bluuebunny/crossref_metadata_2025 huggingface dataset:
“If-then”-scenarios in the care of pregnant women with diabetes in socially vulnerable positions
Authors: Schlütter M , Henriksen T B , Maindal H T , Burau V
Published: October 2024

Background

Pregnant women with diabetes in socially vulnerable positions face a multiplicity of medical, social, and psychological risks during pregnancy and birth and are susceptible to health inequities. This presentation explores the tentative nature of care provided to these women.

Methods

We base our findings on ethnographic fieldwork among health professionals at an obstetric outpatient clinic in Denmark.

Results

The unpredictability of diabetes during pregnancy calls for a flexible approach to treatment, placing significant demands on health professionals, pregnant women, and their partners and their ability to adjust to new scenarios. Our initial findings underscore that care is not static; it is dynamically adjusted to meet the medical, social, and psychological needs of the women. The adjustments in care encompass the negotiation and monitoring of insulin dosages, fetal weight, appointment frequencies, and additional consultations and impromptu phone consultations to follow up. An example of the tentativeness in care could be that if there is a sudden decrease in insulin requirements close to the due date then the birth might be induced. Beyond medical monitoring and treatment, the care extends to social initiatives that the health professionals must coordinate with various municipalities, depending on where the pregnant women live. This could include a joint meeting after the delivery between the woman, her partner, a health professional from the obstetric ward, and a social worker from the municipality. Often, this meeting is mentioned during consultations and intersectional meetings before the birth but is not formally arranged. Instead, it is tentative - if the pregnant woman would like a meeting upon discharge, then the health professional will set up a meeting.

Conclusions

Medical, social, and psychological care practices for women with diabetes in socially vulnerable positions are replete with “if-then” scenarios.

Key messages

• Care for pregnant women with diabetes in socially vulnerable positions is characterized by its fluidity and flexibility adjusting to the interplay of medical, social, and psychological needs.

• The “if-then” scenarios that characterize the care for pregnant women with diabetes in socially vulnerable positions put high demands on the ability to adapt and adjust continuously.
TOPSE for babies in Norwegian: Examining the reliability of a tool to measure parenting self-efficacy
Authors: Burkeland-Lie M , Skogen J S , Hysing M , Dovran A
Published: October 2024

Background

Parents’ confidence in their parenting abilities and self-efficacy (PSE) is an important factor for parenting practices. The Tool to measure Parenting Self-Efficacy (TOPSE) is a questionnaire created to evaluate parenting programs by measuring PSE. Initially, it was designed for parents with children between 0-6 years old. A modified version specifically for parents of infants aged 0-6 months (TOPSE for babies) is currently being piloted. In this study, we have investigated the reliability of the Norwegian version.

Methods

The study included 123 parents of children aged 0-18 months who completed a digital version of the TOPSE questionnaire. Professional translators performed the translation from English to Norwegian and a back translation in collaboration with the author group. Mean and standard deviation were calculated for each of the questionnaire’s six domains, and a reliability analysis was conducted using a Bayesian framework for the total sample (parents of children aged 0-18 months) and specifically for the parents of the youngest group of children (0-6 months).

Results

The overall Bayesian alpha coefficient for the six domains ranged from 0.54 to 0.83 for the entire sample, and from 0.63 to 0.86 for parents with children aged 0-6 months. For two of the domains, one item in each proved to primarily contribute to the low alpha coefficients and removing them improved the reliability, especially for parents of the youngest group of children.

Conclusions

Reliable tools to assess PSE and evaluate parenting programs is important. The Norwegian version of TOPSE for babies seems to be a reliable tool for measuring PSE, although there are variations across the children’s age groups and domains.

Key messages

• The findings from this study indicate that TOPSE in Norwegian is a reliable tool for assessing PSE.

• While our findings are promising, further research is warranted to establish a more robust evaluation, across both mothers and fathers, parental age and socioeconomic groups.
Resilience and mental and physical health of higher and lower educated youth during COVID-19
Authors: Kollmann J , Hollaar MHL , Servant-Miklos G , Kocken P L , Denktas S
Published: October 2024

Background

COVID-19 had a considerable impact on the mental and physical health of youth. To limit the impact of this crisis on their health, resilience was required. This study aims to discover how resilient, in terms of mastery, emotional reactivity and social support, groups of youth with different SES were during COVID-19, and what risk and protective factors they experienced.

Methods

Two qualitative datasets were analyzed. One dataset included 10 interviews of university students during April-May 2020, and the other dataset included 8 interviews with pre-vocational secondary education adolescents during October 2021 to March 2022. Interviews were held in person or online. Data were analyzed with thematic analysis in Atlas.ti.

