bluuebunny/crossref_metadata_2025_split huggingface dataset:
To what extent can remote treatment address geographic barriers to psychotherapy?
Authors: Samuel H 
Published: October 2023

Abstract

Background
The COVID-19 pandemic led to a surge in remote psychotherapy, suggesting it might also be a good way to overcome distance barriers to treatment post-pandemic. This study examined patterns of receiving psychotherapy before and after the COVID-19 outbreak, as well as patients’ perceptions of remote care. We conducted an internet survey of 400 Israelis who received psychotherapy in 2020 and 10 in-depth interviews with patients.

Results
57% of patients from Israel's geographic periphery reported receiving remote treatment, compared to 30% of patients from central Israel (p &lt; 0.01). Among those who began treatment before the onset of the pandemic, 76% reported receiving remote treatment or combined remote and face-to-face treatment after the pandemic's outbreak. In contrast, only half of those who began treatment after the onset of the pandemic received remote treatment. The interviews indicated that it is harder to start treatment and establish a therapeutic alliance with the therapist remotely than to continue therapy that had started face-to-face. Patients who experienced remote therapy were more likely than others to rate it as effective as face-to-face therapy in terms of its ability to achieve treatment goals (44% vs. 20%), to foster dialogue on sensitive issues (48% vs. 34%) and to create a therapeutic relationship with the therapist (41% vs. 25%). Additionally, they were less likely to identify interpersonal communication difficulties as a drawback of remote therapy (55% vs. 78%) and more likely to be willing to continue using it post-pandemic (25% vs. 5%), (all p &lt; 0.01).

Conclusions
The findings suggest that for some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy. However, most patients still prefer face-to-face therapy. Offering remote treatment after establishing a therapeutic connection via face-to-face treatment will probably be more popular among consumers than strictly remote care.

Key messages
• For some patients, remote psychotherapy can be an effective way to address geographic barriers to psychotherapy, especially when a therapeutic alliance has already been established.
• Most patients prefer face-to-face therapy. However, patients who experienced remote care were more likely to rate it as effective as face-to-face therapy and to continue using it after the pandemic.
Healthcare for Asylum Seekers and Refugees; A Scoping Review
Authors: Middleton M , Coyle R , O'Donovan D 
Published: October 2023

Abstract

The number of asylum seekers and refugees entering the UK is increasing. There is a strong body of evidence considering the health needs and barriers that this group experience. There is far less evidence on the best models for the organisation, delivery and provision of health services for these populations. This scoping review synthesised the published evidence and evaluations on how health care services for asylum seekers and refugees are organised and delivered across the UK. Electronic databases were searched in June 2022 to identify relevant peer reviewed literature from 2002 onwards. Mental and physical health services for adults and children were included. To source grey literature, requests for relevant service evaluations were made through the UK Health Security Agency, the Office for Health Improvement and Disparities Migrant Health Network and the websites of relevant organisations were searched. Six semi structured interviews were carried out with public health practitioners and clinicians working with asylum seekers and refugees. Twenty-one articles were included in the scoping review. Nine (42.8%) were focused on services in London. Seven (33.3%) articles were service evaluations. The majority were descriptive analyses, surveys or reports. Only seven (33.3%) of articles included service users’ views. A thematic analysis grouped the articles and interviews into six themes; accessibility, link worker, training, integrated pathways, GP registration and time. There is a paucity of evidence relating to the delivery and effectiveness of services for asylum seekers and refugees in the UK. The key themes identified were consistent over the 20-year search period. Recommendations for services include routine evaluation of services with dissemination of findings and patient and public involvement. Given the increasing numbers and health needs of this group, the economic evaluation of health care services is essential.

Key messages
• There is a paucity of evidence on healthcare delivery for asylum seekers and refugees.
• Key themes for services are accessibility, link worker, training, integrated pathways, GP registration and time.
The experience of racism against migrants in healthcare in Europe: a scoping review
Authors: Pattillo M , Stieglitz S , Angoumis K , Gottlieb N 
Published: October 2023

Abstract

Background
Racial discrimination is frequently mentioned as a social determinant of migrants’ health. However, in the European context, racial discrimination and its impact on migrants’ access to healthcare is under-researched. This scoping review makes a first step toward filling this void by mapping the literature on racism against migrants in healthcare in Europe and identifying evidence gaps.

Methods
Following PRISMA guidelines, four databases were searched for empirical, peer-reviewed studies on manifestations, experiences, or impacts of racism against migrants in healthcare settings in European countries, published in English between 1992 and 2022. Out of 2365 articles screened, 43 were included in the data extraction. A quality assessment and narrative synthesis were performed.

