bluuebunny/crossref_metadata_2025 huggingface dataset:
WhySchool mental health training programs: effective for students, teachers, and school health staff
Authors: Conceição V , Gusmão R
Published: October 2023

Introduction

Adolescent mental health is an increasing concern due to the high prevalence of mental disorders and low levels of mental health literacy (MHL). Enhancing MHL and promoting access to services during this critical developmental phase is essential. Teachers and other educational professionals are vital in addressing mental health issues, encouraging positive mental health, reducing the stigma associated with mental illness, and promoting help-seeking behaviors.

Methods

This study evaluates the WhySchool project, a mental health training program for teachers, school health professionals, and students in Portugal, consisting of two interventions. The first intervention was a prospective pre-post study for teachers and school health professionals who underwent training during 2015-2016 and 2018-2020, with three evaluation phases. The second intervention was a quasi-experimental study in 2019-2020 for students who received the intervention program in a classroom setting administered by previously trained teachers.

Results

The first intervention significantly improved teachers’ and school health professionals’ mental health literacy, help-seeking attitudes, stigma reduction, and confidence in referring students in case of need. These effects remained stable at the M2 follow-up. In the second intervention, MHL scores increased significantly in the intervention group, while the control group showed no significant change. Stigma reduction and help-seeking attitudes also improved significantly in the intervention group, with no significant change in the control group.

Conclusions

The WhySchool program significantly and positively impacted teachers’ and students’ mental health literacy, help-seeking attitudes, and stigma reduction. The results underscore the importance of incorporating mental health programs into school curricula and providing teachers and school staff with the necessary tools and knowledge to deliver these programs effectively.
Pay-for-performance for appropriate prescribing using routine healthcare data from general practices
Authors: Arslan I G , Verheij R A , Ramerman L
Published: October 2023

Background

A national pay-for-performance (P4P) scheme was introduced in the Netherlands to incentivize appropriate prescribing among general practitioners (GPs) using routine care data of electronic health records (EHRs). The goal of this program was to encourage GPs to choose the most clinically appropriate and cost-effective medication for their patients to promote an affordable and sustainable health system. Nivel facilitated and evaluated this program. Facilitators and barriers of this P4P program were assessed as part of this endeavour.

Methods

Semi-structured interviews were conducted with all stakeholder representatives (n = 15) to evaluate their experiences with the program. The interviews were analysed thematically.

Results

Our research was structured around the three ‘flows’ necessary for an effective learning health system. The ‘data to knowledge’ flow was impacted by: 1) effect of different EHR information systems on data quality, and 2) advantages of using EHR data for measuring quality of care, minimising GPs’ administrative burden. The ‘knowledge to practice’ flow was impacted by: 1) meaningfulness and robustness of indicators, and 2) measure for appropriate prescribing. The ‘practice to data’ flow was impacted by: 1) feedback to GPs, with most stakeholders emphasizing the need for GPs to reflect on their results with other GPs to stimulate learning, 2) impact of the P4P model, such as improvement in quality of GP registration in EHRs and better stakeholder collaboration, and 3) methods, communication and GP perspectives on the performance payment.

Conclusions

The study showed the factors that can support or hinder P4P programs in promoting appropriate care with EHR data for a sustainable and affordable health system. Enhancing uniformity of EHR information systems is crucial for more consistent quality of care assessment. To encourage GPs to deliver better care, it is recommended to complement monetary incentives with other forms of incentives.

Key messages

• This study showed that routine healthcare data are feasible for the use in P4P schemes promoting a sustainable and affordable health system.

• P4P as a standalone approach may not be optimal for promoting a sustainable and affordable health system.
Direct costs of rheumatoid arthritis multidisciplinary care in Ireland
Authors: Priyadarshini A , Kenny C
Published: October 2023

Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining a chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary and secondary care within the Health Service Executive in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member of the primary (N = 21) and secondary care (N = 13) RA pathway. Overall cost of each patient type was calculated using time-driven activity-based costing along with medication and clinic running costs. Treating newly diagnosed RA patients costs second highest in primary (€337.39/year) and highest in secondary care (€922.32/year). While patients with advanced RA were most expensive to treat in primary (€469.18/year) and least costly in secondary care (€615.70/year). In primary care occupational therapists were the most expensive allied health care professionals (HCPs) at €1.19/min, followed by physiotherapists at €1.17/min. GP secretaries were the least costly at €0.30/min. In secondary care, consultant rheumatologists and phlebotomists were most and least costly respectively at €3.10 and €0.60/min/patient. Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more (€8718.98/year) than Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) (€120.87/year). In terms of personnel cost newly diagnosed patients and patients with advanced RA are expensive to treat as these require more time with the HCPs. Being referred to departments outside of rheumatology such as orthopaedics, advanced RA patients cost less in secondary care. The difference between whether a patient was on a csDMARD or bDMARD had the biggest influence on total, overall costs amongst the RA patient.

