bluuebunny/crossref_metadata_2025 huggingface dataset:
10.G. Workshop: Digital interventions for improving public mental health
Authors:   Organised by: Heidelberg University (Germany),   Chair persons: Charlotte Gayer-Anderson (UK), Ulrich Reininghaus (Germany)
Published: October 2021

While current routine mental health services provide a range of treatment options for individuals with mental health conditions, specialized support remains difficult to access and tailoring interventions to service users' needs remains challenging. Similarly, the use of, and access to, measures for prevention and mental health promotion continues to be limited, as these are often not tailored to individual needs, preferences, and real-world settings. There is increasing interest in utilizing digital health technologies for improving public mental health provision (i.e., mental health promotion, prevention and treatment of mental disorders) as they allow for adaptive, scalable, real-time, and real-world delivery of intervention components in individuals' daily life. This has driven the development of novel internet-based (eHealth) and app-based mobile health (mHealth) interventions for various mental health outcomes of which ecological momentary interventions (EMIs) represent a powerful approach. To accomplish this, novel research concepts (e.g., living labs) are increasingly being used to develop, optimize, evaluate, and implement digital interventions in routine public mental health provision through a transdisciplinary approach that involves users from the target population and relevant stakeholders throughout the research process to facilitate co-production and lowering barriers of implementation. The workshop's objective is to exemplify the multifaceted use of digital intervention in areas of public mental health and diverse communities and settings. This will include a) novel approaches to modifying continuum beliefs about mental health and an online anti-stigma intervention, b) an EMI to reduce suicide risk among adolescents (EMIRA), c) a self-Help app for Syrian refugees with posttraumatic stress (Sanadak), d) a location-based game to promote (mental) health literacy of adolescents (Nebolus), and e) an artificial intelligence-informed mHealth training for mental health promotion and prevention in adolescents and young adults (AI4U). The discussion will be led by Prof. Steffi Riedel-Heller, MD, MPH, and will focus on the benefits and opportunities afforded by digital technologies in public mental health provision.

Key messages

Digital interventions signal great promise for improving public mental health. There is a need to carefully evaluate digital interventions before implementation or making them publicly available.
A systematic literature review on the use of health care resources during pandemic response
Authors: Peelen A , Beishuizen B , Stein M , Tostmann A , Bleeker-Rovers C , Timen A
Published: October 2021

Background

The COVID-19 pandemic demonstrated the need for better pandemic preparedness and response, and more international collaboration. The H2020 EU-funded PANDEM-2 project aims to prepare Europe for future pandemics. As part of the project, an European dashboard consisting of epidemiological data and insights on available pandemic health care capacity is developed. To model and map the availability of pandemic resources, data on the use of these resources and interdependencies between resources are needed to parametrize the resource model of the PANDEM-2 dashboard.

Methods

We conduct a systematic literature review. The database Embase.com was searched on articles that include a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example PPE usage, length of stay on the ICU, or vaccine efficacy. Our search included data from all continents and focuses on infectious diseases that have been declared a pandemic by the WHO in the last twenty years, which are the H1N1 influenza (2009-2010) and COVID-19 (ongoing).

Preliminary results

The search query and additional sources resulted in 1215 articles, of which 187 are included for the full text eligibility assessment. We identified several pandemic resources in the field of vaccination (vaccine efficacy), contact tracing (apps), general practitioners, the hospital (staff, PPE, ventilators), and national and regional public health institutes. Furthermore, interdependencies between resources and possible resource gaps were found, for example in hospital staff and PPE.

Conclusions

To be better prepared and to be able to respond fast to a pandemic outbreak, it is important to have insight in the availability of pandemic resources on a national and regional level, their use and mutual dependencies. This makes it possible to anticipate on fast changes and possible shortages by reallocating resources within and between regions.
Identification of competences in regional health network management
Authors: Movia M , Amort F
Published: October 2021

Background

Aim of Com.HeNet is among others to identify competences which are needed to implement and manage a health network on regional level in European countries.

Description

All participating countries have used the same method for data gathering. Templates in terms of method guidelines were developed and used uniformly. First, a structured literature search was conducted to gather data regarding circumstances, structures and challenges in relation to RHNM. Relevant existing papers, reports and officially released documents from public facilities or e.g. reports from governmental authorities have been included. Grey literature from online websites and resources were also accessed. The second method represents semi-structured guided expert interviews. The interview guideline was developed by European experts (n = 10) from divers fields e.g. Public Health, Sport science and Management. Afterwards pre-testing the interview guideline, relevant experts and stakeholders from diverse fields, were interviewed e.g. Public Health, Health Promotion, clinical services, politics, practitioners or research. Overall n = 33 interviews were carried out [Austria = 5, Bulgaria = 5, Germany = 5, Hungary =5, Spain= 6, Poland =7]. Afterwards the interviews have been transcribed and analysed. The statements were evaluated in a structured and summarizing analysis for homogeneity / diversity / quantity of the various opinions. All results were incorporated in a uniform predefined template (competence profile).

