bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coping with stress due to gender prejudice in Chilean transgender people: New findings using a qualitative approach
Authors: Barrientos J 
Published: October 2023

Abstract

Background
Like other nations, in Chile, transgender people confront high levels of prejudice operating across structural, interpersonal, and individual levels. The Minority Stress Model indicates that prejudice-related stress is related to worse health indicators. Coping has been used to understand how people deal with this prejudice-derived stress. This study describes and characterizes how gender ‘prejudice is managed and coped with among transgender people in Chile.

Methods
We used a snowball sample to recruit 26 transgender Chileans. The inclusion criteria were to be Chileans or lived in Chile last 6 months, identify as transgender and be 18 years old. We used a semi-structured interview guide with open-ended questions to capture the subjective self-designation of gender identification. Interviews lasted approximately 75 minutes. We used thematic and critical discourse analyses to identify themes and subthemes.

Results
The results indicate that all participants experienced prejudice at different times and varied intensities. Prejudice occurs at home, where parents dońt accept this identity, & at school in the form of bullying. Prejudices were also suffered in health centers & hospitals, where doctors exercised prejudice. Prejudice also depended on the period of the transition process. Prejudice was most intense at the beginning of the transition process & decreased as transition progressed. The results showed that trans-identifying persons used the following coping strategies: self-concealment, performing their gender (e.g., more feminine appearance), & advocacy for their rights & education. Each strategy is used in varied situations & by how one defined oneself.

Conclusions
Coping strategies & the concept of coping must be revisited among trans-identifying persons. The coping strategies used are relevant for planning clinical and social interventions aimed at trans people who still live in prejudice due to their identity in many countries.
Application of the Syndemic Theory and Analysis of Synergy
Authors: Küçükali H 
Published: October 2023

Abstract
Syndemic Theory is a relatively new theory developed first within the field of medical anthropology and later adopted by social epidemiology and public health. The term “syndemic” stands for “synergistic epidemics” where two or more health (related) problems (1) co-occur and (2) synergistically interact with each other (3) within a specific socioenvironmental context which itself also interact with the health problems. These deleterious interactions result in an increased health burden. The first example in the literature was the SAVA syndemic (Substance Abuse, Violence, AIDS) identified among the urban poor. More recent studies applied the theory to the COVID-19 pandemic and the global system of Obesity-Undernutrition-Climate Change. The theory also suggests that a syndemic requires different prevention strategies than it would do if those problems were independent of each other. This theory aligns with the systems approach that we employ in the SPACE project and it has a great potential to provide actionable insights. SPACE contributes back to the theory not only by testing it on less studied cognitive and environmental health domains but also linking it with the systems approaches. This presentation provides a worked example of the application of syndemic theory to investigate air pollution, physical inactivity and cognitive decline. We will explain the use of a variety of methods to analyse synergistic interactions while recognizing the central role of the social and environmental contexts.
How important is evaluator's alignment for the reliability of assessment procedure for recognizing the good practice?
Authors: Rados Krnel S , Lesnik T , Vinko M 
Published: October 2023

Abstract
Implementing evidence-based interventions that are proven to be successful and effective in improving individual, community, and population health is widely recognized as the best approach to addressing public health challenges. To avoid the development and implementation of less effective or successful or even harmful practices, clear criteria for the assessment of practices that are considering different dimensions of the interventions in public health, are needed. Registers of programs and interventions in the field of prevention and health promotion play an important role here, provided that appropriate evaluation/assessment criteria are used for the selection of practices presented on the portals. Nevertheless, the challenge of choosing the “right” approach and criteria in assessing the health promotion and disease prevention interventions still remain. The development of the system for the assessment of health promotion and disease prevention interventions consists of several steps, from defining the criteria, development of evaluation methodology, selection of evaluators, piloting the assessment procedure and finally to regular use of the entire system/portal. An often-overlooked, but important step is how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions. In this workshop we will present how we used statistical tools to assess the consistency between the evaluators and thereby gaining insight into the reliability of the criteria as a measuring instrument for the assessment of the interventions as well as to check how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions.
Does physical activity mediate the association of health literacy with cognition in older adults?
Authors: Meier C , Wieczorek M , Maurer J 
Published: October 2023

Abstract

Background
Health literacy (HL), defined as the ability to find, understand, and use health-related information and services, is positively associated with global cognitive functioning and healthy behaviours. Also, current evidence suggests that physical activity may prevent or delay cognitive decline and dementia. This study explores the mediating role of physical activity in the relationship between HL and cognition in a representative sample of older adults aged 58+ living in Switzerland.

