bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies to recruit people with selected nationalities for the interview survey GEDA Fokus
Authors: Koschollek C , Geerlings J , Bug M , Blume M , Kajikhina K , Hövener C
Published: October 2022

Background

People with migration history (PMH) are underrepresented within health monitoring at Robert Koch Institute (RKI). To better describe the health status of PHM, the RKI is currently conducting the health interview survey GEDA Fokus with different migrant groups. Aim of this contribution is to present which sub-groups in this sequential mixed-mode survey design are reached by which mode.

Methods

People aged 18-70 years with Croatian (hr), Italian (it), Polish (pl), Syrian (sy) or Turkish (tr) nationality were drawn out of 99 residents’ registration offices all over Germany (N = 33,436). Study persons were invited sequentially to participate online (saq-web), paper-based(saq-paper) and in person (CAPI) or by telephone (CATI) in Arabic, Croatian, German, Italian, Polish or Turkish. Saq-web was available in German only or bilingual. Data collection took place from November 2021 to April 2022. Per nationality, 1,200 participants were recruited.

Results

As of 25th of April, 6,197 people took part, most often per saq-web (49%), which was less often used among participants aged ≥ 50 years (35% vs. 56%). Pl participants used saq-web most often in German only (55%), sy participants most often used the bilingual version (77%). Saq-paper was more often used by participants aged ≥ 50 years (41% vs. 22%) and less often by tr (21%) and sy (24%) participants. Participants with it nationality most often took part on their own initiative (saq) (92%), while tr (33%) and pl (28%) participants were recruited via personal contact (CAPI/ CATI) more often.

Conclusions

Preliminary results show that offering multiple modes of administration helps to reach different sub-groups. Personal contact contributes to reach those not directly taking part on their own initiative. The opportunity to utilize the bilingual version of the questionnaire was well accepted, especially among those with presumably shorter duration of residence in Germany.

Key messages
Perceived discrimination and mental health among adolescents in Germany
Authors: Blume M , Koschollek C , Kajikhina K , Waldhauer J , Hövener C
Published: October 2022

Background

The association between perceived discrimination and mental health in adolescents has been widely documented. Aim of this contribution is to show how the relationship between mental health and perceived discrimination at school, work or job training differs depending on socio-economic or migration-related determinants.

Methods

The present analyses was conducted with data from German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 2 (2014 - 2017). Weighted linear regression analyses were conducted to explore the association between perceived discrimination at school, work or job training and behavioral problems in adolescents (14-17 years). Also, we examined the extent to which the association is moderated by the parents’ income, education as well as the language spoken at home.

Results

Of all young people, 25.5 % reported perceived discrimination at school, work or job training. Behavioral problems were reported more frequently in adolescents with discrimination experience (12.5 % vs. 3.23 %). Multivariate analyses showed that the coefficients of the association between perceived discrimination and behavioral problems differed by parents’ level of education (low 4.07 (2.39-5.74)/high 2.47 (1.29-3.65)), income (low 3.61 (2.06-5.16)/high 0.35 (-1.81-2.51)), or language spoken at home (German 2.02 (0.33-3.70)/ Other 3.48 (-0.27-7.23)).

Conclusions

A large proportion of adolescents experienced discrimination, with this being reported more frequently among young people with behavioral problems. Parents’ income and education as well as the language spoken at home are relevant for this context. To ensure that health inequalities are not exacerbated by discrimination, targeted prevention measures are needed in these settings. These should address not only the individual needs of young people, but also the underlying conditions and thus aim to promote health equity in the long term, especially in already disadvantaged groups.

Key messages
Mental health care in the post-partum: differences between Danish-born, migrants and descendants
Authors: Santia P , de Montgomery CJ , Marti-Castañer M
Published: October 2022

Background

Research suggest migrants are at higher risk of mental health (MH) disorders in the post-partum (PP), while they have less access to care. However, MH need and care have been studied separately, descendants have been, mostly, excluded and migrants, studied as a homogeneous group. We aim to assess differences in MH care use between Danish-born, migrants and descendants in the PP after a MH need is identified; and to characterize migrants at lowest risk of accessing MH care.

