bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuity of care during the COVID-19 pandemic: Qualitative results from a mixed-methods study
Authors: Deml M , Jungo K , Rachamin Y , Gicquel F , Dubois M , Bertato S , Dubois J , Senn O , Streit S
Published: October 2021

Background

Decreases in health service use were observed globally during the COVID-19 pandemic. In the quantitative part of this mixed-methods study, we documented similar trends in Switzerland, with a retrospective cohort study showing a 15-20% decrease in general practitioner (GP) consultations/chronic disease monitoring in spring 2020. These changes need to be understood, particularly for individuals at risk of COVID-19 complications, as many have conditions requiring regular monitoring.

Methods

With a mixed-methods design, we examine continuity of care for at-risk groups (people: ≥65-years-old, with cancer, diabetes, respiratory disease, etc.) between Mar-2020 and Apr-2021. Following quantitative analyses, we qualitatively studied changes in GP/patient practices thru semi-structured interviews with 23 GPs and 36 at-risk patients. We here focus on thematically analyzed qualitative results.

Results

Qualitative data helped explain observed reductions in consultations/monitoring: 1) some patients were discouraged to seek care by official recommendations and/or GPs during the first semi-shutdown; 2) some patients perceived GP offices as closed/overburdened; 3) some patients feared contracting coronavirus; 4) some patients sought alternatives to traditional primary care consultations (e.g., tele-consultations, consulting pharmacists/other professionals, self-reliance). Many patients did not feel that there was discontinuity of their cares. GPs commonly described feeling like an underutilized resource during the pandemic and explained how they could have been mobilized for population needs.

Conclusions

During the first wave, there was a mismatch between 1) GPs' reported availability/preparedness to adequately care for at-risk patients, and 2) some GPs discouraging at-risk patients to come for consultations, at-risk patients' perceptions that their care was not “urgent” in a pandemic setting, and patient perceptions that GPs were otherwise unavailable/overburdened.

Key messages

Qualitative data offer explanations for health service use reductions during the COVID-19 pandemic. Results provide potential paths forward and highlight GP views of being an underutilized resource.
Evaluation of a school-based intervention to promote mental health literacy. Preliminary results
Authors: Kirchhoff S , Freţian A , Wahl P , Bauer U
Published: October 2021

Background

Mental illness is one of the leading causes of ill-health and disability. The current COVID-19 pandemic poses an additional challenge on mental health, e.g., through increased levels of anxiety, depression and fears about the future. As most mental illnesses develop before the age of 25, young people are a critical target group for prevention. Mental health literacy (MHL) is considered to be a key determinant of positive mental health, thus, being crucial for mental health promotion and dealing with the aftermath of the pandemic. This project aims at (i) adapting an evidence-based MHL curriculum for German schools, as school-based interventions are suitable in reaching most young people, and (ii) evaluating its acceptance and effectiveness regarding MHL and stigmatizing attitudes.

Methods

An interdisciplinary team including representatives from self-help groups for mental health translated and adapted the Canadian “TeenMentalHealth” curriculum for German schools. The evaluation design includes a pre, post, follow-up assessment of MHL, stigmatizing attitudes, and help-seeking efficacy.

Results

For better applicability of the curriculum, the original program was shortened, while keeping its core contents such as knowledge and myths around mental health and illness. Written and digital material was developed and distributed to teachers, which were trained to deliver the intervention. Preliminary results show high acceptability, a significant increase in MHL and a decrease in stigmatizing attitudes, while help-seeking efficacy remained unchanged.

Conclusions

An MHL intervention was successfully adapted for the German school setting. While evaluation is ongoing, first results indicate its effectiveness in promoting MHL among students, decreasing stigmatizing attitudes and high acceptability, even during the times of the pandemic. Further evaluation is necessary to confirm the preliminary findings and to gain insight into the missing effect on help-seeking efficacy.
Challenges to effective breastfeeding among indigenous Ngäbe-Bugle communities in Panama
Authors: Ma B , LaBrot B , Atkinson I
Published: October 2021

Background

Panama's overall infant mortality rate is 13.2 deaths per 1000 live births and 28.4 per 1,000 among indigenous populations such as the Ngäbe-Bugle. 93.8% of the Ngäbe population is impoverished and the cost of formula is prohibitive, resulting in poor substitutes such as cheap sugary beverages. These mothers received little education for breastfeeding and it is understandable why breastmilk ‘alternatives' are used. This study explored factors impeding effective breastfeeding in a representative community-based cohort of indigenous Ngäbe-Bugle mothers. This study used the hypothesis that preventable breastfeeding challenges are common and likely negatively impact infant health.