Results

In general, university students displayed resilience despite the tumultuous beginning of the pandemic, and their mental and physical health was positive. Protective factors that helped them during COVID-19 were spending time with friends and family, being healthy and having a healthy lifestyle, and being able to avoid stressful situations. Risk factors that impacted their resilience were loneliness, COVID-19 anxiety, and missing stability and routine. Adolescents receiving pre-vocational secondary education showed mixed resilience later in the COVID-19 period, and they made negative observations about their health. Protective factors that helped them were achieving good results in school, hobbies, and avoiding stressful situations. Risk factors they experienced were lack of motivation and having difficulties at school. They experienced worry about school progress during COVID-19.

Conclusions

University students and lower educated adolescents seemed to have differing resilience during the impactful stages of COVID-19, possibly due to differences in their psychological development. To protect their well-being, it is important that policy makers consider the protective and risk factors that impact the health of youth during crises.

Key messages

• Resilience differs among the two different age groups and education levels.

• Policy makers should consider the protective and risk factors that impact the health of youth during crises.
Stakeholder perspectives on supplemental milk for infants under six months with growth faltering
Authors: Puthussery S , Okeke C , Gavine A , McFadden A , Tseng P
Published: October 2024

Background

Growth faltering is a significant public health issue among infants aged <6 months (m). Supplemental milk is commonly used for infants with growth faltering, with variations in type and duration. We synthesized qualitative evidence on stakeholder perspectives about equity, feasibility, and acceptability of the type and duration of supplemental milk for infants aged <6m with growth faltering.

Methods

We conducted a comprehensive search of six electronic databases in addition to manual searches to identify all qualitative studies published during January 2000-June 2022. Identified articles were screened in two stages against an inclusion criteria with titles and abstract screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist. The primary outcome was equity, feasibility, and acceptability of various supplemental milk for infants <6mwith growth faltering.

Results

Eighteen studies, reporting perspectives of mothers, fathers, grandmothers and healthcare providers were included. Studies were conducted in North America (9), Africa (5) and Asia (3) and South Australia (1). Donor human milk (DHM) (13) and infant formula(9) were the main supplementary milk reported followed by cow/goat milk (2). Key sub-themes derived were: education/awareness, socio-economic status (SES), race and religion, practicality, availability of resources, sustainability, cost, affective attitude, perceived effectiveness and ethicality. Maternal/caregiver SES was a key sub-theme across all three supplemental milk feeds, acting either as a barrier or facilitator for uptake.

Conclusions

DHM and infant formula were the most commonly reported supplemental feed for infants aged <6m with growth faltering. Maternal/care giver factors were perceived as key to ensure equity, feasibility, and acceptability with respect to type and duration of supplemental milk for infants aged <6m with growth faltering.

Key messages

• Stakeholders perceived donor human milk and infant formula as main supplemental milk for infants aged <6 months with growth faltering.

• Maternal/care giver factors are key to ensure equity, feasibility, and acceptability of supplemental milk for infants aged <6 months with growth faltering.
An evaluation of the first ten years of Newborn Screening for cystic fibrosis in Ireland
Authors: McGuire F , Linnane B , Collins A , Marsden P
Published: October 2024

Ireland has the world’s highest incidence of cystic fibrosis (CF). Newborn screening for CF (NBSCF) improves outcomes but identifies carriers and may yield false positive/inconclusive results. This study aimed to evaluate the performance of the first 10 years of the Irish NBSCF programme. Data collected by the programme between 01st July 2011 and 30th June 2021 were analysed, including cases of CF, CF carriers and Cystic Fibrosis Screen Positive Inconclusive Diagnosis (CFSPID). Microsoft Excel was used to calculate sensitivity, specificity and positive predictive value (PPV). Results were compared to European Cystic Fibrosis Society (ECFS) standards. Overall 650,809 neonates were screened, with 290 cases of CF, 533 CF carriers and 21 CFSPIDs reported. NBSCF identified 284 (98%) of the children with CF, sensitivity was 97.93% (95% CI 96.29-99.57), specificity was 99.91% (95% CI 99.91-99.92%), PPV was 0.34 (95% CI 0.31-0.37). The observed incidence of CF was 1 in 2,203, still Europe’s highest. Of the six undetected cases, most were of Asian ethnicity, suggesting panel limitations for diverse ethnicities.The Irish NBSCF programme exceeded ECFS standards. Most false negatives were caused by CFTR mutations undetected by the genetic panel. Increasing the size of the genetic panel increases detection of CFSPID and carriers and is not currently recommended. Ongoing validity monitoring is vital as the Irish population diversifies.

Key messages

• The Irish Newborn Screening Programme for Cystic Fibrosis is effective.

• Ongoing validity monitoring is vital as the Irish population diversifies.
The relationship between perceived parental phubbing and smartphone addiction in adolescents
Authors: Tonbuloğlu Altıner Ö , Mutlu Karakaş N , Özbaş C , Uğraş Dikmen A , Özkan S
Published: October 2024

Background

Parental phubbing refers to the degree to which parents reduce or ignore their interactions with their children while taking care of their smartphones. Today, it has become important to conduct studies to understand the effects of parental phubbing on adolescents, which is increasing globally. This study aims to evaluate the relationship between perceived parental phubbing and smartphone addiction as well as depression in adolescents.