Key messages

• The study provides a breakdown of costs of RA multidisciplinary care in Ireland, facilitating understanding cost drivers and potential areas for cost-savings.

• The study advances the understanding of RA management in HSE Ireland.
Mental Health: a focus on retention of healthcare workers
Authors: Godderis L
Published: October 2023

Introduction

Shortages of healthcare workers are an important challenge for European hospitals. High turnover rates are considered one of the major factors responsible for the outflow of healthcare workers. In the METEOR project, we focus on turnover intentions, job satisfaction and burnout as critical determinants for turnover among healthcare workers in four European countries (i.e. Belgium, the Netherlands, Italy and Poland).

Methods

The METEOR project included three types of data collection methods. First, we identified and analysed the existing determinants of job retention among healthcare workers from literature. Second, we collected data in eight European hospitals by conducting an online survey to assess turnover intentions related to the work climate, job satisfaction and burnout. Third, we organised 12 co-creation and consensus-building workshops with key stakeholders to collect qualitative data on job satisfaction and job retention.

Results

First, based on our survey, 17% of physicians and 9% of nurses intend to leave their hospital, while 9% of physicians and 13% of nurses intend to leave healthcare. Second, the determinants found in literature for job retention were categorized into six themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants were job satisfaction, career development and work-life balance. Third, the workshops showed that nurses and physicians are highly engaged in their patient-work, but are drained by paperwork, an unhealthy work-life balance, a lack of teamwork, limited development opportunities and no appreciation from supervisors.

Conclusions

The intermediate results of the METEOR project show that there is no one-size-fits-all solution to tackle the problem of job retention in healthcare. Initiatives to retain people in healthcare must respond to multiple factors, as they stay (or leave) for a variety of reasons.
Roll-out of a universal childhood COVID-19 vaccine programme for 12-15 year olds in Northern Ireland
Authors: Gallagher N , Spiers R , McBrien B , McCalmont H , Slavin S , Johnston J
Published: October 2023

On 3rd September 2021 the UK Chief Medical Officers (CMOs) jointly published a recommendation that all children aged 12-15 years be offered the COVID-19 vaccine. They concluded that, further to the minimal advantage at individual level for this age group, vaccination would likely help reduce transmission within schools, thus providing a sufficient extra advantage necessary to introduce the programme. In recommending this to Ministers, UK CMOs recognised that the overwhelming benefits of vaccination for adults were not as clear-cut for young people aged 12-15. Children, young people and their parents would need to understand potential benefits, potential side effects and the balance between them. The roll out of the programme had to be undertaken at pace. In NI it was decided that the school setting would be the optimum delivery location as it maximises uptake and reduces inequalities in uptake. A multi-agency project implementation group was formed. The vaccine programme was delivered between October-December 2021, and it brought unique challenges, including; safety concerns around a new vaccine; delays in policy announcements; creation of public and professional resources with complex evidence; anti-vax sentiment and security issues; scale and pace of rollout; and communication with multiple stakeholders. Engagement with schools and teaching unions was crucial, with bespoke support resources developed to aid this. This unique implementation process highlighted the success of the existing school-based vaccine delivery model in NI. It provided opportunities to work closely with education colleagues, and to develop innovative materials for communication of balanced public health messages to a variety of audiences. It also presented unique challenges such as anti-vax discourse and concern around vaccine side-effects. It is unclear if these challenges led to a lower uptake than seen in other school-based vaccine programmes (40.6%).

Key messages

• The implementation of the COVID-19 vaccine in children aged 12-15 years presented unique challenges however the school-based delivery model was deemed a success.

• Further investigation into the uptake is warranted.
Psychometric properties of a new functional health literacy questionnaire in Portuguese adolescents
Authors: Capitão C , Feteira-Santos R , Virgolino A , Santos O
Published: October 2023

Background

Health literacy is associated with health behaviours. There is a lack of suitable instruments for assessing this determinant of health in adolescents. The Newest Vital Sign for the Portuguese adolescents (NVS-PTeen) is the only tool available; however, it was adapted from the original version and has some cultural constraints. We developed the Functional Literacy Questionnaire (FLiQ), the first scale to assess functional health literacy in adolescents using the information on a food label according to the European Union Regulation. This study aimed to assess classic psychometric properties of the FLiQ, in comparison to NVS-PTeen, among Portuguese adolescents.

Methods

We conducted a longitudinal observational study with three phases: (1) characterisation of the scale's content validity (Delphi panel with a group of experts; data collected through online forms); (2) self-administration of FLiQ and NVS-PTeen to adolescents enrolled in 7th to 9th grade (online or paper format); and (3) retest of FLiQ to the same group of subjects, after four weeks.