Methods
We used data from 1,603 respondents to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe (SHARE) in Switzerland. HL was assessed using the HLS-EU-Q16 questionnaire. Mild cognitive impairment (MCI) was defined as 1.5-standard deviation below the mean of the age- and education-specific global cognition score. Physical activity was self-reported based on a question on the frequency of engagement in activities requiring a moderate level of energy. The associations between these three variables were assessed using separate probit regression models, controlling for social, health, and regional characteristics. A causal mediation analysis with parametric regression models was used to test the mediation hypothesis.

Results
Preliminary results showed that lower levels of HL were associated with a lower likelihood of being engaged in physical activity (p &lt; 0.05) and with a higher likelihood of having MCI (p &lt; 0.05). In addition, being engaged in physical activity was associated with a lower probability of having MCI (p &lt; 0.01). Causal mediation analysis indicated that 30% of the association between low HL and MCI was mediated by physical activity.

Conclusions
Given the mediating role of physical activity in the relationship between low HL and MCI, improving HL in older adults may foster engagement in physical activity, which could act as a protective factor in MCI.

Key messages
• Improving health literacy may have the potential to foster engagement in physical activity and may contribute to the prevention of mild cognitive impairment.
• Healthy aging programs should not only promote physical activity as a preventive measure to reduce or delay cognitive decline but focus on strengthening individuals’ health literacy skills.
Can a volunteer-based befriending service reduce loneliness and social isolation and improve mental health in older people? A quasi-experimental effectiveness study of existing non-governmental befriending services in Denmark
Authors: Friis Bo A , Lasgaard M , Christiansen J 
Published: October 2023

Abstract
Befriending services are a widespread intervention that is mainly implemented in community and residential settings to counter social disconnectedness in older adults. The services involves a structured relationship (e.g. weekly visits and agreed upon in-house or out-of-house activities) between a befriender, who is most often a volunteer, and a befriendee, who lack social connections or experience loneliness. Social and humanitarian non-governmental organisations are the primary provider of these services, playing a vital role in supporting and connecting older adults worldwide. Previous research on befriending services has been limited by non-controlled study designs, small sample sizes, high attrition rates, and poor measurement. Additionally, befriendees often face vulnerabilities related to their physical and mental health, which pose significant barriers for research in this field. These limitations highlight that befriending services remain poorly understood, particularly regarding their effectiveness in improving social connections and reducing loneliness. This presentation provides a brief overview of current knowledge on befriending services for older adults, leading to the introduction of an ongoing nationwide effectiveness study of the befriending services provided by two Danish social and humanitarian non-governmental organisations. The quasi-experimental, pragmatic study design will be thoroughly introduced, discussing opportunities and challenges when evaluating large-scale volunteer-driven interventions in a real-world setting. This will involve reflecting on critical methodological decisions, such as the study design, selection of outcome measures, and implementation of procedural steps to minimize attrition.
Willingness to Pay for Universal Health Coverage among the General Population in Armenia
Authors: Aslanyan L , Sahakyan S , Muradyan D , Khachadourian V , Petrosyan V 
Published: October 2023

Abstract

Background
In Armenia, as in many low and middle-income countries, a large segment of the population is still required to make high out-of-pocket payments to obtain essential services at the secondary or tertiary levels of healthcare. Countries are showing growing interest to provide financial protection to their citizens via a universal health coverage system. We assessed the willingness to pay for universal health coverage (UHC) among the general population of Armenia, and the factors that influence their willingness to pay.

Methods
We administered a national telephone survey (random digit dialing), among the adult population (18-65 years old) of Armenia. Multivariable logistic regression was applied to analyze the data.