Methods

In this cross-sectional study, 314 adolescents aged 10-18 years who applied to the general pediatrics outpatient clinics of a university hospital in Ankara, the capital of Türkiye, were included. The questionnaire form used for data collection consisted of questions about the sociodemographic information of the participants, ‘Perceived Parental Phubbing Scale’, ‘Kutcher Adolescent Depression Scale Short Form’, and ‘Smartphone Addiction Short Form for Adolescents’ items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyse the data. A value of p < 0.05 was considered statistically significant.

Results

Depression and smartphone addiction levels were found to be significantly lower in adolescents who did not smoke, engaged in regular physical activity and had a close group of friends (p < 0.05). It was also found that the level of perceived parental phubbing was significantly higher in adolescents whose parents’ education level was above high school and who felt lonely (p < 0.05). Low level positive correlations was found between perceived parental phubbing and both depression (r = 0.116, p = 0.041) and smartphone addiction (r = 0.128, p = 0.023).

Conclusions

As the level of parental phubbing perceived by adolescents increased, the levels of depression and smartphone addiction in adolescents increased. These negative effects of parental phubbing on adolescents should be taken into consideration by mental health professionals.

Key messages

• It is important to consider and question parental phubbing as one of the related factors in adolescents with high levels of smartphone addiction and depression.

• There is a need for studies to increase the awareness of parents, who are important role models for adolescents, about the concept of phubbing and its effects on adolescents’ mental health.
Prevention of sexual exploitation of children in sport clubs and social work in Switzerland
Authors: Wieber F , Deforth M , Winogradow D , Marti S , Dratva J
Published: October 2024

The Convention on the Rights of the Child, ratified in 1989, provides a clear normative basis for the protection of children from violence, abuse and exploitation. Despite efforts to protect children, many children and young people are victims of sexual violence. In the extracurricular sector, clubs offer great potential for preventing sexual exploitation. However, obstacles such as the taboo nature of the topic and the clubs’ limited resources make it difficult to develop and independently implement specific prevention offers. The aim of the project was to record the activities and competencies of sports clubs, youth associations and other youth organizations in the area of prevention of sexual assault among children and adolescents in the leisure sector and to determine the need for prevention services in the canton of Zurich in Switzerland. In addition, information was obtained on the impact of existing prevention services as well as information on their further development in terms of content and organization. Together, 979 participants from sports clubs, youth associations and youth organizations (e.g. board members, coaches, leaders) as well as the parents of children who are members of these clubs were surveyed. An impact model was developed for systematic modeling, as proposed by “Health Promotion Switzerland”. The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents. However, the current implementation of prevention measures also shows that there are still barriers to implementation and room for improvement in prevention work. Participants from all areas would particularly like support with advice on how to deal with suspected cases/incidents, the provision of information materials and the creation of a protection concept. Specific ideas for the further development of prevention work were also generated and will be discussed.

Key messages

• The prevention of sexualized violence is seen as a very relevant topic by sports clubs, youth associations, open child and youth work and parents.

• The study reveals that prevention measures are only partially implemented and identifies barriers and facilitators for improvement.
Vaccine awareness and hesitancy among Ukrainian refugee mothers in Bulgaria
Authors: Karcheva M , Nedkova-Milanova V , Stoynovska M
Published: October 2024

Issue

Migration carry out risk of disrupting the epidemiological well-being among refugees and host populations. Since the beginning of Ukraine crisis over 50 000 refugees remain in Bulgaria; 92% are women and children. There is suboptimal childhood immunization coverage among Ukrainian refugee community prior to arrival in Bulgaria.

Description of the problem

Childhood vaccination is mandatory in Bulgaria for TB, hepatitis B, diphtheria, tetanus, pertussis, poliomyelitis, rubella, measles, mumps, Haemophilus influenzae B and pneumococci. Refugees with uncertain immunization status are vaccinated according to the national immunization schedule and receive personal immunization card. As of March 2024, we conducted cross-sectional study to assess knowledge and attitudes of Ukrainian mothers through an interview.

Results

Of 105 mothers interviewed, 72.38% were with higher education. Arrived women were not familiar with Bulgarian health system and especially with vaccination. Absence of language barrier and presence of doctors among them facilitated our study.56.19% believe that migration has disrupted their children’s vaccinations. 56.19% consider that migration has disrupted their children’s vaccination. Aware of benefits of vaccines were 91,43%, they mainly trust doctors-84.76%, they pay attention to the positive discussion in the media-55.77%.Mothers realize the importance of herd immunity, considering that vaccinated children protect the others-68.57%.Leading reasons for mistrust of vaccines, mothers indicate - doubt in favor of vaccine-24.76%, medical contraindications for child-21.90% and doubts about quality of the vaccine-19.05%.They pay attention to positive discussion in the media-55.77% and have confidence in Bulgaria’s institutions.

