bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discrimination against migrants: does social capital moderate harmful effects on mental health?
Authors: Biddle L , Stacherl B , Heidinger E 
Published: October 2024

Abstract

The harmful mental health effects of perceived discrimination are well established. Yet, the role of regional-level social capital in mitigating these effects remains underexplored. Using data from the German Socioeconomic Panel (SOEP; 2010-2021) we apply random effects models to assess the effect of perceived discrimination on mental health (mcs subscale of the SF-12) adjusting for individual socio-demographic factors and regional-level socioeconomic deprivation. We assess interaction with general social capital (civic organisations, electoral turnout, generalised trust) and migrant-specific resources (proportion of non-nationals and share of far-right votes). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to assess for bias introduced by selective mobility into regions. In the non-refugee sample, we confirm negative effects of frequent discrimination experiences on mcs (ß: -3.74; 95%CI: -4.39, -3.08). Moderation analyses show insignificant results for general social capital, but a negative interaction effect of proportion of non-nationals (ß: -0.71; 95%CI: -1.34, -0.08). Analyses among refugees confirm the negative effect of discrimination on mcs (ß: -6.29; 95%CI: -7.49, -5.08) and the moderating effect of the proportion of non-nationals (ß: -1.63; 95%CI: -2.78, -0.48), as well as showing a positive moderation effect for generalised trust (ß: 0.84; 95%CI: 0.11-1.57). Results demonstrate the negative implications of living in areas with a high proportion of non-nationals for migrants experiencing discrimination, which may be explained by the higher marginalisation of migrants in these areas and increased service access barriers. The absence of a moderation effect of general social capital appears to be the result of selection bias, with positive effects of generalised trust seen for refugee migrants.

Key messages
• Ethnic discrimination affects mental health of refugee and non-refugee migrants.
• The effect of discrimination on mental health are stronger in areas with higher proportion of non-nationals.
Awareness and knowledge about Female Genital Schistosomiasis among European healthcare workers
Authors: Marchese V , Remkes A , Kislaya I , Rausche P , Brito A , Hey J , Rasamoelina T , Rakotoarivelo R , May J , Fusco D 
Published: October 2024

Abstract

Background
Female Genital Schistosomiasis (FGS) is a gynaecological manifestation of persistent infection with Schistosoma haematobium, which can lead to severe consequences, such as miscarriage and infertility. It is estimated to affect 56 million women globally, mostly in sub-Saharan Africa (SSA). Most migrants in Europe are female, often from SSA and therefore at risk of FGS, hence healthcare workers (HCWs) knowledge of FGS is essential for the provision of adequate care. This study aims to assess awareness and knowledge of FGS among European HCWs to inform strategies to improve the management of migrant health.

Methods
In June 2023 - January 2024 we conducted a cross-sectional online survey targeting medical doctors (MDs), nurses and midwives (NMs) working in fields of infectiology, gynaecology, urology, family, travel, internal or occupational medicine. The prevalence of FGS awareness and knowledge was estimated, Poisson regression was used to identify factors associated with MDs’ awareness of FGS.

Results
Among 922 surveyed HCWs, 43.7% (CI95%: 39.6-47.9) of MDs and 12.0% (CI95%: 8.8-16.0) NMs have heard about FGS. FGS awareness among MDs was associated with work in clinics for migrants (prevalence ratio (PR)=1.33, CI95%: 1.10-1.59) and specialization, being lower for gynaecology (PR = 0.67; CI95%:0.51-0.88), and family medicine (PR = 0.42, CI95%:0.30-0.59). Among MDs, 7.1% (CI95%: 5.1- 9.5) had medium knowledge, while 25.3% (CI95%: 21.8-29.0) had low, and 67.6% (CI95%: 63.7-71.4) no knowledge on symptoms, complications or diagnostic tools for FGS. FGS knowledge was mostly acquired through academic curricula (34.7%), scientific literature (28.4%) and conferences (25.6%).

Conclusions
The study shows limited awareness of FGS among European MDs and NMs, and highlights that European HCWs may not be adequately prepared to deal with diseases that are gaining relevance on the European continent due to the global connectivity and the dynamic nature of our societies.

