bluuebunny/crossref_metadata_2025 huggingface dataset:
A critical discussion of theoretical foundations and measurement methods of gender roles
Authors: Jaehn P , Cook S , Holmberg C
Published: November 2019

Background

Public health researchers have frequently investigated associations of individual gender role norms or attitudes with a variety of health outcomes. It has been suggested that the construct of gender roles is multidimensional, including norms about gender inequality and gender-related division of labour. Implications of multidimensionality and limitations of applied measurement methods, however, have rarely been discussed critically in published studies.

Methods

I will summarise theoretical considerations about the multidimensionality of the construct of gender roles. Examples of recently applied approaches to operationalise gender role attitudes in mental health research will be presented. The talk will conclude with a discussion of advantages and limitations of these approaches regarding consistency with theory, applicability, and reduction of measurement error.

Results

Gender role norms include assumptions about inequality and division of labour in the public and private sphere. Items about gender role attitudes are regularly included in questionnaires of large social surveys and are suitable to explore associations with disease occurrence or quality of healthcare. Data reduction methods such as factor analysis might be applied to differentiate dimensions and to reduce measurement error.

Conclusions

Shortcomings in considering theoretical foundations and inconsistencies in operationalisation might have contributed to the limited recognition of findings about possible impacts of gender roles on health. We need to advance measurement methods to increase the quality of public health research on gender. Finally, aspects of gender on the contextual level should complement investigations of individual gender roles.
The European Court of Human Rights and the protection of prisoners’ health
Authors: Wallace A E M
Published: November 2019

The European Court of Human Rights (ECtHR) is a key actor in the regulation of prison conditions at the European level. Before 1998, the ECtHR did little more than legitimate state practice in terms of detention, no matter the effects on the health of those detained. Yet, since 1998, the ECtHR has recognised that prisoners are in a particularly vulnerable situation due to their almost total dependence on the authorities, and has defined a number of positive obligations that States are under to protect the health of prisoners.

Several reasons have been suggested for this evolution. Firstly, in 1998, the ECHR system was restructured and the ECtHR became a permanent court. Secondly, the Council of Europe’s enlargement process to the East brought about an explosion in the number of applications from prisoners in post-soviet States complaining about severely inadequate prison conditions and overcrowded conditions. Thirdly, the ECtHR began to work more closely with Committee for the Prevention of Torture (CPT), an interdisciplinary body that looks to make structural changes to prison conditions and focuses on the effects on health to prisoners. In this connection, the ECtHR post-1998 also began to rely more heavily on external standards, such as CPT standards, WHO guidelines, and UN Minimum Standards to supplement its reasoning.

This study examines the dynamics between the ECtHR’s normative standards of prison conditions and other international prison health standards by tracking the ECtHR’s use of external materials in its assessment of the acceptability of prison conditions. It does so in the context of the ECtHR’s jurisprudence relating to tuberculosis prevention, treatment and control in prisons.

Apart from standard improvement, preliminary results demonstrate an increase in the use of WHO documents corresponding with the evolution in the Court’s thinking, and indicate that such documents are increasingly recognised as minimum legal requirements for governments to meet.
Structural and ethical challenges in participatory research with migrant and minority groups
Authors: Gottlieb N D
Published: November 2019

Based on experiences with participatory research projects with forced migrant and ethnic minority groups in Germany, Israel and Canada, Dr. Gottlieb will first reflect on the structural challenges that especially young researchers face when doing - or intending to do - participatory research. Secondly, she will discuss ethical issues that can arise in participatory research, in particular when grave inequalities, fragmentations and conflicts within the researched communities exist. In such contexts, certain generally valid research ethical questions merit particular attention; e.g. the questions ‘Who represents whom?’, ‘Who gets access to the research process and its benefits?’ and ‘How are direct and indirect benefits distributed among different community members?’ Another set of questions concerns potential discrepancies between common goals in participatory research - such as empowerment, agency, leadership and innovation - and community norms. E.g., what is the risk of participatory research projects intensifying existing internal, e.g. intergenerational or gender-based, rifts and/or getting their practice partners into conflict with their communities and customs? To what extent ought research encourage individuals within a community to “go against the stream”?

In light of (post-)colonial histories and trauma such questions can be especially charged, both politically and emotionally. It is therefore a huge responsibility for the researcher to carefully consider the role of the study within its wider context, to weigh its potential (intended and unintended) effects and broader outcomes on individual and community levels, and to balance them with the study goals and intended benefits and its consequences for health research.
Health mediator model as a way to access to care and health information for Syrian refugees in Turkey
Authors: Kayi I , Şimşek2 Z , Yıldırımkaya G
Published: November 2019

The number of Syrian refugees residing in Turkey has increased over 200 times since 2012 reaching to 3,621,330 (April 2019). Turkey has granted temporary protection status, including access healthcare in the city of registration. Ministry of Health provides on-site health service in temporary shelters, however more than 90% of the Syrian refugees choose to stay in community settings, which along with language barriers limits their ability to access health care and information.