Methods

We conducted a closed response and open questionnaire survey of 139 selectively sampled Ngäbe women with 529 live births in 2018-2019. Mothers reported the need for support, use of milk substitutes, and breastfeeding complications such as mastitis. Systemic barriers such as poor access to healthcare professionals were also assessed. Data was analyzed with SAS and Power-BI statistical software by independent statisticians.

Results

71% of mothers stated a need for more support. 32% ceased breastfeeding and used milk substitutes. Latching difficulties (2%), pain (3%), sore, cracked, and bleeding nipples (2%), and mastitis (8%) contributed to cessation. 80% reported no formal education on infant feeding and 83% were unaware of breastmilk benefits. 12% received breastfeeding support from healthcare professionals and 2% received it from a village midwife.

Conclusions

Among the Ngabe, lack of knowledge or access to health services contribute to breastfeeding complications and challenges resulting in cessation and the use of poor milk substitutes.

Key messages

Breastfeeding initiation and continuation rates are negatively affected by poor education, poor healthcare access, and complications resulting in breastfeeding cessation and milk substitution. Supporting mothers with community-based education and improved healthcare access seems likely to positively impact these challenges to effective infant nutrition.
Gender differences in the impact of COVID-19 pandemic on socio-economic and psychological wellbeing of students in Russia
Authors: Andreenkova A , Andreenkova EV
Published: October 2021

Background

Pandemic of COVID-19 had strong impact on young people in high education whose life plans, education prospects and personal networks were threatened. Based on theoretical framework of differential consequences of catastrophic events for less privileged groups, we explore the impact of pandemic (IP) on genders in student communities.

Methods

The C19 ISWS survey was conducted in spring 2020 by web-survey method among students of Russian universities (2738 cases). IP was measured in five domains: 1) socio-economic: subjective evaluation of economic wellbeing before and during the pandemic; 2) psychological (Depression Scale CES D8); 3) social ties: change in frequency of contact with family and friends, intensity of contacts in hours per day; 4) physical health (experience of COVID symptoms); 5) academic workload in hours before and during pandemic. ANOVA analysis was used to investigate strength of impact on gender groups after controlling for other factors (age, city, grade).

Results

Change of financial wellbeing experienced 39% of students with 4% significant difference between male and female students. Male and females had different mental reaction to COVID on few aspects - anxiousness (13 points difference), apathy (12 points), restlessness (9 points) and general depression (7 points), but not on social aspects as loneliness and isolation. IP was not differential for health (22% in average experienced the symptoms of COVID), academic workload (decreased hours per day on 5% for both genders) and social ties (strong decrease in contacts with friends, small decrease in contacts with family but similar by genders).

Conclusions

IP is strong and differential by gender for socio-economic and socio-psychological wellbeing, but similar for social communication and social ties, health and academic workload. These results may serve as a basis for forming more effective communication strategies and social support to mitigate IP for male and female students.
Association between parents’ education level and KIDMED index: a cross-sectional study
Authors: Melis A , Anastasia A , Zannoner A , Salussolia A , De Dominicis F , Arrichiello F , Ferretti F , Marini S , Masini A , Dallolio L
Published: October 2021

Background

Mediterranean diet (MD) is considered a healthy dietary model with several beneficial effects.

A strict adherence to the MD in children, coupled with daily exercise, can prevent obesity and significantly reduce the risk of correlated chronic diseases, such metabolic syndrome. The aim of this study is to evaluate the association between parents' educational level and compliance to the MD in a convenience sample of Italian children.

Methods

We conducted a cross-sectional study among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) between May and June of 2017. Children's and parents' information were collected at baseline (i.e. age, BMI, occupation, educational level). A weekly food diary was administered to evaluate the participant's dietary habits. The degree of adherence to MD was derived from these diaries using the KIDMED index developed in 2003 by Serra-Majem et al. We used multiple linear regression models, adjusted for age and gender, to investigate how parents' educational level affected children's KIDMED index.

Results

Adherence to the MD was high, medium and poor in, respectively, 4%, 60% and 36% of children. Higher prevalence of overweight and obesity was observed among those with lower adherence to the MD. The linear regression model shows that fathers' educational level is not associated to children's KIDMED index variation. On the other hand, a higher mothers' educational level is linked to an increased weekly KIDMED index (p = 0.012) as well as an increased weekend KIDMED index (p = 0.048).

Conclusions

Mothers' education level is associated with increased adherence to MD, both weekly and weekend. The greater difference has been observed during weekend, when children of highly educated mothers score higher at KIDMED index.

