Abstract Background Maternal experience of labour and delivery is multidimensional and is influenced by a variety of factors. Aim to report maternal childbirth experience as described by the women themselves during the COVID-19 pandemic in Sweden using a WHO Standards-based tool adapted for an online survey (Quality of maternal and newborn care-QMNC). Methods Women ≥ 18 years of age who gave birth from March 1, 2020 to June 30, 2021 were asked to give voluntary consent to participate in an online survey. The survey included 40 questions on four key domains: provision of care, experience of care, availability of human and physical resources and organisational changes due to COVID-19. Results 5003 women were included in the analysis. Among those who underwent labour (n = 4528), 46.7% perceived a reduction in QMNC due to the COVID-19 pandemic, 50.7% were not allowed a companion of choice, 62.5% reported that health workers were not always using protective personal equipment and 36.5% rated the number of health workers as “insufficient”. Fundal pressure was applied in 22.2% of instrumental vaginal births and 36.8% received inadequate breastfeeding support. In addition, 18.4% of women did not feel treated with dignity and 6.9% reported some form of abuse. In general, findings were significantly worse among women who did not undergo labour (n = 475). Conclusions Swedish mothers’ satisfaction of care provided during childbirth was strongly influenced by many variables. Actions to promote high-quality, evidence-based, patient-centered respectful care for all mothers and newborns are urgently needed.
Abstract Background Unaccompanied minors (UMs) are children under 18 settling in foreign countries without the care of a guardian. Host countries' governments are responsible for the care of UMs. In France, UMs theoretically receive child protection. However, assessment systems frequently deny their protection because of minority status rejection. As a result, they navigate through social precarity and have limited access to healthcare services. In Paris, the non-governmental organisation Médecins du Monde (MdM) offers them medico-psycho-social care. In March 2020, lockdown measures to contain COVID-19 further reduced unprotected UMs' access to social and healthcare services. This critical situation prompted MdM to adapt their care provision to the pandemic. In this research, we sought answers to the following research question: what were unprotected UMs' social and healthcare needs during lockdown and what was MdM's response? Methods First, we estimate the evolution of social and healthcare needs of a cohort of 58 unprotected UMs during the eight-week lockdown using secondary data. Second, using interview data with MdM volunteers and staff (n = 15) we further explore UMs' needs and document the experience of phone consultations with this cohort of UMs. Preliminary Results Time series show a constant increase of UMs' needs through time. MdM's new form of care provision may have contributed to alleviate their feeling of isolation. It also had unintended consequences. Conclusions In light of the alarming healthcare status of unprotected UMs, we recommend that France implements the public health authorities' recommendation to provide appropriate shelter to UMs regardless of their status, at least during health crises. Key messages This study fills a research gap related to a pressing political and public health issue. This study advances evidence-informed debates debates on the influence of models of care provision on UMs’ social and healthcare needs during health crises.
Abstract As COVID swept through Europe, and the world, with high rates of illness and death, so did symptoms of anxiety, depression, post-traumatic stress disorder, stress, and psychological distress. This study examines the relationship between gender and psychological distress among Latvians over 50 years old within the first 6 months of the COVID-19 pandemic. Data from Wave 8 COVID-19 data of the Survey of Health, Aging, and Retirement in Europe (SHARE) as an early data version of the SHARE Corona survey conducted between June and August 2020. It features the data collected by telephone (CATI) on topics related to COVID-19 for a large sub-sample of SHARE panel respondents. This study examined a sample of 980 adults over 50 years old in Latvia. Bivariate analysis were performed utilizing the Pearson chi-square test for association to examine differences in symptoms of psychological distress by gender during the first six months of the COVID-19 pandemic. Level of significance was determined by the p-value test statistic. Alpha level was established at .05. A chi-square test for association shows that there were statistically relationships between gender and feeling nervous (X2 (2, N = 976) = 22.11, p < .001), feeling depressed (X2 (3, N = 976) = 10.95, p < .01), and trouble sleeping (X2 (2, N = 976) = 20.40, p < .001). This study rejects the null hypothesis that no differences exist between the genders, as women reported greater psychological distress during the first 6 months of the COVID-19 pandemic. Additional multi-method analysis is consistent with these findings and concludes that this is due to the greater concern women report for family, and the burden which placed limitations on meeting their children and grandchildren. Key messages Gender differences exist in experiences of psychological distress during the early COVID-19 pandemic among the aging population in Latvia. With the high rates of illness and death associated with the COVID-19 pandemic, so were symptoms of anxiety, depression, post-traumatic stress disorder, stress, and psychological distress.
