bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of COVID-19 on persons with concurrent mental health and substance use disorders
Authors: Leonhardt M , Lien L 
Published: October 2022

Abstract

Background
The COVID-19 pandemic with its restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for persons with mental health (MHD) and substance use disorders (SUD), who are particularly vulnerable to social exclusion. In this project, we aim to explore the impact of the pandemic on persons MHD/SUD, nearer, how the lockdown effected their daily life and further, the utilization of health care services under the consecutive waves of the pandemic.

Methods
The project has two parts: First we conducted 17 individual interviews and one focus group with persons with MHD/SUD, using thematic analysis. Second, we merged the Norwegian Patient Register, the Register for Infectious Diseases and data from Statistics Norway. We matched data of 41500 individuals with MHD/SUD after gender, age and health region with a sample from the general population as a control group and study the health care service utilization under the consecutive waves of the pandemic in Norway in 2020-2021.

Results
Within the qualitative study, we identified four interrelated main themes: (1) The COVID-19 outbreak as a perceived challenge, (2) A decline in mental health and well-being, (3) Increased substance use challenges, and (4) Diverse experiences with health and social services. The results show further that people with MHD/SUD have challenges with digital tools and/or do not have the appropriate equipment. Persons with MHD/SUD face greater barriers in accessing the health care system compared to the general population as a control group. Results of the register study are still preliminary.

Conclusions
Persons with MHD/SUD face major challenges during the COVID-19 pandemic There is reason to believe that new pandemics will emerge in the future. In this context, it is essential to gain knowledge of how to care for vulnerable groups in society and how to reach them in emergencies.

Key messages
• Continuous maintenance of low-threshold services for persons with MHD/SUD during a pandemic is essential.
• Improvement of digital skills of service users or alternatives to digital consultations should be considered.
Uptake and impact of COVID-19 preventive measures amongst migrant populations in the Netherlands
Authors: Torensma M , Harting J , Boateng L , Agyemang C , Lassooy-Tekle Y , Jacob Y , van den Muijsenbergh M , el Fakiri F , Prins M , Stronks K 
Published: October 2022

Abstract

Uptake of preventive measures to reduce transmission of viruses such as SARS-CoV-2, is crucial in the control of pandemics. To ensure equitable uptake we explored contextual factors that shaped uptake of COVID-19 preventive measures amongst smaller, albeit substantial, migrant populations in the Netherlands. 39 persons of Eritrean, Ghanaian, Indonesian and Filipino origin, with diverse legal status and length of stay in the Netherlands, participated in five online focus group discussions. Thematic analysis of data was informed by concepts from the Precaution Adoption Process Model and Protection Motivation Theory. Awareness and knowledge of preventive measures was shaped by limited Dutch proficiency, access to understandable information and interference of misinformation. Engagement by preventive measures was subject to COVID-19 threat appraisal and the ease with which complex behavioural messages could be translated to individual situations. Perceived vulnerability of undocumented migrants in particular, motivated information-seeking. A strong social norm to keep with cultural and religious practices, and limited opportunity for preventive behaviour in work and home context hindered uptake of preventive behaviour. Preventive measures brought about job, food, and housing insecurity, and increased barriers in access to healthcare for undocumented migrants. Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures. Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants. Our results suggest importance of multilingual information tailored to literacy needs; education and modelling of behaviour; and, regulations to ensure continued access to financial and material resources to minimise negative spill-over effects. Results were incorporated in two policy briefs advising local and national government. Collaboration with municipal health services lead to multilingual public health information.

Key messages
• Migration-related, sociocultural, and socioeconomic factors shape uptake of preventive measures.
• Preventive measures negatively impact work, housing and access to healthcare of undocumented migrants.
COVID-19 vaccination intent and associated factors in healthcare workers: cross-sectional study
Authors: Zhelyazkova A , Kim S , Klein M , Prueckner S , Horster S , Kressirer P , Choukér A , Coenen M , Adorjan K 
Published: October 2022

Abstract

Background
Considering the vaccine hesitancy recorded among healthcare workers (HCW) during the 2009/10 influenza pandemic, we aimed to examine the COVID-19 vaccination intent of HCW at one of the largest hospitals in Germany and to identify associated factors.

Methods
We conducted a cross-sectional anonymous survey at LMU University Hospital in Munich, Germany, between February 25 and March 20, 2021. Data was collected on COVID-19 vaccination intent as main outcome and on potential associated factors.

