain and fainting contribute to negative immunization experiences and non-compliance in about 20% of un-immunized people. We introduced the CARD™ (Comfort, Ask, Relax, Distract) system - the first vaccine delivery framework demonstrated to reduce ISRR - to 240 second year pharmacy students undergoing mandatory immunization injection training and subsequent elective practical experience delivering immunizations in 2022 at the University of Toronto, Canada.

Objectives

The objective was to explore pharmacy students’ perceptions and behaviours following CARD™ education within the injections training course and then after participating as immunizers at influenza pop-up clinics.

Results

Eighteen pharmacy students participated after the injections training course and 19 participated after the pop-up clinics. Students reported CARD™ was aligned with client needs and preferences and national professional standards. They believed it was important to address ISRR and had higher confidence in their ability to support clients during immunization. Students reported deeper understanding of CARD™ after practical experience, including inviting client participation rather than imposing coping strategies.

Conclusions

We are the first group to incorporate evidence-based education about reducing ISRR to training curricula of pharmacy students. We demonstrated that students value education about CARD™ and that including a practical component is important to implementation fidelity. This information is relevant for injection training programs across disciplines and countries.

Key messages

• Incorporating CARD™ in injections training and experiences is acceptable to pharmacy students.

• Reducing ISRR promotes more positive experiences for clients and immunizers.
Pornography associated with youth violence
Authors: Rueda-Bello F , Alarcón-Rascón G E , Rivera-Luna A D , Martinez-Melchor M , Montalvo-Yepez S A , Marquez-Celedonio F G , Villegas-Dominguez J E , Trujillo Peña G J
Published: October 2023

Background

Violence is a very present situation in the various contexts of humanity, with Veracruz, Mexico being one of the most violent states in the country. There are studies that suggest that the consumption of pornography may be associated with an increased risk of violent behaviors due to physiological stimuli and legitimizing the behaviors observed in it. Objective: to determine the association between addiction to pornography and violence in young people from Veracruz, Mexico.

Methods

A cross-sectional, observational, prospective and analytical study was carried out between November and April 2023. Young people between the ages of 12 and 25, residents of Veracruz, Mexico were included; subjects with known psychiatric diagnoses were excluded. Data collection was carried out using Google Forms, applying the ‘Buss and Perry’ violence test (A.Cronbach 0.87) and the ‘EMAP’ pornography addiction test (A.Cronbach 0.95). SPSS v22 software was used for data analysis, X2 test with Odds Ratio (OR) and 95% confidence interval (95%CI) and MannWhitney U test.

Results

1399 subjects were included, with an age of 19.3±2.8 years, 514 participants indicated consuming pornography (all digitally). Pornography addiction was identified in 495(35.3%) subjects and 399(28.5%) with moderate or higher violence. Addiction to pornography was shown to be a factor associated (OR/CI95%) with moderate or higher levels of physical (1.4/1.-1.7), verbal (1.3/1.0-1.6) or general (1.3/1.0-1.7) violence.), anger (1.3/1.0-1.7), hostility (1.4/1.1-1.8), as well as severe physical violence (1.3/1.0-1.7), in the same way that pornography consumption was associated with moderate or superior levels of physical and verbal violence, anger, hostility and violence in general (p < 0.05).

Conclusions

The use of pornography and addiction to it facilitate the presence of physical and verbal violence, anger, hostility and violence in general in moderate or greater intensity, as well as severe physical violence.

Key messages

• Access to pornography through digital media facilitates the presence of violent behavior in young people, so it is necessary to find ways to regulate access to pornography.

• It is necessary to establish strategies to provide education to young people, in order to educate and help the interpretation that young people can give to this type of explicit material.
Association between language barrier and inadequate prenatal care utilization among migrant women
Authors: Eslier M , Deneux-Tharaux C , Schmitz T , Luton D , Mandelbrot L , Estellat C , Radjack R , Azria E
Published: October 2023

Background

Language barriers may limit access to care and thus be associated with increased risk of adverse maternal and perinatal outcomes. Our objective is to assess the association between this language barrier and inadequate prenatal care utilization among migrant women.

Methods

The analysis took place in the French multicentre prospective PreCARE cohort, conducted in four university hospital maternity units in the northern Paris area, having a professional interpreting service. This cohort included 4803 migrant women registered and giving birth between 2010 and 2012. Migrants’ language barrier was categorized in three groups: no, partial or total. Inadequate prenatal care utilization was assessed according to the modified Adequacy of Prenatal Care Utilization Index through multivariable logistic regression models.

