Perceived controllability of a SARS-CoV-2 infection: an investigation of intersectional differences.

BACKGROUND: The perceived ability to influence an infection with SARS-CoV-2 has an impact on compliance with protective measures. Factors influencing perceived controllability are not yet fully known. The aim of this study was to identify intersectional differences in perceived controllability. Insights into these intersectional differences could help to develop user-centered strategies to improve the acceptance of protective measures. METHODS: Data from the seventh wave of the German Ageing Survey (DEAS) was used to investigate differences in the population regarding the perceived controllability. The role of socio-demographic and socio-economic predictors was investigated using multivariable linear regression modeling. Intersectional differences were examined using interaction terms. RESULTS: Information on 4,823 respondents aged 46 to 100 years were available, of which 50.9% were female. Migration status (yes vs. no: ß = -0.27; 95%-CI = -0.48,-0.06), education level (high vs. low: ß = 0.31; 95%-CI: 0.08, 0.55) and employment status (retired vs. employed: ß = 0.33; 95%-CI: 0.19, 0.48) were found to be significantly influencing perceived controllability. Interaction effects were found with respect to sex and migration status, with migrant women rating their perceived controllability lower than non-migrant women (ß = -0.51; 95%-CI = -0.80, -0.21), while no differences were evident between migrant and non-migrant men (ß = -0.02; 95%-CI = -0.32, 0.28). Further intersectional differences were not observed. CONCLUSIONS: The results show that intersectional differences in perceived controllability occur especially between migrant and non-migrant women. Possible causes may lie in language barriers, which in connection with lower health literacy may affect perceived controllability. Dedicated efforts to improve controllability among older adults, those with lower educational attainment and migrant women are warranted.

Additional burdens of family caregivers during the COVID-19 pandemic: A qualitative analysis of social media in Germany.

Caregiving is associated with various burdens for family caregivers. The COVID-19 pandemic and the protective measures implemented to restrict public life, such as social distancing and the closure of services and educational institutions, add further challenges. Little is known about how they are perceived by family caregivers. Based on an analysis of German social media posts, the aim of this study was to explore the additional strains family caregivers experience during the pandemic. The websites of three social media services were searched using the respective search engines provided by the websites. Data from a 10-month period (March to December 2020) were identified and examined. A total of 237 publicly available posts were included in the analysis. Seven main categories were identified using a thematic approach: care and support, deterioration of the condition of the person being cared for, psychological challenges, financial challenges, infection control, access to protective equipment, and acknowledgement of family caregivers. Family caregivers are affected by additional burdens during the pandemic, which makes the development of support and relief services tailored to this population group necessary.

[Strategies, guidelines and recommendations for coping with the COVID-19 pandemic in palliative and hospice care facilities. Results of a scoping review]. / Strategien, Richtlinien und Empfehlungen zur Bewältigung der COVID-19-Pandemie in Einrichtungen der Palliativ- und Hospizversorgung. Ergebnisse eines Scoping-Reviews.

BACKGROUND: Palliative and hospice care facilities face different challenges emerging from the COVID-19 pandemic. In particular, this results from the high age and pre-existing diseases of patients as well as the physically close contact between staff and patients. OBJECTIVE: The aim of this study was to identify existing strategies, guidelines and recommendations in Germany and other countries with respect to addressing the challenges of the COVID-19 pandemic in palliative and hospice care. MATERIAL AND METHODS: The databases PubMed, CINAHL, Web of Science and PsycInfo were searched as part of a scoping review. Additionally, Google Search and Google Scholar were used to identify "grey literature". All German and English language articles related to inpatient palliative and hospice care were included which were published between January 2020 and August 2021. RESULTS: A total of 51 publications were included in the analysis. The identified measures can be clustered into 10 different categories: infection control measures, structural measures, visiting regulations, communication structures, education and training, psychosocial support measures, specific considerations for people with dementia, advance care planning, farewell and measures after death. CONCLUSION: With respect to addressing the COVID-19 pandemic, the primary focus is on measures to enable communication between patients, staff and relatives, psychosocial support measures, structural measures and recommendations for training and education of all stakeholders. Measures for the palliative care of people with dementia in times of a pandemic as well as the farewell and grief management of bereaved families received less attention.

[Reasons for rejecting official recommendations and measures concerning protection against SARS-CoV-2-a qualitative study of social media posts]. / Gründe für die Ablehnung behördlicher Empfehlungen und Maßnahmen zum Schutz vor SARS-CoV-2 ­ eine qualitative Studie auf Basis von Beiträgen in sozialen Medien.

BACKGROUND: In order to slow down the spread of SARS-CoV­2 (severe acute respiratory syndrome coronavirus type 2) the federal states and the government in Germany have implemented protective measures with far-reaching consequences for the population and the economy. Amongst others, these measures include the temporary restriction of the operation of leisure facilities as well as contact and travel restrictions. These government regulations and recommendations have provoked mixed reactions, with some parts of the population not complying accordingly. OBJECTIVES: The aim of the present study is to explore reasons for the noncompliance with protective measures on the basis of social media posts. MATERIALS AND METHODS: Three social networks (Facebook, Twitter, and YouTube comments) were systematically investigated for the period 2 March to 18 April 2020 with regard to attitudes and beliefs about "social distancing" and other protective measures by means of qualitative document and content analysis. A total of 119 postings were included in the analysis and interpreted. RESULTS: Six main categories and four subcategories were identified in terms of the rejection of protective measures: misinformation of social media (trivialization and doubts about the effectiveness of protective measures), mistrust of the established public media, knowledge deficits and uncertainty, restriction of basic rights, the role of authorities (population control and poor trust in the Robert Koch Institute), and economic consequences of the pandemic. CONCLUSION: Misinformation in social media and knowledge deficits may contribute to underestimating the pandemic. In addition, economic pressures may contribute to rejecting protective measures. To increase the acceptance of implemented protective measures, health education and transparent and evidence-based communication represent relevant determinants.