Lessons

The Government of Bulgaria provided significant support and medical care for the prevention of vaccinepreventable diseases among Ukrainian children. Institutions and volunteers work for successful integration of refugees.

Key messages

• Need to know the immunization status of Ukrainian children admitted to Bulgaria.

• Increasing trust in vaccines and the health system in general in Bulgaria requires additional explanatory campaigns among refugees.
Health services consumption and barriers in the health care of persons of Roma origin in Bulgaria
Authors: Kamburova M , Ivanova B , Tihomirova R , Mineva-Dimitrova E , Dimitrov D , Yordanova Z , Ivanova A , Valentinova Ts
Published: October 2024

Introduction

Persons of Roma origin often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the health services consumption and barriers in the health care of persons of Roma origin in Bulgaria.

Methods

The cross-sectional study was conducted and a semi-structured face to face interview were applied in 2022. Adult citizens of Roma origin were covered as follows: residents of Knezha - a total of 59 people and households from the towns of Knezha and Kotel - 18 families (50 persons). The cities are representative of settlements of medium size with separate neighborhoods of Roma origin. Data processing was performed by SPSS v.24.

Results

Over two thirds of the covered persons of Roma origin do not have health insurance. In each household an average of 1.8 uninsured people was found, but in some of the families almost all of the elderly members are not insured. Due to lack of health insurance in 14% of the households were reported a refusal to provide health care by general practitioners (GPs) and specialists in out-hospital care. 82.1% of Roma women have never had a mammography and 71.4% a smear test. In 83.3% of the households required direct payment for the provision of health services, which corresponds to the high share of informal payments in health care in Bulgaria (34 % in 2023), but among the Roma population this share is significantly higher. The households have to pay for specialized out-hospital care (66.6%), GPs (22.2%), and for emergency assistance (5,6%). 44.4% of the families have used the services of emergency care in the last one year. While in one third of the families an adult member was hospitalized in 27.8% of them there is a need for hospital treatment, which is unrealized.

Conclusions

The Roma population in Bulgaria is characterized by an unfavorable health profile and the health services provided to the persons of Roma origin are inadequate to their needs.

Key messages

• Persons of Roma origin in Bulgaria often face serious inequities concerning their state of health and their access to good quality health services.

• Improving the socioeconomic status of people of Roma origin will increase their opportunities for health insurance and going to improve their access to health services.
A Qualitative Study of Implementation Outcomes of a Group-Based Intervention for Immigrant Parents
Authors: Sibbie P , Lämsä R , Skogberg N , Peltonen K , Laajasalo T
Published: October 2024

Background

Inequities in service utilization between immigrant families and native populations have emerged within the Nordic welfare countries, highlighting the need for culturally sensitive parenting support. Despite the proven efficacy of parenting interventions, their implementation phases have not been adequately addressed in extant implementation research, particularly regarding structural racism and inequities. This study aims to contribute to the literature from an implementation perspective by describing a pilot of ‘Being a Parent in Finland,’ a culturally sensitive group-based intervention for migrant parents. Its specific focus is on investigating barriers to and facilitators of implementation outcomes from the perspectives of service providers.

Methods

The qualitative data consisted of thematic interviews (N = 6) with service providers (N = 9) compiled at distinct phases of the pilot from 2021 to 2023. In addition, data triangulation was utilized through document analysis of 125 pages of various documents regarding the pilot as a supplementary data collection method. Content analysis was conducted on the data using Atlas.ti 23.

Results

The findings stress the alignment of the target group, service placement, and preventive measures for enhancing parenting intervention’s acceptability, appropriateness, and feasibility. Implicit objectives, such as perceiving the target group as ‘at-risk,’ can impede intervention success and exacerbate stigmatization of the target group. Culture- and context-specific adaptations, and community engagement foster parental trust and intervention accessibility.

Conclusions

The findings underscore the significance of congruent objectives, community engagement, and adaptive iterations in preventive parenting interventions. Advocating for these elements in implementation strategies is crucial for reducing stigmatization and enhancing equity and efficacy in services tailored to minority parents.

Key messages

• Acknowledging equity in both implementation research and strategies is paramount.

• Implementing trust-building is crucial for culturally sensitive parenting interventions.
Dialogue between researchers and older immigrant women in Norway post COVID-19: A qualitative study
Authors: Kour P , Agata G K , Diaz E
Published: October 2024

Background

In the wake of the COVID-19 pandemic, marginalized groups, particularly older immigrant women, have faced new challenges, prompting an urgent need for research to understand their post-pandemic needs and foster inclusive healthcare systems. In view of this, older immigrant women and researchers developed a project based on dialogue, holding monthly meetings for a year, with the aim of improving health literacy for the women, and enlightening the researchers on the women’s challenges. This study has sought to understand the experiences of the dialogue between older immigrant women and researchers.