With UNFPA we have designed a health mediator model to improve access to health care and awareness on priority concerns such as mental health, reproductive health, child health, health system in Turkey and legal status provided to Syrian refugees. This study is a participatory operational research to test the health mediator model. Operationalization took place in 3 phases: (1) selection and training of Syrian health mediators and provincial coordinators; (2) household visits and data collection; (3) evaluation and supervision.

So far, we have trained 174 health mediators from 24 different Turkish cities. Training took 5 days with up to 30 participants each. UNFPA collaborated with NGOs that work with Syrian refugees for coordination purposes. Health mediators made household visits to reach out to Syrian families, gave health education and where necessary support for access to health care services, and conducted a needs assessment. Data collected has been the subject to weekly supervision meetings by local NGOs, health mediators and coordinators to set priorities for the upcoming week.

Health mediator model was effective in reaching out to hard-to-reach groups among Syrian refugees, increased health system and legal awareness, contribute to improved healthcare access and prevention of negative health outcomes such as teenage marriages and pregnancies.

Inclusion of refugees in decision-making and guidance during the implementation of the project was key for project success.
Applying Community Based Participatory Research on sexual health & sexual violence with refugees, asylum seekers and undocumented migrants in Europe and the European Neighbourhood
Authors: Keygnaert I
Published: November 2019

Background

Refugees, asylum seekers and undocumented migrants are at risk of sexual violence (SV). SV can induce ill-health in the victims, their offspring and community. However, prevention and response actions are leaping behind and rarely tap on the agency of the migrants themselves. Community Based Participatory Research (CBPR) is a collaborative research approach in public health that focuses on inequalities and aims to improve the health and well-being of community members by integrating knowledge in action, including personal, social and policy change.

Methods

Building on the concept of Desirable Prevention from a human-rights and gender-sensitive perspective, in three consecutive projects we applied CBPR to study SV and sexual health (SH) and collegiately developed SV prevention and response tools for personal, social and policy change.

Results

Each of the three CBPR projects was steered by local Community Advisory Boards composing of key stakeholders. With 1001 Community Researchers being refugees, asylum seekers, undocumented migrants and asylum reception professionals themselves we collegiately conducted the mixed-method research and co-created the tools that were validated at largely attended public seminars and implemented widely. While the projects clearly resulted in social and policy change, several professional researchers personally struggled with the principle of co-learning and co-creation while migrants struggled with the regained respect and identity that fell away beyond project scopes and in between project resulting in poor mental health in some.

Conclusions

Applying CBPR with refugees, asylum seekers and undocumented migrants on sensitive topics as SV and SH is a valuable research approach. Yet, the CBPR principles of cyclical participatory processes and the commitment to sustainability might clash with the current funding and timing of EU research projects challenging participants’ mental health and researchers’ ethics.
Increase Capacity in Injury Research in Eastern Europe – the iCREATE Project
Authors: Dulf D , Coman M A , Peek-Asa C , Switzer S , Chikhladze N
Published: November 2019

Introduction

Injury rates are highest among LMICs. Many of the leading injury causes are increasing disproportionately in LMICs compared with high income countries. Although medical and public health education in each of these countries has been growing over the last several years, injury and violence prevention has not yet been recognized as a priority. The iCREATE project aims to create a critical mass of injury researchers from multiple disciplines and to engage agencies and stakeholders in conducting high impact research that reduces the burden of injuries and violence in the LMICs of Armenia, Georgia, and Rep. of Moldova.

Progress

Based on priority needs in our partner countries and the expertise of the training team, the project focuses on: road traffic injury prevention, prevention of violence against women and children and acute care. Although it is the first project of capacity building in injury research implemented in these countries, the partnership builds on and translates existing successful infrastructure. The lead of the project (University of Iowa) has conducted similar projects in other countries from Eastern Europe and one of the training sites (Babes-Bolyai University) is currently a partner in the project.