Results

Among the 4803 migrant women included, 16.3% had a partial and 3.8% a total language barrier. Migrants with language barrier had resided less time in France, experienced social deprivation and undocumented status more frequently than those with no language barrier. Compared to migrants with no language barrier, those with partial (RR 1.23, 95%CI 1.13-1.33) and total (RR 1.28, 95%CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity, and region of birth did not modify these association, which were noted particularly among socially deprived women.

Conclusions

Migrant women with language barrier have a higher risk of inadequate prenatal care utilization than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Key messages

• Compared with migrant women with no language barrier, those with such barrier, either total or partial, have a higher risk of inadequate prenatal care utilization.

• These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.
Irrational nutrition as a risk factor during pregnancy and childbirth
Authors: Stefanova P , Georgiev A , Vasileva R , Kostadinov Sergey
Published: October 2023

Introduction

Nutrition is a factor influencing pregnancy, birth and late fetal development. In Bulgaria, there is a tendency to increase both malnutrition and obesity. This leads to an increase in pregnancy complications. Questions related to nutrition during pregnancy are part of the National Program for Antenatal Care in Bulgaria. The aim is to study the factors associated with eating disorders in pregnant women.

Material and methods

A documentary study and a direct individual survey were conducted among hospitalized pregnant women at Pleven University Hospital. The questions touch on socio-economic, health and educational aspects.

Results

Only half (48%) are at an optimal weight. The percentage of pregnant women with malnutrition is high (24%). The highest proportion of malnourished pregnant women are teenagers (35%), and those over 30 are overweight (27%). The study proved the link of malnutrition with low social and economic status, low/no education. Obesity prevails in the group of unskilled workers (45%). Malnutrition is characteristic of teenage pregnancy (35%), living alone (80%), for ethnically isolated groups (Roma 71%) or living in small settlements (52%). The scope of antenatal care among the respondents is only 28%. Deviations in nutrition led to frequent hospitalizations (52%), anemia (39%), spontaneous abortions (59%). Women with eating disorders more often suffer from infections during pregnancy (46%) and complications in the puerperium (52%). No association was found with preterm birth, premature rupture of the amniotic sac, and low birth weight.

Conclusions

There is a significant share of pregnant women with eating disorders in Bulgaria. The proportion of malnourished pregnant women increases, increasing the risk of complications. Proper nutrition of pregnant women depends on socio-economic factors, education, employment.

Key messages

• In Bulgaria, a National program for antenatal care, including problems with the diet of pregnant women, has been introduced.

• The high proportion of pregnant women with improper nutrition increases the risks for pregnant women and newborns.
Socioecological correlates of parental lifestyle patterns during the prenatal period
Authors: Lecorguillé M , Charles M A , Lioret S , Heude B
Published: October 2023

Background

There is growing evidence that family lifestyle patterns in early life are associated with the risk of child obesity. However, beyond the influence of socio-economic position, scarce are studies on the social determinants of such lifestyle patterns. The aim was therefore to investigate the socio-ecological correlates of parental lifestyle patterns in pregnancy.

Methods

We selected 1,110 families from the EDEN birth cohort, recruited in two maternity hospitals in France between 2003 and 2006. In a previous work, we identified two parental lifestyle patterns characterized by 1) “high parental smoking, low maternal diet quality, and low leisure physical activity 2) “low parental body mass index and high gestational weight gain”. Within the framework of both socio-ecological and hierarchical approaches, we conducted multivariable linear regression analyses, with socio-ecological factors added progressively from the most distal to the most proximal, i.e. urban environment variables (block 1); socio-economics, geographic origin, parents’ age, parity (block 2); and psychological factors or access to health care (block 3).

Results

Parents with a higher socio-economic position (education level, household income), first-time or older mothers and those having attended antenatal sessions had lower scores on the first pattern. Multiparous women, with an intermediate level of education, and older fathers had lower scores on the second pattern. No major associations were reported with urban environment or psychological factors.

Conclusions

Beyond the expected socio-economic gradient of family lifestyle patterns, we report novel insights into potential levers specific to the prenatal period, such as the opportunity of parenting preparation to engage in healthy behaviours. Analyses will be replicated in three other European cohorts, if confirmed, these findings will be valuable to increase the effectiveness of future childhood obesity prevention strategies in early life.

Key messages

• Higher socio-economic conditions and attendance of parenting preparation classes are associated with healthier family lifestyle in pregnancy.

• The identification of potential facilitators and barriers for family lifestyle in early life will help for further translation to effective childhood obesity prevention and implementation strategies.
Changes in adolescent physical activity levels pre and post COVID-19 in Ireland
Authors: Ng K , Woods C B
Published: October 2023

Background

The World Health Organisation (WHO) recommends moderate to vigorous physical activity (MVPA) for at least, on average, 60 minutes per day, and muscle strengthening exercises at least three times a week for adolescent health. Lockdowns, sports club and school closures during COVID-19 limited children's PA opportunities. The aim of this study was to examine changes in PA behaviour among students in schools undertaking a PA intervention (the Active School Flag: ASF) over three consecutive years.