Results
Our synthesis of the extant evidence identifies three interrelated ways in which racism manifests in and impacts migrants’ healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. However, our analysis demonstrates that for many country and healthcare contexts, research on racism in healthcare is lacking. Most studies apply an explorative qualitative research design, while the comparability and generalizability of research results are low. Furthermore, there is a near-exclusive research focus on racism at the interpersonal level, with little data on institutional and structural levels.

Conclusions
The review pinpoints limitations and lacunae in the current body of knowledge; namely a lack of evidence for many country and healthcare contexts, a dearth of generalizable results, and a near-exclusive focus on racism on the interpersonal level as compared to structural levels. At the same time, its findings underscore how racism reinforces inequities in healthcare and health outcomes. It thus highlights the need for systematic research on racism in healthcare in Europe.

Key messages
• Racism against migrants in healthcare reinforces health inequities through anti-migration bias, health(care)-related prejudice, and differential medical treatment.
• Research on racism in healthcare in European countries is scarce; especially systematic and generalizable evidence and evidence on racism on structural levels is lacking.
“Economic migrants will anyway be deported soon”. Negotiating access and deservingness of refugees
Authors: Ziegler S , Bozorgmehr K 
Published: October 2023

Abstract

Background
Conflicting rationales permeate the European discourse on refugee migration: inclusiveness and human rights clash with xenophobia and aims to protect territory and wealth. Against this backdrop, health care access for newly arrived refugees in many European countries is restricted. The legal frame in Germany allows for extended restrictions as well as inclusive health care. While vague legal formulations create uncertainties regarding entitlements, they allow for discretionary decisions by a plethora of health care and government actors.

Methods
An ethnographic field study in two German refugee outpatient clinics including participant observation and interviews with 29 members of health care, administrative, social work and interpreting staff was conducted. By means of a qualitative content analysis we explored prioritisation criteria and negotiations about service provision to refugees by street-level decision-makers.

Results
Medical decision makers adopted government criteria to increase the chances of success of requests for reimbursement. We could identify various non-medical criteria, like asylum status and logistics impacting on access to care. Political and societal discourses seeped into discussions on granting or denying medical services: Medical and government decision-makers reflected on prospects of staying associated with the countries of origin of asylum seekers and illegitimate motives for flight, such as poverty, while negotiating what services should be provided to whom.

Conclusions
The vagueness of legal concepts allows for the implementation of restrictions based on non-medical grounds in practice, that would contradict international conventions if included in the legal norm unambiguously. In the face of contradictory imperatives, the state has chosen to leave policymaking to practitioners. They are in danger of being instrumentalized as agents of migration control, exclusion and deterrence, which raises practical and ethical questions.

Key messages
• Legal uncertainty leads to inconsistent medical care practices, that can exacerbate health inequities.
• Health professionals have to be made aware of their responsibility as gate keepers to the medical system for refugees, so they cannot be politically instrumentalized as agents of migration control.
Drug use among non-binary people in Europe: findings from European Web Survey on Drugs
Authors: Vale Pires Cristiana , Montanary Linda , Matias João 
Published: October 2023

Abstract

Traditionally, the survey-based methods used in drug research and drug monitoring at national and European levels tend to be blind to the specific experiences of non-binary people who use drugs. The invisibility of gender-diverse people is related to the use of standard one-step methods in the sex/gender demographic question, specifically the use of binary and mutually exclusive categories (male/ female or M/F). This presentation is based on the quantitative analysis of a sample of 817 non-binary people (non-probabilistic sample) who responded to the European Web Survey on Drugs 2021 (EWSD 2021), promoted by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). In specific, this presentation describes the sociodemographic profile, living conditions, drug use patterns (lifetime prevalence, last year's prevalence, last month's prevalence), and the context of drug use of non-binary people who responded to EWSD. The relationship between the non-binary gender identity and other categorical variables was analysed by using descriptive statistics and the Chi-square test for independence on the software IBM SPSS Statistics. This analysis allowed a preliminary identification of the specific drug use trends and health and social needs of non-binary people who use drugs, which will also be briefly included in this presentation. Moreover, this was the first time EMCDDA used a two-step approach method to collect data regarding sex (M/F) and gender (Man, Woman, Non-binary). In this sense, relevant methodological considerations regarding gender inclusiveness in survey data collection will also be presented, highlighting the relevance of systematically collecting gender-inclusive data to monitor gender-specific drug use patterns and trends and to inform the design of gender-responsive policies and social and health responses to drug problems.

Key messages
• Non-binary people who use drugs present gender-based specificities in drug use patterns.
• It is relevant to systematically collect gender inclusive data to monitor gender-specific drug use patterns and trends.
An international and interdisciplinary Delphi study to measure digital public health system maturity
Authors: Maass L , Zeeb H , Rothgang H 
Published: October 2023

Abstract

Background
The Covid-19 pandemic showed how crucial digital public health (DiPH) interventions are for continuous treatment and system sustainability. Several studies highlighted how the digital system transformation might improve access to and quality of healthcare services. However, there is no consensus on how to best assess the national readiness for the digitalization of such systems. Therefore, this Delphi study aimed to collect indicators to measure the maturity of DiPH systems nationally.