Activities include skill-building workshops; summer classes; long-term degree-based and professional development training; focused exploratory research projects; and collaborative data infrastructure projects. The focus is on long-term MPH and PhD training in order to build research and leadership skills focused on injury prevention in the partner institutions. Some results of the first three project years are implementation of Injury prevention Curricula in three medical universities from the partner countries, and a Center of Injury and Violence Prevention established in Armenia. Furthermore, 33 trainees were trained, 8 hospitals implemented injury registries and 12446 registry records were collected so far across 3 countries.
Practical experience with SCIROCCO twinning and coaching- the perspective of a transferring region
Authors: Pavlickova A
Published: November 2019

One of the SCIROCCO twinning and coaching activities was conducted between two healthcare systems: Scotland and The Basque Country. The objective of this presentation is to describe the experience of the transferring region, Scotland. In particular, it will outline the role and engagement of the voluntary sector in the provision of integrated care in Scotland, in terms of: Organisation, including the definition of the voluntary sector, its size and stakeholders;Engagement of the voluntary sector with integration of careIntroduction to Carrgomm and its activities (04/09/2018 study visit organised in Scotland)Conclusions, lessons learned.
Workshop: Social Cost-Benefit Analyses in Public Health
Authors:   Organised by: Netherlands National Institute for Public Health and the Environment Chair persons: Ardine De Wit - Netherlands, Paul Van Gils - Netherlands
Published: November 2019

Economic evaluation in health care has a long-standing tradition in Europe, especially in the United Kingdom and the Netherlands. The incorporation of economic evaluations in resource allocation decisions is increasingly becoming embedded in national guidelines.

In other fields, however, the social cost-benefit analysis (SCBA) framework has been used for a vast period of time, especially in fields such as logistics or transportation. A social cost-benefit analysis (SCBA) evaluates the favorable and adverse effects of policy actions and the associated opportunity costs of those actions. The favorable effects are defined as the benefits, and the opportunities foregone are defined as the economic costs. The SCBA provides an overview of all effects, risks and uncertainties of a policy, and the resulting advantages and disadvantages for society as a whole. By quantifying and monetary valuing these advantages and disadvantages as much as possible in Euros, the SCBA provides insight into the impact of the measure on social welfare, expressed as the balance of benefits (in Euros) minus the costs.

In 2013, Dutch guidelines were developed for the proper and standardized execution of SCBA of future policies in public health. Building on this increased awareness, in 2014, the National Institute for Public Health and the Environment (RIVM) published reports on SCBA for prevention and care. Since then, a few SCBA’s have been published which evaluated various regulatory policies.

The aim of this session will be to elaborate on 1) the SCBA methodology and to provide a brief introduction to methodological aspects (no abstract provided); 2) a SCBA to evaluate the consequences of Cognitive Behavioral Therapy for alcohol and cannabis addiction; 3) a SCBA to evaluate the consequences of tobacco control policies; and 4) a SCBA to evaluate the consequences of three policies to limit alcohol use; and 5) a SCBA to evaluate the consequences of two interventions to prevent toxoplasmosis.

Key messages

SCBA is a fairly new method in health care to map the consequences of long-term policy measures. With the help of an SCBA it is possible to indicate who pays for and who benefits from an intervention.
Using a cultural contexts of health approach to address the challenge of antibiotic resistance
Authors: Ledingham K
Published: November 2019

This presentation will provide an overview of key findings from a 2019 policy brief published by the WHO Regional Office for Europe using a cultural contexts of health approach to address the global health challenge of antibiotic resistance (ABR; see publication http://www.euro.who.int/en/publications/abstracts/antibiotic-resistance-using-a-cultural-contexts-of-health-approach-to-address-a-global-health-challenge-2019). It will delineate what a cultural contexts of health approach is and why it matters for tackling the contemporary threat of ABR. It is now increasingly recognized that the systematic neglect of cultural factors is one of the biggest obstacles to achieving better health outcomes and better standards of living worldwide. Using a cultural contexts of health approach, the presentation will describe how the prescription and use of antibacterial medicines, the transmission of resistance, and the regulation and funding of research are influenced by cultural, social and commercial, as well as biological and technological factors. The presentation will demonstrate how culture can serve as an enabler of health and provides new possibilities for change.
Psychological support in short term after the January 2015 terrorist attack in Paris, France
Authors: Vandentorren S , Vuillermoz C , Motreff Y , Pirard P , Lesieur S , Baubet T , Chauvin P
Published: November 2019

Background

A terrorist attack occurred in Paris in January 2015 against the staffs of the Charlie Hebdo magazine and a kosher grocery. This study examined psychological support given to the people directly exposed, witnesses and close relatives of those who were injured, hostages or died.

Methods

The IMPACTS survey was an open cohort lead in 2 waves (6 and 18 months after the events). Psychologists interviewed in face-to-face 190 civilians in wave 1. A questionnaire was used to collect data on socio-demographic characteristics, exposure level, psychological and social support, impact on work and social functioning, and mental health disorders.

Results

Among the 190 participants in wave 1, 24.3% did not receive psychological support neither in 48 hours, between 2 and 7 days, and after 1 week. Among those who had received support, they had a contact in average with 3 institutions or associations. Within the 48 hours, psychological support was mainly provided by Medico-psychological emergency unit (CUMP) (45.2%). Between 2 and 7 days, CUMP (42.6%) and a Parisian hospital in specialized care unit for trauma (44.6%) had mainly offered psychological support. One week after events, psychological support was mainly provided by consultation in specialized care unit for trauma (41.4%) or in ambulatory (27.6%). Lack of psychological support was more frequent among men, unemployed, and witnesses (versus those who were directly exposed).