Methods

We utilized participant observation in five dialogical meetings between older immigrant women and researchers, followed by semi-structured interviews with 8 older immigrant women and 7 researchers in Bergen. Data was analyzed using thematic analysis, supported by audio-recorded and transcribed interviews, alongside notes from participant observations.

Results

Analysis yielded three main themes of health knowledge, collaboration, and power dynamics. The dialogue was seen as a positive experience by both older immigrant women and researchers, with a view to establishing collaboration and trust. It also encouraged user participation in research, for the women, and carrying out research that was relevant to this otherwise ‘invisible’ population to the health system, for researchers, whilst empowering the women with knowledge to improve and maintain their own health.

Conclusions

This study sheds light on the crucial role of dialogue between older immigrant women and researchers in understanding post-COVID-19 needs. The findings underscore the importance of fostering collaboration, trust, and user participation in research, empowering marginalized populations while addressing gaps in the healthcare system. By amplifying the older immigrant women voices’ and promoting inclusive research practices, we can foster responsive and equitable healthcare systems.

Key messages

• Dialogue between older immigrant women and researchers is essential for understanding post-COVID-19 needs, fostering collaboration and trust.

• User participation empowers marginalized groups, while relevant research improves healthcare inclusivity and outcomes for all.
Co-designed study with the Traveller Community in Ireland to determine cancer awareness & attitudes
Authors: Fox P , Jalal R , Fitzpatrick P , Frazer K , Kavanagh L , Collins M B , Kennedy U , McCarthy T , Quirke B , Joye R
Published: October 2024

Background

Irish Travellers are a distinct ethnic minority group (formal recognition March 2017). They experience higher mortality than the general population at all ages for all causes of death.

Study Aim

To determine cancer awareness and attitudes among the Traveller Community in Ireland, and to identify barriers/enablers to cancer risk reduction behaviours and early diagnosis of cancer.

Methods

A co-designed multi-method study was developed in collaboration with Pavee Point, a national NGO for Travellers, the National Social Inclusion Office (NSIO) and the National Cancer Control Programme (NCCP) including: 1. Consultation with Pavee Point and NSIO representatives to inform the study proposal and methodology. 2. Co-design of methodology for ethics applications and subsequent data collection plan including interview topic guides and the development of a culturally appropriate version of the NCCP’s 2022 National Survey on Cancer Awareness, adding questions on social determinants of health and screening participation. 3. Collaboration with 12 peer-led Primary Health Care for Travellers Projects (PHCTPs), to provide in-person training for Traveller Community Health Workers to undertake a cross-sectional survey of 380 adult Travellers. 4. Collaboration with PHCTPs to undertake 20 semi-structured interviews with Travellers. 5. Conduct of semi-structured interviews with healthcare professionals to explore perceptions of barriers/enablers for Travellers engaging with the health system.

Lessons Learned

Working closely and collaboratively with our study partners, we gained valuable insights which enabled effective and efficient data collection across 8 counties, while exceeding our survey target sample size. Implications for Research: Collaborative, trusting, and respectful relationships are critical for all studies, but particularly when working with minority groups.

Conclusions

The study findings will inform policy for improved cancer outcomes among Travellers in Ireland.

Key messages

• Formation of a collaborative and respectful relationship with the Traveller community has facilitated successful research.

• Traveller Community Health Workers (peer researchers) were key to the success of data collection.
Heterogeneity in health and lifestyle among preschool children with migrant background in Sweden
Authors: Alseddig S , Nkulu Kalengayi F K , Vaezghasemi M , Lundahl L , Lindkvist M , Lindvall K , Silfverdal S A , Ivarsson A
Published: October 2024

Background

Parental country of birth and socioeconomic status affect children’s health, lifestyle, and access to care. But inequality patterns may vary depending on the outcome and indicator being studied. While prior studies have focused on single health outcomes, this study assessed the relationship between parental migrant status and a range of health and lifestyle indicators among 3-year-old children.

Methods

Using an outcome-wide approach, we analyzed data from cross-sectional population-based surveys of 3-year-old (2014-2018) in Northern Sweden, which included 9,099 children aged 33-42 months. The surveys were administered to parents. Logistic and linear regressions were performed to examine the association between parents’ place of birth and outcome indicators. Additionally, we controlled for parents’ income and education using multiple regression models.

Results

Children with at least one migrant parent were perceived by their parents to have poorer health (OR:1.5, CI:1.01-2.36) and more socio-emotional problems (OR: 2.8, CI: 2.20-3.59) compared to those with two Swedish parents. While there were no significant differences in estimated BMI, lifestyle indicators showed that these children consumed more sweets (OR:4.5, CI: 3.02-6.58), less milk (OR: 1.3, CI: 1.09-1.55), fewer vegetables (OR:1.6; CI: 1.22-2.05) and brushed their teeth less frequently (OR: 2.8, CI: 2.17-3.53). However, they spent more time playing outdoors on weekdays (OR:1.6, CI:1.22-2.00) and weekends (OR: 1.5, CI: 1.18-1.94), but screen time remained consistent between weekdays and weekends.