Key messages

Mothers’ educational level plays an important role in children’s eating habits, with higher educational level associated with a better adherence to the MD. It is critical to implement parents' toolkit to promote healthy dietary patterns and adherence to MD in order to correct these social differences.
Tools available to measure awareness of the European Code Against Cancer in the European Union
Authors: Espina C
Published: October 2021

Adopted on 3rd February 2021, Europe's Beating Cancer Plan aims to reduce the cancer burden for patients, their families and health systems, and is a major strategic priority of the European Commission in its present mandate. The Cancer Plan commits to updating the European Code Against Cancer and includes the objective of making “at least 80% of the population aware of the Code by 2025”. In order to measure progress towards and attainment of this goal, metrics and tools at European level would be needed. Possible options include, but are not limited to, the “Eurobarometer”. Since 1973, the European institutions commission regular public opinion surveys in all EU Member States. The European Commission's Eurobarometer Surveys is a series of multi-topic, pan-European surveys covering attitudes towards policies, economy, and health, among other topics. It comprises survey series or instruments such as the Standard Eurobarometer (regular face-to-face interviews with approximately 1,000 subjects in each Member State), the Special Eurobarometer (in-depth thematic studies relevant to the activities of the European institutions) or the Flash Eurobarometer (ad-hoc thematic surveys carried out within a short timespan), among others. Some of these options may provide a suitable tool to standardize and measure awareness and perceptions on cancer risk factors in a valid and reliable way, as well as the corresponding cancer preventive measures, and the European Code against Cancer itself, in the European population overtime. However, developments arising from the Cancer Plan, such as the recently established Knowledge Centre for Cancer of the Joint Research Centre of the European Commission, may offer more a suitable, continuous process. This brief presentation will prepare the audience for an interactive discussion on the pragmatic challenges and opportunities that lie ahead for the monitoring and evaluation of the European Code against Cancer.
3.O. Workshop: Children and adolescents’ mental health during the corona pandemic
Authors:   Organised by: EUPHA-CAPH, EUPHA-PMH,   Chair persons: Julia Dratva (EUPHA-CAPH), Jutta Lindert (EUPHA-PMH)
Published: October 2021

The COVID-19 pandemic is an unprecedented public health crisis impacting all age groups and all areas of society, irrespective of the risk of exposure or disease severity. In fact, containment measures put into place, such as social distancing, limiting mobility or closing of schools, carry many risks for health, especially for mental health. It is also said, that the pandemic accentuates existing health risks. Childhood and adolescence is characterized by ongoing physical, social, emotional and academic developments and dependencies, and is therefore considered a population of increased vulnerability. While this age group is not a high risk group for SARS-CoV 2 diseases, they are heavily impacted by the containment measures, which caused a drastic change to their everyday lives with closures of schools and recreational activities, social distancing and stay at home orders. Loss of day structure and contact to friends can be destabilizing. Children and adolescents rely on their parents for stability and security. However, the general and specific fears related to health and economic situation during the pandemic may affect parents' ability to provide this support. First evidence indicates a drastic rise in mental health problems in children and adolescents with potential long-term impact. The workshop addresses mental health in children and adolescents during the pandemic and will provide the opportunity to discuss public health reactions to this mental health crisis. We present four studies with data collected during the lock-down or pandemic, of which two present data on psychological difficulties and associated risk factors, underlining the role of parents in mental health of children and adolescents, while the other two address solutions, namely interventions for improving mental health literacy in adolescents and parental support groups. While the workshop topic relates to COVID-19 pandemic, the lessons-to be learned go beyond the current public health crisis.

Key messages

Covid-19 containment measures come with serious side-effects for mental health in children in Europe, strongly associated with parental health and economic situation. Public health must address the rise in mental health problems in children during and after the pandemic to ensure a healthy development of this generation.
Longitudinal data collection on an international level during the COVID-19 pandemic
Authors: Sisenop F , Lindert J
Published: October 2021

Background

Different sampling approaches can be used in longitudinal surveys. The COVID-19 pandemic disrupted possibilities to conduct random based longitudinal surveys. However, longitudinal data on public mental health responses are urgently needed.

Methods

We conducted a longitudinal study in eight European countries (Albania, Belgium, Germany, Italy, Lithuania, Romania, Serbia, Slovenia) including 18+ year olds with the goal to reach as many people as possible and generate robust data. We used various sampling approaches (convenience sampling, snowball sampling, panel data) utilizing social media, professional organisations, educational institutions and personal direct contact. To gather robust data, focus was on multiperspectivity rather than representativeness. A mix of sampling approach is possible. Digital sampling methods were feasible in the European region.

Results

In total 2,426 participants filled out >50% of the questionnaire in the overall sample, which is, also due to the rapidness of survey development, a good result for data on mental health and resilience during COVID-19 pandemic. COPERS study has shown that a mix of various sampling approaches is possible and a good option to generate datasets in a relatively short time span. However, no responses rates can be calculated using.