Conclusions

This study suggests offering psychological support to the whole population that have been potentially impacted, and also for those who had not been directly threatened. Long-term psychological follow-up of the most affected ones remains an objective to consolidate initial care.

Main message: Psychological follow-up should be provided not only to threatened people but also to the most vulnerable people (unemployed).
Can we rely on non-randomised studies? Findings from a meta-epidemiological review
Authors: Rejon-Parrilla J C , Salcher-Konrad M , Nguyen M , Davis K , Jonsson P , Naci H
Published: November 2019

Background

Increasingly, health technology assessment (HTA) agencies must decide whether new medicines should be used routinely in the absence of randomised controlled trial (RCT) data, relying solely on non-randomised studies (NRS), which are at high risk of bias due to confounding. Against the background of increased availability and improved methods to analyse non-randomised data (e.g., propensity score methods and instrumental variables), it is important for decision-makers to have guidance on the analysis and interpretation of NRS to inform health economic evaluation. We therefore aimed to systematically and empirically assess the performance of NRS using different analytical methods as compared to RCTs and develop recommendations on the basis of our findings.

Methods

We conducted a large-scale meta-epidemiological review to obtain estimates of the discrepancy in treatment effects in matched RCTs and NRS of pharmacologic interventions from published meta-analyses indexed in MEDLINE and the Cochrane Database of Systematic Reviews. We also consulted with HTA bodies, regulators and academics from five European countries to learn from their experience with using non-randomised evidence.

Results

We compiled the largest dataset of clinical topics with matching RCTs and NRS using various analytical methods to date, covering >100 unique clinical questions. Incorporating information on direction of effect and effect size from >700 unique studies, the dataset can be used to evaluate discrepancies in treatment effects between study designs across a wide range of therapeutic areas.

Conclusions

An empirically based understanding of the risk of bias in NRS is required in order to promote the adequate use of non-randomised evidence as input for health economic decision-making.
Motrial - An Academic and Collaborative Search Engine Dedicated to Behavioural and/or Public Health Intervention Publications
Authors: Ninot G
Published: November 2019

Issue/problem

Trials are the most reliable source of evidence on the efficacy, safety and cost-effectiveness of interventions aimed at preventing, caring or curing. Their number in the field of non-pharmacological interventions (NPIs), especially behavioural interventions, has increased exponentially since 2000. Their methodology is improving with the support of several organisations such as CONSORT, SPIRIT, TIDieR, PRISMA and IBTN. They can fuel meta-analyses and systematic reviews in return of better quality.

Description of the problem

One of the difficulties in carrying out these meta-syntheses is the exhaustive and relevant search of trials. Publications are not always identified in biomedical databases (e.g., PubMed, Embase). New article publishing offers are available to authors such as Open Access journals (e.g., PLOS One, Scientific Reports, Helyion, JAMA Network Open). Data collection of trials is more difficult, longer and subject to biases.

Results

The Plateforme CEPS, which has the general objective of encouraging clinical trials on NPIs, has created a search engine that makes it easier to find these trials. Motrial (www.motrial.fr) distinguishes the main publication from secondary publications and duplicates. It indicates whether the trial has been declared to an ethics committee, registered to the competent authorities and received funding. This academic search engine in English is free. The search can be configured with methodological and ontological criteria. If not already done, the user is invited to join the main publication of the trial with the declaration of its protocol to an official instance. Motrial displays the main characteristics of the trial and its main publication. Each request can be saved, modified, completed.

Lessons

Data collection of non-pharmacological intervention trials is difficult, long, and subject to biases. The free and academic meta-search engine Motrial is a tool that helps to advance knowledge utilisation.
Co-Creation in participatory epidemiology
Authors: Bach M , Santos-Hövener C , Jordan S
Published: November 2019

Background

Participatory epidemiology aims to involve public health professionals, health activists, and community representatives in epidemiological studies. Paramount are equitable research partnerships for identifying the causes of health problems, generating data, and finding ways to address health related issues. Alongside the research process, co-creation informs various aspects of participatory epidemiology.

Methods

A scoping review was conducted to develop the conceptual foundations of participatory epidemiology. Workshops with staff from public health administration and public health practitioners were held to check feasibility of the concept for public health monitoring, policy making and the development of relevant public health recommendations. From this research, principles and practices of co-creation were identified.