Conclusions

Semi-structured/ guided interviews represent a suitable method to gather data in terms of required competences for health network management. Desktop research / literature search is appropriate to support the qualitative data gathering.

Main message

The mix of the two methods as well as the international views of respective countries was a positive value for the project.
Does parental supply of alcohol predict later adolescent alcohol use in a highly permissive context?
Authors: Ksinan A , Ksinan Jiskrova G , Hrežová E , Pikhart H , Bobák M
Published: October 2021

Background

Considerable number of children and adolescents get their first experience with alcohol in a family setting. Evidence suggests that parental supply of alcohol is a risk factor for drinking later in life. However, the vast majority of previous studies have been conducted in North America or Western Europe. Czechia has amongst the highest alcohol consumption per capita, including among adolescents. Providing own children with sips of alcohol is widely perceived as a good way to introduce them to safe drinking. This study examined whether parental supply of alcohol would predict alcohol use among adolescents in an Eastern European alcohol-permissive context.

Methods

We used a subsample of 2,570 adolescents from ELSPAC, a longitudinal study of Czech mothers and their children. The outcome was adolescent alcohol use at age 15, reported by adolescents and their pediatricians. Different sources of alcohol (parents, family member, friend, own supply, or other sources) at age 11 were used as longitudinal predictors. The structural equation models controlled for sex, family structure, maternal education, and parental alcohol use.

Results

Parental supply of alcohol consistently emerged as the strongest longitudinal predictor of using alcohol in adolescence. The adjusted odds ratio for self-reported and pediatrician-reported frequent drinking at age 15 was 2.64 [1.45, 4.83]) and 2.68 [1.26, 5.67], respectively. The population risk fraction attributable to parental supply of alcohol at age 11 was 23%, reflecting the high prevalence of parental supply (18%),

Conclusions

Parental supply of alcohol is a risk factor for later adolescent alcohol use in this high alcohol-permissive population. These findings should encourage preventative strategies aiming to decrease the high rates of alcohol use among Czech adolescents by focusing on dispelling the myth of safe introduction to alcohol by parents.

Key messages

Parental supply of alcohol at the age of 11 was associated with increased alcohol use at age 15. These findings dispel the common myth in Czechia of safe introduction to alcohol by parents.
Housing and health: An empirical framework for refugee reception centres
Authors: Hintermeier M , Rast E , Ziegler S , Bozorgmehr K , Biddle L
Published: October 2021

Background

Housing is a key social determinant of health. Newly arriving asylum seekers and refugees (ASR) in Germany are assigned to reception centres (RC), comprising large, shared facilities in remote locations. Our aim was to explore how housing affects health from the perspective of ASR in order to develop an empirical framework for further research.

Methods

We conducted a secondary analysis of 47 qualitative interviews with ASR living in German RC and developed a multidimensional framework containing the effects of housing characteristics on health in this setting. An initial coding scheme with five dimensions was developed from the literature: material aspects, meaningful aspects, housing as an expression of socioeconomic status, community, and immediate environment. Using thematic analysis, sub-codes were generated inductively, resulting in the final framework.

Results

Important material aspects included building structure, basic amenities, sharing of living space and food provision. Among these, room sharing and food provision were particularly relevant for participants. Meaningful dimensions important for health included autonomy, privacy, safety and stability, which were limited in RC due to missing door locks, room sharing, restrictions of movement and frequent transfers between centres. Based on participants' statements, the community was divided into “outside” and “inside” the RC, which, unlike the “outside” community, have collective and organisational characteristics. We subsumed statements about distances to services and amenities into immediate environment. However, participants reported that short distances did not always guarantee access.

Conclusions

We identified important interdependent dimensions of housing which affect health and well-being among ASR and consolidated them into an empirical framework which can serve as a basis for further research, including the future development of measurement instruments to assess effects of housing on ASR health.

Key messages

ASR narratives show that housing dimensions with importance for health in reception centres have specific characteristics and are interdependent. We developed a framework which can be used for further research on the effects of housing on ASR health in this setting, including the construction of quantitative measurement instruments.
The new Framework and the Core Elements of complex intervention research
Authors: Craig P , Skivington K , Moore L , Simpson S , Matthews L
Published: October 2021

The new framework will be presented. The main phases of intervention research: development or identification, feasibility, evaluation and implementation are connected to 6 core elements:

Context: any feature of the circumstances in which an intervention is conceived, developed, evaluated and implemented Programme theory: how an intervention is expected to lead to its effects and under what conditions. Programme theory should be tested and refined at all stages and used to guide the identification of uncertainties and research questions Stakeholders: those who are targeted by the intervention, involved in its development or delivery, or more broadly those whose personal or professional interests are affected, that is who have a stake in the topic. This includes patients, the public, and professionals Refinement: the process of ‘fine tuning' or making changes to the intervention once a preliminary version has been developed Uncertainties: identifying key uncertainties that exist given what is already known and what the programme theory, researchers and stakeholders identify as being most important to find out. These judgements inform the framing of research questions that, in turn, govern research perspective choice Economic considerations: exploring the comparative resource and outcome consequences of the interventions for those people and organisations affected

The presentation will discuss how to use the framework, highlighting that complex intervention research can be an iterative process. Repeating of phases is preferable to automatic progression to the next phase if uncertainties remain unresolved.