Conclusions

Online surveys are a good tool to reach people in times of crisis. Furthermore, they can be adapted directly in case of changes, if necessary and desired. Using different ways of recruitment, a diverse group of people can be recruited. However, online surveys require a certain technical understanding, which not all potential participants have. Question remains how multinational research is evolving and being shaped. This asks for possibly new methods to define and detect sampling bias.
Infographics and the knowledge translation framework
Authors: Hilderink HBM , Deuning C , van der Wilk E
Published: October 2021

The concept of Knowledge Translation (KT) can be used to narrow the gap between knowledge producers, such as researchers, and knowledge users, such as policy makers. KT is the process in which complex research and data are translated into more easily to understand understood content to support evidence-informed policy making. KT covers a wide variety of activities including knowledge dissemination, two-way exchange process between researchers and knowledge users, and communication. The nature of these activities can be classified in four models of interaction, Push, Pull, Exchange and Integration. Especially, the push model is applied when potential users are still unaware that they should be considering information on a certain topic, which is often the case for Burden of Disease (BoD) results. Next to push method as such policy briefings and health status reports, a product focusing on visualization might be more effective. A visualized product that has gained popularity is the infographic as a collection of imagery, charts, and minimal text that gives an easy-to-understand overview of a topic. Also regarding BOD, with its complex methodology and large amounts of data and information, infographics can be an efficient tool for KT. However, the use of infographics for BoD is still rather limited and could benefit from effective data visualization techniques applied in other fields within public health. Though communication through an infographic can be rather powerful, one has to be aware that the interpretation of the infographic by the receptor can also result in less-balanced messages. In this presentation, the concept of KT will be linked to visualization techniques as infographics using good and bad examples from BoD and beyond.
Health system description and assessment: a review of systematic tools for analyses
Authors: Waitzberg R , Rechel B , Maresso A , van Ginneken E , Quentin W
Published: October 2021

Introduction

Comparing health systems allows policymakers to benchmark against other countries, and improve processes and performance. A template to guide authors on how to present systems' features and performance in a meaningful manner is the basis for understanding and assessing a country's health system. This study presents an overview of approaches for standardized descriptions and analyses of health systems.

Methods

We conceptualized four criteria to define a “template” for our analysis. It must have (1) a framework, (2) a list of indicators, (3) instructions for authors on how to write an informative document, and (4) should cover health systems design and performance.

Based on these criteria we searched the academic and grey literature, and the web for templates.

Results

We found 29 tools that can be used as templates to describe and assess health systems. While ten tools are comprehensive, 19 tools focus on specific topics such as primary care, universal coverage, and quality of care. Another 21 tools focused on health system performance assessment but cannot serve as templates, as we define it. Most tools were developed by big organizations such as WHO, OECD and USAID.

Discussion

New models of governance and accountability are leading to increased interest in health system performance. A good template is key to write documents with an organized, coherent and meaningful description and assessment of a health system while allowing for cross-country comparison. We found ten tools that may serve as models of comprehensive templates, while most tools focus on specific topics or on performance assessment only.

Conclusions

This study provides a first-ever overview of templates that analyze health systems features and performance. Future studies could explore successful examples to consolidate a template that may potentially improve analysis and comparison of health systems in order to support policymaking.

Key messages

We found ten comprehensive tools for describing and assessing health systems. Our overview may help to improve existing templates by learning from experiences of different organizations.
Image of psychiatry and psychic illness during the COVID-19 pandemic: social media monitoring
Authors: Bogdan I , Chistyakova D , Pravednikov A
Published: October 2021

Background

Experts indicate that despite the demand there was no increase in referrals to Moscow psychiatric services in 2020. Among contributing factors are image/public perception of psychiatry and psychiatric diseases that are heavily influenced by social media.

Methods

More than 700 thousand social media messages of Muscovites matching relevant keywords (January-August, 2020) were downloaded using specialized software. Alongside with quantitative analysis, qualitative analysis was performed on a random subsample of 401 messages and respective images.

Results

Our analysis allowed combining messages into 6 groups and the biggest one was “Frivolous attitude to psychiatry”. In these messages, psychiatric terms are mainly used as means of stigmatization, to insult the opponent, even in cases when person is “guilty” of liking the “wrong” ideology, politicians or fashion. This heavily stigmatizes seeking help in official psychiatric facilities. People discuss numerous psychiatric diagnoses but at the same time they do not distinguish between types of psychiatric services (even in- and outpatient facilities). In the overall majority of messages people rely not on their personal experience, but on their thoughts based on e.g. stigmatizing pieces of art. This often leads to highly incompetent statements. COVID-19 references were very few in the subsample (<4%) but it should be highlighted that sometimes information gaps are filled with esoteric and conspiracy theories which do not promote seeking help in official psychiatric facilities either.

