bluuebunny/crossref_metadata_2025_split huggingface dataset:
3.L. Round table: Vaccine Literacy and vaccination uptake for newly arrived migrants and people living in prisons
Authors:   Organised by: Infectious Diseases Control Section, Italian National Institute of Health, University of Pisa, Sapienza University of Rome (Italy),   Chair persons: Lara Tavoschi (Italy)
Published: October 2023

Abstract

Health systems are complex and health organisations are often structured and operate in ways that make access to vaccination services difficult and inequitable for some marginalized populations. In addition, professionals may not be equipped to identify and address the cultural and social needs of these groups of people. The concept of vaccine literacy (VL) emphasizes that VL is not simply knowledge of vaccines, but also development of a less complex health system for communicating and offering vaccines as a conditions of a functioning health system (Ratzan, 2011). Newly arrived migrants (NAM) and people living in prisons (PLP) are two populations with overall low vaccination rates compared to the general population. Efforts to change this situation must emphasize activities not only geared toward increasing individual vaccine literacy, but more importantly supporting the system to become more vaccine literate. The general aim of the “Access to Vaccination for Newly Arrived Migrants -AcToVax4NAM” project is to improve the responsiveness of health systems in terms of vaccination literacy, making the conditions for access to vaccinations more equitable and guaranteed. Similarly, the “Reaching the hard-to-reach: increasing access and vaccine uptake among the prison population in Europe -RISE-Vac” aims to improve the health of people living in prisons in Europe by promoting staff and prisoners’ VL, enhancing vaccine offer and increasing vaccine uptake. During the workshop, AcToVax4NAM and RISE-Vac will discuss strategies and tools developed within these two EU co-funded projects (3rd EU Health Programme) to address vaccine literacy at the organizational and individual level for the particular target groups.

Key messages
• Individual and organisational vaccine literacy are equally important to increase vaccine uptake and vaccination coverage among disadvantaged communities.
• Intersectoral and multidisciplinary approaches are needed to tackle inequalities in access to prevention services including vaccination services.
Vaccine Literacy and “whole-of-prison” approach to increase vaccine uptake and vaccine coverage in prison settings
Authors: De Vita E 
Published: October 2023

Abstract
Prison settings are complex when it comes to healthcare services. The remit of healthcare provision may be with Ministry of Health or Ministry of Justice or combination of the two. Prison staff is also composed of custodial staff, HCW working in prison and other professionals, including educators, psychologists, etc. Within prison population deprived communities are overrepresented, and individuals often have multiple and complex health needs. Yet, equivalence to care between community and prisons is upheld by UN and European Prison Rules. In order to increase VL in prison, interventions need to respond to the existing complexity, tackling individual as well as organisational levels. Within RISE-Vac, tools have been prepared to engage prison staff and prison population. Participatory approach were used to conceptualised and develop the materials. An overview of the material content and development process will be provided, with a focus on the package tailored to PLP and the engagement of people with lived experience of incarceration.
Identifying high-risk subgroups for self-harm in young people
Authors: McEvoy D , Brannigan R , Walsh C , Arensman E , Clarke M 
Published: October 2023

Abstract

Self-harm in adolescents and young adults (AYAs) is the result of a complex interaction of biological, psychiatric, psychological, social, and cultural risk factors. A lot of research has already been conducted to identify the risk factors for self-harm in AYAs. On the other hand, there has been less research conducted on the simultaneous effects of, and the interactions between, multiple risk factors for self-harm in heterogeneous AYA individuals. In this study, we conducted a latent class analysis (LCA) of three waves from the Growing Up in Ireland (GUI) longitudinal cohort study at ages 13, 17 and 20 to identify homogenous subgroups of AYA individuals who exhibit similar risk markers for self-harm at these three time points. Then, we evaluated the risk that these subgroups ever self-harmed by age 17, self-harmed at age 20, or were persistently self-harming across both time points. The most at-risk group appeared to be the individuals aged 17 who had been diagnosed with depression/anxiety. Compared to the low-risk-marker group, the ‘diagnosed with depression/anxiety’ group had a 30-fold risk of self-harm at age 17, and 32-fold risk of persistently self-harming by age 20. The ‘undiagnosed but high depression’ group at this time point was also at significant risk of self-harm. This research enables us to understand which risk markers tend to co-occur together and will help to identify high-risk groups for self-harm both clinically and in the community. An investigation of risk markers like this can potentially be used in the design of public health interventions to reduce the burden of self-harm, and indeed suicide, in young people.