Methods

ASF is a whole school intervention. Its aim is to increase student PA opportunities and thus, PA levels. ASF implementation team includes students, teachers and school management. Using a repeated cross-sectional panel study design, all students in five pilot ASF schools were invited to complete the ASF whole-school survey in September 2019, 2020 and 2021. Descriptive statistics, contingency tables and multi-logistic regression analyses evaluated changes in PA behaviour over time.

Results

Students in five schools (N = 7530, 33% male; 65% female, 2% other) took part. Physical inactivity (WHO guidelines for only 0-2days) dropped from 25% in 2019 to 22% in 2020 and 23% in 2021. Analysis by gender showed females to be most active in 2020 (p = .004). No significant changes, over time, were found for muscle-strengthening exercises. Four out of the five schools reported a significant increase in active travel and a decrease in car transport behaviour from 2019-2021, no gender differences were found.

Conclusions

COVID-19 public health restrictions varied over the duration of this study (higher in 2020 than at other time points). Little or no change in overall PA or muscle-strengthening exercises was established, yet significant increases in active transport to and from school were reported. Further research should explore mechanisms and the potential of a displacement hypothesis for types of PA change during this time.

Key messages

• COVID-19 movement restrictions, such as lockdowns, school and sports club closures contributed to increases in active transport to and from school, while other forms of PA remained largely unchanged.

• The Active School Flag may be an effective programme to reduce the amount of students who are physically inactive.
Impact evaluation of KOICA MNCH project in Jimma Ethiopia using a difference in differences analysis
Authors: Kim K H
Published: October 2023

Background

The maternal mortality ratio in Ethiopia is 412, which is higher than its neighboring countries. To address this issue and improve the health of women of childbearing age, the Maternal Neonatal and Child Health (MNCH) project was implemented in Jimma zone, Oromia, Ethiopia with support from the Korea International Cooperation Agency (KOICA). The objective of this study is to measure the impact of the project on maternal health in Jimma, Ethiopia.

Methods

The study employed DID analysis to measure the impact of the project on five key variables, including ANC 4, institutional delivery, satisfaction with MCH-related services, pregnancy-related knowledge, and delivery-related knowledge. A total of 789 participants were randomly selected for the baseline survey from both the intervention and control groups in 2017. The same groups were surveyed again one year later using the same study design for the endline survey.

Results

The study found that the trends in ANC4 and the level of satisfaction with the MCH service provided were similar in both the intervention and control groups. However, significant impacts were observed in terms of institutional delivery, pregnancy-related knowledge, and delivery-related knowledge. The odds ratio for institutional delivery was 2.83 (p < 0.01) for women in the intervention group compared to the control group. Similarly, the odds ratio for pregnancy-related knowledge was 0.67 (p < 0.01), and the odds ratio for delivery-related knowledge was 1.70 (p < 0.01) for women in the intervention group compared to the control group.

Conclusions

The study concludes that the KOICA MNCH project partially achieved its objective, as the intervention had a positive impact on institutional delivery and maternal knowledge levels. However, the insignificant impact on ANC4 and the level of satisfaction with MCH services suggest the need for further intervention to fully address maternal health issues in Ethiopia.

Key messages

• This study is significant because it has provided empirical evidence that maternal health projects implemented in the Jimma Zone of Ethiopia can positively impact various aspects of maternal health.

• The results of this study can serve as a valuable reference for policymakers and healthcare professionals involved in designing and implementing maternal health interventions.
How to create a healthy kindergarten – lessons learned from a participatory project in Germany
Authors: Kuchler M , Rauscher M , Kaczmarczyk D , Leimann J , Tollmann P , Quilling E
Published: October 2023

Issue/problem

Families play a central role in children's health. However, many health-promoting programs do not reach families who would need these the most. Through the involvement of families in the planning and implementation of health promotion activities, e.g. in kindergarten, acceptance and the adoption of health-promoting behavior can be increased in the family setting.

Description of the problem

The central question was how to successfully involve families in the planning and implementation, especially those who are otherwise not reached by programs. In a three-year project, six kindergartens in Germany planned and implemented health-promoting actions with families and network partners. Each institution organized search conferences and formed project groups. A youth welfare agency trained and accompanied the kindergarten staff to coordinate the participatory processes.