Methods

This retrospective cohort study includes 45571 women who gave birth from 2002 to 2018 in Denmark and had a MH need identified by a nurse in the PP program. MH care use, from delivery to two years PP, was retrieved from national registries and includes contacts with the general practitioner, psychologist, psychiatrist, emergency room, hospitalization, and medication expedition. Cox regression models estimated time to MH care use, by migrant status and migrant characteristics, adjusted by history of MH, sociodemographic and birth variables. Results are shown as hazard ratios (aHR [95% CI]).

Results

Final sample consisted of 75.7% Danish, 19.7% migrants and 4.7% descendants. Median time to treatment was 4 months for Danish and 6 months for migrants and descendants. Risk of accessing MH care was lower for migrants (aHR 0.75 [0.70; 0.79]) and descendants (aHR 0.77 [0.70; 0.86]) than for Danish-born. Among migrants, refugees showed higher risk of accessing MH care (1.22 [1.04; 1.42]) than non-refugees; recently arrived showed lower risk (<5 years, 0.85 [0.74; 0.97]) than those living in Denmark for ≥10 years; and migrants from East Africa showed the lowest risk of accessing MH care (0.47 [0.33; 0.66]) compared to migrants from North Europe.

Conclusions

There is a gap in PP MH care between Danish-born women, who show higher and earlier access to care, and migrants and descendants. Refugee background, length of residency and origin impact migrant's MH care use and should be considered.

Key messages
Attitudes towards mandatory vaccinations during the COVID-19 pandemic in Bulgaria
Authors: Hadzhieva S , Chamova R , Ivanova E , Radeva N , Rohova M , Mihaylov NL , Paunov Ts , Kolarova M , Pancheva R
Published: October 2022

Background

Vaccinations are an essential public health strategy to control preventable diseases. A much-discussed approach to increase coverage is mandatory vaccination; however, its legitimacy and effectiveness were put to question during the COVID-19 pandemic. As of March 1,2022, Bulgaria had one of Europe's lowest immunization coverage rates against COVID-19. Only 29.3% of Bulgarians had completed COVID-19 vaccination, compared to 71% in the EU and EEA, and the country ranked last in number of booster doses (9.9% vs 51.4 %). This study aims to investigate the public's attitudes toward proposed mandatory COVID-19 vaccination and toward the long-standing mandatory child immunization schedule in the context of the COVID-19 pandemic.

Methods

An online cross-sectional survey was conducted in April 2022 using a self-administered anonymous questionnaire to collect information on sociodemographic characteristics, vaccination status and attitudes toward mandatory vaccination to COVID-19 and the mandatory childhood immunization schedule.

Results

Out of 1433 reached respondents, 1200(84%) completed the survey. The largest relative share of respondents is between 35-44y-33.3%; 72.7% were women; mainly highly educated (50.8%), and vaccinated participants (59.3%). There is a significant and large difference between vaccinated and unvaccinated regarding the full support of mandatory COVID vaccinations (46.1% vs 1.8%), and regarding mandatory child vaccinations (77.9% vs 50.4%). Mandatory childhood vaccination schedules are supported by 88.7% of those in favor of obligatory COVID-19 vaccinations and 56% of those who oppose them (p < 0.001). Significance is preserved after adjustment for vaccination status.

Conclusions

Public health authorities need to develop well-organized vaccination campaigns in which accurate evidence-based information is adequately disseminated with respect to individuals’ autonomy. More research on the determinants of vaccination attitudes in Bulgaria is necessary.

Key messages
Quality of health care in Germany: results of a pilot study to assess health system performance
Authors: Hengel P , Achstetter K , Blümel M , Schwarzbach V , Busse R
Published: October 2022

Background

Health System Performance Assessment (HSPA) is used as a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a systematic HSPA was piloted for Germany. The conceptual framework includes different dimensions, e.g., access, population health, efficiency, and quality of care. In the following, Germany’s performance is analysed in terms of quality of care.