Key messages
• We identified sub-groups of young people with a high-risk of self-harm and suicide from the general population.
• These identifiable sub-groups can inform intervention policies and strategies for prevention programmes both in clinical and non-clinical settings like schools.
Quantifying missed opportunities in health sector for women and girls victims of violence in Albania
Authors: Ylli A , Sant Fruchtman C , Revenga Becedas R , Wallenborn J , Qirjako G , Cobos Munoz D 
Published: October 2023

Abstract

Health facilities are important contact points for victims of violence against women and girls (VAWG) in need of care. In Albania relevant data about health sector utilization remain scarce. This is a first attempt aiming to quantify missed opportunities for survivors of VAWG at the health system. We used a sample of 151 victims of VAWG, residents of Tirana Capital, retrieved from the dataset of Counseling Line for Women and Girls, a non-governmental agency. All cases were victims of physical violence during 2018-2022. For each case in the sample, health records for the same period were traced in Tirana hospitals and primary health care (PHC) facilities medical registries. Hospital records were traced for all 151 cases, while PHC records were completed only for the cases with a national ID. No case of VAWG was formally registered or reported by health services in Tirana in the 5 years prior to survey. Nonetheless, 51.5% of survivors had used PHC services and 20.4% had used hospital services during the same period. 8.6% had been at the emergency service of Trauma Hospital with acute symptoms of physical body harm and 12.5% had received obstetric-gynecologic care. The average number of visits at PHC for the women using the services was 3.3, ranging from 1 to 15 visits during 5 years. The most common reasons for the visits at PHC were chronic conditions (28.7%), followed by infection diseases (22.%) and mental illness (16.5%). Health sector opportunities to provide specific treatment and support to victims of VAWG are missed at multiple levels in Albania. While piloting integrated health and social care at selected PHC facilities in the country provide a good momentum for responding to some of the unmet needs, a more comprehensive agenda for the health sector should address physician's failure to identify and deal with VAWG as a health problem.

Key messages
• Health sector opportunities to provide specific treatment and support to victims of violence against women and girls are missed at multiple levels in Albania.
• Interventions in the health sector should address physician's failure to identify and deal with violence against women and girls as a health problem.
Pressure, bullying and low social support predict depressive symptoms and self-directed violence
Authors: Stea T , Bonsaksen T , Smith P , Kleppang A L , Steigen A M , Leonhardt M , Lien L , Vettore M V 
Published: October 2023

Abstract

Background
More in-depth evidence about the complex relationships between risk and protective factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing pressure, bullying, and low social support on depressive symptoms and self-directed violence in adolescence.

Methods
A cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts.

Results
Poor family economy and low parental education predicted high pressure, bullying, low parental support and depressive symptoms in males and females. Further, high pressure predicted depressive symptoms among males and females, and self-harm and suicide thoughts among females, but not males. Bullying predicted depressive symptoms, self-harm, and suicide thoughts among males and females. Low parental support predicted bullying, depressive symptoms, self-harm and suicide thoughts among males and females, and high pressure among females, but not males. Low teacher support predicted high pressure, depressive symptoms, whereas low friends support predicted bullying, depressive symptoms and suicide thoughts among males and females, and self-harm among males, but not females. Results also showed that depressive symptoms predicted self-harm and suicide thoughts among males and females. Finally, pressure, bullying and depressive symptoms were the main mediators by which family economy, parental education, friends support, teacher support and parental support predicted self-harm and suicide thoughts.

Conclusions
Low socioeconomic status, pressure, bullying and low social support were important predictors of depressive symptoms and self-directed violence among Norwegian adolescents through direct and indirect mechanisms.