Results

FLiQ's overall content validity was excellent (average-content validity index=.95). A total of 372 adolescents (50.3% girls) aged between 12-17 years (median age: 13) participated in the study. Of these, 150 completed the test-retest assessment. Internal reliability was good (Kuder-Richardson-20=.70; 95% confidence interval (CI) .66-.75), as well as temporal reliability (intraclass correlation coefficient=.82; 95%CI .76-.87). FLiQ total score was correlated with the school year (rho=.17), and with Portuguese (rho=.35) and Maths grades (rho=.33). Exploratory factor analysis showed that FLiQ is composed by two dimensions (verbal and numeric competencies).

Conclusions

FLiQ is a valid and reliable scale to measure functional health literacy among Portuguese adolescents. It can be used to monitor the literacy levels over time.

Key messages

• FLiQ is the first scale for measuring health literacy using the information on a food label according to the European Union Regulation No 1169/2011.

• Health literacy is pivotal to public health promotion. The results suggest that this scale is suitable for monitoring and assessing public health promotion among adolescents.
Does mindfulness-based intervention in school-setting improve mental health in one-year follow-up?
Authors: Volanen S-M , Hintsanen M , Simonsen N , Vahlberg T
Published: October 2023

Background

Mindfulness-based interventions (MBI) have shown promising results on students’ well-being in several countries, including Finland. However, less is known of the long-term effects of MBIs. We investigated the effects of MBI on mental health in school-setting in a one-year follow-up in an extensive randomized controlled trial Healthy Learning Mind.

Methods

Finnish pupils (Intervention group N = 542, active control group N = 557) aged 12-15 years were randomized into a 9 week MBI group, and a control group with a relaxation program. The primary outcomes were resilience (RS14), socio-emotional functioning (SDQ), and depressive symptoms (RBDI) at baseline, and at follow-up at 52 weeks (T52). Analyses were done with multilevel linear models.

Results

Positive intervention effect was found for socio-emotional functioning between intervention and active control group (Group×Time β=−0.866, p = 0.014). Socio-emotional functioning remained same in the intervention group (β = 0.338, p = 0.178) whereas difficulties increased in the active control group (β = 1.205, p < 0.001). Mindfulness did not show effects on the resilience (p = 0.303) or depressive symptoms (p = 0.925). In an additional exploratory analysis, among the students who had continued practicing mindfulness at least once a week (n = 45) compared to the all pupils in the active control group, no significant differences were found in resilience (p = 0.197), socio-emotional functioning (p = 0.186), or depressive symptoms (p = 0.802). However, although not significant, those 45 pupils, who continued mindfulness practices at least once a week scored systematically better on resilience and socio-emotional functioning compared to active controls.

Conclusions

Short 9-week MBI in school-setting provides slight benefits for socio-emotional functioning in one- year follow-up. Since only 45 pupils continued independent practice for one year, it is difficult to reliably appraise the long-term benefits of MBI in school-setting.

Key messages

• We need more information on the type of support pupils need to keep up practice. The low number of pupils who keep up practicing hampers better understanding of the long-term effects of MBIs.

• The MBI effectiveness research in school settings would benefit from behavioral science perspective.
Trends in mental health diagnosis and use of resources in Europe during the COVID-19 pandemic
Authors: Rodríguez-Blázquez C , Garriga C , Forjaz M J , Sandu P , Bernal E , Miller K , Gruber B , Vuković J , Šitcs J , Tolonen H
Published: October 2023

Background

The European Population Health Information Research Infraestructure (PHIRI) conducted research through use cases of applicability for public health policies during the COVID-19 pandemic. The aim of this study is to present changes in diagnosis of depression or anxiety and the use of health services before and during the COVID-19 crisis.

Methods

Aggregated datasets with the total number of diagnosis of depression or anxiety (ICD10: F30-F39 and F40-F48 codes) and the number of visits to primary care, hospital or emergency department were generated were generated. Diagnoses were obtained from electronic health records in Austria, Estonia, Finland, Croatia, Latvia, Romania and Aragon (Spain), using the PHIRI federated research infrastructure. Incident trends were depicted by month and year of visit (2017 and 2020).

Results

Overall, 1,514,311 diagnoses of depression or anxiety were reported in 2017 vs. 1,102,468 diagnoses in 2020. By countries, monthly mean diagnosis of depression or anxiety ranged 2.7/10000 population (standard deviation, SD:0.2) to 148.4(20.0) for 2017; after lockdown in 2020 incidence decreased in most countries. Visits to primary, specialized care and emergency related to anxiety and depression diagnoses dropped after lockdown but they increased in general in all countries during 2021.

Conclusions

Despite differences in the European health systems, a slight impact on COVID-19 on mental health diagnoses could be detected. This study highlights the potential use of harmonized data for providing evidence for future pandemic preparedness.

Key messages

• The use of a federated research infrastructure has allowed assessing the impact of COVID-19 in mental health across European countries in a harmonized way.