Methods

Indicators to assess the dimension of quality of care were selected based on a systematic search of established instruments in national and international HSPA initiatives. Other criteria for the inclusion of indicators were data availability and international comparability. The indicators were evaluated in terms of their time trend (2000-2020) and in international comparison (e.g., Austria, Denmark, France).

Results

Overall, 17 indicators were selected to assess quality of care, of which two could not be analysed due to missing data. Indicators include, e.g., emergency readmissions after hospital stays, patient-reported medical errors, coercive measures in psychiatric wards, and in-hospital mortality. Trend analyses were possible for 14 indicators and most of them showed positive developments. In country comparisons, which were feasible for seven indicators, Germany mostly ranked below average. In-hospital mortality for acute myocardial infarction, e.g., was 8% in 2019 in Germany (other countries: 4%-7%) and has been stable since 2014. For stroke, Germany performs better and ranks three of five (6%; range: 5%-9%) in 2019.

Conclusions

Measuring quality of care for a systematic and comparative German HSPA was proven to be feasible. However, some indicators could not be mapped so far due to lack of data. The results give insights into quality measurements across different sectors and can support evidence-based policymaking.

Key messages

• In the first health system performance assessment (HSPA) for Germany, quality of care was evaluated over time (2000-2020) and compared to eight European countries using 17 indicators.

• Measurement of quality was feasible, but data availability should be strengthened in the future as country comparisons were possible for only half the indicators and two could not be analysed at all.
Informal caregivers’ profile needs: where do we stand?
Authors: Henriques A , Sousa Loura D , Nogueira P , Costa A
Published: October 2022

Background

Non-communicable diseases’ increase and demographic ageing require a solution to manage long-term care (1), where informal caregivers are key actors (2). Optimization in policies designed to support their caregiving role is needed. Portugal is an aged country with high prevalence of family that take care of dependent relatives. ‘Informal caregivers’ profile in Lisbon County: a health community approach’ is a nurse-led research project designed to meet these challenges with the main aim: to develop a profile on informal caregivers in Lisbon county.

Methods

Reporting the descriptive phase, a survey containing health/social questions was submitted to a non-probabilistic representative sample of careers, aged 18 years old or above in about 300 caregiver’s caring dependent persons resident in Lisbon, in 2021. Univariate descriptive analysis was performed.

Results

Married and retired women’ caring for a parent were the most typical informal caregiver profile (n = 13, 4%). The majority do not have support from social services (n = 209, 61%). Two thirds live with the cared-for person (n = 219, 64%). Almost half (n = 150, 44%) have a university degree and only few planned the transition to a caregiver role (n = 13, 4%). No more than 10% had access to support programs (n = 71, 20%).

Conclusions

Caregivers’ unmet needs can complexify societal mechanisms relying on their work. Addressing these needs will be key to develop a strategy focused on supporting informal caregivers’ priorities.

References

1. Zigante, V. (2018). Informal care in Europe: exploring formalisation, availability and quality. Publications Office of the European Union. https://doi.org/10.2767/78836.

2. Crisp, N. (Coord.) (2014). Um futuro para a saúde - todos temos um papel a desempenhar. Fundação Calouste Gulbenkian. https://www.gulbenkian.pt

Key messages

• Caregivers profile needs will be key support a strategy on informal caregivers’ priorities.

• No more than 10% of informal caregivers in a relevant European County had access to support programs.
Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK
Authors: Blake H , Carlisle S , Fothergill L , Hassard J , Favier A , Corner J , Ball JK , Denning C
Published: October 2022

Background

Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite.

Methods

Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152; focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework.

Results

Uptake was high (n = 464 students opted-in; 98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

Conclusions

This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings.

Key messages

• Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing.

• This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.
Modeling and analysis of psychological mechanism for preventive behaviors against the COVID-19
Authors: Fukukawa Y , Kurita S
Published: October 2022

Background

The COVID-19 pandemic has dramatically changed human life style. People all over the world are still on the way to establish “New Normal”. The purpose of this study was to construct a cognitive model that predicts preventive behaviors against the infectious disease.