Conclusions

Parental migrant status has varying impacts on children’s health and lifestyle, with some indicators showing worse outcomes for children with migrant parents compared to those with Swedish parents, while others do not. An outcome-wide approach is crucial for targeted actions to strengthen protective factors and mitigate risk factors, and ultimately reduce inequalities in early childhood.

Key messages

• The link between parental migrant status and children’s well-being is complex. Not all indicators show worse outcomes, inequality patterns vary based on the specific outcome and indicator measured.

• An outcome-wide approach is crucial to identify action areas for targeted interventions to reinforce protective factors and mitigate risk factors, and ultimately reduce inequalities during childhood.
Shifting focus - the need to prioritise an inclusive public health approach to trauma
Authors: Hopkins J
Published: October 2024

Since 2017, the Welsh government has prioritised the development of a Public Health Approach to understanding the impact of Adverse Childhood Experiences. Taking the work of Bellis et al, and the population level research to understand the prevalence of ACEs, and associated risks (Bellis etc al, 2015), the ACE Hub Wales was established to coordinate a multi-agency, cross sector approach to preventing, tackling and mitigating the impact of adversity in childhood. The Hub developed its approach to advocate for more public awareness of the life course risks to health if the right support was not accessed or available to children, such as poor mental health and chronic conditions such as type 2 diabetes and heart disease in adulthood. From 2021 there has been a dramatic shift to attempting to understand the experiences, and unmet needs, of children and people who have come to Wales to seek sanctuary, migrant women who have no recourse to public funds, and people experiencing racism and discrimination. In 2021, the ACE Hub Wales co-produced a Wales national trauma-informed practice framework including a set of principles placing inclusion at the heart of the approach in Wales; shining a light on the need to have a cultural, intergenerational and gender-based understanding of adversity and trauma which links directly to, informs and supports the government’s ambitions to be a nation of sanctuary and to be anti racist by 2030. To continue to ignore the experiences of adversity and trauma by people of colour, and Gypsy, Roma and Traveller people; is to perpetuate the health inequity experienced in healthcare, and justice systems. Wales has committed to developing wisdom, not just knowledge, that means that a public health approach is inclusive of all of our communities in Wales.

Key messages

• The experiences of racialised ad minoritised communities from population studies of adversity and trauma is traumatizing.

• Understanding the life course impact of adversity and trauma must include the experiences of racism and discrimination to be inclusive and trauma-informed.
Changes in integration and wellbeing by educational background among migrants in Kristiansand
Authors: Ahmed K , Sima Y T , Lunde A , Fadnes L T , Kumar B , Diaz E
Published: October 2024

Background

Integration levels and wellbeing of newly arrived migrants change according to their everyday activities in their new home country. Although migrants have very different educational backgrounds and expectations regarding work in Norway, the compulsory educational activities are the same for all, disregarding their educational background.

Aims

To examine the changes in integration and wellbeing among newly arrived migrants participating in a compulsory integration program in Norway, according to their educational background.

Methods

As part of the Integration for Health project (I4H) we collected information from participants in Kristiansand municipality through a self-filled questionnaire in 2023 (N = 102) repeated six months apart, including questions from the Immigrant Policy Lab Index and the WHO-5 Well Being Index. For both screening tools, higher scores indicate better integration and wellbeing. Information on educational background was dichotomized into either health or non-health (natural and technical) sciences, using health sciences as the reference. We used generalized estimating equations to calculate relative risks (RR) with 95% confidence intervals (CI) adjusted for age and gender.

Results

The mean age was 34 years (SD 8.3) and 59% were women. Mean residency time was 3 years (SD 0.14). In terms of education, 14% had health sciences, and 86% had other educational backgrounds. We did not find change in wellbeing over the six-month period (RR 1.0 (95% CI 0.9-1.1), and this trend was similar for both educational groups (RR 0.9 (95% CI 0.8-1.1). Integration score slightly increased after six months (RR 1.0 (95% CI 1.0-1.1). However, there was no difference by educational background (RR 1.0 (95% CI 0.9-1.0).

Conclusions

Changes in wellbeing and integration among participants in the compulsory introductory program with short residency time, do not seem to vary by educational background in a six-month period.

Key messages

• Schools and introductory programs in the host country can be used as a arena to enhance both the integration and wellbeing of newly arrived migrants.

• Strengthening migrants’ educational opportunities in the new host country is also of importance.
Mental health trajectories among Syrian refugees in Norway: A longitudinal cohort study
Authors: Sima Y T , Strømme E M , Diaz E
Published: October 2024

Background

Refugees encounter various risk factors that can affect their mental health throughout the migration process. However, while most studies focus on mental health challenges at the time of resettlement, only a few explore these changes over an extended period. This study aims to explore changes in mental health among Syrian refugees in Norway and to identify influencing factors.