Abstract In Romania, during the COVID-19 pandemic, the community healthworkers faced high risks of infection in their efforts to protect communities, due to exposure to psychological distress, fatigue and stigma, especially as they are the grass-root healthcare delivery workers. No proper training had been delivered to community health workers. We describe an intervention aimed at increasing Romanian community health workers skills and competencies. The objective of the training was to increase the capacity of community health workers and health mediators to adequately manage the COVID-19 pandemic in their communities, through the delivery of online training sessions focused on managing their communities and themselves. The courses addressed up-to-date information on SARS-CoV-2 virus, transmission, symptoms and methods of prevention and treatment of COVID-19, to community case management and addressing cross-cutting issues such as: disability, immunization, violence against children. A total of 144 sessions were delivered, totaling 288 hours, divided between eight trainers. During these 288 hours, 1658 community health workers and health mediators were trained, accounting for 75% of the community health workers and health mediators in Romania. The overall feedback was extremely positive, as the training provided the participants very useful information. Nonetheless, several learning points have been made regarding the provision of more hands-on examples and cases, an increase in the length of the course and in the number of courses, the delivery of the course - on site courses were demanded. The training contributed to increasing the capacity of community health workers and health mediators to adequately manage the COVID-19 pandemic. The training offered the basic knowledge and skills for community healthworkers and it offered a basis for offering large scale, online training for the Romanian health workforce, which could be used as a case study for other European settings. Key messages COVID-19 doesn’t affect everyone equally! We ought to equip our healthworkforce in the pandemic fight. Grass-root intervention for a better health - training the community health workers.
Introduction Infectious diseases can disrupt the environment in which children live and have negative consequences for the well-being, development and mental health of this population. Objectives Our aim is to compare the number and diagnoses of patients admitted during the first COVID-19 pandemic year to patients admitted during the same period in the previous year. Methods Retrospective observational study of patients admitted between March 1, 2020 and February 29, 2021 and the analogous period of 2019-2020 in a child psychiatry unit. Microsoft Excel was used for descriptive statistics. Results In our first pandemic year, there were 47.9% less admissions to our inpatient unit (n=717), comparing to the previous year (n=1376). Regarding the outpatient-type evaluations, there were 37.7% more admissions than the previous year (n=1813). Considering the fact that the number of inpatiens was limited in 2020 due to the restrictive measures imposed, most of our patients were consulted on an outpatient basis. During the 5 weeks nationwide lockdown, 72 children were consulted, 42.8% representing psychiatry emergencies. Regarding the diagnoses made in the whole pandemic year, disorders of psychological development were the most common, with almost half of the total of admissions (44.4%). The number of autistic outpatients in the pandemic year (n=1004) was almost double than the one before (n=572). Conclusions Even though there was a reduction of admissions to the child psychiatry inpatient unit during the first pandemic year, we did not identify major differences regarding the discharge diagnoses comparing to the year before. Disclosure No significant relationships.
