Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model.

Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.

Increasing numbers of potentially traumatic experiences can decrease the beneficial effect of a manualized group psychotherapeutic intervention in migrants and refugees across multiple countries.In absence of a full threshold diagnosis of post-traumatic stress disorder, post-traumatic stress symptoms still mediate the relation between potentially traumatic experiences and some outcome improvements at follow-up.While the moderating role of number of potentially traumatic experiences applies to all outcomes (depression symptoms, psychological distress, functional impairment, well-being, and quality of life), the mediating role of post-traumatic stress symptoms in this relation only applies to well-being and quality of life.

Impairments in psychological functioning in refugees and asylum seekers.

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

Employer impact on COVID-19 vaccine uptake among nursing and social care employees in Austria.

Introduction: Since becoming available, vaccines against COVID-19 have been a focus of public debate. This is particularly relevant among healthcare and social workers, who interact with vulnerable patients and clients on a daily basis. With employers implementing educational programs and offering incentives to raise vaccine willingness among their staff, it is crucial to understand drivers of vaccine acceptance and hesitancy as well as the impact employers can play on vaccine decision-making. Methods: We conducted a cross-sectional study via computer-assisted telephone and web interviews. We recruited from a pool of employees from nursing and social care institutions in Vienna and Lower Austria operated by one healthcare NGO. Variables included in the analysis were socio-demographic attributes, reasons for or against the vaccine, sources of information, opinions of mandatory vaccination, and whether respondents had previously been infected with COVID-19 or knew someone who had. Results: 86.2% of respondents had received at least one dose of the COVID-19 vaccine. 13.8% were unvaccinated. Vaccinated respondents' main reason for getting the vaccine was to protect themselves (79.6%) as well as others (74.1%), while non-vaccinated respondents cited a fear of short or long-term side effects (58.8 and 42.4%, respectively) as their primary reason for not getting vaccinated. 72.8% of the unvaccinated said no incentive would make them change their mind, while 17.4% specified abstract concepts or systemic change as effective incentives. Monetary incentives were not seen as a motivator. Unvaccinated respondents were significantly more worried about the future than vaccinated respondents (78.8 vs. 26.3%, p < 0.001). They were also significantly more likely to view their employers' vaccine recommendations as "manipulative" (50.6 vs. 12.4%, p < 0.001), while vaccinated respondents were significantly more likely to view them as "supportive" (68.0 vs. 25.9%, p < 0.001). Conclusion: While employers have the means to mediate public health decision-making by providing information, deciding to become vaccinated is a more complex process including public debate, world views, political influences, and the uptake of information. Employers can act as mediators for public health decision-making, moving policy measures beyond an individualized view of health choices and health literacy toward more structural, systemic, and community-based efforts.

Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis.

BACKGROUND: Online information on COVID-19 vaccination may influence people's perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. OBJECTIVE: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. METHODS: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The "frequently asked questions" or "questions and answers" section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. RESULTS: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46% (23/50) of the websites stated that they do not know, and another 40% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78%), headache (36/50, 72%), fatigue (33/50, 66%), and muscle/joint pain (31/50, 62%). CONCLUSIONS: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented.

Using telemedicine in nursing homes during the COVID-19 pandemic: A multi-perspective view on the implementation process.

AIM: Centring on nursing homes, we analysed the implementation process of a tablet- and videoconferencing-based telemedicine application from the perspectives of management, nursing staff and physicians. DESIGN: We used a qualitative design based on interviews to explore diverse perspectives on the implementation of telemedicine. METHODS: We conducted fourteen face-to-face or online interviews with a purposeful sample of five managers, six nurses and three general practitioners treating residents in Austrian nursing homes during the COVID-19 pandemic. We condensed data using thematic analysis. RESULTS: Nursing home management implemented telemedicine rapidly, using a top-down approach met with ambivalence by staff. On the part of nurses, their professional understanding of person-centred care was challenged. Telemedicine also impacted cooperation between nurses and physicians, influencing their respective understanding of their roles. Working experience with digital nursing documentation had a positive effect on users' acceptance of the telemedicine solution.

Agent-based simulations for protecting nursing homes with prevention and vaccination strategies.

Due to its high lethality among older people, the safety of nursing homes has been of central importance during the COVID-19 pandemic. With test procedures and vaccines becoming available at scale, nursing homes might relax prohibitory measures while controlling the spread of infections. By control we mean that each index case infects less than one other person on average. Here, we develop an agent-based epidemiological model for the spread of SARS-CoV-2 calibrated to Austrian nursing homes to identify optimal prevention strategies. We find that the effectiveness of mitigation testing depends critically on test turnover time (time until test result), the detection threshold of tests and mitigation testing frequencies. Under realistic conditions and in absence of vaccinations, we find that mitigation testing of employees only might be sufficient to control outbreaks if tests have low turnover times and detection thresholds. If vaccines that are 60% effective against high viral load and transmission are available, control is achieved if 80% or more of the residents are vaccinated, even without mitigation testing and if residents are allowed to have visitors. Since these results strongly depend on vaccine efficacy against infection, retention of testing infrastructures, regular testing and sequencing of virus genomes is advised to enable early identification of new variants of concern.