Results
In total, 2555 HCW completed the survey; 48,3% (n = 1325) of them had already received at least one COVID-19 vaccine dose. Of those not yet vaccinated 51,7% (n = 1320), 83,6% (n = 1104) reported intention to get vaccinated, while 10,2% (n = 134) were undecided and further 6,2% (n = 82) reported refusal. Disagreeing that everyone should receive the generally recommended vaccines was associated with refusal (RR = 529,500, p = 0,000) while being vaccinated against influenza in the 2020/21 season was linked with lower likelihood of refusal or indecisiveness (RR = 0,124, p = 0,000; RR = 0,182, p = 0,000). Low or partial conviction of the effectiveness and safety of COVID-19 vaccines were linked to refusal (effectiveness; RR = 485,471, p = 0,000; RR = 9,247, p = 0,000; safety: RR = 116,829, p = 0,000; RR = 5,423, p = 0,025). Feeling ill informed about COVID-19 vaccines was associated with refusal and indecisiveness (RR = 25,900, p = 0,000; RR = 21,104, p = 0,000).

Conclusions
At the beginning of the vaccination campaign in Germany, a small proportion of HCW at LMU University hospital was hesitant on receiving a COVID-19 vaccine. Factors associated with refusal or indecisiveness were a sceptical attitude towards vaccines in general as well as feeling ill informed about COVID-19 vaccines, especially regarding their effectiveness and safety. Having received an influenza vaccine was associated with COVID-19 vaccination intent.

Key messages
• The presented results provide insight into the reasons for hesitancy of HCW against COVID-19 vaccines, indicating a pattern-like behaviour in the acceptance of novel vaccines by HCW.
• The evidence from our analysis can help inform the communication aims and emphases of vaccination campaigns among HCW within similar organizational contexts or in future outbreak scenarios.
Non-COVID activity in French emergency department during COVID-19 pandemic (March 2020 to March 2022)
Authors: Fouillet A , Forgeot C , Pontais I , Pedrono G , Caserio-Schönemann C 
Published: October 2022

Abstract

Background
The COVID-19 epidemic and mitigation actions had major impacts on health and healthcare use by the French population. Since 2004, the French public health agency daily collects individual data of visits in the emergency departments (ED) OSCOUR® network (94% of national visits in 2022). We aimed to analyse the evolution of non-Covid ED visits from 2020 to March 2022, in order to identify potential indirect impact of the epidemic.

Methods
The main medical diagnosis (MD) coded in ICD-10 from each ED visit from 2017 to March 2022 was classified into 17 ICD-10 chapters and in 95 disjoint subgroups of pathologies. The observed numbers of ED visits by age group and by chapters/subgroups were compared to expected numbers, estimated using an overdispersed Poisson regression model based on 2017-2019 data.

Results
The observed numbers of ED visits for all chapters and for a large part of subgroups were significantly lower than the expected numbers during the three lockdowns in all age groups and progressively returned to the expected level in 2021. A change in the pattern of a limited list of subgroups was observed: ED visits for purpura, chronic blood diseases and neurologic disorders in children decreased during the first lockdown and remained under the expected level until March 2022. Inversely the number of ED visits for mental health and wheezing in children, for pulmonary embolism in adults and for neoplams in the elderly increased and remained over the expected values until 2022.

Conclusions
Syndromic ED system was a pillar of the French reactive surveillance of direct and indirect impacts of COVID-19 epidemic. The changes observed for different subgroups of pathologies may reflect a negative impact of the epidemic, a positive effect of protective measures on the spread of other infectious diseases, a modification in the organization or in the use of health care in specific domains. Further studies using hospitalization data could explore these hypotheses.

Key messages
• Existing syndromic surveillance system implemented before the emergence of SARS-COV2 enabled to monitor non-Covid-19 visits to emergency departments and assess changes in patterns of pathologies.
• An increase in the number of emergency department visits during the COVID-19 epidemic was observed for mental health in children, for pulmonary embolism in adults and for neoplams in the elderly.
Bulgarian population – before COVID-19 and now
Authors: Tsanova D , Valentinova Ts , Vitkova Ts , Statev K , Mineva-Dimitrova El , Seizov A 
Published: October 2022

Abstract

Background
The demographic picture in Bulgaria became worse and worse since the democratic changes at the end of the 20th century. Our country was at one of the first positions according to the level of death rate and the rate of population decline. The study aims to analyse the effect of the COVID-19 pandemic on the main demographic indicators in Bulgaria.