Conclusions

Analysis showed high level of stigmatization of the service in social media, which can distract people from seeking help when needed. It can be recommended to create appropriate social media monitoring system to find main topics for informational interventions and monitor the effectiveness of such interventions.

Key messages

Psychiatry and psychic illness are highly stigmatized in social media. Social media monitoring can help in destigmatization of psychiatric care.
How the Euripid collaboration contributes to price transparency of pharmaceuticals
Authors: Habl CAH , Fischer SF
Published: October 2021

Background

Spending on pharmaceuticals is growing continuously with a forecast of reaching over one trillion Euro in the next five years. Also, the average price of newly launched medicines is steeply raising, thus putting pressure on public payers. With several new advanced therapies in the pipeline, there are concerns in terms of both affordability and access for all patients who may need these treatments. To manage high launch prices, public payers in Europe more and more rely on private law contractual arrangements with pharmaceutical companies, requiring significant price discounts and other types of managed-entry agreements (MEAs).

Methods

In spring 2021 we analysed the EURIPID database (www.euripid.eu) for occurrence and frequency of MEA in the 28 countries (AT, BE, BG, CH, CY, CZ, DK, EE, EL, ES, FI, FR, HR, HU, IE, IL, IS, IT, LV, LT, NL, NO, PT, RO, SE, SI, SK, and UK) that are covered. Euripid is a voluntary, non-profit collaboration between mainly European countries on building up and maintaining a database with information on national prices of medicinal products.

Results

24 out 28 countries acknowledge the existence of MEA in their country. The highest number was identified in Italy with 1,317 agreements, followed by Latvia with 555 and Austria with 235. Seven countries use MEA as more or less standard instrument to manage their public pharmaceutical budget, whereas other countries just use it on case-by-case basis. Analysis shows that products above 100.0 Euro per unit (i.e. per shot or tablet) are much more likely to have a MEA than products with lower prices. Still, we found MEA in place also for products with a sales price per unit with <1.0 Euro. When looking into therapeutic areas, Antineoplastic and immunomodulating agents (ATC group L) including cancer medicines and immunosuppressants and medicines for the nervous system (ATC group N) dominated. Also, for some companies the likelihood of a MEA is higher than for others.

Key messages

Managed Entry Agreements (MEA) have become a standard tool for many public payers to manage high launch prices of pharmaceuticals. The scope of use varies widely: in some countries almost all newly launched pharmaceuticals are subject to such an agreement.
Geographic and socioeconomic equity in PHC performance among the elderly in three Nordic countries
Authors: Satokangas M , Arffman M , Agerholm J , Hougaard CØ , Andersen I , Burström B , Keskimäki I
Published: October 2021

Denmark, Finland, and Sweden pursue equity in health for their citizens through universal health care. It is however unclear if these services reach the elderly population equally between different socioeconomic positions (SEP) or living-areas. Our aim was to assess both socioeconomic and geographic equity in primary health care (PHC) performance among the elderly 2000-2015 in the City of Copenhagen, Metropolitan Area of Helsinki, and Stockholm County. Hospitalisations for ambulatory care sensitive conditions (ACSC) was applied as a proxy for PHC performance. Hospitalization data for population aged ≥45 was acquired from the Danish National Patient Register, Finnish Care Register HILMO and patient administrative register from Stockholm County Council. Over time development of geographical variation in ACSC within each metropolis was analysed with Poisson multilevel models. These models were adjusted with individual SEP to distinguish between geographic and socioeconomic disparities. When compared to Stockholm, incidence rate ratios of ACSCs were higher both in Copenhagen (IRR 1.25; CI 95% 1.17-1.35) and in Helsinki (1.39; 1.30-1.49). While the average effect of time slightly decreased in each of the three capital regions (0.97; 0.96-0.98), this decrease was slightly more pronounced in Helsinki than in Stockholm (0.98; 0.97-0.99). Geographic variation in ACSCs seemed the highest both in Copenhagen and in Helsinki. Over time these variations seemed to reduce in Helsinki and in Stockholm, but not in Copenhagen. Adjusting for individual SEP seemed to explain a half of this variance in Helsinki and a third in both Stockholm and Copenhagen - after which over time geographic variation seemed to reduce also in Copenhagen. Geographic disparities in PHC performance among the elderly seem to have narrowed in Finland and in Sweden but remained stable in Denmark. However, in Denmark this seems to rather reflect socioeconomic disparities than stagnant development of PHC.