Results

Participatory processes emerged in all institutions despite corona-specific challenges. However, the degree of involvement varied. Staff, families and network partners identified needs and implemented appropriate actions. These were somewhat similar to existing programs also in other countries, but the involvement of multiple parties produced different results because the participants tied in with their own interests and resources.

Lessons

All parents are keen to be involved in their children's health. However, in order to involve them, a suitable framework is needed that corresponds to their family life for example, through the appropriate choice of place, time and form. In addition to the resources available, the participatory culture of the institutions and the attitudes of the staff had a major impact on involvement. Training and support in participatory processes are necessary to develop dialogue and joint action and to involve families in a sustainable way. These findings are transferable internationally.

Key messages

• Family involvement in children's health promotion is essential to make a real contribution to their healthy development.

• It is therefore essential to create low-threshold opportunities that take into account families’ living environments and lifestyles.
The rise of depression and the risk of suicide: Understanding dysphoria in modern society
Authors: Overholser J , McGovern C , Silva C
Published: October 2023

Problem

Depression is on the rise and can result in the intense despair that underlies suicide risk.

Description of the Problem

Modern society has changed in ways that disrupt personal life, reduce lasting values, and create a disconnect from close interpersonal relations. It is important to understand the prevalence of despair and the high rates of death by suicide.

Results

A comprehensive scoping review identified five relevant factors that play a role in the rise of distress and despair across society. First, many people rely on alcohol or drugs to temporarily suppress emotional reactions. Drug abuse has become commonplace. Further, the over-use of antidepressant medications may result in the social and emotional causes of depression remaining untreated. Second, prescription pills and guns are the most common methods used in a suicidal act and both are commonplace throughout the U.S. Third, many adults struggle with occupational stress and chronic financial worries. In addition, many adults feel their job is repetitive and mundane, providing a source of income but little benefit to person or society. Fourth, many people experience pervasive feelings of loneliness and social isolation, often feeling disconnected from family and friends. Some aspects of social isolation may be related to an excessive use of technology that has changed social interactions in ways that are not helpful. Fifth, many people have been losing hope or lack meaning in life. As society becomes filled with interpersonal conflict, political strife, and suppressed hatred, feelings of hopelessness can grow. Some people have reached a level of fatigue over the assorted crises facing the world today.

Lessons

The rising suicide rates are not a time-limited epidemic, but despair has become endemic to modern society, quietly undermining the emotional lives of many people. Societal changes can promote positive mental health by addressing each of these five factors.

Key messages

• Mental Health professionals can promote non-pharmacological means of managing stress and depression.

• All fields can encourage supportive and compassionate bonds when confronted with people in distress.
Educational attainment and symptoms of anxiety and depression in young adulthood
Authors: Östberg V , Åhlén J , Brolin Låftman S
Published: October 2023

Background

Young adulthood is a life phase when mental health problems are common. Although education is known to exert an influence on health, increased knowledge about the links between educational attainment and mental health problems in young adults is needed. The aim of this study was to analyse if educational attainment at the end of upper secondary (U.S.) school (i.e. age 19) predicted self-reported anxiety and depression symptoms two years later.

Methods

Data was derived from the Swedish population-based cohort study Futura01 (n = 3247; 56% women). Anxiety and depression were measured by self-reports in 2022 (age 21) through the Patient Health Questionnaire (PHQ-4). Educational attainment was measured through linked registry information from 2020 (age 19). Linear regression analysis was used. Covariates included parental country of birth, parental education and family type.

Results

Co-occurring symptoms of anxiety and depression were more common among young adults with a compulsory than a U.S. academic degree (women: b = 0.79, 95% CI 0.49, 1.09; men: b = 0.77, 95% CI 0.37, 1.17). Symptoms of depression only were more common among women with a compulsory degree (b = 0.60, 95% CI 0.20, 1.00), and among participants with a U.S. vocational degree (women: b = 0.51, 95% CI 0.09, 0.94; men: b = 0.50, 95% CI 0.08, 0.91), compared to those with a U.S. academic degree. Symptoms of anxiety only were, in contrast, less common among men and women with a compulsory degree compared to those with a U.S. academic degree, although statistically significant only among women (b=-0.50, 95% CI -0.88, -0.12).

Conclusions

Educational level in young adulthood was clearly associated with subsequent symptoms of anxiety and depression but the social patterning varied between symptoms. Lower educational level was linked to a higher reporting of co-occurring anxiety and depression and of depression only, while a higher educational level was linked to a higher reporting of anxiety only.

Key messages

• Young adult educational attainment was negatively associated with symptoms of co-occurring anxiety and depression and of depression only, but positively associated with symptoms of anxiety only.