Methods
The three-stage international and interdisciplinary Delphi study included 82 experts. During the first round, participants proposed indicators to measure maturity among the technological and legal requirements of DiPH tools, the willingness of the general public to use them, and the degree of application of DiPH tools to the national healthcare system. The suggestions were qualitatively assessed and presented for ranking on a 4-point Likert scale during the second round. Experts were also able to rephrase or add indicators. In the third round, experts could only rank indicators.

Results
Finally, 96 indicators to measure the maturity of DiPH systems were finally. Of these, 31 fall under the legal and 24 under the technological requirements. 26 assess the social level and 15 the degree of application. All dimensions can be clustered into 3-4 sub-groups each. The qualitative analysis highlighted the importance of data protection regulations, affordable smartphone and internet access, interoperability between interventions, financial incentives, user motivation and literacy, and whether interventions were implemented as local pilots or national services.

Conclusions
The study identified indicators for interdisciplinary assessing DiPH system maturity. While this Delphi can’t answer how best to integrate these indicators into national health system evaluation procedures, this approach is an essential first step towards an index to measure the maturity of DiPH systems.

Key messages
• When assessing the digital public health system's maturity, one needs to include legal, technological, and social influencing aspects and not only evaluate the health services implementation degree.
• International and interdisciplinary Delphi study panels are vital for finding consensus on indicators to create tools of international importance and usability to measure health system maturity.
Contested and Evolving Pandemic – A Follow-up Study on National Policymakers’ Interpretations
Authors: Paananen H , Janhonen K , Kihlström L , Satokangas M , Tynkkynen L-K 
Published: October 2023

Abstract

Background
The prolongation of the COVID-19 pandemic has shown that perceptions of the crisis change over time. In this follow-up study we explore how national level policymakers interpret COVID-19 pandemic as a past, present, and future event and crisis. By doing so the contested nature of pandemic governance reveals, i.e. that the interpretations of the on-going crisis shape the policy choices and health system response. National policymakers have been demanded to make sense of emergent and ambiguous events and to form public health actions accordingly. Different interpretations on pandemic have been in core of pandemic governance and have influenced public policy and pandemic responses.

Methods
We applied a qualitative follow-up research design. Study informants were identified by purposive sampling by their position as central government pandemic policymakers in Finland. The semi-structured interviews were collected in 2021 (n = 21) after the first two pandemic waves, and in winter 2022-2023 (n = 16) after full vaccinations of the population.

Results
Three interpretations of COVID-19 were identified: Underlining the hard work needed to overcome the crisis, pandemic as a past event was framed through undeniable success. As an ongoing crisis, pandemic was discussed as having become mundane and less important on the public health agenda. As future crisis the pandemic was merged into a continuum of other (non-public health related) crises instead of being reflected solely from health perspectives.

Conclusions
The way of interpreting a crisis has significant influence on public policy. Prolonged pandemic showed contested nature of public health crisis in general public policy agenda; and its’ ending was not represented as clear cut, as it dissolved and was entwined into other crises and agendas. Crisis interpretations effect on future, since they profoundly affect how crises responses, future pandemic preparedness, policies or evaluation of effects are framed and formed.

Key messages
• Conceptions on COVID-19 crisis evolve in time and they effect policies to be formed.
• Contested nature of pandemic draws attention from solely public health policies into continuum of crises on public policy agenda.
Shifting towards a Well-being Economy in Wales for a fairer, sustainable and healthier society
Authors: Stielke A , Ashton K , Dyakova M 
Published: October 2023

Abstract

Wales, and other nations globally, face long-standing challenges such as climate change and on-going impacts of the pandemic. This has increased persisting health inequities, widening the health gap and putting health and social systems and other public services under even more pressure. Economic models that prioritise growth and profit over well-being of societies and the planet underpin these developments, this is unsustainable and threatens human, economic and planetary well-being. New political imperatives are emerging across Wales that foster new collaborations and innovative, sustainable and inclusive solutions that shift towards a Well-being Economy, creating shared and co-created well-being for current and future generations. Health is key component to create a Well-being Economy in Wales and is a driver and beneficiary. Public Health Wales’ work has been focused around the social determinants of health taking a holistic approach enabling cross-sector responsibility for health to shift to a Well-being Economy. Wales has created an enabling legislative environment with the (i) Well-being of Future Generations (Wales) underpinning all public body decisions, (ii) created a strong Foundational Economy and (iii) established a Future Generations Commissioner that encourages public bodies to take greater account of the long-term impact of their decisions. Metrics were implemented that go being Gross Domestic Produce (GDP) and monitor well-being outcomes in all sectors decisions. Welsh culture and language has been vital to create a sense of belonging and community cohesion building trust and healing social fractures. Shifting towards a Well-being Economy in Wales takes a whole of systems approach, working across sectors at all levels. A variety of mechanisms such as legislations, metrics, accountability measures and participation takes the approach forward. Public health appears to be a driver, co-creator and beneficiary in the approach.