Key messages
• These results also provide increased knowledge about how multiple risk and protective factors across domains impact both depressive symptoms, self-harm and suicide thoughts among adolescents.
• This study highlights the importance of policies aiming at reducing economic and social inequalities, as they may also improve youth mental health.
Risk factors for domestic violence during the COVID-19 pandemic-a multi-country longitudinal survey
Authors: Palantza C , Witteveen A B , Patanè M , Pinucci I , Sijbrandij M 
Published: October 2023

Abstract

Background
A pressing public health issue exacerbated by the COVID-19 pandemic is domestic violence. The lockdowns harshened its major risk factors, such as financial strain, substance use, low social support, and also confined victims with their abusers. Cross-sectional studies confirm most of these associations, but longitudinal evidence is lacking. We investigate the association of domestic violence victimisation with these factors across the stages of the pandemic internationally and the characteristics linked with first vicitmisation in the pandemic.

Methods
We used four waves of an online survey of the adult general population of 14 countries in five continents in May 2020-May 2022 (N = 6051). Partner and child abuse were assessed with single items, sociodemographics and COVID-19 related data with Likert-type items, substance use and social support with validated scales. The Oxford Lockdown Stringency Index was used. Differences by onset of violence were tested with chi-squared, ANOVA and Kruskal-Wallis tests, and the associations with mixed effects logistic regression.

Results
Results are preliminary. Survivors with onset of violence before and during the pandemic were quite similar and differed from those not victimised in financial strain and social support. Social support (OR .83 CI .76-.91), employment status, especially unemployed (OR 5.24 CI 1.98-13.87), and polysubstance abuse (OR 2.22 CI 1.25-3.95) significantly predicted violence across time controlled for demographics. Lockdown stringency had no significant effect (OR 1.0 CI .98-1.01).

Conclusions
The findings are in line with the literature and clarify that the most robust financial strain proxy across time is unemployment. Pre-existing demographic, economic and health-related vulnerabilities remain impactful across countries and individuals, so screening by healthcare providers for victimisation should be targeted and policies should focus on maintaining financial stability, particularly in the long run.

Key messages
• The socio-economic repercussions of the COVID-19 pandemic are more impactful than confinement on the long-term risk of domestic violence internationally.
• Cases of domestic violence with onset during the pandemic show similar socio-economic vulnerabilities as those with onset before.
Factors associated with discrimination in GPs’ decisions towards migrants with mental health problems
Authors: Duveau C , Wets C , Delaruelle K , Demoulin S , Dauvrin M , Lepièce B , Ceuterick M , De Maesschalck S , Bracke P , Lorant V 
Published: October 2023

Abstract

Background
Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of individual (e.g. age and ethnicity), interpersonal (e.g. provider trust), and organizational (e.g. perceived workload) factors on general practitioners’ (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with a MB and for a depressed patient without a MB.

Methods
An experimental study was carried out in which GPs were shown one of two video-vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797) had to decide on their diagnosis, treatment, and referral. ANOVA and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables.

Results
Overall, we found that there were ethnic differences in GPs’ decisions regarding diagnosis and treatment recommendations (F = 3.56, p &lt; 0.001). GPs also considered the symptoms of the patient with a MB less severe (F = 7.68, p &lt; 0.01) and were less likely to prescribe a combination of medical and non-medical treatment to patients with a MB (F = 11.55, p &lt; 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was malingering or exaggerating his distress.

Conclusions
This paper showed that GPs’ trust in their patients and GPs’ workload affect ethnic bias in medical decisions. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs’ trust in their migrant patients.

Key messages
• This research provides an insight into the discriminatory decisions made by GPs in mental healthcare.
• Future research should take interpersonal and organizational factors into account when developing new interventions to improve quality of care for migrants with mental health problems.
Reproducing differential racialisation: social triage in migrant mental health services in England
Authors: Mladovsky P 
Published: October 2023