Methods

A total of 3,000 Japanese respondents aged from 18 to 86 years participated in a web survey in January 2021. The data of 2,913 respondents (1,633 males and 1,280 females) were eligible for analysis. The following information regarding cognitive characteristics was assessed: 1) Cognitive reflection ability (Frederick, 2005), 2) Experiential thinking style (Pacini & Epstein, 1999), 3) Germ aversion (Duncan et al., 2009). In addition to those characteristics, the participants were asked to answer 6 items to rate their preventive behaviors against the COVID-19, such as keeping social distance and wearing a mask. A structural equation modeling technique was used to test the causal relationships among the measures. We hypothesized that experiential thinking style and germ aversion would mediate the causal link between cognitive reflection ability and preventive behaviors.

Results

Correlation analyses indicated that cognitive reflection ability was negatively associated with experiential thinking style, whereas experiential thinking style was negatively associated with germ aversion. Furthermore, the higher germ aversion was, the more the participants enforced the covid-19 preventive behaviors. Parameter estimation of the causal model using the measures by the bootstrap method indicated that the model acceptably fit the data with CFI of 0.997, TLI of 0.996, and RMSEA of 0.008 (95% CI = 0.004:0.011).

Conclusions

The findings of the study suggest that there is a cognitive psychological process that induces preventive behaviors against the COVID-19. The results should be useful to improve public health interventions for future pandemics.

Key messages

• A web survey was conducted for 3,000 Japanese adults to construct a cognitive model that predicts preventive behaviors against the COVID-19.

• The structural equation modeling indicated that the participants’ experiential thinking style and germ aversion mediated the causal link between cognitive reflection ability and preventive behaviors.
A time-varying SIRD model for dynamic vaccination strategies against COVID-19
Authors: Cartocci A , Lucarelli V , Messina G , Nante N , Cevenini G , Barbini P
Published: October 2022

Introduction

The COVID-19 pandemic has demonstrated how the optimal allocation of the limited doses of vaccine available represents one of the main useful measures to mitigate the transmission of the infection and reduce the mortality associated with it, especially at an early stage of the pandemic. The use of a compartmental model allows us to understand which population groups to vaccinate and to what extent to act depending on the type of health or social objective to be achieved.

Methods

A time-varying susceptible-infected-recovered-deceased (SIRD) compartmental model, stratified into ten age groups, was developed on Italian data. Simulations were performed every 15 days from December 2020 to April 2021. An optimal vaccination strategy was achieved by minimizing deaths or infected, considering the total vaccine doses available.

Results

We showed how the effects of a vaccination campaign can be planned in a way that maximizes lives saved and/or minimizes infections. Regarding the minimization of deaths, the model prioritizes the elderly (>80 years) and then those between 60 and 80 years, in all simulations. Regarding the cost function of new infections, the first simulation assigns all available doses to those over 90 years of age. In the later simulations, the doses are assigned mainly to the 20-29-year-old and the 89+ year old.

Conclusions

Optimal allocation of available vaccine doses is useful in mitigating transmission of infection and reducing mortality. Application of the mathematical model can be useful at the beginning of an epidemic caused by a new pathogen, when data are scarce, and it is therefore necessary to introduce a standardized approach. This kind of simulation is useful to understand whether the implemented vaccination strategy needs to be recalibrated, too.

Key messages

• Time-varying compartmentalised models can be used both to continuously inform decision-makers about changes in epidemic traits and to simulate the effects of targeted pandemic containment strategies.

• The application of compartmental models can be very useful at the onset of an epidemic to more successfully contain it and structure the health, political, and economic plan.
Isostrain among tourism employees in Tunisia during COVID-19 pandemic
Authors: Maatouk A , Ben Fredj S , Zammit N , Ghammem R , Maatoug J , Boujebha S , Guesmi N , Zendah B , Ghannem H , Hadj Mabrouk K
Published: October 2022

Background

Psychological and social factors related to work activity can improve or deteriorate the physical and mental health of employees. Since the COVID-19 pandemic, the psychological well-being of workers has been strongly affected. Particularly, jobs with isostrain characterized by high work demands and low work control, coupled with low social support, place employees at highest risk for poor mental health. We aimed to assess the factors associated with isostrain among employees in the tourism sector in Sousse.

