Introduction Electroconvulsive therapy is a proven treatment for mood and psychotic disorders in adult patients. It is estimated that in children and adolescents this type of therapy is underutilised despite the fact that the most recent studies have supported the success of ECT in these patients. A case is described of a 15-year-old male patient diagnosed with psychotic disorder who was previously treated with several antipsychotics, including clozapine, and finally treated with electroconvulsive therapy. Objectives Review of the clinical indications of electroconvulsive therapy in children and adolescents with psychotic or mood disorders through a clinical case of a patient admitted to a Psychiatric Short Stay Unit Methods Detailed psychopathological description of the case as well as the treatments used (psychotropic drugs and electroconvulsive therapy). Results After the administration of electroconvulsive therapy, an improvement in both positive and negative psychotic symptomatology was observed, with a decrease in soliloquies and an improvement in affective flattening. Conclusions Electroconvulsive therapy is an effective treatment in adolescent patients with psychotic and mood disorders, which should be considered as indicated as an effective treatment. Disclosure No significant relationships.
Mallol Castaño L, Del Sol Calderón P, Paricio Del Castillo R
Abstract Background Parental burnout (PB) is a relatively new syndrome resulting from chronic parenting stress. Besides efforts to enhance scientific and public understanding of PB, little is known about its link to intimate partner violence (IPV), and the psychometrics of German measures for PB remain an under-researched topic. This study aims to address these gaps by 1) testing the interplay of PB, parenting, couple satisfaction, and IPV, 2) examining the psychometrics of the German version of the Parental Burnout Assessment (PBA). Methods Data were collected online as part of an international PB study including Austrian parents aged 18 or older with at least one child at home (0-18). Overall, N = 121 mothers from a community sample reported on family functioning, PB, couple quality and gender roles. Structural equation modeling was applied to assess the fit of the theoretical model. Furthermore, data from N = 220 Austrian and German parents on PB and familial variables during the Covid-19 pandemic were collected to analyze the psychometrics of the German PBA. Confirmatory factor analyses were performed to test the validity of the PBA. Results SEM indicated a good model fit, χ^2(37) = 35.51, p = .54; CFI = 1.00; RMSEA = .00, (95% CI = .00 -.06). Furthermore, an indirect effect of couple satisfaction on the link between IPV to PB and IPV to parenting was found. Conclusions This study provides preliminary evidence for the importance of couples’ relationship satisfaction in understanding links between IPV and PB as well as parenting in German-speaking mothers. On the basis of these findings, future public health efforts may be organized to focus on preventing PB indirectly or directly by targeting couples’ relationship. Additionally, psychometric results of this study can inform researchers and practitioners about the applicability of the German PBA, improving screening of at-risk parents, and offering support for parents at early stages. Key messages Our findings underscore the importance of couples’ relationships for understanding parental burnout in German-speaking parents. Valid and reliable assessment of parental burnout can support the screening of at-risk parents at early stages.
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 We know the coexistence of traumatic factors (loss of affective relationships, experiences of abuse, extreme risk situations, etc.) is common in psychiatric pathologies in which level of stress experienced exceeds normal capacity of the person, favoring the appearance of dissociative or excision mechanisms. A common mistake is to pathologize them and try to eliminate them. Objectives The objective of this paper is to study trauma and defense mechanisms involved, in order to carry out a better approach. Methods A bibliographic search was performed from different database (Pubmed, TripDatabase) about trauma, mechanisms involved and the construction of identity. Results We know neural pathways mature asymmetrically in evolutionary development (functions related to attention, concentration and executive function having special importance) and thus, traumas occurred in moments of greatest vulnerability such as early childhood, can damage and interfere with the correct integration of neural processes, producing disproportionate and unnecessarily maintained alert responses (common basis for many pathologies such as borderline personality disorder or traumatic psychosis). In response to this, reactive mechanisms are produced (such as dissociation or cleavage) that are not necessarily pathological and therefore, we should not always intervene by eliminating them because they often function as a protective factor, allowing to preserve functioning and favoring recovery. Conclusions In conclusion, we need a better understanding of mechanisms involved in trauma, executive function and the alarm system beyond anxiety reactions, trying to understand the function of symptom without eliminating it, but evaluating whether there are healthier alternatives can be promoted for the complete recovery of the patient. Disclosure No significant relationships.