Abstract

In England, coverage for treatment of post-traumatic stress disorder (PTSD), a health condition that disproportionately affects forced migrants, is universal, in principle provided free of charge to all. Yet, multiple informal access barriers typically arise and informal systems of social triage may emerge. Using intersectional analysis, this study asks what political and moral rationalities inform social triage in the NHS. It is particularly attentive to how and why a supposedly universal service reproduces differential racialisation, in which multiple and co-existing populations are stratified and ranked as more or less belonging to a nation. Fieldwork was conducted in two waves, in 2015-2016 and in 2019-2021. It included six months of participant observation in an NGO; 21 semi-structured interviews with health professionals across 16 different NHS and NGO service providers, purposively sampled until saturation was reached; six interviews with mental health commissioners and national policymakers; and analysis of grey literature. Transcripts and fieldnotes were analysed inductively to identify themes using NvivoR1. Results were validated by interviewees. Despite being covered, undocumented migrants and asylum seekers were systematically excluded from NHS PTSD services, through social triage. People with refugee status were prioritised. Mental health care providers consciously and subconsciously reproduced differential racialisation, which generated health inequality. This was facilitated by: austerity; omitting immigration status in measurement of health inequality; securitisation of mental health services and minoritised Muslim populations; and bifurcated activism in which the forced migrant sector was disconnected from established struggles to combat racism in mental health care. Policies extending coverage to undocumented migrants and asylum seekers must be accompanied by extra monitoring, as well as financial, political and social support to service providers.

Key messages
• Health professionals informally, but systematically, reproduce differential racialisation in the rationing of health care through practices such as obfuscation and silencing critique.
• Informal systems of social triage erode universal health coverage. This is exacerbated in contexts of austerity, where health professionals use their discretion to ration limited resources.
Mortality gradient by education: differences between natives and immigrants in Italian Census cohort
Authors: Ventura M , Leone S , Di Napoli A , Petrelli A , Pappagallo M , Grande E , Frova L 
Published: October 2023

Abstract

Background
A socioeconomic mortality gradient, favourable to the most advantaged social groups, has been documented in both high migratory pressure (HMPCs) and highly developed Countries, including Italy. However, little is known on how this association differs between natives and immigrants. This study aimed at comparing the mortality gradient by education among these population groups, evaluating differences for macro-area of origin or citizenship.

Methods
Using a longitudinal design, the 2011 Census population was followed up to 2019. All-cause mortality was retrieved by record linkage with the Causes of Death register. The association of education (as the main exposure) and social class (based on the Erikson and Goldthorpe classification) with mortality was evaluated in subject aged 30-64, separately by sex, citizenship/macro-area of origin. Mortality rate ratios (MRR) and 95% confidence intervals were estimated using negative binomial regression models, adjusted for age and area of residence.

Results
23,572,516 subjects (7% immigrants from HMPCs) and 410,746 deaths (3% from HMPCs) were analysed. Among natives, a mortality gradient by education was observed (low/high MRR: 2.37[2.16-2.60] males; 1.79[1.64-1.96] females), whereas a weaker association without trend was found for HMPCs immigrants (MRR: 1.12 [1.00-1.25] males; 1.12[1.00-1.26] females). A higher mortality for less educated was observed for males from Romania, India, China, and for females from Central-Eastern Europe, Sub-Saharan Africa and Central and South America. A lower mortality was found for the least educated from Morocco.

Conclusions
The higher mortality among less educated subjects is confirmed among natives, while it is less evident in immigrants from HMPCs. However, differences observed between citizenships, macro-areas of origin, and sex, highlight the need for social policies accounting for specific risk factors and cultural specificities affecting correct lifestyles and health services access.

Key messages
• A mortality gradient by education was found among natives in Italy, whereas a weaker association without trend was observed for immigrants from high migratory pressure Countries.
• The differences observed between citizenships or macro-areas of origin, and sex, highlight the need for social and health policies culturally oriented to specific target population.
Regulatory approaches to front-of-pack nutrition labelling
Authors: Gokani N 
Published: October 2023

Abstract
Even though nutrition labelling has been regulated by the EU since the 1990s, the tactics of industry, with the support of a minority of Member States, have prevented effective measures on front-of-pack nutrition labelling (FoPNL). In its Farm to Fork Strategy, the European Commission committed to introduce legislative proposals for harmonised front-of-pack nutrition labelling by the end of 2022. The deadline has passed and no indications appear of matters moving forward. This is even more concerning for public health as the current regulatory framework prohibits interpretive FoPNL, fails to guide Member States towards well-designed schemes, and prohibits schemes becoming mandatory.