• Slight changes in mental health diagnoses and use of resources could be detected in several European countries due to COVID-19 pandemic.
Hypertension incidence among Ghanaian migrants and non-migrants: the RODAM-Pros cohort
Authors: van der Linden E L , Beune EJAJ , Owusu-Dabo E , van den Born BJH , Agyemang C O
Published: October 2023

Background

Sub-Saharan African (SSA) migrants are disproportionately affected by hypertension, compared to the European-host population. Underlying reasons for the increased hypertension prevalence are still unclear, and longitudinal data are lacking. The aim of this study was to describe hypertension prevalence and incidence rates among Ghanaian migrants residing in the Netherlands, compared to non-migrants residing in Ghana, and the European-Dutch host population.

Methods

We analysed data of the multicentre Research on Obesity and Diabetes among African Migrants prospective (RODAM-Pros) study collected at baseline (2011-2015) and follow-up (2019-2021). Hypertension was defined as a systolic blood pressure ≥140mmHg and/or diastolic ≥90mmhg and/or the use of antihypertensive medication.

Results

In the follow-up data collection, 2165 Ghanaian participants (n = 638 from rural Ghana, n = 608 from urban Ghana, and n = 919 Ghanaian migrants in Amsterdam) and 2098 European-Dutch participants were included. Preliminary results show age-standardised prevalence rates of hypertension at follow-up of 36.9% in rural Ghana, 54.3% in urban Ghana, 59.5% in Amsterdam-Ghanaians, and 33.2% in European-Dutch males. Age-standardised 6-years incidence rates of hypertension were 29.0% in rural Ghana, 27.6% in urban Ghana, 34.4% in Amsterdam-Ghanaians, and 7.3% in European-Dutch females.

Conclusions

These first results show high prevalence and incidence rates of hypertension with differing rates between Ghanaians living in Ghana and in Europe. Future analysis will aim to identify determinants underlying these rates. The findings from the RODAM-Pros study will be valuable for designing effective prevention and clinical management strategies to prevent the burden of hypertension and related complications, both in SSA and SSA migrants in Europe.

Key messages

• Hypertension prevalence and incidence are highest in Ghanaian migrants, and incidence rates are substantial in non-migrants in Ghana.

• Determinants of these rates need to be elucidated to design effective preventive strategies.
Mental health and suicidal behaviours among Irish adolescents - results from the Planet Youth study
Authors: Cannon M , Power E , Dooley N , Cotter D
Published: October 2023

Mental health and wellbeing outcomes for young people are poorly understood in the context of natural disasters. There is a little high-quality evidence at a population level describing mental health and wellbeing in young people in Ireland following the global COVID-19 pandemic. We invited all young people attending specific school grades living within two defined geographical areas (one urban and one rural) to participate. Young people completed a 60-minute survey on their health and well-being between October and December 2021 in school. We wished to investigate the prevalence of mental health difficulties and associations between direct COVID-19 related factors and mental health. A total of 4404 young people responded, and the overall response rate was 79%. The population mean difficulties score of the Strengths & Difficulties Questionnaire (SDQ) [1] was 14.89. The majority of young people reported that pandemic restrictions had a negative effect on their mental health and loneliness. Self-reported rates of lifetime self-harm were 37.75% and self-reported rates of lifetime suicide attempt were 11.14%. Urbanicity and female gender were associated with reporting poorer mental health outcomes. Infection with COVID-19, illness due to COVID-19 in a family member and death of a family member were not associated with mental health outcomes. Elevated SDQ difficulties scores at a population level may be a cause for concern as they have previously found to predict the population prevalence of current mental disorder within a 1-2% point margin of error. In comparison to previous population studies, this population of young people had markedly poorer mental health and wellbeing.
Plasma polyunsaturated fatty acids and mental disorders in adolescence and early adulthood: 2 cross-sectional and longitudinal associations in a general population cohort
Authors: Mongan D , Cotter D
Published: October 2023