Results

Co-creation is of importance for participatory epidemiology. 1) Methodologically: Co-creation asks to apply multiple perspectives (research, practice, communities) in data collection and synthesis, what may require the adaption of a given study design. 2) Research practice: Co-creation in participatory epidemiology means producing epidemiologic evidence while contributing to concrete public health interventions, two goals that have to be balanced. 3) Personal attitudes: In participatory epidemiology academic researchers, practitioners, and community representatives are requested to acknowledge each other as co-researching partners, which can be challenging for each of them.

Conclusions

Co-creation is a prerequisite for establishing equitable research partnerships. In participatory epidemiology, co-creation offers ways to produce meaningful knowledge for research and practice.

Main messages

Participatory epidemiology offers ways of producing epidemiologic evidence while contributing to public health practice. Co-creation is a prerequisite, way, and attitude to conduct meaningful research, hopefully for all of those who are involved.
Accessibility to oral health care of precarious and non precarious populations in Côte d’Ivoire
Authors: Sangare A D , Samba M , Meless G D , Guinan J C , Traore J F , Da Danho V , Adou A J , Bakayoko-Ly R
Published: November 2019

Introduction

The purpose of any health system is to guarantee access to care for the entire population served. However, the socio-economic insecurity situation of people in precarious situations, raises the problem of their access to oral health care considered to be expensive. The objective of this study was to compare the dental status and modalities of oral health care use by people in precarious situations to group of non-precarious population in Abidjan, in Côte d’Ivoire.

Methods

The cross-sectional study was conducted at the University Hospital Center of Treichville. It concerned all users of the dental office of this hospital. Subjects in precarious situations were identified using a screening tool. Was considered to be in a precarious situation, a person living with less than 1.5 USD/day, having no fixed address, looking for a job, having no health insurance or having difficulties in dealing with medical and pharmaceutical costs. We have identified variables for the modalities of oral health care use and follow-up. The frequencies of these variables were calculated and comparisons were made between subjects in precarious and non- precarious situations using the Chi2 test.

Results

256 people participated in the study. The tool for identifying precariousness made it possible to distinguish 128 subjects classified in precarious situations and 128 others in non- precarious situations. The number of missing teeth in people in precarious situations was twice as high as in non-precarious subjects. Renunciation of dental care was more common in the precarious group (46%) than in the non- precarious group (32%). Absenteeism rates at the first two appointments were higher among the precarious (54%) than among the not precarious (46%).

Conclusions

These results show the need to sensitize the population on the importance of oral health and the establishment of social protection mechanisms to ensure greater accessibility to care for people in precarious situations.

Key messages

Improving the oral health of populations, especially vulnerable population groups, requires the establishment of social protection mechanisms to remove the financial barrier to access to care. Educating the public about the importance of oral health for overall good health is essential to improving the use of dental care.
Building bridges between community, primary healthcare and academia for solidarity in health
Authors: Khozhamkul R , Kosherbaeva L , Izmukhambetov T , Tolegenova S , Jurgutis A , Sydykov B , Davletov K
Published: November 2019

Considering Astana declaration on Primary healthcare (PHC) and universal healthcare coverage UN member countries agreed on committing for PHC development. Kazakhstan prepared legal basis for that during ongoing healthcare system reform. Meanwhile, there is no clear mechanism for integration of sectors to address person and community centeredness for health, which has emerged into a need of rethinking engagement between outpatient clinics and their communities. Local NGO “Community health committee” has led the bottom-up initiative in collaboration with Kazakh National Medical University, Outpatient clinic of Almaty State hospital #5, Medeo district mayor’s office and WHO European Center for PHC for creation of an integrated plan to strengthen diseases prevention and health promotion at the district. Project aims to strengthen people centeredness of PHC at Medeo district, through equal integration of all stakeholders into every step of decision-making using community based participatory research framework. Project includes development of teamwork in PHC teams’ through multi-professional training, development of nurses’ competencies for more autonomous work in community, community capacity building and empowerment. After gaining support from all stakeholders, we organized two interactive seminars with community members and PHC teams in order to assess district health needs and build an action plan. Ownership of community members in decision on priority health problem provided community buy-in, high level of engagement and enthusiasm in designing and implementation of the project activities. Voice from empowered community on priority health needs were accounted by local policymakers and led for creation of action plan on identified needs to be implemented in 2019 -2020. One of the main limits of the community engagement is gaining trust and sustainability of the group, we are mitigating it through involvement of academia as an “umbrella”.

Key messages

Project will create a model for equal partnership in disease prevention and health promotion in Kazakhstan. Engaging all key stakeholders based on equal partnership creates sustainable outcomes for health and solidarity.
Youth engagement on health as a political issue
Authors: Eric L
Published: November 2019

Background

In France, young people do not participate in the development of health policy. The latter is built on a representation of the young person who, because of his age, cannot have an opinion and proposals for his health and improve that of others. However, different young people are involved in health actions and propose improvements for the health system and prevention. The communication concerns the ’Re’Pairs Santé’, young people who are committed with Unis-Cité, a national association, to developing health actions with other young people.