Key messages
• Re-envisioning the economy in Wales towards a Well-being Economy is crucial to improve health and well-being and tackle inequalities.
• Wales’ Well-being Economy approach has created a national cultural change at all levels that focuses on co-created well-being for all.
Comparison of the Choices criteria with national logo criteria in Sweden and Singapore
Authors: Tognon G , Lee C , Chan W K , Ingman A , Wasserman M , Hunsberger M , Lissner L , Middelham J , Roodenburg AJC , Smorenburg H 
Published: October 2023

Abstract

Background
Food-based dietary guidelines often do not consider processed food products and typically do not address the rising popularity of plant-based meat and dairy alternatives or non-nutritive sweeteners. Multi-level nutrient profiling systems, such as the Choices 5-level criteria, can surmount these limitations and support nutrition policies, including the development and enhancement of national front-of-pack labeling systems. Nevertheless, new criteria for plant-based meat and dairy alternatives, as well as for foods containing non-nutritive sweeteners, must be established.

Methods
This study investigates the comparison of the Choices criteria with the Keyhole logo used in Sweden and the Healthier Choice Symbol employed in Singapore and proposes adaptations to align with food-based dietary guidelines. Additionally, scoping literature reviews on the health effects of non-nutritive sweeteners and international policies guiding their use were conducted. Alignment was evaluated by determining whether foods categorized as healthy by Choices (i.e., classified as level 1 or 2) were also eligible for a national logo in Sweden and Singapore.

Results
The results demonstrated that Choices can serve as a foundation for national endorsement of logo criteria. Qualifying criteria for plant-based meat and dairy alternatives, as well as for non-nutritive sweeteners, were also developed.

Conclusions
The Choices 5-level criteria can support stimulating and restrictive nutrition policies and facilitate a desirable transition to a healthier, more plant-based diet.

Key messages
• Food-based dietary guidelines often do not consider processed food products and typically do not address the rising popularity of plant-based meat and dairy alternatives or non-nutritive sweeteners.
• The Choices 5-level criteria can support stimulating and restrictive nutrition policies and facilitate a desirable transition to a healthier, more plant-based diet.
An equity lens on COVID-19 transmission policies in Catalonia, Spain: a PROGRESS-PLUS analysis
Authors: Gutiérrez-Zamora Navarro M 
Published: October 2023

Abstract

COVID-19 pandemic has affected all individuals, but especially vulnerable populations. In Spain, Catalonia has been the most affected region by the infection, with higher incidence rates among foreigners, certain occupations, and neighborhoods. Interventions addressing differential vulnerability to infection are crucial in addressing the impact of social factors on pandemics. I aimed to describe the presence of social factors in the formulation of policies to address COVID-19 transmission in Catalonia, Spain. For this, a descriptive policy analysis on the frequency of the presence of social factors was carried out using the PROGRESS-PLUS framework, from the Campbell and Cochrane Equity Methods Group. It represents 8 dimensions of inequalities: Place of residence, Race, Occupation, Gender/sex, Religion, Education and Socioeconomic status. ‘Plus’ refers to other dimensions that may imply inequality. For the production of results, 29 policies were analyzed. Only policies formulated between the two states of alarm and the de-escalation phase were included (March 14, 2020-May 9, 2021). Of these, 72.4% (n = 21) mention at least one component of the framework. ‘Age’ was the most mentioned component 37.9% (n = 11); followed by ‘Occupation’ (27.6%, n = 8); ‘Place of residence’ (10.3%, n = 3). ‘Gender’ and ‘Income’ were mentioned once (3.4%). ‘Educational level’ and ‘Race’ were not mentioned in any policy. For ‘Plus’ component, 18 policies (62.1%) mention some dimension of vulnerability, such as disability, mental disorders, immigration, deficient housing conditions or ‘vulnerable groups’ but without specifying who these groups are. To conclude, it is necessary to increase the relevance of health equity when formulating policies to face future pandemics. It is needed to establish protocols that consider inequality in pandemics, in conjunction with investing in public health and healthcare. Further research on this issue is also relevant to draw lessons learned for future pandemics.

Key messages
• Despite the mention of axes of inequality in most of the policies studied, it is necessary to increase the priority of health equity in its formulation, especially for future pandemics.
• Since inequality is a structural issue, protocols should be implemented before health emergencies occur in order to increase their effectiveness in terms of equity and health outcomes.