Abstract Introduction Although vaccines against HBV have been available since the 1980s, the long-term immunity is still debated. When assessing immune persistence, a number of clearly defined variables must be taken into account. Often the expression ‘infant vaccination’ means the administration within the first year of life at any age, but a difference of a few months may imply a different antibody persistence over the years. This study assessed the anti-HBs titre 20 years after the primary vaccination course and estimated the effect of age at 1st dose and time interval between doses on long-term protection. Methods Data on age, sex and date of administration were collected. Inclusion criteria: born to negative mother, 3-dose schedule, no previous HBV infection, age at enrolment 18-24 years; age at 1st dose 2-12 months. Titres ≥10IU/l were considered protective. A logistic regression was performed, adjusting for sex, follow-up time and date of 1st dose and analysis. Results We included 5,485 participants (64% female). The mean anti-HBsAg increased from 46, 52, 85 to 193IU/l when the 1st dose was administered in the I, II, III or IV trimester of life, respectively. Similarly, the proportion of individuals with titre <10IU/l decreased from 51 to 18% between the two extreme quarters. The risk of a titre <10IU/l decreased with age at the 1st dose (AOR: 0.84; 95%CI: 0.78-0.91 per one-month increase) and time between the 2nd and 3rd doses (AOR: 0.89; 95%CI:0.85-0.94). Conclusions The mere presence of a titre <10IU/l does not equate lack of protection. However, antibody levels are very different depending on the actual age of vaccination. One-month delay within the first year is associated with a -18% chance of a titre <10IU/l 20 years later. Although this information needs to be combined with local epidemiology and surveillance to obtain an informed risk-benefit balance, the implications from a public health and economic perspective may be diverse and worth considering. Key messages • Still within the first year of life, a delay in the administration of the 1st dose of HBV vaccine and a longer time between the 2nd and 3rd dose imply a higher antibody persistence even 20 years later. • Considering the local circulation of HBV and surveillance, this result could be taken into account to obtain an informed risk-benefit balance.
Introduction Despite the high prevalence of psychiatric disorders among children and adolescents, services are often accessed too late or not at all. Inpatient-equivalent treatment can be a good option here, as it can counteract structural barriers by enabling treatment from home. Although national and international studies highlight the benefits, this form of treatment is offered by only a few psychiatric facilities. Objectives The aim is to provide a decision-making aid for the introduction of outreach treatments with regard to cost-effectiveness. Based on this, the question will be answered whether telemedicine can be an option for the distribution of rare (human) resources. Methods 1) Based on a systematic review, the best available evidence will serve for deriving hypotheses and providing assumptions for the decision-making model. 2) Decision analytic modeling will be used to determine the cost-effectiveness of inpatient-equivalent treatment compared to conservative inpatient treatment. 3) An additional systematic review will provide information on the use of telemedicine in inpatient equivalent treatment. Results The following questions need to be discussed: 1)Is there an indication for all psychiatric diseases and age groups? 2) Are there ethical considerations that need to be taken into account, especially in the use of telemedicine? What incentives need to be set for psychiatrists to opt for inpatient-equivalent treatment? Conclusions The results of the study may help to raise awareness of inpatient equivalent treatment among decision-makers. Furthermore, fears could be reduced, since admission to a psychiatric facility can mean a stigmatizing intervention in the lives of young patients. Disclosure No significant relationships.
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.
Introduction The prevalence and pattern of emotional abuse of children in Nigeria is poorly understood. Data from other parts of the world indicate it is commoplace and has enduring negative mental health impact. The current study aims to understand the phenomenon the more. Objectives To determine the prevalence and pattern of emotional abuse of children in their homes in Nigeria Methods Cross sectional survey of 1, 5444 secondary school students aged 11-18 years in Ilorin Nigeria using multistage random sampling technique with proportional allocation was done. Respondents completed the ICAST-CH questionnaire which covers child abuse in its several forms including emotional abuse. Prevalence of emotional abuse was computed. Results All respondents (100%) had experienced emotional abuse at home in the last one year Table 1: Prevalnce annd pattern of emotional abuse at home among children in Ilorin NigeriaEmotional Abuse* (n=1554)FrequencyPercentageThreatened to hurt or kill you or threatened with evil spirits1554100Screamed at152898.3Bullied by another child at home121878.4Insulted112272.2Made you feel embarrassed57436.9Wished you were dead22414.4Locked out of home19612.6Threatened to abandon you956.1 Conclusions Emotional abuse of children at home is common place in Ilorin Nigeria. It would seem important to educate parents on what emotional abuse is and its potential impact in children. 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.