Main messages

Complex intervention research may begin at any phase, depending on what is appropriate for the intervention in question, and does not necessarily move sequentially through the phases. The core elements should be considered early and revisited continually throughout, as this will make it most likely that the intervention will be implementable in practice.
COVID-19 containment measures analysis
Authors: Bahr Thurid
Published: October 2021

On a bi-weekly basis, COVID-19 control measures were analyzed through a deeper investigation by the Evidence-Based Public Health Unit at ZIG. The biweekly analysis focused on a list of countries selected on the basis of their accelerating or decelerating COVID-19 epidemiological trend. For this, a policy analysis framework was developed to contextualize the epidemiological trend in conjunction with the change in the public policy landscape.
Evaluating and synthesizing COVID-19 evidence
Authors: Bcheraoui Charbel El
Published: October 2021

The Evidence-Based Public Health Unit monitored the peer reviewed literature for policy-relevant publications. New publications deemed relevant were evaluated using validated appraisal tools, and the findings were communicated in terms of their relevance to public health policy. Alternatively, evidence around specific public health policies were synthesized and also communicated in reports relatively to their effectiveness in controlling the pandemic.
Measuring the invisible: perinatal health outcomes of unregistered women giving birth in Belgium
Authors: Schönborn C , De Spiegelaere M , Racape J
Published: October 2021

Background

Research on the perinatal health of women without legal residence remains limited. We aimed to describe the sociodemographic profiles of women who were not registered in the Belgian National Population Registry, and to analyse the associations of registration status with pregnancy outcomes.

Methods

We analysed data from birth and death certificates linked with the National Population Registry for all singleton births between 2010 and 2016 (n = 871 283). With logistic regression we estimated the odds ratios for the associations between three perinatal outcomes and maternal registration status, stratified by nationality and adjusted for socioeconomic status.

Results

Mothers not legally residing in Belgium represented 1.9% of births. Unregistered women from newer EU member states and non-European countries were socioeconomically disadvantaged. Except for women with South American nationality, all other unregistered groups had higher rates of prematurity, low birthweight, and perinatal mortality, compared to registered mothers (p < 0.0001). Unregistered women from Belgium and EU15 countries had higher rates of prematurity, low birthweight, and perinatal mortality, even after adjustment for socioeconomic status (p < 0.0001). In contrast, the excess perinatal mortality in unregistered non-European mothers was partly attributed to their precarious socioeconomic situation.

Conclusions

Unregistered women giving birth in Belgium are socioeconomically heterogeneous, with some living in Belgium (undocumented) and others abroad. Overall, unregistered women had increased risks of adverse perinatal outcomes, but the causal mechanisms probably differ starkly between Belgians, Europeans and non-Europeans; further research is needed to understand these accrued rates. Studying the populations “invisible” in national statistics is important to identify the groups in most need of integration and access to services.

Key messages

Unregistered women were a heterogenous group with increased risks of adverse perinatal outcomes. Unregistered women from non-EU countries were presumably undocumented migrants. Their accrued rates of adverse outcomes were partly, but not entirely, explained by their worse socioeconomic situation.
School teachers’ perception on parental migration and left-behind children in rural Georgia
Authors: Antia K , Berner-Rodoreda A , Winkler V
Published: October 2021

Background

Georgia, like other Eastern European countries, showed a dramatic increase of international labour emigration after becoming independent in 1991. Since then, thousands of children are left-behind (LBC) in the care of extended family members while their parents work abroad. School teachers are frequently in contact with LBC and their caregivers. The main aim of this study is to explore school teachers' perceptions on parental migration and LBC in rural Georgia.

Methods

In this qualitative study, we conducted six focus-group discussions with public school teachers and six in-depth interviews with school principals from two migrant sending regions. We applied a reflexive thematic analysis approach, systematically analysed data and identified main themes and sub-themes from the collected data. The theoretical framework of the socio-ecological model of human development underpins this study.