Polyunsaturated fatty acids (PUFAs) may be pertinent to the development of mental disorders, for example 28 via modulation of inflammation and synaptogenesis. We wished to examine cross-sectional and longitudinal 29 associations between PUFAs and mental disorders in a large cohort of young people. Participants in the 30 Avon Longitudinal Study of Parents and Children were interviewed and provided blood samples at two 31 sampling periods when approximately 17 and 24 years old. Plasma PUFA measures (total omega-6 [n-6], 32 total omega-3 [n-3], n-6:n-3 ratio and docosahexaenoic acid [DHA] percentage of total fatty acids) were 33 assessed using nuclear magnetic resonance spectroscopy. Cross-sectional and longitudinal associations 34 between standardised PUFA measures and three mental disorders (psychotic disorder, moderate/severe 35 depressive disorder and generalised anxiety disorder [GAD]) were measured by logistic regression, adjusting 36 for age, sex, body mass index and cigarette smoking. There was little evidence of cross-sectional 37 associations between PUFA measures and mental disorders at age 17. At age 24, the n-6:n-3 ratio was 38 positively associated with psychotic disorder, depressive disorder and GAD, while DHA was inversely 39 associated with psychotic disorder. In longitudinal analyses, there was evidence of an inverse association 40 between DHA at age 17 and incident psychotic disorder at age 24 (adjusted odds ratio 0.44, 95% confidence 41 interval 0.22 - 0.87) with little such evidence for depressive disorder or GAD. There was little evidence for 42 associations between change in PUFA measures from 17 to 24 years and incident mental disorders at 24 43 years. These findings provide support for associations between PUFAs and mental disorders in early 44 adulthood, and in particular, for DHA in adolescence in relation to prevention of psychosis.
10.I. Skills building seminar: A seat at the table: Engaging patients and citizens in public health policy-making
Authors:   Organised by: Sciensano (Belgium), EUPHAnxt,   Chair persons: Marie Delnord (Belgium), Jinane Ghattas (EUPHAnxt)
Published: October 2023

Patient and citizen engagement is an essential element of effective healthcare delivery and policy-making, leading towards patient-centred care and improving health outcomes. An important shift is taking place from paternalistic and deficit models towards a more participatory approach. Notably, patients provide valuable input on the ethics, acceptability, trustworthiness and effectiveness of policy initiatives based on their preferences, values and experiences. This is particularly relevant in the area of cancer prevention and treatment, where patient and citizen involvement plays an important part in the European Beating Cancer Plan (EBCP) and EU4Health programme. Cancer care is a societal challenge that raises many issues such as reimbursement of and timely access to prevention, diagnosis and treatment, the use of genomic data, behaviour modification, surveillance, data protection, the integration of therapeutics and research. This challenge is relevant for the population as a whole as everyone is vulnerable to the disease and everyone is impacted by screening, immunization, and preventative initiatives. As such, there is a need for a long-term plan to systematically and actively involve patients and citizens in policy and decision-making. The Belgian Cancer Centre of Sciensano is organising a workshop to improve patient and citizen engagement in policy-making. In this emerging field, no clear quality standards, accepted methods or even recommendations for when to involve certain publics on what topics exist. This workshop will offer an overview of the current state of play and provide practical tools and recommendations for future implementation. During the workshop, participants will learn about the theoretical background, practical implications and potential benefits of public engagement. The workshop will focus on three types of engagement (large scale, targeted and structural), offer concrete examples and discuss risks and benefits of different methodological approaches. In the second part of the workshop, a hypothetical citizen engagement project about the implementation of risk-stratified cancer prevention will be designed, using a co-creative approach involving all participants. The participants will be guided through the process of formulating appropriate questions, setting up a suitable design and preparing implementation of outcomes.

Key messages

• Engagement of patients and citizens is a crucial component of efficient healthcare delivery and policy development.

• The booming field of patient and citizen engagement offers a lot of different methods and strategies. It is important to use the appropriate tool in all circumstances.

Speakers/Panelists

Wannes Van Hoof

Sciensano, Brussels, Belgium

Louise Mathieu

Sciensano, Brussels, Belgium
10.Q. Workshop: Ukrainian refugees in Europe: tackling challenges in health needs and access to health care
Authors:   Organised by: EUPHA-MIG,   Chair persons: Marie Nørredam (Denmark), Sally Hargreaves (UK)
Published: October 2023

Because of the Russian invasion, nearly 8 million refugees fleeing Ukraine have been registered across Europe of whom 90% are women and children. Ukrainian refugees’ health and access to health care is a concern of utmost importance in this context; and a critical public health challenge for the European countries. To undertake this task knowledge is needed on how Ukrainian refugees experience problems related to health, wellbeing, and access to health care services in host countries. Yet, knowledge is scarce on general health needs, health reception and access to specific services among Ukrainian refugees in European countries. In this context, our workshop intends to bring together four projects that shed light on health needs and well-being of Ukrainian refugees in different European countries as well as the organization of support and access to healthcare systems. The workshop is structured in a first part with presentations and a second part with an open discussion involving the audience. Each presentation will last a maximum of 8-10 minutes. The first presentation concerns health and wellbeing of Ukrainian refugees in the UK including the role of initial health assessments and local authority involvement. The second presentation addresses Ukrainian refugees’ wellbeing, adaptation and use of health care services in Denmark. The third presentation highlights health and healthcare needs among refugees from Ukraine arriving in Norway during 2022. Finally, the fourth presentation is also from Denmark adressing general practitioners’ assessment of Ukrainian refugees arriving to Denmark. In the last part of the workshop, the chairpersons will open a discussion with all workshop participants in order to exchange experiences. The discussion will focus on how to support research and public health interventions targeted Ukrainian refugees including which areas need urgent focus. By learning from each other, this workshop aim to inform public health researchers and stakeholders on challenges and possible solutions to the important public health problem of Ukrainian refuges health.