Methods

20 ’Re’Pairs santé’ were interviewed in 3 French cities on their motivation for this engagement. Similarly, 80 young beneficiaries of their actions were met in focus groups to get their perception of Re’Pairs santé.

Results

The engagement of Re’Pairs santé is part of a dimension of solidarity, and on their experience as young people to change the way adults and public policies are represented. For other young people, if there is an improvement in their health knowledge, half of them are involved in other local associations and/or are involved in changing health within their own structure.

Conclusions

Health is not a minority issue both in the daily lives of young people and as a potential source of engagement. The Re’Pairs santé investment allows other young people to get involved in other structures. Thus, the social impact is not limited to the transmission of health information but promotes social cohesion and the development of social capital. The place and role of young people in the development of public health policies must be better valued and legitimized in order to better meet their expectations but also to destigmatize a population that has many resources.

Key messages

Fostering youth engagement on health. Youth should be considered as a resource for health policies.
Giving blood: providing treatment, providing knowledge
Authors: Tiberghien P , Gallian P , Morel P , Bougard D , Chiaroni J , Gross S , Djoudi R , Pagès J-C , Toujas F
Published: November 2019

Background

In France, 1,6 million donors contribute 3 million blood donations / year collected and tested by the French public transfusion service (Etablissement Français du Sang - EFS). At each donation, 2 ml plasma of are stored for 3 years for further testing if needed. In addition to providing life-saving blood products, blood donors may also provide knowledge through the sharing of their health data and bioresource collected at time of donation.

Objective

To describe how blood donors can provide knowledge in addition to blood products.

Results

Over the last 10 years, blood donors in France have enabled several studies performed by EFS in collaboration with research and reference laboratories as well as public health authorities. A linked assessment of Ab titers (+ clinical history) in donors having given blood before and after the 2009 H1N1 flu epidemic, as well as measles, rubella and hepatitis E virus seroprevalence studies (+ specific health questionnaires) have generated high value epidemiological data. Screening for arboviruses (such as Zika virus) and hepatitis A virus in donors during epidemics have increased knowledge of infectious spread and disease characteristics. Testing of plasma samples collected before variant Creutzfeldt-Jakob disease occurrence in two donors revealed the presence of circulating prion more than 1 year before diagnosis. A project to further take advantage of such a bio resource is underway. Upon occurrence and notification of a disease (or any pre-defined health event) in one of the 1,4 million repeat blood donors, all samples from prior donations would be gathered in a cohort of samples of all donors having notified an identical health event. Such cohorts would provide valuable samples to assess disease-specific biomarkers at pre-symptomatic phases.

Conclusions

Providing the opportunity to donors to give knowledge in addition to blood can result in production of high value biomedical data. Giving blood, being a public health actor.

Key messages

Blood donors may provide knowledge and bioresources in addition to blood products. Blood donors in France have enabled several large-scale epidemiological studies.
Crowdfunding for unmet medical needs: the case of CAR-T and Gofundme
Authors: Toscano F , Golinelli D , Guicciardi S , O’Donnell E , Rossi S , Messina G , Fantini M P
Published: November 2019

Background

Crowdfunding (CF) is the practice of financing a project by raising money from a large number of people. Many patients use online CF platforms to fund medical needs, whether unmet by their healthcare service - therefore to be sought elsewhere -, or when unable to afford them. CAR-T (Chimeric antigen receptor T-cells) is an innovative therapy approved to treat several types of lymphoma and with potential to treat many other cancers. CAR-T is available in most countries through clinical trials only and its diffusion is limited by high costs. Gofundme is a CF platform ’leader in online medical fundraising’. The objective of this study is to shed some light on the phenomenon of CF for CAR-T therapy, describing the campaigns started on Gofundme.

Methods

We extracted data from CAR-T campaigns started in Europe and publicly available on Gofundme until March 2019. Data related to each campaign has been analyzed and reported through descriptive analyses.

Results

Since 2017, 26 CAR-T treatment campaigns have been started. Due to the privacy policy of the platform, we were able to retrieve data from only 12 of them; 3 campaigns were closed, thus not disclosing enough data to be included. Nine campaigns were studied: 4 from Italy, 4 from the UK, 1 from Spain. The United States were the main destination. The median campaign goal was 180k€. The number of campaign shares on social media and the percentage of goal raised seemed to be linked.

Conclusions

CF is unquestionably a good expression of the Internet: it channels empathy towards important causes, providing tangible help. However, when applied to healthcare - especially to experimental treatments -, several questions arise. Patients affected by treatment resistant cancers may be prone trying new treatments to keep the hope alive, even when indication is missing or scientific evidence is lacking. Policymakers should monitor healthcare related CF campaigns, both for equity and safety reasons.