Results

We identified the following themes expressed by both teachers and school principals: parental migration and transnational families as a survival strategy; LBC's vulnerabilities and dangers due to migratory separation; school teachers as mediators and supporters for LBC. School teachers and school principals perceive parental migration as a negative experience for children causing problems of physical and mental health, well-being and academic performance. Structural factors such as poverty, lack of support and lack of community involvement further worsen this situation. Teachers see themselves as the only supporters for LBC and their transnational families. School principals mitigate the situation by employing various strategies, such as regular meetings with class tutors, extra-tutoring for LBC, psychological counselling and developing/enacting internal guidelines.

Conclusions

LBC, transnational families and public schools in Georgia are in urgent need of external support such as providing psychological services at schools.

Key messages

Left-behind children in transnational families are vulnerable. Community and school-based interventions are needed to support LBC and teachers in fostering resilience and coping mechanisms among LBC.
Does the Family Affluence Scale reflect parental earned income, education and occupational status?
Authors: Corell M , Chen Y , Friberg P , Petzold M , Löfstedt P
Published: October 2021

Background

The Family Affluence Scale (FAS) is an alternative measure of families' socioeconomic conditions, developed for surveys to children and adolescents. It was adopted by the Health Behaviour in School-aged Children (HBSC) survey in 1993/94 and is frequently used in international research examining socioeconomic inequalities in health among children and adolescents. It has been validated in several countries, but not with register data. The aim of this study was to examine the external validity of the FAS among adolescents in Sweden, by using register data for parental earned income, level of education and occupational status.

Methods

Data from the baseline (2015 − 2019) of the Study of Adolescence Resilience and Stress (STARS), comprising 2 283 13-year-olds in the region of Västra Götaland, were used. The FAS III consists of six items; unshared bedroom, car ownership, computer/tablet ownership, dishwasher, number of bathrooms and number of holidays abroad. Register data from Statistics Sweden (2014 − 2018) were linked to the adolescents. Pearson's and Spearman's correlation coefficients were calculated.

Results

Total parental earned income was moderately correlated to adolescents' scoring on FAS (0.31 < r < 0.48, p < 0.01), depending on examination year. Correlations between mothers' and fathers' educational level and adolescent's scoring on FAS were low (r = 0.19 and r = 0.21 respectively, p < 0.01). FAS was higher among adolescents with working parents, but the correlation between parent's occupational status and FAS was low (r = 0.22, p < 0.01). The low FAS group mainly comprised low income households and the high FAS group mainly high income households. However, in the medium FAS group, all income quintiles were equally represented. Consequently, the medium FAS group should be used as the reference group.

Conclusions

The FAS was moderately associated to total parental earned income and mainly identified low income and high income households.

Key messages

The FAS may be used as an alternative measure of total parental earned income in studies based on self-reported socioeconomic status among adolescents. Ensuring that instruments intended to measure socioeconomic conditions are valid is crucial in public health.
Impact of COVID-19 on migrant populations in high-income countries: a systematic review
Authors: Hayward SE , Deal A , Cheng C , Orcutt M , Norredam M , Veizis A , Campos-Matos I , McKee M , Kumar B , Hargreaves S
Published: October 2021

Background

Migrants in high-income countries (HICs) may have been disproportionately affected by the COVID-19 pandemic, yet the extent to which they are impacted, and their predisposing risk factors, are not clearly understood. We did a systematic review to assess clinical outcomes, indirect health and social impacts, and key risk factors in migrants.

Methods

Our systematic review following PRISMA guidelines (PROSPERO CRD42020222135) identified peer-reviewed and grey literature relating to migrants (foreign-born) and COVID-19 in 82 HICs. Primary outcomes were cases, hospitalisations and deaths from COVID-19 involving migrants; secondary outcomes were indirect health and social impacts and risk factors.

Results

3016 data sources were screened with 158 from 15 countries included in the analysis. We found migrants are at increased risk of SARS-CoV-2 infection and are over-represented among cases (e.g. constituting 42% of cases in Norway [to 27/4/2020], 26% in Denmark [to 7/9/2020], and 32% in Sweden [to 7/5/2020]); some datasets from Europe show migrants may be over-represented in deaths with increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected, with certain nationality groups disproportionately impacted. Migrants experience a range of risk factors for COVID-19, including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement.

Conclusions

Migrants in HICs are at high risk of COVID-19, with a range of specific risk factors that have not been well-considered in the public health response to date. These data are of immediate relevance to the policy response to the pandemic, with strategies urgently needed to reduce transmission. Migrant populations must also be better considered in national plans for COVID-19 vaccination roll-out.

On behalf of ESGITM

Key messages

Migrants in high-income countries may be disproportionately represented in COVID-19 infections and deaths, with higher levels of many vulnerabilities and risk factors. Migrants must be better included in all aspects of the pandemic response, including vaccination roll-out.
Are 2020’s medical students still suffering from gender stereotypes? An Italian study
Authors: Boietti E , Bert F , Gualano M R , Pompili E , Rousset S , Franzini Tibaldeo E , Tatti R , Siliquini R
Published: October 2021

Background

Gender medicine is crucial to reduce health inequalities in Europe. Knowledge about medical students' attitudes and beliefs regarding sex and gender is important to improve gender medicine courses. The aim of this study is to evaluate gender awareness and its predictors in Italian medical students.