Results
The total number of survey participants was 787 with a 67% response rate. The mean age of the study participants was 41, and 55% of them were women. The majority of participants (60%) were employed. Around 45% of participants had an average monthly expenditure below AMD 200,000 (about USD 510) and more than one-third (36%) of participants had an average monthly income below AMD 200,000. The majority (72%) of participants were willing to pay 2%−6% of their monthly income to obtain UHC. Multivariable logistic regression analysis showed that one year increase in participants’ age was associated with a small decrease in willingness to pay (OR = 0.97, CI = 0.96; 0.99). Participants with an average monthly expenditure of more than AMD 200,000 (about USD 510) were about 3.4 times more likely to pay 2%−6% of their monthly income than those with an average monthly expenditure of less than AMD 200,000 (OR = 3.44, CI = 1.63; 7.30).

Conclusions
UHC could be a viable solution for improved healthcare access; however, socioeconomic factors influence public readiness to pay for it. To successfully implement a UHC system, governments need to design progressive premium contributions providing more subsidies to lower socioeconomic groups of their populations.

Key messages
• Socioeconomic factors of a population can impact their willingness to pay for a universal health coverage system.
• Governments must tailor premium contribution to UHC systems to the socioeconomic composition of their populations and implement progressive contribution approaches.
Action for Health and Equity, Addressing medical Deserts (AHEAD)
Authors: Hinlopen C 
Published: October 2023

Abstract
The Project AHEAD (Action for Health and Equity, Addressing medical Deserts) aims to support policy makers in their health workforce reforms targeting medical deserts: ‘the end point of a complex ‘medical desertification’ process, that implies continuous and increasing inability of a given population to access health services in a timely and contextually relevant manner’. The AHEAD project is carried out in Italy, Moldova, the Netherlands, Romania and Serbia, highlighting different manifestations of medical deserts.
AHEAD features two unique selling points: a medical deserts diagnostic tool (MDDT) and a consensus building methodology.
1. The MDDT intends to support policy makers in identifying and monitoring medical deserts (and areas at risk), by visualising health worker and health services densities, at disaggregated level, on interactive maps. Evaluation findings indicate great interest for this tool among policy makers, as well as challenges in data availability.
2. The Consensus Building (CB) Methodology brings together a broad group of stakeholders playing a role in, or affected by, medical desertification. During a series of interactive workshops, they jointly explore causes and effects of medical desertification, exchange experiences, and develop feasible and context-specific policy solutions. These policy solutions are subsequently discussed during national policy dialogues, where commitments are made by the various actors and duty bearers to implement them. Evaluation findings acknowledge the added value of this participatory, multi-stakeholder approach.
Because the policy options are context-specific, policy dialogues yielded a wide variety of policy solutions. However, several common themes emerged relating to the variety of actors needed at the tables, the importance of their different and complementary mandates, and the need to address related power dynamics.
Sustaining treatment of vulnerable people: assessing needs for integrated care in mental health
Authors: Mejsner S B , Aslaug J , Burau V , Mark D , Fehsenfeld M 
Published: October 2023

Abstract

Background
About half the population in Denmark will experience mental health challenges during their lives. Among them a group of vulnerable people often experiences higher unmet needs and lack of coherence between sectors. They therefore require cross-sectoral initiatives. The Flexible Assertive Community Treatment (FACT) model offers integrated healthcare access to people with severe mental illness, through interprofessional teams across health and social services. The model is implemented in Central Denmark Region between the specialist (regional) and the (municipal) community mental health services. This study aimed to explore the pathways through the healthcare system of citizens with severe mental illness, and to analyze the abilities of provider organizations to meet the needs of the target group.

Methods
The study draws on interviews and observations with participants of FACT that suffer from severe mental illness, interviews with the health and social care professionals involved, and observations of interactions between the two groups of informants.

Results
The participants of FACT experienced smoother pathways between the regional and municipal sectors and more integrated access to services, as they had only one gateway instead of several. They further experienced closer relations with and between the professionals in the FACT teams (e.g., psychiatrists, community and social workers, nurses). These professionals to a larger extent understood and pursued the participants’ individual needs. This created for example higher levels of trust and contributed to the sustainment of the participants in treatment.