Key messages
• In Europe, the health specialities that are the first point of patient access to the health system show a low level of awareness and knowledge of Female Genital Schistosomiasis.
• Rising knowledge of FGS among European HCWs through academic curricula and continuous medical education is important to ensure adequate diagnosis and management of disease in migrant populations.
Reflecting (on) power?Critical reflections by healthworkers in Germany on racial power and privilege
Authors: Tezcan-Güntekin H , Papadopoulou S , Stüwe E , Meshkova K , Merz S 
Published: October 2024

Abstract

Background
Healthcare users have increasingly reported on experiences of racial discrimination in healthcare encounters in Germany (Aikins et al. 2020). While research on the experiences of racialised users predominates, examining the perspectives of white professionals, especially those holding positions of authority, regarding their internalised stereotypes and discriminatory practices is also crucial. This study therefore investigated the prevalence of conscious or unconscious biases related to critical whiteness and anti-racism among healthcare workers (doctors, nurses and therapists) and how these attitudes shaped their professional practice.

Methods
Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002).

Results
Respondents exhibited varying degrees of reflective abilities, and there are limited opportunities for structured self-reflection focused on recognizing and addressing racism. The research interview constituted a much-needed space for such reflection. Those who are sensitised about their own positions of privilege often are so due to external influences and personal trajectories (teenaged children, trade union activism) rather than through the values or structures of their institutions. Unconscious racism nonetheless still manifests, demonstrating the need to create more inclusive environments where critical self-reflection on racism is encouraged.

Conclusions
To effectively combat racism, German healthcare institutions must systematically implement anti-racist and intersectional interventions. This also entails creating spaces for reflection where staff can openly examine and acknowledge their own biases, fostering an environment conducive to collective action for promoting anti-racist workplace practices.

Key messages
• Opportunities for self-reflection critical of racism should also be offered across institutions in order to ensure trusting, non-hierarchical spaces.
• Reflections on one’s own social positioning and privileges are not common in all circles, so the necessity of this attitude should be communicated in an error-friendly manner.
Productivity loss due to acute COVID-19 and post COVID-19 condition in the Northern Netherlands
Authors: Monteiro Sanchez G , van Ooijen R , Rosmalen JGM , Fens T , van Asselt T , Brouwer S , van Zon SKR 
Published: October 2024

Abstract

Introduction
The COVID-19 pandemic caused significant socioeconomic and health shocks worldwide. Yet, research is still scarce on how acute COVID-19 and post COVID-19 condition (PCC) have impacted workers productivity in terms of absenteeism, presenteeism and reduced unpaid work. This study examines the effect of acute COVID-19 and PCC on Dutch workers’ loss of work productivity in standardized hourly costs compared to those with neither disease.

Methods
This study included data from 31 waves (March 2020 - October 2022) of the Lifelines COVID-19 cohort, a populational cohort from the Netherlands. Productivity was measured in 7 waves in terms of absenteeism, presenteeism, and loss of unpaid work using the Medical Technology Assessment Productivity Costs Questionnaire. We selected workers aged 18 to 64 in the first wave (n = 10,950). Using administrative data, average hourly costs of productivity were calculated as 38.67€ for absenteeism and presenteeism and 15.94€ for unpaid work. The friction cost method was used. To compare group differences, a Kruskal-Wallis rank sum test with Holms-Bonferroni p-value adjustment was performed.

Results
In total, 33.4% of participants had acute COVID-19, 5.7% had PCC, and 60.9% had neither disease. The mean total combined productivity loss per person of those with PCC was 7,118€, compared to 3,410€ for those with acute COVID-19, and 3,076€ for those with neither. When comparing groups, significant differences in costs were found for all aspects of productivity, except for unpaid work loss between acute COVID-19 and those with neither disease.

Discussion
Although the number of people with acute COVID-19 represents a large societal cost in terms of accumulated loss, those with PCC incurred on average twice as much productivity losses per person across all domains. This study highlights the high costs associated with PCC, which continues to chronically burden workers. Policies should be aimed at lessening this burden.