Key messages

• Cross-country sharing of public health knowledge regarding Ukrainian refuges health.

• Adressing public health challenges and possible solutions regarding Ukrainian refuges health.
Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau
Authors: Damerow S M , Adrian H V , Indjai B , Fisker A B , Sørensen J B
Published: October 2023

Background

Guinea-Bissau has among the world's highest maternal-perinatal mortality. Here, the European Union financed a national health system strengthening initiative to improve access to quality peripartum care from 2013-21. Thereafter, the initiative was supported by the World Bank. We conducted a situational analysis to explore factors shaping the provision of timely and quality peripartum care amid this transition in rural Guinea-Bissau.

Methods

We conducted in-depth interviews with eight peripartum care providers in four rural regions, and participant observations (192 hours) at the regional hospital and a health center in one region in 2021-22. Interviews and observation notes were analyzed using thematic network analysis aided by theories of social practice and the WHO framework for quality maternal and newborn health care.

Results

Peripartum services were provided under severely resource-constrained conditions. Care providers especially experienced a lack of materials (e.g., essential drugs, consumables, appropriate equipment), space and staffing, and commonly voiced feeling overburdened. Material constraints were explained by discontinued donor supplies. To navigate this context, providers used several tactics, including: delegating monitoring and support tasks to birth companions; prescriptions of materials for purchase; omitting tests; and using materials thrifty, e.g., by shifting tasks requiring gloves to the staff member wearing them or rationing disinfectants. These tactics had several consequences: diffusion of health worker responsibilities; financial barriers to care; delays; unsanitary conditions; and compromised occupational and patient safety.

Conclusions

With provision of quality peripartum care being highly dependent on external support amid scarce domestic resources, support disruptions led to severely compromised care. This highlights the need to strengthen donor-coordination warranting continuity and quality of essential health services.

Key messages

• Disruptions in donor support led to severely compromised peripartum care in rural Guinea-Bissau.

• This underscores the need for strengthened donor-coordination warranting continuity of service quality.
Urban environment, unhealthy buildings as a root of inequalities and importance of SDGs
Authors: Kusturica M P , Jevtic M , Matkovic V , Bouland C
Published: October 2023

The current pandemic reinforced inequalities and injustice on multiple levels: health, social, and especially urban environment. Cities represent human prosperity and wealth, but also inequity, and health detrimental environments lacking green spaces and sufficiently good air quality, transportation, water supply. Emergencies like COVID-19 pandemic, but also other natural disasters like earthquake and humanitarian crisis have brought a renewed interest in the urban environment and healthy living. With the special circumstances, last year's special attention from public health has become an urban environment concern. The built natural environment, various public spaces like urban parks and forests, transportation hubs and urban open public spaces, are not only significant factors influencing the spread of infectious diseases, but those spaces also have protective roles for health, particularly mental health. There are a lot of examples which reflect increased inequalities in urban areas. Various urban facilities and buildings are in very unhealthy conditions and produce a lot of risks for their inhabitants. Public spaces revealed influential properties for older patients, whereas middle and young-aged adults were more influenced by traveling and the location of business services. The ethnic and minority vulnerability has also a legacy of historical issues in urban planning and unhealthy buildings. This is characterized by diverse racial and minority group populations, with the increased risk from COVID- 19, but also noticeably lower accessibility to green open areas for physical activity. It seems that the Covid crisis have increased the risk of slowing down the achievement of sustainable development goals in urban areas: It is especially important to re-examine the goals and prevent the slowdown in progress towards goals 11 (Sustainable Cities and Communities), 10 (inequalities) in connection with SDG 3 Health) and SDG 17 (strong global partnerships).
Can the built environment impact on the health and well-being of people with dementia? Evidence from Literature and Stakeholders Involvement
Authors: Mangili S , Trabucchi M , Capolongo S
Published: October 2023

Worldwide there are about 55 million people have dementia and the number is expected to grow exponentially in the coming years. Because of the comorbidities and symptoms of the disease, these often live within residential care facilities. The impact that the built environment can have on people's health is now well known, although many aspects are still under-investigated. This research aims to analyze which are the relationships between the built environment and health and well-being outcomes in people with dementia (PwD) by comparing data from the systematic literature review with the direct experiences of experts. The methodology consists of two parts: a systematic literature review and the involvement of stakeholders with expertise in dementia. The first analysis was conducted on scientific databases (Scopus, Pubmed, and Web of Science), using significant keywords, outlining a comparison matrix that correlates architectural aspects and the health of people with dementia. The second analysis was conducted through the compilation of the matrix, between architectural-spatial and health and well-being outcomes which emerged from the literature and was expanded by the study authors, between architectural-spatial aspects (such as location, size, indoor environmental qualities, signage) and health and wellness outcomes of patients with dementia (such as Delirium, wandering, ADL, BPSD, falls). The literature review identified how some studies relate health outcomes and the built environment. Many aspects seem to be widely explored, for example, quality of life (QOL), BPSD (Behavioral and Psychological Symptoms of Dementia), the number of rooms per household, light, or the creation of a home-like environment. Many of the studies do not analyze the impact that specific features of the built environment can have on people with dementia, including concerning health outcomes.
Do child mental & physical health explain inequalities in adolescent NEET status? A UK Cohort Study
Authors: Creese H , Taylor-Robinson D , Hargreaves D
Published: October 2023