What Self-Management Skills Do Turkish Caregivers Have in Caring for People with Dementia? Results of a Qualitative Survey.

Family caregivers can be overwhelmed by the care they provide within the family without external support. The development of self-management skills and the associated ability to actively and responsibly manage one's own health or illness situation therefore plays a vital role in the home care of people living with dementia. As part of an individualized intervention for family caregivers of people of Turkish origin with dementia, existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving and in interviewees' own practices to maintain their health. Ten caregivers of Turkish origin who were responsible for family members living with dementia were interviewed using problem-centered interviews. We found that the target group has very heterogeneous self-management competencies, which are based, on the one hand, on existing supportive resources and, on the other hand, on diverse care-specific, psychosocial and life-world challenges in intrafamily care that have not been overcome. Self-management skills in family caregivers are influenced by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic combination of resources and challenges results in varying levels of self-management ability among family caregivers. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies. There is great need for action in promoting self-management skills among Turkish caregivers of people living with dementia in home care. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity.

Cost-of-illness and Economic Evaluation of Interventions in Children and Adolescents With Chronic Pain: A Systematic Review.

OBJECTIVES: Chronic pain in children and adolescents (CPCA) is widespread with an increasing prevalence. It is associated with a decreased quality of life and an increased parental work loss. Accordingly, CPCA may pose a substantial economic burden for patients, health care payers, and society. Therefore, this systematic review aimed to synthesize (1) the results of existing cost-of-illness studies (COIs) for CPCA and (2) the evidence of economic evaluations (EEs) of interventions for CPCA. METHODS: The systematic literature search was conducted in EMBASE, MEDLINE, PsycINFO, NHS EED, and HTA Database until February 2023. Title, abstract, and full-text screening were conducted by 2 researchers. Original articles reporting costs related to CPCA published in English or German were included. Study characteristics, cost components, and costs were extracted. The quality of studies was assessed using standardized tools. All costs were adjusted to 2020 purchasing power parity US dollars (PPP-USD). RESULTS: Fifteen COIs and 10 EEs were included. The mean annual direct costs of CPCA ranged from PPP-USD 603 to PPP-USD 16,271, with outpatient services accounting for the largest share. The mean annual indirect costs ranged from PPP-USD 92 to PPP-USD 12,721. All EEs reported a decrease in overall costs in treated patients. DISCUSSION: The methodology across studies was heterogeneous limiting the comparability. However, it is concluded that CPCA is associated with high overall costs, which were reduced in all EEs. From a health-economic perspective, efforts should address the prevention and early detection of CPCA followed by specialized pain treatment.

Pictorial Assessment of Health-Related Quality of Life. Development and Pre-Test of the PictoQOL Questionnaire.

The aim of the present study was to develop a pictorial questionnaire for the assessment of health-related quality of life (PictoQOL) and to examine its content validity and usability across three exemplary population groups of different origin residing in Germany (non-migrants, Turkish migrants and Arabic-speaking migrants). A mixed-methods design combining qualitative and quantitative methods was used, comprising 6 focus group discussions with a total of 17 participants, 37 cognitive interviews and a quantitative pretest with 15 individuals. The PictoQOL consists of a pictorial representation of a total of 15 different situations. Using a visual Likert scale, respondents indicate how much each situation applies to them. Some representations proved to be culturally sensitive and were adapted. Respondents found the use of an additional graphic layer in the form of symbols in addition to pictures helpful for interpretation. The PictoQOL is considered to allow a more accessible assessment and better comparability of HRQOL across different population groups regardless of their literacy level. It is therefore considered to be superior to existing instruments for routine use in health research and practice. Future studies need to examine its convergent and factorial validity.

An Intersectional Perspective on the Utilization of Cervical Cancer Screening among Migrants. A Cross-Sectional Analysis of Survey Data from Austria.

In most European countries, migrant women have lower rates of cervical cancer screening utilization than non-migrant women. While studies have illustrated that disparities can be partially explained by social determinants, they usually did not take into account the heterogeneity of the migrant population in terms of cultural background or country of origin. Applying an intersectional approach and using 2019 data from a representative survey from Austria on 6228 women aged 20-69 years, the present study examines differences in the utilization of cervical cancer screening in the five largest migrant groups (i.e., individuals with a nationality from or born in a Yugoslav successor state, Turkey, Romania, Hungary, or Germany) residing in Austria. By means of a multivariable analysis, amongst others adjusted for socioeconomic and health-related determinants, it is illustrated that particularly Turkish migrant women have a lower utilization than the Austrian majority population (adjusted odds ratio (OR) = 0.60; 95% confidential interval (CI): 0.40-0.91), while no significant differences between the majority population and other groups of migrants became evident. The findings are indicative of the heterogeneity of migrants and likely result from different obstacles some groups of migrants encounter in the health system. This heterogeneity must be taken into account in order to support informed decision-making and to ensure adequate preventive care.