Key messages

Despite the universal health care in Denmark, Finland and Sweden, there seems to persist both socioeconomic and geographic disparities in PHC performance among their elderly populations. Among the elderly, over time geographic disparities in PHC performance seem to have improved in both Finland and Sweden – but stagnated in Denmark due to the socioeconomic disparities.
The impact of COVID-19 on migrants in Greece: a retrospective analysis of national data
Authors: Hargreaves S , Kondilis E , Papamichail D , McCann S , Orcutt M , Carruthers E , Veizis A
Published: October 2021

Background

For 56,000 refugees and asylum seekers in Reception and Identification Centres (RICs) and Reception Sites (RS) in Greece, living in severely substandard living conditions, prevention measures have been severely limited. We assessed the impact of COVID-19 on migrants in these settings.

Methods

We did a retrospective analysis of policy documents and national surveillance data to identify COVID-19 outbreaks and estimate incidence among migrants residing in these camps (26th Feb - 15th Nov 2020). Incidence proportion (IP) of COVID-19 confirmed cases was calculated for three population groups (migrant populations in RICs, migrant populations in RSs, and the general population in Greece) during three time periods (first wave, second wave, and overall across the 9-month period).

Results

25 outbreaks were identified in migrant reception facilities, with 6 (85.7%) of 7 RICs and 18 (56.3%) of 32 RSs reporting at least one outbreak during the study period. The overall 9-month COVID-19 IP among refugee and asylum seeker populations residing in RSs on the Greek mainland was 1,758 cases per 100,000 population; in RICs the incidence was 2,052 cases per 100,000 population. Compared to the general population the risk of COVID-19 infection among migrants in reception facilities was 2.5 to 3 times higher; the risk of acquiring COVID-19 infection was higher among migrant populations in RSs on the Greek mainland (IP ratio: 2.45; 95% CI: 2.25-2.68) but higher still among migrant populations in RICs in the Greek islands and the land border with Turkey (IP ratio: 2.86; 95% CI: 2.64-3.10), where living conditions are particularly poor.

Conclusions

We identified high levels of COVID-19 transmission among migrants in reception facilities in Greece, with immediate implications for policy and practice to ensure refugee and asylum seeker populations are included in national response plans to reduce transmission, alongside ensuring their inclusion in plans for COVID-19 vaccine roll out.

Key messages

Thousands of migrants in Greece live in severely substandard conditions and largely excluded from the COVID-19 response. We identified high levels of COVID-19 transmission among migrants in reception facilities in Greece, with immediate implications for policy and practice.
“Time does not heal all wounds”: mental health impact of sexual victimisation in old age
Authors: Nobels A , Lemmens G , Thibau L , Beaulieu M , Vandeviver C , Keygnaert I
Published: October 2021

Background

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalizing disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to adequately address SV in later life. Studies researching the mental health impact of lifetime SV, i.e. SV that happened during childhood, adulthood and old age, are currently lacking. In this study we research the association between lifetime sexual victimization and adverse mental health outcomes in older adults, and its moderators.

Methods

Between July 2019 and March 2020, 513 older adults living in Belgium participated in a structured face-to-face-interview. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety and post-traumatic stress syndrome (PTSD) were measured using validated scales. Suicide attempts and self-harm were questioned during lifetime and in the past 12-months. SV was measured using behaviorally specific questions based on a broad definition of SV.

Results

Over 44% experienced lifetime SV, 8% in the past 12-months. Rates for depression, anxiety and PTSD were 27%, 26% and 6%. Almost 2% committed suicide, 1% reported self-harm in the past 12-months. Lifetime SV was linked to depression (p =.001), anxiety (p =.001), and PTSD in participants with a chronic illness/disability (p = .002) or no/lower education (p <.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12-months.

Conclusions

Lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are urgently needed.

Key messages

The mental health impact of sexual victimisation continues into old age. Tailored mental health care for older SV victims and capacity building of professionals are of the utmost importance.
Burden of disease methods: integrating COVID-19 to the cause list
Authors: Wyper G
Published: October 2021

Until recently, most efforts to understand the comparative population health impact of COVID-19 have been made using mortality-based metrics. This has intensified discussion over methodological choices; in particular, how we value the life-years prematurely lost due to COVID-19. The direct impact of COVID-19 on population health has varied across countries, with wide variation in incidence and infection fatality rates. Understanding and quantifying the combined impact of morbidity and mortality is a key step to standardizing comparisons across countries, and to quantify the within-country impact of COVID-19 relative to other causes of disease and injury, sub-national areas or demographics. Burden of disease metrics, such as disability-adjusted life years (DALYs) offer a means of monitoring the direct population health impact of COVID-19 infection. They also offer opportunities to assess the indirect impact of the pandemic that has occurred due to national lockdowns and restrictions to vital services. We present recommendations on methodology for estimating DALYs for COVID-19 at national level. These include a protocol for calculations, the data requirements and approaches to overcome data gaps, a consensus health outcome, and the disability weights to describe the severity of each health outcome. These standardized approaches to estimating DALYs due to COVID-19 can allow for more accurate and comparable estimates of the burden of disease across populations.
Burden of Disease of COVID-19 in European countries: examples from Germany and Scotland
Authors: Wengler A
Published: October 2021