Abstract Sexual and reproductive health (SRH) is a key dimension of health and well-being of individuals. Sexuality Education (SE) is one of the most important means of promoting sexual well-being of youth and a key component of HIV and sexually transmitted infections (STIs) prevention. International treaties and global health organisations explicitly urge governments to take the necessary measures to ensure the provision of SE, that should: be age-appropriate, start as soon as possible, promote mature decision-making, be directed towards improving gender inequalities and engage young people in all phases of activities. It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health. Although school-based SE (SBSE) alone may not be enough to ensure the rights of young people to SRH and prevent STIs, school programs are a very cost-effective way to contribute to these goals. Moreover, addressing these topics in schools is a thematic indicator for monitoring the UN Education Agenda 2030. Existing evidence indicates a great variability in the offer of school-based SE throughout the world. GEM report (2016) reveals that basic school curricula and educational standards rarely include SE programs, and multi-country reviews show limited progress in developing national strategies for the implementation of SE or in developing high-quality programs implemented on a large scale. Theoretical and research evidence indicate that SE, and in particular Comprehensive Sexuality Education (CSE), positively impacts the behaviour of young people, improving SRH outcomes by reducing risk-taking. UNESCO in 2018 defined CSE as “a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives”. In 2022, Italy is one of a few European countries that still lacks a comprehensive approach to SE that is coherently and equally implemented across the country and SE is not yet included in Italian schools’ curricula. As a consequence, several studies conducted on Italian young people report that they have poor sexual health knowledge, a low and inconsistent use of condoms and contraception, very little access to SRH services such as youth sexual health clinics and high levels of gender-based violence and homotransphobia. Moreover, 20% of all STIs detected in Italy affect young people. Yet, according to Italian students, school has clearly been pinpointed as the most appropriate place to receive information about SE. Key messages • Some European countries, including Italy, do not include SE in national school curricula. Often, available SBSE programs lack a comprehensive approach, with limited coverage across the countries. • Including CSE in national school curricula is an action urgently needed in order to provide young people with evidence-based, age-appropriate and accurate information on SRH and wellbeing.
Abstract Gender Equality is vital for a peaceful, prosperous, and sustainable world for all individuals. Care- and help-seeking behaviour is strongly associated with health status, but, also gender, with women's health strongly correlating to that of the whole family and directly linked to the wellbeing of all members in our communities, and the resilience and sustainability of health systems. Health and social care delivery has been lacking a gender-centred approach, with a two-prong effect, on professionals/workforce (hierarchies and leadership imbalance) and on users/recipients/care seekers (lack of gender-sensitive care provision). The COVID-19 pandemic is a global health threat and societal challenge that has already exacerbated pre-existing structural gender inequalities. It is, therefore, imperative to rebuild a better, gender-equal society for the future. This crisis has highlighted the roles of women in the health workforce, incl. as informal carers for vulnerable adults and children. The increase in gender-based violence has also come to the spotlight, due to lockdown measures, implemented to combat COVID-19, resulting in serious physical and mental harm, as well as socioeconomic damages. Furthermore, sexual and reproductive health rights have been particularly affected due to pre-existing barriers across Member-States placing additional strain on individuals and systems. All these compounding factors also result in further limiting access to leadership positions for women. This roundtable aims to capture the perspective of our interdisciplinary panelists from leading European and global institutions to comprehensively map the needs, priorities, and key action areas of public health, in order to achieve gender equality and empower all women and girls across the globe. Objectives Assess the roles of women in the health workforce, to highlight gender inequalities, and to discuss regional differences across the European Region; Present and discuss the new Gender Equality Index 2021 (to be released end of Oct 2021), which will focus on health in relation to gender equality, covering mental health, sexual and reproductive health and pandemics of communicable diseases, and in particular of COVID-19; Combine the perspective of academia, multilateral bodies, practitioners and NGOs, for concerted action to combat the increase in sexual and domestic violence, and to Bridge disparities and overcome barriers to gender-sensitive health and social care services for all women, incl., migrant and refugee populations. The roundtable brings together for the first time EUPHA, WHO, UN Women, and of the European Institute for Gender Equality, in a joint effort for European and global public health, to support our workforce and safeguard the future. Mindful of the role women in health and social care, we also include panelists from the International Confederation of Midwives and from NGOs working in the field of combating violence against women. Speakers/Panelists Carlien Scheele European Institute for Gender Equality, Vilnius, Lithuania Alia El Yassir UN Women, Istanbul, Turkey Victoria Vivilaki International Confederation of Midwives, Den Haag, Netherlands Iveta Nagyova PJ Safarik University, Department of Social and Behavioural Medicine, Kosice, Slovakia Pille Tsopp-Pagan Women against Violence Europe Network, Vienna, Austria Key messages We need to join forces to fight sexual and domestic violence, as major public health threats globally, considering their worsening during the COVID-19 pandemic. Women account for the majority of caregivers and healthcare workers, especially nurses, explore the untapped potential of midwives, and step up efforts to strengthen protection and support.
