Lived Experience Research Articles

Exploring the mental health impact of asylum-seeking of sexual minority men: a qualitative study

Abstract Background Sexual minority individuals, often called LGBTQ+, encounter significant danger and violence in some countries worldwide. This forces many to seek asylum in a range of European countries. The study aimed to explore the experiences of seeking asylum and its implications for the mental health of sexual minority forced migrant men in Sweden. Methods An exploratory qualitative approach was used, and 15 adult gay and bisexual cisgender men were interviewed individually. Participants were recruited through a combination of purposeful, convenience, and snowball sampling. Systematic text condensation was used to analyze data. The analysis was conducted in close collaboration with three migrants with lived experience. Results The asylum-seeking process proved emotionally challenging, involving procedures with negative impacts on mental health. Challenges included disclosing intimate information during asylum interviews and enduring long periods of uncertainty with limited information on asylum case progress. Fundamental to participants’ experiences were the behaviors and attitudes of the professionals involved in legal procedures. Disrespectful and homophobic conduct during asylum interviews, enacted by interpreters and caseworkers, had been experienced by participants. The accuracy of interpretation emerged as crucial, possibly influencing the outcome of asylum claims as well as participants’ comfort in sharing information. Conclusions Sexual minority men seeking asylum in Sweden find themselves in an unfamiliar and emotionally challenging position. The challenges highlighted in this study implicates that the stressful asylum process may lead to health burdens among this population. The study emphasizes the critical role of a safe, affirming and supportive environment for asylum seekers. Further research is needed to develop effective support methods to ensure the health and well-being of sexual minority forced migrant populations during the asylum process. Key messages • The stressful asylum process may lead to health burdens among forced migrant sexual minority men. • There is a need for public health action to develop effective support methods addressing the mental health challenges faced by sexual minority forced migrants during their asylum process.

Lived experiences: What made or would have made a difference to me when growing up?

Abstract We sometimes forget the people behind the numbers and those affected by our research. The video on lived experiences aims to put a human face on childhood social care ahead of the panel and audience discussion. Rather than asking care experienced people specifically about their health, which people may find intrusive or even irrelevant for their experience, we will seek to understand what did or would have made a difference to their lives. Dr. Allik, who has led and facilitated a number of knowledge exchange and engagement activities related to childhood social care, will take the responsibility of organising the collection different video recordings on lived experienced of childhood social care. We will work in collaboration with already existing organisations that advocate for (care experienced) children’s rights to produce the video. Dr. Allik will also be supported by the knowledge exchange team at the UofG, including choosing the appropriate methods of seeking recordings, compiling, and curating the video.

10.M. Scientific session: JA ImpleMENTAL Abstract Workshop

Abstract JA ImpleMENTAL is major initiative across Europe and was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Programme. The workshop is organized by JA ImpleMENTAL in partnership with EUPHA Mental Health Section, a member of the JA ImpleMENTAL Stakeholder Forum. It will include four presentations that will contribute to an interesting discussion about the future of community mental health services that are user-centered, recovery-oriented and human rights based as well as about the synergies with national strategies and the EU Initiatives. Vasileia Konte the JA ImpleMENTAL Coordinator will provide an overview of the Mental Health System Reforms based on the Belgian Best Practice model, which is implemented in 11 countries. It will elaborate on key activities and prioritized key areas of mental health system transformation as well as enablers, barriers and key lessons learned from the implementation process. Danijela Štimac Grbić from Croatia will present the Croatian experience in the implementation of a mobile rehabilitation team for providing psychosocial interventions in the community in which peer workers are employed for the first time. Based on the successful work of the mobile team, Croatia has included 30 new mobile teams in its network of public health services that will operate throughout Croatia. Teresa Nicolas Lopez from Murcia Spain will present the project “Inclusive Life Projects” which offers comprehensive community care to adults with severe mental illness within projects of autonomous living and provides a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Anna Paradesioti from Cyprus will focus on how to achieve a smooth transition from inpatient to community mental health services promoting collaboration among those services and professionals, by adopting an intersectoral approach. Jutta Lindert will provide valuable comments by bringing helpful insights and views of the Stakeholder Forum. Key messages • Transformation towards community based care increase availability and efficiency of services. • User’s centered human rights based recovery approach care with engaging stakeholders including people with lived experience.