Methods

A cross-sectional study was conducted between September and November 2020 among tourism workers belonging to 12 hotels and restaurants in Sousse, Tunisia, using a self-administered questionnaire. ‘Isostrain’ was assessed using the Karasek questionnaire. ‘Isostrain’ is a situation where there is a combination of ‘jobstrain’ (‘tension at work') and low social support (score below the median of the group). SPSS 20 software was used to analyze the data.

Results

A total of 226 workers were included. The mean age was 38.2 ± 9.6 years. The sex ratio was 2.7. The majority of employees (64.8%) were working at workplace during COVID-19 lockdown. The prevalence of isostrain was 5.4%. Isostrain was reported by 5.7% of women (p = 1). All workers older than 50 years did not have isostrain (p = 0.6). Moreover, isostrain was found among 6.6% of workers with less than 5 years of work experience (p = 0.4), 4.8% of married employees (p = 0.7), and 7.6% of employees with a university education (p = 0.53).

Conclusions

Isostrain can affect employees in the tourism sector. Social support should be promoted among workers to ensure good mental health.

Key messages

• Prevalence of isostrain in tourism sector of Sousse during COVID-19 pandemic is quite high.

• Preventive strategies of mental health should be promoted at workplace in Tunisia.
How to handle occupational well-being of critical care workers. A lesson from the pandemic
Authors: Magnavita N , Soave PM , Antonelli M
Published: October 2022

Background

The PSIC study (Prospective Study of Intensivists and COVID-19) monitored the intensivists working in one of the two COVID-19 hub hospitals in Central Italy over 2 years from April 2020. This study showed how mental health varies in relation to the stressors posed by the different pandemic phases.

Methods

In 4 surveys corresponding to the 4 pandemic waves, the intensivists were invited to indicate changes in work activity and measure their state of mental health using standardized questionnaires administered via SurveyMonkey.

Results

During the pandemic there was a change in occupational stressors that led to insomnia, anxiety, depression, burnout, job dissatisfaction, unhappiness and intention to quit. The predominant stressors in the first wave were fear of unprotected exposure, distrust of safety measures, and compassion fatigue from having to inform relatives of the adverse outcome of treatment. In the second and third waves the workload, the monotony due to always following only one type of patient, the isolation, and the lack of time to meditate were the more relevant factors. The fourth wave added the stress deriving from interacting with anti-vax patients

Conclusions

Specific prevention strategies have been developed and applied for each of the stress factors identified. Excessive workload and lack of time for meditation originated from lack of staff were remedied with extraordinary temporary hires. The management of compassion fatigue and relations with anti-vax people were addressed with specific policies and training. The monotony and isolation in COVID-19 wards can only be resolved through employee turnover in ordinary departments. Organizational and financial efforts are necessary to protect the health of intensivists during a pandemic.

Key messages

• Monitoring of critical care workers during the pandemic waves indicated the preventive measures necessary to ensure their mental health and quality of care.

• Protecting healthcare workers is a priority.
Socioeconomic and geographic inequalities in colorectal cancer in Cyprus: An ecological study
Authors: Lamnisos D , Giannakou K
Published: October 2022

Background

Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The aim of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socio-economic inequalities in Cyprus for the periods between 2000 and 2015.

Methods

A small area ecological study in Cyprus, with census tracts as units of spatial analysis, for the period between 2000 and 2015. The incidence date, sex, age, post code, primary site, death date in case of death or last contact date in case of alive for all cases of CRC from 2000-2015 were obtained from the Cyprus Ministry of Health. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model.

Results

There are geographical areas having 15% higher SIR and SMR, with most of those areas located at the east coast of the island. Higher M/I ratio values were found in the rural, remote, and less dense areas of the island while lower rates were observed in the metropolitan areas. An inverted U-shape pattern in CRC incidence and mortality was observed with higher rates in the areas classified in the second quartile of the socio-economic deprivation index and lower rates in rural, remote, and less dense areas. A different pattern emerged in the M/I ratio indicating a stepwise increase across increasing levels of socioeconomic deprivation.

Conclusions

These findings can potentially provide useful information at local and national levels and can inform public health authorities to appropriately allocate resources for geographically targeted prevention and control plans to increase CRC screening.