Methods

During 2020, we performed a cross-sectional study among medical students from the University of Turin, Italy. We used the validated Nijmegen Gender Awareness Scale in Medicine (N-GAMS) to investigate gender sensitivity (GS) and gender role ideology towards patients (GRIP) or doctors (GRID). Multivariable logistic regression model was performed to explore potential predictors of gender awareness.

Results

Globally, 430 participants completed the survey (68.4% were females). The 62.5% of male students had a poor knowledge of gender medicine. GRID score significantly differs between males and females (1.64±0.68 vs 1.51±0.49; p = 0.028). Males had lower GS scores (coefB -0.96, p < 0.05), while students who had a better knowledge on gender medicine (coefB 0.14, p < 0.05) and those who have received good example from tutors (coefB 0.14, p < 0.05) were more gender-sensitive. Older age (coefB 0.04, p < 0.05), a better knowledge on gender medicine (coefB 0.12, p < 0.05) and having had a tutor sensitive to gender issues (coefB 0.13, p < 0.05) were predictors of more stereotyped opinions towards patients. Having had a tutor aware of gender medicine (coefB 0.03, p < 0.05), male sex (coefB 0.12, p < 0.05) and older age (coefB 0.03, p < 0.05) were associated with more stereotypes towards doctors.

Conclusions

Gender stereotypes are still common. During university courses and practical training more attention must be paid to explain that stereotyped gender differences are not scientifically proven and they do not contribute to provide better care. Therefore, the implementation of gender specific teaching throughout elective courses should be seriously considered.

Key messages

Receiving more knowledge and more attention about gender medicine during university education was associated with higher gender stereotypes in our sample of medical students. Interventions in European university education are needed to make gender medicine education more effective in order to reduce gender stereotypes and contribute to better care.
Artificial sweeteners and cancer risk in the prospective NutriNet-Santé cohort
Authors: Debras C , Chazelas E , Srour B , Julia C , Kesse-Guyot E , Andreeva VA , Galan P , Hercberg S , Deschasaux-Tanguy M , Touvier M
Published: October 2021

Background

Added sugars' deleterious effects have been established for several chronic diseases, leading food industries to turn towards high-intensity sweeteners. Their safety is debated and findings remain contrasted regarding their role in the etiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies but epidemiological data are lacking.

Thus, our objective was to investigate the associations between sweetener intakes (total from all dietary sources, and most frequently consumed: acesulfame-K e950, aspartame e951 and sucralose e955) and cancer risk (overall and by sites).

Methods

Overall, 102,046 adults from the French NutriNet-Santé prospective cohort (2009-2021) were included. Consumption of sweeteners was obtained by repeated 24h-dietary records including brands and commercial names of industrial products. Associations between sweeteners and cancer incidence were assessed by multi-adjusted Cox hazard models.

Results

Compared to non-consumers, high-consumers had higher risk of overall cancer (n = 2527, hazard ratio=1.12, 95% confidence interval=1.00-1.25, P-trend=0.005). In particular, acesulfame-K (HR = 1.18 [1.04-1.34] P = 0.003) and aspartame (HR = 1.20 [1.05-1.38] P = 0.001) were associated with increased cancer risk. Similarly, higher risks were observed for breast (n = 723, HR = 1.25 [1.02-1.53] P = 0.01, HR = 1.39 [1.11-1.74] P = 0.003 and HR = 1.33 [1.05-1.69] P = 0.007 for total sweeteners, e950 and e951, respectively) and obesity-related cancers (n = 1509, HR = 1.16 [1.00-1.33] P = 0.02, HR = 1.23 [1.04-1.45] P = 0.01 and HR = 1.22 [1.02-1.45] P = 0.01 for total sweeteners, e950 and e951, respectively).

Conclusions

These results suggest that artificial sweeteners (especially e950 and e951), which are found in > 12,000 foods and beverage references worldwide, may be associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of sweeteners by the European Food Safety Authority.

Key messages

In this large-scale prospective cohort of French adults, intake of high-intensity artificial sweetener intake (especially acesulfame-K and aspartame) was associated with higher risk of cancer. These results provide novel insights to feed EFSA’s expertise for the ongoing risk assessment of artificial sweeteners.
Looking upstream: a framework for analysing the impact of trade on public health
Authors: Koivusalo M , McCallum A
Published: October 2021

Background

Trade has been a commercial and political determinant of health since the Middle Ages. It was the transmission route for increased prosperity and, as the result of mobility, pandemics, such as plague. The importance of trade agreements (TA), their potential to increase inequity and restrict scope for regulating for health are not discussed widely in public health. Comprehensive TAs, emerging impacts of Brexit, global disruption associated with SARS-CoV-2, access to vaccines and climate change require urgent attention. With renewed interest in economy of wellbeing we examine the impact of trade and TAs for public health practice.