• In young adulthood educational level is associated with anxiety and depression in complex ways. Efforts to improve educational attainment and/or mental health need to consider this complexity.
What impact does informal caring have on Mental Wellbeing? A cross-sectional analysis of survey data
Authors: Beaumont A , Gulliford M
Published: October 2023

Background

It is estimated that 1 in 8 of the English & Welsh population are unpaid informal carers. There is an upward trend in the number of carers in a growing and ageing population. This study aimed to quantify the mental wellbeing of informal carers as compared to the English general population.

Methods

The study drew from secondary analysis of the Health Survey for England, including 10,300 participants of all ages. The outcome measure was the Warwick Edinburgh mental wellbeing scale (WEMWBS) a 14-item validated survey which measures subjective well-being and psychological function with higher scores denoting greater wellbeing. Derived caring status, age & sex were explanatory variables. Multiple linear regression was employed to estimate associations.

Results

Of the 7,297 eligible adult participants, 1,244 were carers. The adjusted mean difference in WEMBS for men compared to women was 0.53 (0.10 to 0.96, P = 0.016). When including caring status, the mean difference for carers compared to non-carers was -1.71 (-2.29 to -1.13, p < 0.001) adjusted for age and sex. In sub groups of age, (<25, 25-64, and >65) there was evidence that caring was associated with lower wellbeing for ages <64 but no evidence of difference in > 65 years.

Conclusions

There is compelling evidence that informal carers have a lower WEMWBS score, indicating poorer mental wellbeing. However, this does impact all age groups equally as there was only evidence of carers <64 having a lower WEMWBS. This is one of the first studies to quantify the mental wellbeing of carers, and could lead to further studies to identify a causal link, and better support carers.

Key messages

• Informal unpaid carers <64 years, have quantifiably reduced mental wellbeing, compared to the wider population. Further research is needed to reduce the disparity.

• In an ageing population, and with increasing numbers of people informally caring, policy should support them in caring, and to also improve their own health.
Association between Instagram addiction and well-being: the role of resilience and self-esteem
Authors: Lin W C , Zou M L , Hsu H W , Lin W Y , Chen Y H
Published: October 2023

Background

Instagram has become one of the most popular social media platforms worldwide, particularly among young adults. While social media use was found to impact negatively on mental health, few studies have focused solely on Instagram, and research on young adults’ positive mental health is still limited. Therefore, this study aims to explore the relationship between Instagram addiction, subjective well-being (SWB), and depression among college students, as well as investigate the moderating effects of resilience and self-esteem.

Methods

A total of 441 college students in Taipei, Taiwan participated in this study through convenience sampling between December 2022 and February 2023. Participants completed paper-based questionnaires that evaluated Instagram addiction using the Instagram Addiction Scale, SWB using items adapted from OECD Guidelines, and resilience and self-esteem using the Resilience Scale for Adults and Rosenberg Self-Esteem Scale, respectively. Data were analyzed using multiple linear regression.

Results

The sample consisted of 441 undergraduate students and the mean Instagram usage time was 67.4 minutes per day, and the mean addiction score was 27.3. After adjusting for potential confounders, Instagram addiction was negatively associated with life satisfaction (β=-0.06, 95% CI=-0.09∼-0.03), eudaimonia (β=-0.07, 95%CI=-0.12∼-0.03), and positive affect (β=-0.03, 95%CI=-0.05∼-0.01), and positively associated with negative affect (β = 0.05, 95%CI=0.03∼0.08) and depression (β = 0.16, 95%CI=0.12∼0.20). The correlation between addiction and mental health status was even stronger in the low resilience and low self-esteem groups.

Conclusions

College student with higher addiction to Instagram reported poorer mental well-being, with resilience and self-esteem showing moderation effects. Education on proper use and interventions promoting resilience and self-esteem are recommended to prevent the impacts of Instagram addiction on mental health.

Key messages

• Instagram addictions is associated with lower positive and worse negative mental health status.

• Resilience and self-esteem are protective factors for the potential harm of Instagram addiction.
Trends in adolescent mental health problems and the role of lifestyle factors
Authors: Buli B , Larm P , Nilsson K W , Hellström-Olsson C , Lehtinen-Jacks S , Giannotta F
Published: October 2023

Background

Adolescent mental health problems are on the rise globally, including in Sweden. One indicator is an increase in psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the trends in PSS. However, we found limited research on such associations.

Methods

This study is based on data collected every four years from nationally representative samples of 15-year-old boys and girls in Sweden (N = 9,196, 50.5% girls), as part of the Health Behavior in School-aged Children (HBSC) study. PSS was measured using a scale developed from the HBSC symptom checklist. We analyzed the trends in PSS from 2002 to 2018 and fitted models to investigate the associations between the trends and lifestyle factors. We included interaction terms between time and each lifestyle factor and fitted separate models for the high and low socioeconomic status (SES) groups.