Around 1 in 10 young people (YP) (16-24 years) are Not in Education, Employment, or Training (NEET) in the United Kingdom (UK). Socioeconomically disadvantaged YP are more likely to become NEET. Poor physical and mental health and disability are known risk factors for NEET status, yet their potential to mediate the relationship between socioeconomic circumstances (SEC) and NEET status remains unclear. We aimed to quantify which childhood health pathways explain inequalities in adolescent NEET status. We analysed data on 5,786 YP from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life SEC was measured by highest parental occupational status at birth. NEET status was derived from four questions on education, employment, and training at 17 years. Mediators across childhood were grouped into family health (parental limiting illness, mental and general health, and young carer status) perinatal health (birth weight, smoking during pregnancy, school readiness score), physical health (weight status, asthma, general health, longstanding illness at 11 years), and mental health (mental health score, self-esteem, and ASD/ADHA statement). We used logistic regression to examine the total effect of SEC on adolescent NEET status whilst adjusting for confounders (sex, maternal age, and education), then adjusted for potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators. After adjustment for confounding, YP whose parents were unemployed were more than 8 times as likely to be NEET at 17 years compared with those whose parents had managerial occupations (Odds Ratio (OR) 8.55, 95% CI 3.73 to 19.64). After adjustment for all childhood health conditions, there was a 34% reduction to aOR 5.99 (95% CI 2.42 to 14.85). Childhood health conditions partially contribute to inequalities in adolescent NEET status.

Key messages

• Childhood mental and physical health are important for targeting interventions to reduce inequalities in adolescent NEET status.

• More than a third of the social inequality in NEET status was explained by perinatal, physical, and mental health during childhood.
Sexual orientation differences in Swedish young adults’ mental health service use and unmet needs
Authors: Roxo L , Pachankis J E , Bränström R
Published: October 2023

Background

Sexual orientation differences in mental health service (MHS) use have been described before, but evidence from European settings is scarce, and little is known about unmet mental health needs (UMHN). This study examines sexual orientation differences in MHS use and UMHN and associated sociodemographic factors in a population-based sample of young adults in Sweden (aged 17-34).

Methods

We used data from the Pathways to Longitudinally Understanding Stress (PLUS) study (N = 2,126). We performed logistic regressions to model MHS use and UMHN, followed by a subgroup analysis of UMHN among those perceiving a need of MHS. We used interaction terms to understand if associations with sociodemographic factors (gender, age, educational level, income, employment status, household composition, urbanicity and country of birth) differed by sexual orientation and calculated expected proportions.

Results

Overall, 35% of sexual minorities had used MHS the previous year, compared to 20.2% of heterosexuals (OR = 1.52, 95%CI=1.17-1.96, p = 0.002). MHS use was more likely among females, those not employed, not living with a partner, or with low income and less likely for those with less education. UMHN were more likely among sexual minorities (17.6%) than heterosexuals (11.8%, OR = 1.47, 95%CI=1.09-2.00, p = 0.013). Overall, one-third of those with perceived need did not use services, with a significant interaction (p = 0.015) between sexual minority status and gender (60% of sexual minority males vs 36% of heterosexual males and 28% of sexual minority females). For both groups, UMHN were more likely among younger, low-educated and employed persons, and less likely among those with low income.

Conclusions

Sexual minorities are more likely to use MHS but present higher access barriers. Sexual minority men seem less likely to seek help for mental health symptoms. Future research should assess why that happens, while policies should promote friendly mental health services to this group.
COVID-19, breast cancer care, and social determinants of health: a cross-sectional study
Authors: Myers C , Bennett K , Cahir C
Published: October 2023