Can We Protect Those We Care for in A Pandemic? - Prevalence of Neutralizing Antibodies against SARS-CoV-2 in Nursing Homes.

In December 2019, the People's Republic of China and the World Health Organization first reported on a cluster of pneumonia with an unknown cause. Nine months later more than 1.4 million people have died from COVID 19. In this work, the effects of the COVID 19 pandemic on five nursing homes in Austria, which cared for 889 residents in the first half of 2020, were examined. The research question was whether the measures taken were appropriate to prevent an outbreak within the individual facilities. To detect previously unrecognized infections, the present study evaluated the prevalence of neutralizing antibodies against the SARS-CoV-2 virus in residents and employees of the nursing homes. Following the analysis of blood samples, the prospectively collected data was connected to data from screening examinations and data from contact tracing. The present study demonstrated an overall prevalence of neutralizing antibodies against the SARS-CoV-2 virus in nursing homes of 3.7%. Whereas the prevalence in those facilities that have never been hit by an outbreak is 0%, the prevalence in those facilities with an outbreak is up to 4.9%. Neutralizing antibodies against SARS-CoV-2 were detected in 35 persons. A retrospective analysis of all 5 included nursing homes demonstrated that upon regular clinical screening in combination with PCRs an infection with SARS-COV-2 was detected in 66 residents and 24 employees from different professional groups. In only 25 of the 35 persons with neutralizing antibodies against SARS-CoV-2 an infection was proven in advance. This study suggests that specific measures can prevent transmission within a health care facility. Nevertheless, the results also show that a risk reduction to 0% cannot be achieved. In preparation for further pandemic waves there is still the need to reduce the probability of a transmission in nursing homes with specific test strategies.

Telehealth in Times of COVID-19: Spotlight on Austria.

INTRODUCTION: With the spread of Coronavirus disease 2019 (COVID-19), the world has been experiencing an extraordinary state of emergency. As patients entering a doctor's practice can potentially infect medical staff and other patients, using digital alternatives wherever possible is a potential solution to avoiding face-to-face encounters. In these conditions, telemedicine is becoming increasingly relevant. Hence, the aim of this study was to examine telemedicine use and gathered experiences during the COVID-19 pandemic in Austria. MATERIALS AND METHODS: In June 2020, a representative group of Austrian respondents (n = 1000) was asked via online survey whether they had contacted a doctor during spring of 2020, and, if so, whether they had used a telemedical method to do so. The survey also reflected gathered experiences and degrees of satisfaction with the use of telemedicine. RESULTS: A third (33%) of those who contacted a doctor during the target period did so using telemedical tools. The majority of those with previous telehealth experience were satisfied with the help they received. Patients commonly used a telephone to contact their doctors. The overall assessment of telemedical aids tended to be positive, with more than half (53%) of those surveyed seeing significant advantages, and a 90% satisfaction rate among the respondents who used telehealth services. CONCLUSION: The outcomes from this work hint at fairly high acceptance of telemedical communication tools in the studied group of the Austrian population. Based on the high rate of satisfaction among patients who used telehealth, it is expected that the use of telehealth services will increase further in the near future.

[Position paper about the care of refugees : A statement about the psychosocial health care of refugees]. / Positionspapier zur Flüchtlingsversorgung : Eine Stellungnahme zur psychosozialen Versorgung von Flüchtlingen.

This paper is general statement about the psychosocial care of refugees, developed by the of the Austrian Society for Psychiatry, Psychotherapy and Psychosomatics as well as by the Austrian Society for Social Psychiatry. Reasons of recent wave of refugees and the usual mental disorders among refugees are described. The increasing number of refugees, asylum seekers and irregular migrants poses a challenge for mental health services in Europe. As a consequence, several expert recommendations were given. As a first step, basic needs of refugees such as regular housing facilities, sufficient nutrition and safety in everyday life should be met. Fast decisions about the applications for asylum and support of social integration through education and employment are essential for mental health. Provision of mental health care should be needs based as described by the intervention pyramid for mental health and psychosocial support as given by the Inter-Agency Standing Committee of the World Health Organization. In addition, culture-specific aspects must be considered in everyday clinical work and the training of health professionals.