Results

We present a six-part framework for analysis of trade-related measures for public health practice:

Trade flows and/or mobility of people, goods, services or capital. Trade can enhance access to fruits, nuts and vegetables, but also tobacco, alcohol and junk food. Tariffs, tax and minimum unit pricing need to be balanced. Scope for regulation and policy measures at national level irrespective of trade flows. Obligations such as intellectual property rights and investment protection that protect corporations against local action. Authority and reference standards. TAs have changed reference agencies (e.g. Codex, ISO) and can include e-health, medical devices and data-related provisions. New provisions can signal a role for trade in improving health or undermine other international agreements. Public health and crisis exemptions so that essential local services and production can take place

Lessons

This framework enables a focus on trade flows and what is negotiated under trade agreements to inform political decision-making and evaluate what negotiated documents imply for population health.

Key messages

Trade impacts on public health depend on trade flows and what is negotiated in trade agreements. The framework for analysis helps in assessing diverse types of public health relevant impact and identifying priorities for action.
Practices towards SARS-CoV-2 transmission prevention among Polish high school students
Authors: Duda-Duma Ł , Nowak K , Harbich M , Bednarek P , Ganczak M
Published: October 2021

Background

Adolescents play a significant role in SARS-CoV-2 spread. The study objective was to assess practices towards COVID-19 among final year Polish high school students.

Methods

Between December 2020-March 2021 an online cross-sectional survey was conducted. Multistage random sampling selected 24 high schools in the Lubuskie region then 51 classes. Students' practices were assessed by an anonymous questionnaire. Significance was tested by Chi-square test.

Results

Response rate was 72.3%; 638 students (360 females) participated (mean age 18.4±0.6 years); 68.7% attended schools in the cities with <100,000 inhabitants; 31.5% were in the science program. Most (81.3%) declared they always used masks in public spaces in the last month (74.3% males vs 86.1% females, p < 0.001; 77.2% of those living in smaller vs 90.5% in larger cities, p < 0.001; 89.6% in the science program vs 77.6% - in the other programs, p < 0.001); 35% always avoided crowded areas (26.9% males vs 39.4% females, p = 0.001; 29.5% living in smaller vs 47% in larger cities, p < 0.001; 43.8% in the science program vs 30.9% - in the other programs, p = 0.002); 24.3% declared always keeping social distance (19.4% males vs 27.2% females, p = 0.02), 29.9% stated they did not touch their faces (25% males vs 33.3% females, p = 0.02; 27.2% living in smaller vs 36% in larger cities, p = 0.02; 37.8% in the science program vs 26.3% - in the other programs, p = 0.003). Among those wearing masks - uncovered noses (64.6%) and masks around the neck (42.3%; 48.1% males vs 38.9% females, p = 0.02) were the most frequent incorrect practices.

Conclusions

Most high school students, in particular males, living in small cities and attending non-science program have inappropriate preventive practices towards COVID-19. Health education programs are urgently needed to better equip students with COVID-19 prevention skills.

Key messages

The study shows data of final year high-school students' practices towards COVID-19 and maybe used by public health experts to better address educational campaigns oriented to Polish adolescents. Health education aimed at high school students would be crucial to improve compliance with SARS-CoV-2 infection control procedures.
Co-production of health: are communities being heard in local health planning in Portugal?
Authors: Nunes AB , Leiras G , Duarte S , Brito DV
Published: October 2021

Background

Health planning is an essential tool to address communities' health needs. Although recommended by portuguese national guidelines, Local Health Plans (LHP) lack adequate community participation, which could improve their implementation and contribute to achieve the SDG agenda and universal health coverage. The aim of this study is to assess the degree of community participation in LHP in Portugal.

Methods

Data was collected from 52 (out of 54) publicly available LHP in April 2021. Each document was reviewed by two independent researchers and analysed considering time frame, participatory approach, stage of the health planning cycle in which the community was involved and methods used to promote community participation. A descriptive analysis was performed.

Results

Although 52 LHP were available, only 37 were valid for 2020. Although community participation was mentioned in all PLH, most did not include a comprehensive community participation approach (88%). Community representatives were particularly involved in the prioritizing health problems stage of the health planning cycle (81%); no LHP mentioned the involvement of the community in the monitoring and evaluation stage. Methods used to promote community participation were clearly stated in 48% of LHP.

Conclusions

Community participation is a key strategy for successful implementation of LHP in Portugal. Most LHP show a clear concern to include community representatives when it comes to prioritizing health problems and highlight the importance of co-production of health between health services and the community, but fail to integrate community participation throughout the health planning cycle. Specific community fora could improve community participation and therefore better implementation of LHP.