Methods

This is a prospective cohort study using data from CHART and Integration for Health studies, which followed Syrian refugees granted settlement in Norway. Data collection took place in Lebanon between 2017-2018 (baseline), and at one- and four-years post-arrival in Norway. Assessments for anxiety/depression and post-traumatic stress disorder (PTSD) were conducted using the Hopkins Symptom Checklist (HSCL-10) and the Harvard Trauma Questionnaire, respectively. Mixed-effects logistic regression analyzed temporal changes, with results presented as odds ratio (OR) with 95% confidence intervals (CI). The study also explored the effect modification of outcomes by the following baseline factors: age, gender, education.

Results

A total of 132 participants were included in all three data collection points. There was a decrease in the proportion of participants reporting anxiety/depression (from 30% to 28%, OR 0.1, 95% CI 0.1 - 0.2) four years post-settlement. The proportion of participants reporting PTSD symptoms decreased one year after settlement (from 4% to 3%, OR 0.3, 95% CI 0.1 - 0.7), but increased to 4% four years after arrival, showing no improvement from baseline (OR 0.8, 95% CI 0.4 - 2.0). No interactions were observed between changes over time and baseline variables.

Conclusions

After four years in Norway, Syrian refugees reported improvement in anxiety/depression, but PTSD symptoms worsened. This highlights the need for ongoing support that extends beyond the initial phases of resettlement.

Key messages

• Refugees face various risk factors that affect their mental health throughout the migration process.

• Ongoing mental health support for refugees is essential, beyond the initial resettlement phase.
Toolkit for Translating Health Information: A Resource for Crisis Health Communication and beyond
Authors: Nordstrøm C , Tidemann E
Published: October 2024

Issue/Problem

Translating health information accurately and effectively presented a critical challenge in crisis communication during the pandemic. In linguistically diverse contexts, ensuring access to vital health information is essential for promoting public health outcomes. Addressing this issue, we summarized our experience in a comprehensive toolkit for translating health information, aiming to enhance accessibility, reliability, and relevance across various settings and countries.

Description of the Problem

Our initiative responds to the need for standardized translation practices in the dissemination of health information in Norway. Translation practices in the health sector often lack standardization, leading to inconsistencies, inaccuracies, and risk of less comprehension. Questions guiding our project included: How can lessons learned from the extensive translation work done during the pandemic improve the accuracy and consistency of health information translation in general?

Results

We have developed a practical toolkit tailored to diverse linguistic and cultural contexts. Our toolkit summarizes lessons learned from extensive translation work during the pandemic, supported by validation from experts in the field of translation. The toolkit has been welcomed by other organizations, which underscores the potential of standardized translation tools to mitigate barriers to health communication in multilingual settings.

Lessons

Lessons gleaned from translating information during the pandemic highlight the importance of evidence-based translation practices, knowledge of the target demographic and the integration of cultural considerations into translation workflows. Furthermore, our experience underscores the value of inclusive approaches in development, promotion and distribution of the translated materials.

Key messages

• Standardized translation tools can increase access to vital health information, fostering equitable health outcomes.

• Collaboration and inclusive approaches are key drivers in advancing standardized translation practices for effective health communication.
Empowering Young Roma Women in matters of health and primary care: an innovative training program
Authors: Zota K , Balta M , Zioga E , Drougos N , Kouvari M , Pinotsi D , Karnaki P , Veloudaki A
Published: October 2024

Background

Roma communities are rather diverse groups with different level of knowledge, beliefs and motivations in relation to their health. Raising awareness and self-efficacy of these individuals is a challenging field in the EU public health agenda.

Objectives

To address this challenge, the program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach” was developed with the aim to empower Roma women in terms of health and prevention topics pilot testing different educational methods. A two-step co-design approach was performed to determine the training content, tools, methods. The training was implemented in 5 areas throughout Greece (Volos, Chalkida, Thiva, Agia Varvara, Zefyri) in Jan-Oct 2023, including 3 phases: a. Train-the-trainers, b. Training the Roma women and c. Training evaluation.

Results

The educational material developed for health and prevention included 4 units (gynaecological health issues, vaccinations, smoking and nutrition). Each unit consisted of a theoretical background to develop the material, a presentation for future trainers, a presentation for trainees, a brochure, and a poster. For the training a new methodological approach was tested i.e. a health professional or Roma women (after being trained) to deliver the training. In total, 548 pre-post questionnaires were collected. Most trainees, understood the content of the training, acquired new knowledge and found the information interesting and possible to include in their daily life. 80% trainees expressed their satisfaction with the overall presentation. Regarding knowledge improvement based on the type of trainer only a slightly greater degree of improvement was observed for Roma trainers.

Conclusions

It is crucial to develop culturally appropriate health interventions by directly working with communities, to understand their particular needs, and to ensure they receive the information needed to make informed decisions.