Key messages

Policymaker should monitor healthcare related CF campaigns, both for equity and safety reasons. Healthcare related crowdfunding campaigns could be interpreted as an indicator of unmet medical needs.
A partnership between a local public health unit and schools to end female genital mutilation
Authors: Paixão M , Carmona A , Capelão H , Silva A
Published: November 2019

Female genital mutilation (FGM) is a violation of human rights and has immediate and long-term health impacts. Our public health unit is in Amadora, one of the regions in Portugal with the highest prevalence of FGM in immigrant communities.

Recognising the importance of education and of early-life interventions in changing beliefs, we partnered with local schools, a non-governmental organisation and child protection services. We developed a book with information and resources for teachers and created a training package for school professionals. This comprehensive school intervention focused on two aspects. First, it focused on prevention, as we trained school professionals, provided risk score indicators and defined actions to take. Second, in health promotion as we compiled ideas and resources on how to approach this subject in classes while debating sexual health, gender inequality, human rights and cultural heritages.

From November 2018 to February 2019 we collected inputs by all partners and tested the instruments in a pilot school with a mixed-methods approach through questionnaires and a focus group.

The book was distributed to all schools in Amadora, to other public health units and institutions. The preliminary evaluation was done by a questionnaire where 72.7% of the respondents found it useful and addressing the key topics and 54.5% found it detailed enough. These results are preliminary, with further evaluation planned for September 2019 and June 2020 to understand both the experience and needs of teachers after implementing the project.

This project has led to schools showing interest in developing closer cooperation in this and in other health topics.

To our knowledge, this is the first school intervention by a public health team focusing on FGM in Portugal. Other countries have materials on FGM for teachers, however we believe our intervention was the first tailored to a local community and in close collaboration with local schools and institutions.

Key messages

There is potential for a closer collaboration with schools to try to end female genital mutilation and to address other health topics. Local public health units should establish and mobilise local networks of institutions and community partners to tackle complex public health problems.
Services for refugees subject to sexual and gender-based violence in Turkey and Sweden
Authors: Ozcurumez S , Akyuz S , Bradby H
Published: November 2019

Background

Sexual and gender-based violence affects an unknown proportion of Syrians seeking refuge from the ongoing conflict. Exile implies a vulnerability to gendered harms with consequent health effects over the short- and long-term. Services for refugees tend to presume physical gendered harms accruing to women prior to exile, with little attention paid to the effects on refugees’ settlement in the new society.

Methods

Interviews with health and social care providers of services to refugees in Sweden (n = 20) and Turkey (n = 20), including international organisations, non-government agencies, municipal and other statutory agents.

Results

Definitions of sexual and gender-based violence that inform service delivery vary greatly between health and social care service providers, with these definitions proving critical for how services are configured and provided. Service providers may consider longer-term health problems arising from refugees’ experience of sexual and gender-based violence, but refugees’ prospects of integration are rarely explicitly addressed. Refugees’ own views on their health and social care needs do not inform the design or development of service provision.

Conclusions

The experience of sexual and gender-based violence by refugees from Syria is widely recognised among health and social care providers in Turkey and Sweden. However, the experience of such violence is rarely addressed as a public health problem, that is, as a social determinant of ill health and, furthermore, an impediment to successful integration. The long-term, ill effects of sexual and gender-based violence, as seen over the lifecourse, are over-looked when considering refugees.

Key messages

Services for refugees who have been subject to sexual and gender-based violence vary in terms of how that violence is understood and which of its outcomes are addressed. Sexual and gender-based violence when experienced by refugees is rarely seen as a public health problem.
Asylum seekers’ mental health in the Finnish Asylum Seekers Health and Wellbeing Survey (TERTTU)
Authors: Castaneda A E , Lilja E , Garoff F , Mustonen K L , Ahmed A , Skogberg N
Published: November 2019

Background

Asylum seekers have major health and well-being burdens, including mental health. However, there is a lack of population-based survey data on the health status and service needs of asylum seekers in Europe. The TERTTU-project was launched to fill these information gaps and to develop the current health examination protocol for assessing the health, well-being and need for health care services, including mental health, of newly arrived asylum seekers.

Methods

As part of the TERTTU-project, systematic, nationally representative data was collected in 2018 by conducting a health examination and a face-to-face interview survey in reception centers in Finland (n = 1087). The sample was drawn from the Finnish Immigration Services electronic asylum database. Mental health was assessed with the HSCL and PROTECT questionnaires (SDQ among the children), along with questions of potentially traumatic experiences.