Results

In general, the mean scores for PSS increased from 2.26 in 2002 to 2.49 in 2018 (p<.001). Compared to the average mean scores during preceding years, the changes in PSS mean scores at each survey year were also significant in all years except 2010. More frequent breakfast intake, daily consumption of fruits and vegetables, and higher PA were associated with lower PSS mean scores while smoking and alcohol consumption had the opposite association. The only significant interaction (B = .050; CI: .015, ¬ .085; p<.01) was observed in the high SES group, indicating that the increasing trend in PSS was stronger among those who had been drunk once or more in a lifetime, compared to those who had never been drunk.

Conclusions

The results indicate increasing trends in mental health problems among young people in Sweden. Furthermore, the study revealed that alcohol drunkenness was associated with a more substantial rise in PSS over time among those in the high SES group. Further research is needed to understand the reasons behind these findings.

Key messages

• Psychosomatic complaints have increased among Swedish adolescents in recent decades.

• Although alcohol drunkenness has significantly declined among Swedish adolescents, it was not sufficient to influence trends in psychosomatic symptoms among those in the high socioeconomic group.
Strengthening mental health for migrant population: An ecosystem approach
Authors: Yong E , Talib H , Lee H Y , Lam M C
Published: October 2023

COVID-19 and its impact and containment measures accentuated the challenges that migrant workers (MWs) faced including mental health. In Sep 2020, Singapore's Ministry of Manpower (MOM) formed a multi-agency taskforce called Project DAWN, and seeded a population health framework for MWs’ mental health support through: 1.Mental and social wellness awareness and promotion; 2. Identification of at-risk patients and risk factors; 3. Screening for mental health issues; 4. Surveillance for mental and emotional distress: 5. Counselling, and training of para-counsellors; 6. Timely escalation of care; 7. Provision of post-intervention support.

Project DAWN's initiatives were co-created and co-delivered with social services agencies for effectiveness and relevance. It built on existing systems for expedited implementations while keeping the initiatives sustainable. Appropriate solutions were introduced to address care gaps. At the 2-year mark, a mixed-method analysis was done comprising focused group discussions with 84 stakeholders and data from helplines and distress incidents. Qualitatively, respondents cited materials to raise awareness were clear and helpful, trained peer support leaders (PSLs) could apply skills, processes were formed to enable officers, nurses and hospitals to support MWs’ recovery. Quantitatively, there was doubling of helpline callers from 2021 vs 2022 and a stabilisation of distress incidents. Other findings include:

a) Creation and dissemination of translated mental health information to stakeholders

b) Campaigns garnering >320k FB views and >1.7M TikTok views

c) >750 MWs and >90% ground officers trained in basic psychological first aid

d) Mental health assessment and basic psychiatric treatment included in primary care services coverage

Key messages

• Project DAWN and Singapore’s mental health programmes for MWs harnessed the public, private, civil and philantrophic communities and adopted an ecosystem approach for effectiveness and sustainability.

• This is extended for another 3-year series of interventions.
Comparison of psychotropic medication use before and after parental death by number of siblings
Authors: Luukkonen J , Pitkänen J , Junna L , Bister L , Laakso S , Martikainen P , Remes H
Published: October 2023

Background

Ageing populations and decreasing family size suggest more persons might need to take care of their aging parents for longer periods and eventually cope with the loss of their parents with fewer siblings. However, little is known about how number of siblings or specific causes of death, such as dementia, may moderate the burden of impending parental death and coping with parental loss.

Methods

Using Finnish population registers, we assess annual psychotropic medication use among adult offspring around the time of parental death. We use deaths that occurred in Finland during 2004 to 2016 and assess medication use up to two years before and after parental death with generalized estimation equations while controlling for sociodemographic factors. We assess whether sibship size moderates medication use and whether the associations differ by parental causes of death (e.g. dementia, neoplasms or cardiovascular diseases) that convey information about the abruptness of death and care burden prior to death.

Results

Before and after parental death, psychotropic medication use increased more among individuals with fewer siblings. The differences were largest in the first year after parental death, e.g., the increase in medication prevalence was 2.8% (95% CI: 2.5; 3.1) among only children, 2.2% (2.0; 2.2) with those with one to two siblings and 1.1% (0.4; 1.8) with those with three or more siblings. There were little differences between causes of death. Our results are preliminary and based on a 10% subsample of deaths in Finland (n = 110,000).