Key messages

• Maintaining and promoting health is a decisive factor of social inclusion.

• Tailor-made training of ethnic minorities shall be an integral part of the EU public health agenda.
Greenness and mortality in an industrialized area in Southern Italy: a health impact assessment study
Authors: Giannico O V , Mincuzzi A , Bisceglia L , Addabbo F , Catino F , Minerba S , Sardone R
Published: October 2024

Background

In Taranto the effects of industrial installations have been studied, but less attention has been placed on the impacts of green-oriented policies. The “3-30-300” rule states that every citizen should have 30% tree-canopy-cover in their neighborhood and not live more than 300m away from the nearest green space. In this Health Impact Assessment (HIA) study, we aimed to quantify the deaths that could be prevented in population aged ≥20 years by implementing this policy in Taranto.

Methods

Population weighted exposures (PWE) to green spaces (10m) were estimated using the 2022 greenest season NDVI from Sentinel-2 and the 2021 ESA WorldCover within a 300m (WHO 2016) buffer. We set a tree-cover optimal target of 30% and interim targets from 10% to 25%. For each tree-cover target, we set the counterfactual exposure (CE) as the corresponding PWE to NDVI. Age-specific preventable deaths (PD) were calculated by multiplying the baseline deaths (ISTAT) by the preventable fractions (PF). Preventable years of life lost (PYLL) were calculated by multiplying the PD by the specific life expectancy. To compute the 95%CI, we ran 100,000 Monte Carlo simulations to propagate the uncertainties of both CE and ERF to the final estimates.

Results

The PWEs to NDVI and tree-cover-proportion were 0.19 and 8.0%, respectively. For the 30% tree-cover target (currently achieved by the 1.5% of population), the CE (NDVI) and PF (%) were 0.33 (0.32-0.33) and 5.4% (4.1%-6.2%). A total of 126 (97-146) PD and 1270 (976-1474) PYLL were estimated. Three-cover, shrubland and grassland were associated to higher NDVI values, while built-up and deprivation-index were associated to lower greenness. NDVI and summer temperature showed an inverse relationship.

Conclusions

This study as a pioneering effort in Southern Italy. Providing more green space could prevent a substantial number of premature deaths in Taranto, potentially up to 5.4% by achieving a 30% tree-cover.

Key messages

• Providing more green space could prevent a substantial number of premature deaths in Taranto, potentially up to 5.4% by achieving a 30% tree-cover.

• Built-up and deprivation-index were associated to lower greenness. NDVI and summer temperature showed an inverse relationship.
Risk of eating disorders and body image in adolescents in Belgium: is migration status a modifier?
Authors: Eggen M , Yalman G , Holmberg E , Assakali W , Mertens C , Castetbon K
Published: October 2024

Background

The risk of eating disorders (ED) has been linked to body image (BI) dissatisfaction in adolescents. In addition, the origin and host country culture may influence BI dissatisfaction. Our objective was to assess the modifying effect of migratory status on the association between BI and risk of ED in Belgium, a setting characterized by a large proportion of migrant adolescents.

Methods

In the 2022 cross-sectional “Health Behaviour in School-aged Children” (HBSC) study in French-speaking schools, 7,267 adolescents aged 12 to 20 self-completed questionnaires. Risk of ED was determined by an Eating Attitude Test (EAT-7), score ≥5. BI was categorised into 3 groups: “too thin”, “about the right size” and “too fat”. Migratory status was divided into “native”, “2nd generation” and “1st generation” migrants. The association between BI and ED was estimated using logistic regressions adjusted for socioeconomic and psychosocial characteristics. After the inclusion of the “migration*BI” interaction term, migration-stratified logistic regressions were conducted.

Results

Overall, 13.0% of students were at risk of ED. Percentages of ED were 15.7% among those who perceived themselves as “too fat” (vs. “about the right size”: aOR=1.67 [95%CI: 1.34-2.08]) and 19.4% in the “too thin” group (aOR=3.36 [2.54-4.45]). Despite non-significant interaction terms, perceiving themselves as “too fat” (vs. “about the right size”) was not associated with the risk of ED in 1st generation migrants (aOR: 1.24 [0.67-2.29]). Compared with the overall estimation, it was lower in 2nd generation migrants (aOR: 1.43 [1.00-2.03]) while it was slightly higher in natives (aOR: 1.95 [1.45-2.62]).

Conclusions

These findings suggest complex interrelations between BI and risk of ED according to migratory status in adolescents with potential underlying mechanisms involving cultural norms. Promoting positive BI as a possible way for preventing the development of eating disorders need to be further investigated.

Key messages

• This study shows differences of body image dissatisfaction according to the migratory status in adolescents, inducing potential impacts on the risk of eating disorders.

• Better understanding differences in body perception related to cultural background could help prevent risk of eating disorders in adolescents, by promoting positive body image for example.