Abstract Pollution is the worldwide largest environmental cause of disease and premature death, being also considered a risk for planetary health, a cause of ecosystems destruction and intimately linked to global climate change. Pollution is considered costly, with attributable diseases resulting in health-care costs that are responsible for 1.7% of annual health spending in high-income countries. Moreover, in utero and early childhood exposures are responsible for health effects in children. The importance of air pollution as a cause of disease is well reflected in the Sustainable Development Goals (SDG), mainly in the SDG 3, SDG 11, and SDG 15, but indirectly in all the SDGs. To tackle this issue, an integrative and holistic approach linking human and environmental health such as One Health is needed, to provide evidence-based data to support the establishment of reduced air pollutants’ maximum admissible levels. A case-study developed in Portugal in the scope of PMCardImpact project, regarding the exposure of population to particulate matter with a diameter of 2.5 μm or less (PM2.5) and the associated number of cases of cardiovascular diseases will be presented herewith. Four scenarios of exposure will be considered for presenting the results: current scenario of exposure, new WHO Air Quality guidelines, European Commission Air Quality Directive and lastly, a worst-case scenario. This assessment is the starting point for calculation of the burden of disease of CVD that exposure to PM2.5 represent in Portugal. With a view to promote the science to policy interface, PMCardImpact project will make available to policy makers the needed supporting information to act, including actionable knowledge on air pollution trends and related health effects, to implement reducing air pollution policies. This work is funded by FCT/MCTES through national funds to PMCardImpact (EXPL/SAU-PUB/0944/2021) and CESAM (UIDP/50017/2020 + UIDB/50017/2020 + LA/P/0094/2020).
Abstract Background Studies document that adults in disadvantaged socio-economic positions have elevated risks of a severe course of COVID-19, but it is unclear if this holds true for children. We investigate in this population-based study whether young people from socio-economically disadvantaged households in Germany had a higher risk of COVID-19 hospitalization compared with more affluent counterparts. We also examined if differences were related to comorbidities that predict severe courses in children. Methods We included data from all 690,115 children and adolescents (0-18 years) enrolled in a statutory health insurance carrier. Daily hospital diagnoses of COVID-19 were recorded from 1.1.2020 to 13.7.2021. Logistic regressions were used to compare children from households with an indication of poverty (e.g. long- or short-term unemployed) with children from households with insurance holders in regular employment. We also assessed socio-economic characteristics of the area of residence. We controlled for age, sex, days under observation, nationality, and comorbidities (e.g. obesity). Findings A COVID-19 hospital diagnosis was a rare event (n = 1637). Children of long-term unemployed parents had a 1·36 times (95% CI 1·21-1·51) higher adjusted odds of hospitalization compared with those of employed parents. Elevated odds were also found for short-term unemployed or low-wage employment. Those living in poor areas had a 3·02 (1·81-5·22) higher odds of hospitalization than those in less deprived areas. Comorbidities were strongly related to hospitalization, but their adjustment did not change main estimates for household deprivation. Discussion Results suggest that children from poor households are at higher risk of severe courses of COVID-19 than their affluent counterparts. This underlies the need to implement effective Public Health strategies to protect deprived children from COVID-19 and other infectious disease even in high income countries such as Germany. Key messages • Children and adolescents from poor families seem to be at higer risk for sever courses of COVID-19. • Comorbidities were no key mediating factor in this study.
Abstract Background Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood. Methods The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI). Results Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight. Conclusions The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.