Methods
Data from Bulgarian National Statistical Institute were used to analyse population growth and life expectancy and to calculate the death rate, birth rate, infant mortality rate, and the share of people over 65 years of age for 2019 in comparison with 2021.

Results
In 2019 before the onset of COVID-19, the Bulgarian population consists of 6 951 481 people. In 2021 it declines to 6 838 937 people. The decrease in birth rate is not very significant - from 8.9‰ /2019/ to 8.5‰ /2021/. The analysis provides estimates of excess deaths observed during the peak of the COVID-19 outbreak in Bulgaria. The death rate is very much increased - from 15.5‰ to 21.7‰. The increase affects the female and male populations equally - from 19.6‰ for men in 2019 to 23.2‰ in 2021 and from 16.4‰ for women to 20.2‰. The life expectancy shows a certain decrease - from 74.8 years /2019/ to 74.64 /2021/. Correspondingly, life expectancy was reduced for females- by 78.34 - 78.22 and for males by 71.37 - 71.11 years. The level of infant mortality is not changed - 5.6‰. People over 65 years are 21.6% of the total population during the compared period.

Conclusions
The Bulgarian population is very strongly affected by COVID - 19 pandemic. The COVID-19 pandemic has caused a significant number of deaths worldwide but Bulgaria ranks first in the world in terms of mortality rates. Life expectancy decline reflects the impact of temporary epidemic mortality. The impact on children from the pandemic is not very significant for the country. Society should be making major and cost-effective efforts to reduce mortality.

Key messages
• The sharp change in demographic realities has significant effects on the country’s economy.
• The deterioration of natural growth exacerbates the need to increase labour productivity in areas with the fastest declining populations.
Lessons from the epidemiological investigation efforts during the COVID-19 epidemic in Israel
Authors: Inchi L , Bord S , Madjar B 
Published: October 2022

Abstract

Background
The COVID-19 pandemic caused a crisis in the Israeli healthcare system. The wave-like morbidity created an overload of epidemiological investigations, which led to delays and less than successful efforts to prevent infection. For this reason, Israel decided to mobilize the military for this purpose, creating a forced cooperation between the Ministry of Health (MOH) and the IDF, an expert in dealing with crises.

Aim
To examine the implications of the forced encounter between the IDF and the healthcare system, including both tensions and cooperation efforts.

Methods
Twenty in-depth interviews were carried out with MOH and IDF personnel in different roles at various levels towards the end of the second pandemic wave in Israel.

Findings
The findings present a dual picture of cooperation and mutual respect, side by side with contradictions and conflicts. The feeling that the IDF came in to ‘save the day’ placed the healthcare people in an inferior position. Clearly, there was no explicit plan for division of authority. It was clear to the healthcare staff that they have the authority as the professionals, and to the IDF people that they have it as the ‘saviors’ brought in for this purpose. The healthcare people did see the potential of the military force mobilized for this purpose, but felt they were asked for their opinion only initially, when the military personnel had to study the system. As soon as they became familiar with it, they were no longer asked for advice, and control was given to the IDF. The findings also show that the MOH’s qualitative professional approach often clashed with the IDF’s action-based approach.

Conclusions
The military was mobilized as a crisis expert in order to assist the healthcare system in managing said crisis, but in fact this assistance had many side effects. Managing expectations, division of authority and open, sharing communication may have been useful in preventing the conflicts and managing them.

Key messages
• It is important to be aware of the a-symmetrical power relations of the military-healthcare system interface in order to create effective work and true, coherent cooperation.
• Management of expectations, organized division of authority and open, sharing communication may have assisted in preventing the conflicts raised and managing them.
Vaccine Literacy, Covid-19 and influenza: a cross-sectional survey in Prato in the 2nd pandemic wave
Authors: Bruschi M , Stacchini L , Stancanelli E , Velpini B , Lastrucci V , Puggelli F , Berti R , Lorini C , Bonaccorsi G 
Published: October 2022