Key messages
• Post COVID-19 condition is associated with significantly higher average productivity costs per person than acute COVID-19, which highlights the individual burden of this chronic disease.
• Acute COVID-19, despite relatively lower average productivity costs, represents a large societal cost in terms of accumulated loss.
The Norwegian Counties Public Health Survey (NCPHS)
Authors: Aarø L E , Nilsen T S , Knapstad M , Skogen J C , Nes R B , Vedaa Ø , Klepp K I 
Published: October 2024

Abstract

Effective public health initiatives should be based upon a thorough understanding of important health-related factors. The purpose of The Norwegian Counties Public Health Survey (NCPHS) is to gain insights from the adult population on topics relevant for planning of public health policy, interventions, and action at the county and municipality levels. The survey includes a core questionnaire on public health-related topics such as health behaviour, subjective quality of life, distress, subjective health, social support, social capital, community contexts, and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register. NCPHS was piloted in three counties in 2015 and in one county in 2018. After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400 000. Expedient data analysis and reporting has enabled the Norwegian Institute of Public Health to present comprehensive reports within six weeks after completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment, and assessment of household economy. Tables are also made available at the municipality level. The NCPHS represent a valuable addition to existing health registries and regional health surveys, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions, and for evaluation of policies and interventions. The value of such a system during times of crises was demonstrated during the COVID-19 pandemic. At the Lisbon 2024 European Public Health conference, a few selected examples of use of data from the NCPHS system will be presented.

Key messages
• Large-scale community surveys provide important insights for planning of public health policies and action.
• Strong involvement and collaboration with regional and local public health personnell as well as with media and local people is a prerequisite for succeeding.
Monitoring the level of health and inequality over time using the Population Health Performance Index
Authors: Grün A , Bozorgmehr K , Nowak A 
Published: October 2024

Abstract

Background
The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality.

Methods
Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion.

Results
PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments.

Conclusions
The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities.

Key messages
• PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time.
• The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.
Individual level risk factors associated with episodes of heat as recorded within primary care records: a time-stratified case-cross over study
Authors: Thompson R , Kovats S , Hajat S , O’Connell E 
Published: October 2024

Abstract

Background
A key recommended action outlined in Heat-Health Action Plans is to identify individuals at risk and deploy targeted interventions, however this is not routinely undertaken. A major contributing factor is a lack of understanding of individual-level risk factors to support an evidence-based approach to targeted prevention.

Aim
To use electronic health data to identify individual level characteristics associated with increased risk of mortality during heatwaves in England.

Methods
A time-stratified case-crossover analysis was undertaken of individual-level clinical and socio-environmental (SE) risk factors. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days, with analysis stratified by potential risk modifying factors.

Results
Heat mortality risk was modified by a large range of chronic conditions, with cardio-respiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. Prescribed medications also increased odds of death during heatwaves. Heat mortality risk was modified by a range of SE determinants of health investigated, with ORs increasing with age; OR differences by sex, ethnicity and living arrangement; an increasing trend in ORs by alcohol intake and body mass index, excluding the obese-3 group. Results suggest the least deprived have the lowest OR and the most deprived have the highest.

Conclusions
This study has important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies. The results also provide important evidence on the role of disadvantage in driving the inequitable distribution of climate impacts, and the need for better socio-economic data sets linked to health records. The findings highlight the importance of incorporating an assessment of individual SE circumstances when prioritising patients at highest risk during heat events.
Dispensing of antibiotics in community pharmacies before, during, and after the COVID-19 pandemic
Authors: Pinto H , Pessoa V 
Published: October 2024

Abstract

Background
Antibiotic resistance threatens our capability to successfully treat bacteriological infections, becoming a major threat to public health. Therefore, measures must be taken to minimize de incidence of multi-drug resistant bacterial infections. Antimicrobial Stewardship is a systemic healthcare approach devised to foster, enhance, oversee, and assess the judicious application of antimicrobials, aiming to safeguard their efficacy in the future, whilst advocating and safeguarding public health. In the initial phase, a correct diagnosis of antimicrobial utilization is pivotal for the proper implementation of an Antimicrobial Stewardship Program.

Methods
A cross-sectional study encompassing the Alentejo region, Portugal, with a specific focus on central Alentejo, was conducted to analyze the dispensing of antimicrobials in community pharmacies, alongside the examination of the prescribing locations, before, during, and after the COVID-19 pandemic, from 2019 to 2023.

Results
The number of antibiotic packages dispensed decreased, as expected, during the COVID-19 pandemic, but returned to pre-pandemic levels after its conclusion. In several prescribing locations, the proportion of cephalosporins and quinolones exceeded the maximum expected value.