The aims of this study were to explore the impact of COVID-19 on healthcare services and quality of life (QoL) in women living with and beyond BC in Ireland and whether the impact varied by social determinants of health (SDH). The survey study invited women diagnosed with BC to complete a questionnaire measuring the impact of COVID-19, disruption to BC services, QoL, SDH, and clinical covariates during a period of COVID-19 restrictions. The association between COVID-19 impact, disruption to BC services, and QoL was assessed using multivariable regression with adjustment for SDH and clinical covariates. An interaction between COVID-19 impact and health insurance status was assessed within each multivariable regression model. In total, 387 women completed the survey and 30.5% reported a high COVID-19 impact. Women who reported a high COVID-19 impact had significantly more disruption in BC services(OR = 4.54, CI = 2.15, 9.61, p < 0.001) and a lower QoL(β = -12.4, SE 3.31, p < 0.001) compared to women who reported a low COVID-19 impact. Finally, women with a high COVID-19 impact and no insurance experienced significantly more disruption to BC services(OR = 2.53, CI = 1.30, 4.92, p = 0.006) and lower QoL(β = -18.6, SE = 3.92, p < 0.001). There was a large disruption to BC services and decrease in QoL for women with BC in Ireland during the pandemic. However, the impact of COVID-19 was not the same for all women. It is important that women with BC are reintegrated back into BC care and their QoL is addressed through multidisciplinary support services.

Key messages

• Health systems must learn from the pandemic to improve services and to avoid detrimental impact of future disasters.

• Health insurance status is a key determinant for women with breast cancer in Ireland.
My Health My Language bridging the gap in public healthcare messaging
Authors: Begley G , Hamilton D , Armstrong R , Hayes M
Published: October 2023

Issue

Like many other European countries there has been a sharp increase in the number of migrants in Ireland recently. 13.9% of migrants in Ireland have poor or no English (Census 2016) and are not reached with mainstream public health messaging. Prior to the COVID-19 pandemic, most intercultural health resources were written rather than audio-visual. A clear need to reach out to these communities was identified.

Project

In 2021 the Health Service Executive (HSE) National Social Inclusion Office (NSIO) initiated a project with Translate Ireland (TI) to address the gap in intercultural health resources. Through consultation, priority health protection and health service areas were identified for inclusion in a suite of videos in main migrant languages. NSIO consulted with mychild.ie, National Immunisation Office, Irish College of GPs, Public Health, HSE Communications and the Sexual Health/Crisis Pregnancy Programme to ensure the scripts were aligned with HSE policy. TI identified health professionals living and working in Ireland, that were part of the migrant communities, to deliver key messages in the videos. TI worked with the presenters in wording the scripts to ensure cultural appropriateness.

Results

11 primary care/maternal care videos were produced in 17 languages (187 videos), for healthcare professionals and people seeking health information. A dedicated webpage was created to ensure the videos were easily accessible and the project was named My Health My Language. The project was formally launched in June 2022 by the Minster of Health. We engaged with migrant communities, NGOs and government departments to share the multi-media video messages. By June 2023 there are 14,055 views of the videos.

Lessons

As smartphones are widely used by underserved groups, video messaging is very effective, for those with limited English or where English is not their first language. Short URLs on social media are very effective in providing access to videos.

Key messages

• My Health My Language is a health equity initiative, addressing health information needs of people who have limited English or where English is not their first language.

• Culturally appropriate healthcare videos by peer healthcare professionals speaking in their own language have had significant reach, with over 14,000 views since launching in April 2022.
Does health literacy mediate the relationship between socioeconomic status and health outcomes?
Authors: Berete F , Demarest S , Charafeddine R , Meeus P , Bruyère O , Van der Heyden J
Published: October 2023

Background

Health literacy (HL) has been hypothesized as one of the mediators in the pathway through which socioeconomic status (SES) affects health outcomes. This study explores whether HL mediates the relation between SES and a selection of health(-related) outcomes.

Methods

Data from the participants of the Belgian health interview survey 2018 aged 15 years and over were individually linked with data from the Belgian compulsory health insurance (n = 6878). HL was assessed with the HLS-EU-Q6. Mediation analyses were performed using the SES as independent variables, health(-related) outcomes as dependent variables and HL as mediating variable.

Results

People with low SES were less likely to have preventive dental care (PDC), breast cancer screening (BCS), enough physical activity, good nutritional habits, good self-rated health (SRH). In contrast, they were more likely to use antibiotics and antidepressants. A positive correlation was found between HL and PDC, good nutritional habits, physical activity and SRH, but a negative correlation with use of antidepressants. HL partially mediated the association between SES and PDC, use of antidepressants, nutritional habits, physical activity and SRH. In the relationship between these outcomes and education, the mediation effect of HL accounted significantly for 4.4% to 15.4% of the total effect, while it accounted significantly for 4.2% to 12.0% of the total effect in the relationship with income. There was no significant mediating contribution of HL in the pathway by which SES affects influenza vaccination uptake and BCS.

Conclusions

Although the influence of HL in the pathway is limited, the findings suggest that strategies for improving various health(-related) outcomes among low SES groups may benefit from attention to HL. The low percentage mediated for the use of antidepressants might suggest a shared decision between physician and patients.

Key messages

• HL partially mediates the association between SES and PDC, use of antidepressants, nutritional habits, physical activity and SRH. Improving HL might reduce SES disparities in these areas.

• No mediating effects for influenza vaccination uptake and BCS, indicating a possible influence of the universal health coverage in place.