Conclusions
People with severe mental illness struggle to cope with many different aspects of life, including navigating the health system and sustaining treatment. To retain this vulnerable group in treatment it is key that health systems provide continuous and integrated treatment that meets individual needs.

Key messages
• The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness.
• The current study finds that FACT provides valuable tools to offer integrated and person-centered care for people suffering from severe mental illness.
10.F. Workshop: Projecting future burden of disease for informed public health decision making
Authors:   Organised by: COST Action CA18218–European Burden of Disease Network, EUPHA-FS, EUPHA-PHMR,   Chair persons: Brecht Devleesschauwer (Belgium), Henk Hilderink (EUPHA-FS)
Published: October 2023

Abstract

What are the most relevant diseases in a country? As the need for prioritising the use of available resources constantly increases, a timely, sound and comprehensive answer to this question is more than ever needed to inform public health decision making. The burden of disease metrics such as the Disability-adjusted Life Years (DALY) are important indicators for health information. The DALY provides a comprehensive indicator of the health gap in a country, addressing both premature mortality and health loss due to the occurrence of diseases. The European Burden of Disease Network (COST Action CA18218) acts as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. The Action places a key focus on identifying and addressing data challenges, methodological choices and the need for translating research into policy. Where many Burden of disease (BoD) studies aim at producing the best estimates for the recent years, some countries are also making future projections of DALYs. By doing so, BoD studies become even more relevant for the policy making process since the do not cover only current best estimates, but also show what policy makers might be anticipating on. There are different methods to make future projections, varying from trend extrapolations and forecasts to developing scenarios as part of and advanced foresight approach. Future projections of the DALY estimates bring along additional data requirements. To be able to calculate future DALYs, projections of prevalence and causes of death, but also of population demographics, are needed. In addition, methodological choices have to be made to calculate future DALYs, for example regarding life tables. In this workshop, all these aspects will be addressed. Several countries (i.e. The Netherlands, Belgium, Scotland and Norway) will present their approaches to estimate future DALYs. The workshop will start with and interactive Mentimeter session to get a better view on how the audience is familiar with (future) Burden of Disease. Then, a brief presentation is given as introduction to the European Burden of Disease Network. This is followed by the four presentations of future DALYs. The workshop will be concluded by a discussion with the presenters on the lessons learned regarding their experience of doing future projections.

Key messages
• Burden of disease becomes even more relevant for policy makers when projections are included in the Burden of Disease study.
• Data and methodological issues should be properly addressed to better inform policy makers.
Navigating end-stage dementia: Between the quality of life and life expectancy, A qualitative study
Authors: Halevi Hochwald I , Yakov G , Radomyslsky Z , Nissanholtz-Gannot R 
Published: October 2023

Abstract

Background
Caring for people with end-stage dementia living in the community and restricted to their homes is mainly done by home care units (HCU). Another uncommon program, in Israel, is implemented by the home hospice unit (HHU), specializing in palliative end-of-life care (EOLC). The aim of this study is to characterize ethical aspects, conflicts and dilemmas raised by staff and family caregivers, caring for people with end-stage dementia.

Methods
Qualitative research, using 65 semi-structured interviews (25 staff members and 40 family caregivers), was analyzed through a thematic content analysis approach.

Results
Dilemmas regarding palliative care were the main theme, including the definition of the disease as terminal, choosing ‘comfort’ over ‘life-prolonging’, clarifying patients’ wishes, and deciding whether to use artificial feeding. Substantial differences were found between those two settings of care, the main one being the difficulty to predict life expectancy which creates a gap in the caregivers’ expectations, approaches, and goals for EOLC, as well as for making choices and voicing preferences regarding ‘comfort’ and ‘life extension’.

Conclusions
This study shows the importance of developing ethical, felicitous cultural codes for professional staff caring for people with end-stage dementia and their irreplaceable, significant family caregivers. The findings can enable us to develop ethical codes for conducting quality care and practicing equality and mutual help for people with end-stage dementia living at home.

Key messages
• This study emphasizes the need for ethical codes and cultural sensitivities to provide quality care and support to people with end-stage dementia and their families under home care.
• Personalized approaches, training, and support are essential to handle the ethical dilemmas and conflicts that arise during palliative care for people with end-stage dementia living at home.