Tackling Ethnic Health Disparities Through Community Health Worker Programs: A Scoping Review on Their Utilization During the COVID-19 Outbreak.

The coronavirus disease (COVID-19) outbreak has magnified existing health inequities linked to social determinants of health, with racial and ethnic minorities being disproportionately affected by the pandemic. A proposed strategy to address these inequities is based on the implementation of community health worker (CHW) programs able to bridge the gaps between marginalized communities and the formal health care systems. A scoping review was conducted through searching 4 databases: PubMed, Scopus, Web of Science, and Science Direct. Inclusion criteria focused on studies defining any kind of adopted CHW intervention to address inequities related to racial/ethnic groups during the COVID-19 crisis, published from December 31, 2019, to October 31, 2021. Narrative synthesis was undertaken to summarize the findings. In total, 23 studies met the inclusion out of the 107 search results. Data converged on the relevant potential of CHWs on engaging with community leaders, addressing social determinants of health, and issues related to structural racism, promoting culturally tailored health information, and encouraging institutions to policy change in favor of people left behind. Although vulnerability of racial and ethnic minorities was already present before the COVID-19 outbreak, the pandemic has represented a wakeup call to address it more efficiently. In recent years, CHWs have increasingly been acknowledged as valuable members of the health care workforce. As health disparities may increase after our multicultural societies begin to recover from COVID-19, CHWs may play a crucial role in addressing system-level changes to have broad and lasting effects on health outcomes.

Prevalence of virtual reality (VR) games found through mental health categories on STEAM: a first look at VR on commercial platforms as tools for therapy.

BACKGROUND: Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however little insight into the prevalence of commercially available VR games for treatment of mental health problems on commercial platforms such as STEAM, and to what extent they can be used as tools for treatment or add-on treatment of mental health problems. OBJECTIVE: The aim of this study was to take a first look at the prevalence and overview of content of commercially available games. The games were found using search words related to psychiatric diagnosis or care. METHODS: We performed a search for keywords related to symptoms, diagnosis, and treatment strategies of mental health problems. The search was performed November 2020 on STEAM. A scheme was created for elimination and inclusion of games, eliminating those games which were irrelevant to mental health or had triggering elements such as violence, excessive movement which could trigger nausea, horror and pornographic imagery. RESULTS: In total, 735 hits were found, 565 unique games. After the games were reviewed for content via trailers, descriptions and screenshots, 32%, i.e. 182 games passed the inclusion criteria. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate. CONCLUSIONS: Commercial platforms are only at the beginning of the development towards therapeutic content. Currently the quality and usability for therapeutic use is scarce but holds great potential.

Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees.

BACKGROUND: Little is known about gender differences among people exposed to war related trauma. Aim of this study is to explore gender differences in health status and comorbidity of mental and physical disorders in a cohort of Bosnian refugees followed up for 3 years (1996-1999). METHODS: This longitudinal study included 534 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varazdin, Croatia in Bosnian language. Data were collected using Harvard Trauma Questionnaire (Bosnian version) and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. RESULTS: In both assessments there was a statistically significant difference between men and women in the number of physical health disorders, even when results were controlled for educational status. Although there was no difference in total number of symptoms in both assessments (F = 0.32; df = 1; p > 0.05 and F = 1.15; df = 1; p > 0.05), important physical health disorders were significantly more frequent among women than in men in different educational groups, namely high blood pressure and cardiovascular diseases, arthritis, and anaemia. Asthma, tuberculosis, cirrhosis of the liver, ulcer and epilepsy were more frequent in men than in women. There were no differences in frequencies of psychiatric disorders at baseline, but frequency of psychiatric disorders in women was higher at endpoint for uneducated respondents. There was significant difference compared to men in group of respondents without formal education, but only in comorbidity of PTSD and depression which was more often present in females (22.1%) than in males (3.6%). CONCLUSION: Our findings indicate the importance of gender and education on mental and physical health of people exposed to warrelated trauma. Long term health monitoring and programs, especially related to women's health are needed in order to avoid lasting consequences.

Addressing Healthcare Gaps in Sweden during the COVID-19 Outbreak: On Community Outreach and Empowering Ethnic Minority Groups in a Digitalized Context.