Conclusions

Parental death was associated with an increase in adult offspring psychotropic medication use that was larger among those with fewer siblings. Decreases in sibship sizes may significantly increase the care burden on offspring caring for their aging parents. Yet, more studies are needed to establish how sibling characteristics moderate these associations.

Key messages

• There is a clear increase in adult offspring psychotropic medication use in the event of a parental death, yet there was little variation according to cause of death.

• Having more siblings was associated with a smaller and belated increase in psychotropic medication use in the event of parental death, which could be interpreted as sharing the burden.
Use of technology as a mediator for loneliness
Authors: Queen C , Sabzevari R , Pasupathy R
Published: October 2023

This study seeks to identify the significant predictors of loneliness among older adults during the COVID-19 pandemic and asks if using technology can help older adults mitigate the effects of loneliness during periods of social isolation. Data from Wave 9, COVID-19 Survey 2 (Summer, 2021) of the Survey of Health, Aging, and Retirement in Europe (SHARE) were used to determine which factors were meaningful influences on loneliness among older adults during the second wave of the COVID-19 pandemic N = 10 countries in 3 healthcare system clusters. Statistical analysis for this study consists of two steps: Independent-Samples Kruskal-Wallis and the Dunn-Bonferroni tests; then, logistic regression analyses were used to examine differences between 3 cluster identities. The Kruskal-Wallis test shows that the rate of loneliness varies significantly different countries [χ2(9)=583.6;p< .001], with Latvia/Lithuania having the highest rates. Dunn's pairwise tests were conducted for the 3 country clusters with very strong evidence (p < 0.001) of a difference between rate of loneliness between clusters, with cluster 3 countries of Latvia/Lithuania reporting greatest loneliness; and, age, home care, employment, and financial support (p < 0.001) being significant for the use of technology with all clusters having significance. Only cluster 1 showed significance for use of technology for mitigating loneliness (p < 0.05). Findings from this study suggest that, among higher performing health system countries, technology was a significant mediator of loneliness during the second wave of the COVID-19 pandemic. Findings demonstrate that poorer performing countries could benefit from increased capacity for technology-based public health interventions to reduce loneliness among older adults.

Key messages

• Public health interventions can use technology to mitigate feelings of loneliness among older adults.

• Public health programming can focus on introducing technology-based interventions for older adults.
Study conditions and exhaustion in German higher education students: results of the StudiBiFra study
Authors: Stock C , Lehnchen J , Burian J , Deptolla Z , Heinrichs K
Published: October 2023

Background

A body of research indicates that a high proportion of higher education students suffers from poor mental health. Several individual factors have been found to be associated with different aspects of mental health. However, it remains unclear which specific factors in the study environment demonstrate strong links with mental health outcomes. Therefore, this study aims to identify which domains of study conditions show the strongest associations with exhaustion among students.

Methods

The StudiBiFra Study collected data from 20.060 students at 10 German higher education institutions between June 2021 and August 2022. The questionnaire comprised 20 domains of study conditions with 3-8 items in each domain rated on 5-point Likert scales. Exhaustion was measured with 4 items from the Maslach's Burnout Inventory. Scale means and linear regression analyses adjusted for gender and institution were calculated.

Results

The highest satisfaction with study conditions was found in the domains of “culture at the university” and “cooperation of students” and the lowest satisfaction in the domains “time requirements” and “examination and academic achievement”. Significant negative associations were found between all 20 domains of satisfaction with study conditions and level of exhaustion. Regression coefficients were highest for time requirements (ß=-0.58, p < 0.001), examination and academic achievement (ß=-0.51, p < 0.001), and fit of course content (ß=-0.41, p < 0.001).

Conclusions

In order to address exhaustion and to improve health and well-being of students, curricula and study organisation should reduce student burdens. Support systems for students need to be extended and resources such as social support among students should be strenghened.

Key messages

• All measured aspects of study conditions had significant impact on exhaustion of students.

• Existing burdens for students should be reduced and resources should be strengthened.
To what extent can remote treatment address geographic barriers to psychotherapy?
Authors: Samuel H
Published: October 2023

Background

The COVID-19 pandemic led to a surge in remote psychotherapy, suggesting it might also be a good way to overcome distance barriers to treatment post-pandemic. This study examined patterns of receiving psychotherapy before and after the COVID-19 outbreak, as well as patients’ perceptions of remote care. We conducted an internet survey of 400 Israelis who received psychotherapy in 2020 and 10 in-depth interviews with patients.