Key messages

• M/I ratio of CRC was positively associated with regional deprivation since a stepwise increase was found across increasing levels of rural-related socioeconomic deprivation.

• Interventions aimed at reducing the risks of CRC should primarily focus on socially deprived communities in Cyprus.
Co-developing a tailored vaccination intervention with Congolese migrants: a participatory study
Authors: Crawshaw AF , Hickey C , Lutumba LM , Kitoko LM , Nkembi SL , Knights F , Ciftci Y , Vandrevala T , Forster AS , Hargreaves S
Published: October 2022

Background

Disparities in vaccination uptake among migrant populations are well documented. WHO and ECDC have sought renewed focus on participatory research that engages migrants in co-producing tailored initiatives to address vaccination inequities and increase coverage.

Methods

This community-based participatory research study aims to engage Congolese migrants in co-developing a tailored approach to increase vaccine uptake. Phase 1 used poster walls and in-depth interviews with Congolese migrants (n = 32) to explore COVID-19 vaccination beliefs, experiences, and preferred information sources and communication methods, analysed iteratively and thematically in NVivo.

Preliminary results

Institutional distrust has shaped this population’s interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold. We found complex information networks and preference for Francophone, African and social media. Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging. Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective. The population felt coerced by vaccination reminders and mandates, and were resultantly more hesitant to accept COVID-19 vaccination.

Conclusions

The population’s specific characteristics suggest that existing and trusted interpersonal networks and oral communication in first languages should be harnessed to spread credible information and encourage vaccine uptake, and mandate policies are unlikely to be effective. Training local role models to facilitate vaccination dialogues and myth-bust may be effective at changing behaviour. The next phases will gather more information from key stakeholders and engage migrants in workshops to co-design insight-driven, tailored interventions.

Key messages

• Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities.

• Populations with strong interpersonal networks and low trust in public institutions may be receptive to tailored, community-centred dialogue approaches using local messengers and role models.
Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access
Authors: Neale F , Watson M , Hargreaves D , Arora S
Published: October 2022

Background

England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required.

Aim

To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019.

Methods

Retrospective analysis of a de-identified database of integrated care records for 495,357 children.

Results

Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values <0.001 in all cases.

Conclusions

Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care.

Key messages

• Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care.

• Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.
Strategies to increase catch-up vaccination among migrants: a qualitative study and rapid review
Authors: Deal A , Crawshaw AC , Salloum M , Hayward SE , Knights F , Goldsmith LP , Carter J , Rustage K , Mounier-Jack S , Hargreaves S
Published: October 2022

Background

WHO’s Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules.

Methods

We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an in-depth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis.

Results

63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving under-immunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations.

Conclusions

Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catch-up vaccination among marginalised migrant groups.

Key messages

• Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks.

• Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.
Walk the path of cervical cancer elimination in Italy: current scenario and shared recommendations
Authors: de Waure C , Riccardi MT , D'Ambrosio F , Castagna C , Sapienza M , Millevolte R , Pellacchia A , de Vincenzo RP , Calabrò GE
Published: October 2022

Issue/problem

In 2020, the World Health Organization (WHO) called for the elimination of cervical cancer. In order to get it, vaccination against Human Papillomavirus (HPV), screening of cervical cancer and treatment of high-grade cervical disease and cancer must be implemented at country level.

Description of the problem

Italy has implemented HPV vaccination and cervical cancer screening for many years. Nevertheless, nationwide data show that both vaccination coverage and adherence to screening programs are unsatisfactory as compared to the WHO 90 and 70 targets, namely 90% of girls fully vaccinated by the age of 15 years and 70% of women screened with a high-performance test (i.e., HPV-DNA test) by age 35 and again by 45.

Results

In order to address the progress of vaccination and screening at regional level in Italy, a project was conducted in 2021-2022 in order to collect data on relevant indicators and issues. In particular, information was collected on both coverage indicators (for both vaccination and screening) adherence (for screening) and history and characteristics of the vaccination offer (e.g., targets, gratuity) and of screening (e.g., presence of clinical pathways, type of tests used). Collected data were shared with a multidisciplinary panel of experts on HPV-related diseases to issue recommendations to foster the elimination of cervical cancer in Italy. For this purpose, a survey was also conducted to identify potential actions in respect to vaccination, screening and treatment.