Since its early stages, the COVID-19 pandemic has interacted with existing divides by ethnicity and socioeconomic statuses, exacerbating further inequalities in high-income countries. The Swedish public health strategy, built on mutual trust between the government and the society and giving the responsibility to the individual, has been criticized for not applying a dedicated and more diverse strategy for most disadvantaged migrants in dealing with the pandemic. In order to mitigate the unequal burden on the marginalized members of society, increasing efforts have been addressed to digital health technologies. Despite the strong potential of providing collective public health benefits, especially in a highly digitalized context as Sweden, need for a stronger cooperation between the public health authorities and migrant community leaders, representatives of migrant associations, religious leaders and other influencers of disadvantaged groups has emerged. Suggestions are presented on more culturally congruent, patient-centered health care services aimed to empower people to participate in a more effective public health response to the COVID-19 crisis.

Personal wellbeing, work ability, satisfaction with life and work in psychiatrists who emigrated from Croatia.

BACKGROUND: A significant number of citizens, including a great proportion of doctors, both psychiatrists and doctors of other specialties, decided to emigrate from Croatia after Croatia entered the EU in 2013. Aim of research was to investigate possible differences in satisfaction with life and work between 3 groups: emigrants psychiatrists (EP), emigrants physicians of other specialties (E), and psychiatrists currently working in Croatia (C). SUBJECTS AND METHODS: Personal Wellbeing Index (PWI), Work Ability Index (WAI) and some qualitative research questions were used in an anonymous online survey which was conducted in autumn 2019. Link to the survey was shared on different social networks, while 138 physicians were approached directly by e-mail. Response rate: 87% for EP group (representative sample for group of psychiatrist emigrants from Croatia), 48% for E group, and 28% for C group. In total, 62 physicians, 44 of them emigrants (20 EP and 24 E). This study was voluntarily led. Psychiatrists from our sample emigrated mostly to Scandinavia in 65% of cases and to West Europe in 30% of the cases. Other physicians emigrants from our sample emigrated to Middle Europe in 29%, to West Europe in 25%, and to Scandinavia in 42% of the cases. RESULTS: Satisfaction with standard of life, future security and life achievements are significantly higher in EP than in C. Satisfaction with integration in community and satisfaction with close relationships are significantly higher in E than in EP. WAI score of the 3 groups placed them all in the same category "good work ability". For all emigrants and their family members, major challenges after emigration were found to be communication (language), integration into the community, and loss of friends and family connections. 70% of emigrants plan to return to Croatia in the future, depending on better living conditions (income), change in the political situation in Croatia (reduction of corruption), and change in people's mentality. CONCLUSIONS: This voluntary study showed high satisfaction with life and good work ability among psychiatrists who emigrated from Croatia, together with some challenges for them and their family members with language, work, integration into the community, and loss of friends and family connections. Majority plan to return to Croatia depending on political and economic changes in Croatia.

Impact of war trauma and posttraumatic stress disorder on psychopathology in Croatian and German patients with severe mental illness.

AIM: To explore posttraumatic stress symptoms and current psychopathology in a binational sample of Croatian and German participants with severe mental illness. METHODS: We studied 178 inpatients from the Greifswald University (German patients, n=89) and University Hospital Zagreb and Ivan Barbot Neuropsychiatric Hospital (Croatian patients, n=89) with either major depression (n=150), schizophrenia (n=26), or bipolar disorder (n=2). Measurements included Posttraumatic Diagnostic Scale and the Symptom Check List-90-R. Participants were matched according to age, sex, and diagnosis. RESULTS: Croatians reported significantly more war traumatic events (64/82 vs 5/74, chi(2)(1)=77.142, P<0.001) and significantly more Croatians met the criteria for posttraumatic stress disorder (55/89 vs 27/89, chi(2)(1)=17.73, P<0.001). They also suffered from a higher level of psychopathological distress as they scored significantly higher at all Symptom Check List-90-R revised version subscales (P<0.001). The regression models demonstrated that predictors of general psychopathological distress were war trauma (P<0.001), posttraumatic stress disorder (P<0.001), and diagnosis (P=0.01). CONCLUSION: This is the first study comparing the impact of war trauma on psychopathology of participants with severe mental illness between two nations. Our results clearly indicate the importance of trauma assessment in subjects with severe mental illness, particularly in post-conflict settings.