Key messages

Most Local Health Plans in Portugal lack a comprehensive community participation approach. A community-centred approach should be prioritized in order to improve LHP implementation.
First assessment of covid-19 vaccine response in a population at risk
Authors: Bordino V , Cornio AR , Garlasco J , Marengo N , Di Tommaso S , Giacomuzzi M , Memoli G , Vicentini C , Zotti CM
Published: October 2021

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic. Currently, the diagnosis of COVID-19 is confirmed by detecting SARS-CoV-2 via RealTime-RT-PCR in rhino-pharyngeal swab. Serological test is required to evaluate a previous exposure to the virus, as well as antibody response. The aim of this multicentric study is to analyse the antibody response following COVID-19 vaccination in healthcare workers and guests of nursing homes, and to determine differences between subjects with or without a confirmed previous infection.

Methods

Our study included 657 subjects, recruited from guests and healthcare workers of nursing homes in the Piedmont region. 10 days after the completion of the vaccination cycle, a blood sample was taken from the subjects to measure IgG against SARS-CoV-2 spike protein. Serological testing was performed using an enzyme immunoassay kit (EUROIMMUN Anti-SARS-CoV-2 QuantiVac ELISA). We performed statistical analysis with R software.

Results

We recruited 657 subjects aged between 19 to 106. Among them, 404 had a previous infection and 253 didn't have a known previous infection. The serological examination resulted positive in 655 subjects and negative in 2 (X¯ IgG 1095 RU/ml). Samples with titer> 1200 RU/ml will be further diluted to identify the titer and differences from the baseline situation.

Conclusions

This study analyses neutralizing antibodies, which should prevent the virus from binding to target cells via spike protein. According to literature, immunological response to vaccine presents a great variability of antibodies level in the study population. However, no significantly correlations were found between the available variables. Preliminary data show the presence of a very intense antibody response after active vaccine immunization both in subjects with previous infection and in the rest of the study population.

Key messages

Covid-19 vaccine response in a population at risk. Differences between subjects with or without a confirmed previous infection.
Mask reuse during the COVID-19 pandemic: a national survey in Taiwan
Authors: Hu HY , Cheng FS , Yen YF , Lin SY , Weng SH , Chou YC , Chu DC , Chen CC
Published: October 2021

Background

The use of masks is an effective measure to prevent severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection; however, mask reuse is not recommended. Studies examining the factors associated with mask reuse during the coronavirus disease (COVID-19) pandemic are limited. This nationwide survey aimed to determine the prevalence and factors associated with mask reuse among Taiwanese citizens during the pandemic.

Methods

From May 18 through May 31, 2020, a computer-assisted telephone interview system was used to randomly select Taiwanese citizens who were interviewed for COVID-19 preventive behaviors and knowledge on the usage of masks. Multivariate logistic regression was used to identify factors associated with mask reuse during the COVID-19 pandemic. Moreover, generalized estimating equations (GEE) were used to analyze the rate of mask reuse among participants before and during the pandemic.

Results

For a total of 1,075 participants, the overall mean age was 57.4 years, and 82.2% of participants reported mask reuse during the COVID-19 pandemic. After controlling for other covariates, participants who had a greater knowledge on mask usage or had a high supply of masks were less likely to reuse masks during the pandemic. GEE analysis showed that compared with the participants' mask wearing behaviors before the COVID-19 pandemic, they were more likely to reuse masks during the pandemic.

Conclusions

The rate of mask reuse among the general population during the pandemic was significantly higher than that before the pandemic. Individuals were less likely to reuse masks if they had adequate knowledge on mask usage or had a high supply of masks. Since mask reuse is associated with a higher risk of COVID-19 due to the possibility of wearing SAS-CoV-2-contaminated masks, it is imperative to educate people on the correct usage of masks. Further, the government should provide sufficient masks to the general population to decrease the reuse of masks.

Key messages

Mask reuse increased during the COVID-19 pandemic due to the shortage in supply. It is imperative to educate people about the correct usage of masks.
The effect of the COVID-19 pandemic on long-term care managers' intention to quit
Authors: Pförtner T , Pfaff H , Hower K
Published: October 2021

Background

The SARS-CoV-2-pandemic poses major demands for long-term care, which might have impacted the intention to quit the profession among managers of long-term care facilities.

Methods

We used cross-sectional data of an online survey of German long-term care managers from outpatient and inpatient nursing and palliative care facilities surveyed in April 2020 (survey cycle one; n = 532) and between December 2020 and January 2021 (survey cycle two; n = 301).