Results

57% of patients from Israel's geographic periphery reported receiving remote treatment, compared to 30% of patients from central Israel (p < 0.01). Among those who began treatment before the onset of the pandemic, 76% reported receiving remote treatment or combined remote and face-to-face treatment after the pandemic's outbreak. In contrast, only half of those who began treatment after the onset of the pandemic received remote treatment. The interviews indicated that it is harder to start treatment and establish a therapeutic alliance with the therapist remotely than to continue therapy that had started face-to-face. Patients who experienced remote therapy were more likely than others to rate it as effective as face-to-face therapy in terms of its ability to achieve treatment goals (44% vs. 20%), to foster dialogue on sensitive issues (48% vs. 34%) and to create a therapeutic relationship with the therapist (41% vs. 25%). Additionally, they were less likely to identify interpersonal communication difficulties as a drawback of remote therapy (55% vs. 78%) and more likely to be willing to continue using it post-pandemic (25% vs. 5%), (all p < 0.01).

Conclusions

The findings suggest that for some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy. However, most patients still prefer face-to-face therapy. Offering remote treatment after establishing a therapeutic connection via face-to-face treatment will probably be more popular among consumers than strictly remote care.

Key messages

• For some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy, especially when a therapeutic alliance has already been established.

• Most patients prefer face-to-face therapy. However, patients who experienced remote care were more likely to rate it as effective as face-to-face therapy and to continue using it after the pandemic.
Healthcare for Asylum Seekers and Refugees; A Scoping Review
Authors: Middleton M , Coyle R , O'Donovan D
Published: October 2023

The number of asylum seekers and refugees entering the UK is increasing. There is a strong body of evidence considering the health needs and barriers that this group experience. There is far less evidence on the best models for the organisation, delivery and provision of health services for these populations. This scoping review synthesised the published evidence and evaluations on how health care services for asylum seekers and refugees are organised and delivered across the UK. Electronic databases were searched in June 2022 to identify relevant peer reviewed literature from 2002 onwards. Mental and physical health services for adults and children were included. To source grey literature, requests for relevant service evaluations were made through the UK Health Security Agency, the Office for Health Improvement and Disparities Migrant Health Network and the websites of relevant organisations were searched. Six semi structured interviews were carried out with public health practitioners and clinicians working with asylum seekers and refugees. Twenty-one articles were included in the scoping review. Nine (42.8%) were focused on services in London. Seven (33.3%) articles were service evaluations. The majority were descriptive analyses, surveys or reports. Only seven (33.3%) of articles included service users’ views. A thematic analysis grouped the articles and interviews into six themes; accessibility, link worker, training, integrated pathways, GP registration and time. There is a paucity of evidence relating to the delivery and effectiveness of services for asylum seekers and refugees in the UK. The key themes identified were consistent over the 20-year search period. Recommendations for services include routine evaluation of services with dissemination of findings and patient and public involvement. Given the increasing numbers and health needs of this group, the economic evaluation of health care services is essential.

Key messages

• There is a paucity of evidence on healthcare delivery for asylum seekers and refugees.

• Key themes for services are accessibility, link worker, training, integrated pathways, GP registration and time.
The experience of racism against migrants in healthcare in Europe: a scoping review
Authors: Pattillo M , Stieglitz S , Angoumis K , Gottlieb N
Published: October 2023

Background

Racial discrimination is frequently mentioned as a social determinant of migrants’ health. However, in the European context, racial discrimination and its impact on migrants’ access to healthcare is under-researched. This scoping review makes a first step toward filling this void by mapping the literature on racism against migrants in healthcare in Europe and identifying evidence gaps.

Methods

Following PRISMA guidelines, four databases were searched for empirical, peer-reviewed studies on manifestations, experiences, or impacts of racism against migrants in healthcare settings in European countries, published in English between 1992 and 2022. Out of 2365 articles screened, 43 were included in the data extraction. A quality assessment and narrative synthesis were performed.

Results

Our synthesis of the extant evidence identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. However, our analysis demonstrates that for many country and healthcare contexts, research on racism in healthcare is lacking. Most studies apply an explorative qualitative research design, while the comparability and generalizability of research results are low. Furthermore, there is a near-exclusive research focus on racism at the interpersonal level, with little data on institutional and structural levels.

Conclusions

The review pinpoints limitations and lacunae in the current body of knowledge; namely a lack of evidence for many country and healthcare contexts, a dearth of generalizable results, and a near-exclusive focus on racism on the interpersonal level as compared to structural levels. At the same time, its findings underscore how racism reinforces inequities in healthcare and health outcomes. It thus highlights the need for systematic research on racism in healthcare in Europe.

Key messages

• Racism against migrants in healthcare reinforces health inequities through anti-migration bias, health(care)-related prejudice, and differential medical treatment.

• Research on racism in healthcare in European countries is scarce; especially systematic and generalizable evidence and evidence on racism on structural levels is lacking.