Conclusions
The implementation of an appropriate Antimicrobial Stewardship Program in this region is necessary to ensure the correct prescription of antimicrobials, decreasing the risk that antibiotic resistance pose to public health. Emphasis on the application of the Clinical Practice Guidelines issued by the Portuguese Directorate-General of Health regarding the proper approach to bacterial infections should be intensified so that all prescribing locations exhibit proportions of cephalosporins and quinolones below the maximum expected value.

Key messages
• Antimicrobial resistance poses a threat to public health.
• Stewardship is crucial for appropriately safeguarding public health by reducing antimicrobial resistance emergence.
Assessing contextual factors influencing scale-up: a interactive approach involving stakeholders
Authors: Carboni C , Lambert Y , Plessis L , Bardon T , Vreden S , Suarez-Mutis M , Sanna A , Douine M 
Published: October 2024

Abstract

Issue
Pilot interventions are not always put into practice at scale. When they are, effectiveness is often highly reduced in the field due to contextual factors. To effectively implement a scale-up, stakeholders’ involvement is crucial. Curema is an international research evaluating an intervention aiming to reduce malaria transmission by distributing RDTs and treatments in mobile hard-to-reach populations. This intervention might be scaled-up in Brazil, Suriname, and French Guiana as a tool of national malaria programs for specific areas and populations.

Description of the problem
An interactive pre-planning assessment was conducted involving key stakeholders -implementers, decision-makers, and researchers - in working sessions, semi-structured interviews, and formal meetings. Mendelow’s Power/Interest Matrix was used to map stakeholders and a SWOT analysis was conducted using ExpandNet/WHO Framework to evaluate contextual factors and identify levers and obstacles influencing the scale-up.

Results
A total of 23 participants were involved. Health authorities had high power and generally high interest, while implementers and recipients had lower power and different interest levels. National engagement for WHO E2025 or E2030 enhanced scalability and represented a main opportunity in the three countries. Nevertheless, several regulatory and administrative aspects were identified as potential obstacles to be addressed to make scale-up realistic. Funding was also a major concern for sustainability. The need for regional cooperation was emphasized to achieve malaria elimination.

Lessons
Despite financial and regulatory challenges, a window of opportunity is open to scale-up Curema. Identifying and involving stakeholders in a pre-planning assessment and advocating for foster regional cooperation are crucial steps to support the scale-up. Stakeholder analysis should be refined during the scaling-up to capture further changes in factors that might influence the process.

Key messages
• Engagements with WHO represent windows of opportunity to enhance Curema scale-up.
• Stakeholder involvement and regional cooperation are crucial for scaling up Curema in Brazil, French Guiana and Suriname.
The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action
Authors: Diedenhofen G , Baldini L , Menin G , Di Marco M 
Published: October 2024

Abstract

Background
The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action aims to advance health workforce planning across the EU, addressing the pressing need for a resilient, sustainable, and accessible health service systems. Given the evident strain on health systems demonstrated during the COVID-19 pandemic, this initiative seeks to address the critical need for strategic HWF planning. Building on previous projects, HEROES will foster the capacity of EU states in workforce planning, preparing the health systems to meet future challenges.

Methods
The study adopts a collaborative framework involving 19 EU countries, segmented into clusters based on health system characteristics. A stepwise approach (‘AS IS,’ ‘TO BE,’ ‘TO DO’) characterizes the methodology, incorporating extensive data collection, stakeholder engagement, and scenario forecasting. Country-level information on HWF Data and Planning will be compared both across countries in clusters and across clusters.

Results
Initial findings indicate significant disparities in health workforce data quality, availability, and planning methodologies among the states. Identified methodologies also involve real-world data applications and predictive analytics to refine health workforce planning. Efforts are underway to define an Advanced Minimum Dataset (AMDS) to synchronize health workforce data and define planning tools across the clusters, as country-level AS IS reports have been finalized and cross-country comparisons are ongoing.

Conclusions
Collaborative, data-driven health workforce planning can significantly enhance health system resilience and responsiveness. Recommended public health actions include enhancing HWF data integration, forecasting capabilities, and stakeholder participation, with the aim of shaping national health policies and practices. The public health impact is profound, as it allows to improve health service delivery and workforce adaptability in response to dynamic health demands.

Key messages
• The HEROES Joint Action advances EU health workforce planning, with the aim of enhancing the resilience and responsiveness of health systems.
• Strategic data-driven approaches in health workforce planning are pivotal for resilient, accessible and sustainable healthcare systems.