Abstract

Covid-19 is a pandemic and an infodemic, with contrasting information regarding risk and preventive measures, including vaccination. This study aims to assess Vaccine Literacy (VL) of a sample of workers in the province of Prato (Tuscany, Italy) in the second wave of the Covid-19 pandemic (November-December 2020) and to analyze the relationship between VL and attitudes about Covid-19 and flu vaccination. A cross-sectional design was adopted. Sociodemographic characteristics, health information, vaccination behaviour for past and current flu season and intention to get vaccinated against Covid-19 were collected. A multivariate logistic regression was performed to identify predictors of getting a Covid-19/flu vaccination. The Italian Health Literacy tool on Vaccination (HLVa-IT) tool was used to measure VL. A total of 117 questionnaires were analyzed. Among them, 64.9% intended to get Covid-19 vaccine. The mean VL was 3.18 ± 0.43 (functional 2.87 ± 0.72; interactive-critical 3.36 ± 0.45) out of 4. Having more than one comorbidity was a negative predictor of intention to get Covid-19 vaccine (OR: 0.21 95%CI: 0.04 - 0.91). Regarding the flu vaccine, being vaccinated in the previous season was the only positive predictor of being vaccinated in the current season (OR = 24.25 95%CI 7.96 - 87.73). The study was conducted before the authorization of Covid-19 vaccines: little information about them may have contributed to VL not being related to the intention to get vaccination. The negative role of comorbidities could be due to fear of adverse effects on fragile health status. For flu vaccination, VL may have exerted a lower impact because of the positive experience with the flu vaccine in terms of safety and effectiveness in the previous seasons.

Key messages
• The introduction of new vaccines should be supported by effective communication.
• Better knowledge of current vaccines and not just routine administration is desirable for greater personal empowerment.
Training the Armed Forces personnel in COVID-19 contact tracing: a Portuguese case study
Authors: Carmezim Pereira S , Bicho A , Guerra I , Borges M , Vieira BS , Loyens D , Barcelos F , Carreira M , Calé E 
Published: October 2022

Abstract

Background
Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts’ workers.

Objectives
The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support.

Results
More than 200 personnel - sailors, soldiers and airmen - were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees.

Conclusions
This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities.

Key messages
• Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example.
• A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats.
Where are the children of working parents during school closures?
Authors: Mairhofer S , Plagg B , Flarer H 
Published: October 2022

Abstract

Italy was the first European country to be hit hard by the pandemic and in the context of the Covid-19 pandemic, there were several closures of education and care facilities. The first closure of education facilities lasted continuously from March to September 2020, followed by numerous shorter closures. However, if working parents continue to (have to) work, the question arises who will look after the children during this time when facilities close. To answer this question a quantitative survey of working parents during a ‘hard closure’ week in February/March 2021 was conducted in the province of Bolzano (Northern Italy). 3725 adults as parents of a total of 7,372 children from different households responded. Although not officially allowed, 53.4% of all participants sought help from people outside the nuclear family to bridge the situation, mostly from grandparents (79%; n = 1855). The situation that grandparents represented the main risk group at the time and could not yet have sufficient vaccination protection appears particularly worrying here. Other parents’ coping strategies included working early in the morning or at night (23 %; n = 850), or leaving children unsupervised (25 %, n = 929).

Conclusions
School closures shift families to new strategies, including unhealthy models of alternating work/childcare, ‘illegal’ involvement of third parties outside the nuclear family, and neglect of age-appropriate childcare. Our findings highlight that when childcare facilities are repeatedly closed, working families need additional support strategies to reduce contact and minimize secondary harms.

Key messages
• When schools close, parents have to find new strategies for where to take their children, many have contacts outside the home.
• Grandparents (also as a risk group) play a major role in childcare even during a lockdown.
Constructing a socioeconomic status index for colorectal cancer screening evaluation
Authors: Molina-Barceló A , Vanaclocha-Espí M , Pinto-Carbó M , Martín-Pozuelo J , Romeo P , Peiró-Pérez R , Barona C , Ortiz F , Nolasco A , Castán-Cameo S 
Published: October 2022

Abstract

Objective
To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP).

Methods
Cross-sectional study. The study population was composed of men and women aged between 50 and 69 who were invited to participate in the most recently completed round of the Region of Valencia CRCSP in 2020, n = 1,150,684. A multiple correspondence analysis was performed to aggregate information in the Segmented, Integrated and Geographical Population Analysis Code from the Population Information System of the Region of Valencia into an ISESI. Data from the 2016 Region of Valencia Health Survey was used for validation. The relationship between CRCSP participation and the ISESI was analysed by logistic regression models.

Results
The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175).

Conclusions
An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.

Key messages
• An individual socioeconomic status index was constructed and validated using Regional Population Information System data.
• The Individual socioeconomic status index constructed allows to systematically evaluates inequalities in colorectal cancer screening.