Since the start of the pandemic, scientists have been challenged to estimate the impact of COVID-19 on the worldwide population. Research in many countries has concentrated on finding a feasible way of quantifying the effects in terms of severity and ill-health of the infection and its short- and long-term impact, as well as in terms of mortality. All of these factors can be combined when estimating disability-adjusted life years (DALYs). COVID-19 DALY estimates from Germany and Scotland will be presented as examples for burden of disease calculations. The methods used are aligned with the guidelines developed by the European Burden of Disease Network for estimating DALYs due to COVID-19. Nevertheless, both studies made adaptations, which depended largely on data availability and quality, and country-specific context upon which burden of disease assessments were undertaken. The German study showed that a total of 305,641 DALYs (368 per 100,000 persons) were lost in the population in 2020 due to COVID-19. There were 9.6 years of life lost (YLL) per death; women lost fewer YLL than men (8.1 vs. 11.0 YLL). In Scotland, DALYs due to COVID-19 ranged from 96,500 to 108,200 in 2020. This estimate meant that COVID-19 was framed as the second leading cause of disease and injury, with only ischaemic heart disease having a larger impact on population health in Scotland. Both studies indicated that over 98% of DALYs were due to YLL, i.e., a high proportion of DALYs is due to COVID-19 mortality. Notwithstanding methodological differences, the inputs from both studies could be used with common methodology to facilitate comparisons across countries. These findings illustrate how burden of disease indicators can be useful for monitoring public health in an ongoing pandemic.
Injury inequalities in the European Region: trends cross-country and within-country and potential COVID-19 impacts
Authors: Sengoelge M , Laflamme L
Published: October 2021

We will provide a review of the knowledge base from studies on injuries in the WHO European Region from 2010 to 2019, both cross-country and within-country, for all causes and cause-specific. The focus is whether inequalities between countries and within countries persist such that people from low socioeconomic status and from less affluent areas tend to die by injury to a greater extent than others. This has previously been observed for most causes of injury (e.g., traffic, self-directed violence, interpersonal violence, poisoning, burns) but also for several settings (e.g., home, work, transport) based on a review of socioeconomic disparities in injury risks from 1990-2006. In addition, the pandemic touches upon factors with a known impact, directly or indirectly, on the risk and social distribution of injuries (e.g. social isolation, change in transportation mode and volume, alcohohol consumption, etc.). Until the 2020-2021GBD data are available at the regional level for Europe, we hypothesise on how the pandemic may have affected the social distribution of injuries in the Region. For example, we hypothesise a significant decrease in road traffic related injuries due to lockdown measures (reduced commuting to work, 24-hour curfews). There may also be an increase in unintentional injuries related to children spending increased hours in the home environment and an increase in do-it-yourself injuries in adults. We also see a possible increase in self-harm injuries due to the mental ill health burden related to confinement and social isolation, but data thus far from single EU countries do not report an increase in suicides. We will then present a research agenda for investigating how the pandemic has affected the injury burden in the Europe Region.
The impact of the second victim phenomenon in an Italian Academic Hospital: a cross-sectional study
Authors: Moretti V , Scarpis E , Ruscio E , Bianchet B , Doimo A , Farneti F , Castriotta L , Quattrin R , Cocconi R
Published: October 2021

Background

Adverse patient safety events (AEs) can negatively impact on healthcare workers (HCWs) by causing emotional distress and affecting professional ability. The challenge of healthcare organizations is to support HCWs involved in AEs. This study aims to investigate the second victim phenomenon in a large Italian Academic Hospital (AH).

Methods

A cross sectional survey was conducted from June to November 2019 involving all HCWs working at the AH of Udine. HCWs' demographic characteristics and answers to the Second Victim Experience and Support Tool, Italian version (IT-SVEST; 29 items representing 7 dimensions and 2 outcome variables; Likert-scale: 1-5) were collected. Higher scores indicated a greater negative impact of the AEs and a perceived inadequacy of support resources. Median (M) and interquartile range (IQR) were assessed for each item. The agreement (AGR) (respondents with a mean score ≥4) was assessed for each dimension. Relationship between items score and demographic aspects was analyzed with non-parametric tests.