Lessons

A great heterogeneity across Italian regions was observed. The following actions were identified to implement vaccination, screening and treatment: educational campaigns, reminders and active calls for both vaccination and screening and more interoperability of data and definition of clinical pathway involving a multidisciplinary medical team for the proper management of all HPV-related diseases.

Key messages

• Actions are requested at national level to achieve the goals set by the global strategy for cervical cancer elimination with respect to vaccination, screening and treatment.

• Actions identified to foster cervical cancer elimination in Italy includes educational campaigns, reminders and active calls, better interoperability of data and integrated medical team.
Building capacity to use legal tools to address climate change through a public health lens
Authors: Patterson D , Garde A
Published: October 2022

Background

EPH Conferences have an increased focus on the health impacts of climate change. However, until 2021 EPHC abstracts did not address opportunities to challenge government inaction in national and international courts. ASPHER’s European List of Core Competences for the Public Health Professional (2018) only mentions NCDs and data protection law. Yet litigation to address environmental degradation and climate change is well-developed in Europe and beyond. International environmental law was presciently framed as part of global health law by Joaquin Cayon in Laaser U. and Beluli F. A Global Public Health Curriculum. South Eastern European Journal of Public Health (2016).

Objectives

1. Clarify the role of litigation in achieving environmental and climate goals

2. Highlight the role of public health practitioners (PHP) in documenting evidence of harms

3. Propose ways to build PHP capacity to use litigation to address related public health challenges

Results

In 2021 EUPHA-LAW, EUPHA-ENV, the Faculty of Public Health (FPH) (UK) and partners co-hosted a multi-stakeholder, interdisciplinary, open-access webinar on public health, climate change and litigation with experts from WHO, Greenpeace, ClientEarth, Lancet Countdown and the Groningen Centre for Health Law (GCHL). A related workshop was held at the 14th EPHC. In March 2022, EUPHA-LAW, FPH, GCHL and the University of Liverpool hosted a webinar on climate action in the European Court of Human Rights. [Patterson et al, Post COP26: legal action now part of public health’s environment and climate change toolbox, EJPH 31/5/2022.] EUPHA-LAW is preparing a toolkit for public health practitioners and a conference on public health litigation in 2023.

Conclusions

There is keen interest in the public health community to better understand how litigation can address public health challenges including climate change and environmental degradation. Capacity building is needed.

Key messages

• Climate litigation supported by interdisciplinary collaboration can strengthen government resolve and accountability for action to address environmental and climate commitments.

• Litigation can advance public health objectives even without a favourable court decision. Its value also includes the publicity and awareness generated and engagement of multiple stakeholders.
Introduction to the AQ-WATCH Project and the AQ-WATCH Toolkit to fight air pollution
Authors: Li C , Brasseur G , Granier C , Sofiev M , Timmermans R , Basart S , Pfister G , Kumar R , Caillard B , Boose Y
Published: October 2022

Background

WHO states that 9 out of 10 persons in the world do not breath clean air and 8 million people die prematurely from air pollution each year. The problem is well understood, but actions to mitigate it are lacking. The purpose of the EU-funded AQ-WATCH Project is precisely to develop effective tools based on the most advanced science technologies to help decision-makers in government and the private sector to address air pollution issues in regions of the world where they operate.

Objectives

AQ-WATCH aims to develops a supply chain to generate innovative downstream products for improving air quality forecasts and attribution based on existing space/in-situ observations to improve public health and to optimize renewable energy in regions of the world. The project consortium includes research and business-oriented partners, who brings together the required expertise to define the optimal functionalities of these products to bring them to the market.

Results

The AQ-WATCH products are organized into 5 modules: (1) Air quality atlas, (2) Air quality attribution & mitigation, (3) Dust and fire forecast, (4) Fracking analysis, and (5) Air quality forecast. They are developed for 3 target regions (Beijing, Colorado and Santiago de Chile) and are integrated into a unified user-interface, the AQ-WATCH Toolkit. Product developers and prime users in the target regions are constantly interacting, and the user feedback is collected, analyzed and included during the product development.