Results

39% (95% CI 35,6-42,6) of the adults had current severe depressive and anxiety symptoms, 50% (95% CI 46,9-53,9) had an increased risk for PTSD, and 83% (95% CI 80,0-85,3) had experienced at least one potentially traumatic event before arriving to Finland. The most common psychosocial symptoms among 2-6 year-olds were behavioral symptoms (49%) and difficulties in peer relationships (37%). Difficulties in peer relationships were also common among 7-17 year-olds (49%), followed by challenges in the emotional domain (42%).

Conclusions

Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. Based on the survey-data, a national health examination protocol will be developed in 2019 to improve assessment and identification and to enable systematic health monitoring and evidence-based development of services for asylum seekers. A common health examination protocol will also unify practices across reception centers all over the country.

Key messages

Potentially traumatic experiences and mental health problems are common among asylum seekers in Finland. A national health examination protocol allows for the early identification of vulnerable groups and individuals.
Self Rated Health among Syrian refugees in Lebanon and Norway – a cross sectional study
Authors: Haj-Younes J , Strømme E M , Hasha W , Abildsnes E , Fadnes L T , Kumar B , Diaz E
Published: November 2019

Background

Refugees are often exposed to various stressors before, during and after migration that can cause adverse health effects. Prior research indicates that the health status of refugees is a significant factor in determining their success in resettlement. This study aims to assess self-rated health (SRH) and factors associated with SRH among Syrian refugees in Lebanon and Norway.

Methods

The study uses a cross-sectional design with data from a self-administered survey among 827 adult Syrian asylum seekers of whom 506 were recruited in Lebanon, and 321 in Norway. Inclusion criteria were subjects who self-identified as Syrian nationals above the age of 16. The survey was conducted in 2017 and 2018 in collaboration with International Organization of Migration in Lebanon and through mandatory educational activities in Norway. Data analysis was performed for the main outcome self-rated health (SRH), a validated health status indicator, which was dichotomized into “good” and “poor” SRH. Odds Ratios for poor SRH were estimated adjusting for age, gender and country of residence.

Results

A total of 827 of 972 (85%) who were invited answered the questionnaire. The mean age was 33 years and 74% were men. Factors associated with good SRH were being Kurdish (AOR: 0.48 (0.23 to 0.97)) compared to Arabic ethnicity, being married (AOR 0.54 (0.29 to 0.99)) compared to being single, migrating alone (AOR 0.59 (0.37 to 0.96)) compared to co-migration and having low health literacy level (AOR: 0.64 (0.42 to 0.93)). In contrast, poor SRH was significantly increased with long time in transit country/ies (AOR 1.49 (1.07 to 2.06)) and with older age (age 30-34 AOR 3.2, age 35-39 AOR 2.2, age 40 + AOR 2.6) compared to age group 16-24.

Conclusions

Older refugees and those who stay long time in transit are at great risk of reporting poor SRH. Some of the factors associated with better health, like Kurdish ethnicity, low health literacy or migrating alone, deserve further research.

Key messages

Age and long stay in transit is associated with poor SRH among Syrian refugees. Demographic background and migrant related factors should be taken into account when planning refugee resettlement and healthcare provision.
The factors affecting response rate in survey on well-being among people with foreign origin
Authors: Lilja E , Seppänen A , Kuusio H
Published: November 2019

Background

Previous population surveys among people with foreign background (PFB) in Finland have had successful response rates (62%-66%) when using mainly face-to-face interviews. A cross-sectional population survey (FinMONIK) explored more cost-efficient ways to collect the data on PFB.

Methods

The data collection was conducted in Finland between May 2018 and January 2019. The random sample consisted of 12 877 (after removing over-coverage) 18-64-year-olds stratified by region. First, a letter containing a link to the online survey with 18 different language options was sent to the participants. After two reminders, the questionnaire was sent twice on paper to the non-respondents. Finally, supplementary phone interviews were carried out by multi-lingual interviewers. All the participants were able to enter in a draw to win gift cards.

Results

The response rate (RR) for the online survey was 34%. RR was highest for those who had lived in Finland 5 years or less (43%) and lowest among the divorced (23%) and Estonians (27%). The paper questionnaire was mostly preferred by older age groups, increasing the RR of 40-64 year-olds from 31% to 48%. Telephone interviews increased the RR by five percent points, thus making the final RR for the survey 53%. Persons born in the EU and North-America responded the most frequently (58%) whereas RR was lowest amongst the Sub-Saharan African origin migrants (47%). RR was particularly low (42%) for those who had moved to Finland at ages 0-6.

Conclusions

In surveys conducted amongst PFB, relatively good response rates can be obtained by using alternate methods for gathering data instead of costly and time-consuming face-to-face interview. Age and marital status seemed to affect the preference of survey format. The overall RR varied by country of origin.

Key messages

A good response rate can be obtained without face-to-face interviews in migrant population surveys. Migrant population surveys can be conducted more efficiently by combining a variety of methods.