Results

Results from the multivariate logistic regression analysis, including all variables simultaneously, showed that the pandemic-specific demands [OR = 1.034; CI = 1.011-2.057] and the general demands [OR = 1.023; CI = 1.001-1.045] were significantly associated with the intention to quit the profession. This association was significantly stronger for general demands in survey cycle two compared with survey cycle one. The results highlight the pandemic's immediate impact on long-term care. The interaction term between survey cycle and demands indicated that the association between general demands and the intention to quit the profession significantly rose between survey cycle one and two [OR = 1.036; CI = 1.000-1.072], whereas the association between pandemic specific demands and intention to quit the profession did not significantly vary by survey cycle [OR = 0.975; CI = 0.940-1.012].

Conclusions

In view of the increasing number of people in need of care and the already existing scarcity of specialized nursing staff, the results highlight the need for initiatives to ensure the provision of long-term care, also and especially in such times of crisis.

Key messages

The intention to quit the profession among German managers of long-term care facilities has significantly increased during the SARS-CoV-2-pandemic. During the SARS-CoV-2-pandemic the perceived general demands as well as those directly related to the pandemic have increased significantly.
Wearing masks in public spaces in Poland during SARS-Cov-2 epidemic: an observational study
Authors: Ganczak M , Michalska J , Pasek O , Sikora A
Published: October 2021

Background

Face masks can all be effective means of controlling SARS-CoV-2 transmission. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020.

Objective

To assess use of masks in public spaces in Poland during the third wave of SARS-Cov-2 epidemic.

Methods

A non-participatory covert observational study was conducted during the 3rd wave, on three dates (20.03/27.03/03.04.2021) at public spaces in 12 provinces with different SARS-Cov-2 infection risks according to the R number. Ten consecutive individuals were observed by each of 91 medical students, using a structured checklist.

Results

Among 3283 observed individuals, the female/male ratios were 1.1/1.1/0.9 on the three dates. Around three quarters were using masks: 76.2% (858/1126) on date 1, 76.3% (867/1137) on date 2; and 79.7% (813/1020) on date 3. Medical masks predominated on all dates (52.4%-50.5%-55.8%), followed by cloth (34.6%-37.6%-33.0%). Location in a closed space (OR = 3.47-2.64-2.84) was associated with higher usage. Participants in sports were about two-three times less likely to use masks (OR = 0.52-0.58-0.34) as compared to other activities. The proportion using masks correctly was as follows: 62.6% (537/858); 63.1% (547/867); 57.7% (469/813) respectively; significant between-gender difference was observed regarding date 1 (date 1: 306/458, 66.8% females vs 231/400, 57.8% males; p = 0.006, date 2: 284/459, 61.9% females vs 263/408, 64.5% males; p = 0.43, and date 3: 232/408, 56.9% females vs 237/405, 58.5% males; p = 0.63). Uncovered noses (55.5%-59.5%) and masks around the neck (18.1%-24.7%) were the most frequent incorrect practices.

Conclusions

The results show an essential difference between governmental regulations and how the general public responds to the SARS-Cov-2 pandemic in the context of mask usage. Medical masks were predominantly used in public spaces, however, almost every third individual wore masks incorrectly.

Key messages

Knowledge translation with the use of adequate communication channels, would be helpful to increase compliance and correct usage. This message can be used to target specific practices when developing public health campaigns which should be then rigorously evaluated for their effectiveness.
Diet and physical activity during the first COVID-19 lockdown in France (March-May 2020)
Authors: Deschasaux-Tanguy M , Druesne-Pecollo N , Esseddik Y , Szabo de Edelenyi F , Charreire H , Oppert JM , Hercberg S , Touvier M
Published: October 2021

Background

To counter the spread of COVID-19 and avoid overwhelmed health-care systems and numerous deaths, strict lockdown measures were adopted by many countries, causing an unprecedented disruption of daily life. Our objective was to explore the changes in dietary intakes, physical activity, body weight, and food supply occurring during the first lockdown in France (March-May 2020), in light of individual characteristics.

Methods

37,252 adults from the French web-based NutriNet-Santé cohort completed lockdown-specific questionnaires. Nutrition-related changes and their sociodemographic and lifestyle correlates were investigated using multi-adjusted logistic regressions. Clusters of participants were defined combining multiple correspondence analyses and an ascending hierarchical classification.

Results

During the lockdown, trends of unfavorable changes were observed: decreased physical activity (53% of the participants), increased sedentary time (63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (40%) and increased physical activity (19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals:1.8kg (SD:1.3) and 23% lost weight (2kg (SD:1.4)). All of these trends displayed associations with sociodemographic and lifestyle characteristics.

Conclusions

These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions, and differed according to individual characteristics.

Key messages

COVID-19-related lockdown in France led to nutritional changes in both unfavorable and favorable directions, linked to sociodemographic and lifestyle inequalities. Unfavorable changes should be considered to inform future lockdown decisions and monitored to prevent a future increase in the nutrition-related burden of disease.