Conclusions

Collaborative work done in AQ-WATCH shows strategic interaction between our research and business-oriented partners. Contributions from local parties are proven to be valuable for regional adaption of the products. A throughout dissemination including regional workshops is essential to ensure proper knowledge uptake by the target audience. Constant exchange with the private sector is required for a smooth transfer from scientific results to commercialized marketable products.

Key messages

• The AQ-WATCH Project follows EU’s initiative to utilize its space observations with added values to develop easily-accessible tools to fight air pollution applicable to regions of the world.

• The AQ-WATCH Toolkit is developed with iterative feedback exchanges between product developers and local users to address air pollution issues, and will be eventually exploited to the market.
Impact of seasonality on physical activity: a systematic review
Authors: Faubel R , Garriga A , Sempere-Rubio N , Molina-Prados MJ
Published: October 2022

Background

The purpose of this study was to collect and analyze the available scientific evidence of the impact of seasonality on physical activity (PA). PA refers to walking, biking, sports and/or active recreation.

Methods

The systematic search was performed in the following databases: PubMed, PEDro, Cochrane and Embase. All publications from January 2015 to September 2020 assessing seasonal variations on physical activity development in adults were selected.

Results

A total of 1159 articles were identified, of which 26 fulfilled the selection criteria involving 9300 participants from 18 different countries. The results obtained suggest that seasonality affects PA independently of the countries, pathologies of the participants and the tool to collect PA information.

Conclusions

PA level varies across the seasons, with higher PA level in summer compared with other seasons, especially in winter. Sedentary behavior follows the opposite trend. Impact of seasonality variations should be considered in clinical research involving PA as a primary outcome as well as in interventions on PA promotion.

Key messages

• Impact of seasonality variations should be considered in clinical research involving PA as a primary outcome as well as in interventions on PA promotion.

• Seasonality affects PA independently of the countries, pathologies of the participants and the tool used to collect PA with higher PA level in summer compared with other seasons, especially in winter.
Health promotion and disease prevention with digital technologies for older people: Scoping review
Authors: De Santis KK , Mergenthal L , Christianson L , Zeeb H
Published: October 2022

Background

In the aging world digital technologies are needed to target the health needs of older people. This study aimed to identify digital technologies for health promotion and disease prevention for older people by performing a scoping review.

Methods

A search of MEDLINE, PsycINFO, CINAHL and SCOPUS on 09.03.2022 identified 2150 studies. The inclusion criteria were: 1) Population: older people, 2) Concept: any digital health technology, 3) Context: health promotion and disease prevention in home or community settings. Preliminary study selection was performed automatically using the smart groups function in EndNote. Studies were clustered by digital technology type, health target, study design and study focus. Final study selection and data coding will be performed manually by two authors.

Results

Of the 2150 studies, 1874 studies were excluded, 159 studies met the inclusion criteria 1) and 2), but addressed different contexts (digital competence, digital technology development, disease management) or setting (care) and 117 studies were included. Digital technology types were: 1) any technologies (digital, virtual, video, eHealth or telehealth), 2) internet websites accessed via computer, 3) SMS or mobile phones, 4) exergaming or 5) smartphones or wearables. Health targets were: 1) physical activity, 2) mental health and wellness, 3) nutrition or 4) cognitive functioning. Study designs included primary studies (randomized-controlled trials) or reviews (systematic or scoping). Study focus was on effectiveness, feasibility or evaluation of digital technologies.

Conclusions

The health needs of older people are addressed by older technologies. Newer studies use heterogeneous terminology when referring to digital technologies. Future studies should focus on multiple aspects of healthy aging beyond mobility. More work is also needed to understand if and how a shift towards newer technologies occurs and if that is associated with health benefits in older people.

Key messages

• Older digital technologies (computers and mobile phones) address the health needs of older people.

• Mobility is the main health target of digital technologies for older people in the context of health promotion and disease prevention.