Results

A total of 349 HCWs joined the survey. Women were 79.4% and mean age was 39.4±10.7 years. 58.7% of respondents referred to be involved in a AEs. Lots of HCWs expressed feelings of psychological distress (AGR=26.9%) and less experienced HCWs were more affected by feelings of shame than senior ones (M = 4, IQR=1.5 vs M = 3, IQR=2; p < 0.01). Physical distress (AGR=10.9%) and professional self-efficacy (AGR=11.8%) did not had a great impact on HCWs, but younger (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) and female (M = 3, IQR=2 vs M = 2, IQR=2; p < 0.01) HCWs were more inclined to question their skills. Support services offered by Hospital organization may be improved (AGR 8,9%).

Conclusions

Psychological impact of the AEs is relevant in our cohort and less experienced and female HCWs resulted more inclined to doubt their professional abilities when involved. Improvements in support resources should be desirable to create a safer working environment.

Key messages

HCWs’ psychological dimension and perceived professional self-esteem can be negatively affected by adverse events, especially for less experienced and female professionals. Healthcare organizations need to develop and to implement a second victim support program designed to provide emotional, psychological and professional support for HCWs.
Factors influencing (health-promoting) telework during COVID-19: A company sample in Austria
Authors: Lang G , Hofer-Fischanger K
Published: October 2021

Background

Many companies had to switch to teleworking (TW) due to COVID-19 pandemic in spring 2020. However, TW conditions (home office) are not always health promoting. The question was: To what extent companies enabled TW before, during and after the first lockdown (time points t1-t3) and what is the role of workplace health promotion (WHP) in the establishment of health-promoting TW?

Methods

Using TAM, hypotheses were operationalised using a standardised questionnaire. At the beginning of 2020, a selection of 1858 Austrian companies were asked to participate in an online survey. The n = 192 responses from company representatives cover a broad mix of different sectors, industries, company sizes and regions in Austria. The analysis was carried out using structural equation models.

Results

Both the extent of TW implemented (means: mt1=3.7, mt2=18.4, mt3=8.6 days per month/employee) and the proportion of the workforce that could make use of TW (mt1=17.3%, mt2=58.6%, mt3=40.1%) increased significantly during the 1st lockdown and did not return to the pre-lockdown level afterwards. The degree of TW depended on how well the companies were prepared for it (β = 0.271). The (a) experience with TW and the (b) willingness to continue offering TW depended on the preparation (a: 0.243; b: 0.453) and on the actual degree of implementation of TW (a: 0.228; b: 0.193). For the intention to implement health-promoting TW in the company, the general willingness for TW (0.415) but also the existing WHP structures are central requirements (0.446; all p < 0.050).

Conclusions

Far more than before COVID-19, TW is of central interest for public health and WHP. In terms of a holistic health understanding of TW, companies have to adapt to the changing conditions (eg technical, communication) and to establish comprehensive WHP structures and processes. Support for companies can come from training or further education to raise awareness and develop an appropriate health-promoting company culture.

Key messages

Health promoting telework conditions need to be assessed and developed further. Companies need to be supported when implementing health-promoting telework, eg with guidelines, further education.
Government effectiveness and early childhood development in 33 countries
Authors: Cortes J
Published: October 2021

Background

The sustainable development goals call for favoring all the resources and strategies to stimulate early childhood development. Government effectiveness is the central axis of developing such actions, policies, and procedures in all countries, especially in low and middle-income countries.

Methods

We used the early child development module and index from national health surveys (MICS) of 33 countries to calculate the children on track. We also use the World Bank Governance Index, specifically the effective governance score. In addition, we carry out geospatial analyzes with the ArcGIS and GeoDa software to evaluate geographic correlations between the variables studied and identify geographic patterns of child development levels and effective governance. Pearson and Spearman correlation tests were performed in Stata software.

Results

We studied children from 33 low and middle-income countries; from 7 world regions. Thailand (91.1%) and Turkmenistan (90.7%) have the highest percentages of child development and the lowest in Burundi (39.6%). On the GE estimate, the lowest value is in Burundi (-1.3) and the highest in the Democratic Republic of Korea (1). In the GE Rank, the highest values are in Korea with 82.1% and the lowest in Haiti (0.9%). The grade of correlation between ECDI and GE Estimate was moderate positive (0.522, P-0.001, Correlation Spearman test), similarly to (0.518, P-0001, Pearson correlation test).

Conclusions

To date, this study presents the most practical spatial correlation analysis of child development and Government effectiveness using an instrument specially developed for national health surveys. The multifactorial aspect of early childhood development and the significant gaps we found only adds to the challenge of not leaving any children behind.

Key messages

To date, this study presents the most comprehensive spatial correlation analysis of child development and Government effectiveness. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving any children behind.