Study tours as strategy in building multi-level public health system transformation in Ukraine (UA)

Abstract With 14 million Ukrainians in need of psychological aid (UNDP) and a strained health system, UA urgently requires mental health and psychological support services (MHPSS). As a TA partner on the USAID funded Public Health System Recovery and Resilience project in UA, the Philadelphia (PHL) team supports capacity building for population-based MHPSS at the community level with a study tour strategy. Such approaches apply to other countries interested in remodeling public health systems. The strategy aims to advance community based MHPSS through in person tours in PHL with remote follow up to stimulate vision, exchange ideas and accelerate action among governmental, community, and academic partners. The study tours presented overviews on health policy, system development, program services delivered to children and adults, community interventions, and workforce development of professionals and paraprofessionals. All included the foundational principles of trauma-informed practice. The June 2023 tour hosted 11 decision makers and regional officials who embraced the vision for system development and endorsed further engagement. The December 2023 tour hosted 13 practitioners and coordinators of health and social services to observe community programs. Results include development of PHL NGOs and UA social service hub partnerships to implement train the trainer programs for peers/people with lived experience and for mural arts programs to promote community engagement and empowerment. The September 2024 tour involves university partners from nursing, social work and psychology and PHL counterparts to strengthen curricula to include mental health competencies, support faculty development with potential for collaborative research and student exchange, and design post-graduate continuing education courses for upskilling the incumbent workforce. Study tours and direct exchange are an effective strategy for capacity building for MHPSS in Ukraine to address population health needs. Key messages • The sequenced study tour strategy affects distinct levels of change makers in UA. The results are governmental buy-in, partnerships for programmatic development, and academic advancement. • The study tour model promotes systematic change and offers solutions to MHPSS workforce shortages through information exchange, relationship building, and capacity development.

Developing a community engagement toolkit for health impact assessment in Ireland

Abstract Background Community involvement is a core principle of Health Impact Assessment (HIA). However, current guidance for HIA published by Ireland’s Institute for Public Health does not include guidelines on community engagement in HIA. As part of the project HIA-IM - ‘Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities,’ a Community Engagement Toolkit was created, with the aim of providing guidance for those carrying out HIAs and engaging with community in the process. The project will implement two HIAs, on the Cork City Development Plan (2022-2028) and the national Climate Action Plan (2024). Incorporating the learnings from the first HIA, the Toolkit will be employed in the second HIA of the project. Methods To develop the toolkit, a literature review of community engagement in HIA was conducted, with benefits and challenges, key approaches, and case studies of HIA’s gathered from grey literature and peer reviewed articles. In line with the participatory nature of HIA, a public consultation event was held, which was presented as a case study within the Toolkit. Results Findings from the literature review contend that engaging with community in HIA captures the lived experiences and local circumstances of the community, fostering empowerment and greater health awareness. However, many practitioners find community engagement to be practically challenging, citing factors such as time and resource constraints; with risks of consultation fatigue and raising expectations. Conclusions The review identified tools that have been used to mitigate these challenges and risks to facilitate meaningful community participation. These findings, along with learnings from conducting the first HIA, has informed the content of the Toolkit. Therefore, this Toolkit aims to complement national HIA guidance to centre the community voice in future HIA practice. Key messages • Developing a toolkit to strengthen participatory approaches and community engagement in health impact assessment in Ireland. • Centering the community voice in health impact assessment: the inclusion of lived experiences and local circumstances in health impact assessment practice in Ireland.

Inequities faced by those with substance use disorder (SUD)

Abstract This presentation delves into the inequities faced by individuals with substance use disorder (SUD), with a particular focus on people who use drugs (PWUD) and people who inject drugs (PWID). Individuals contending with SUD encounter multifaceted barriers that hinder access to appropriate care and support. This presentation will highlight the discourse surrounding biases that exacerbate health disparities among PWUD and PWID. Structural stigma and discriminatory practices not only impede access to healthcare services but also perpetuate social exclusion, amplifying the challenges faced in seeking help and support. PWUD and PWID often require tailored interventions that address not only their substance use but also co-occurring physical and mental health conditions. However, the fragmented nature of healthcare delivery and the lack of integration between substance use treatment and mainstream healthcare services pose significant obstacles to holistic care provision. Drawing on empirical evidence and lived experiences, this presentation explores strategies to dismantle the barriers faced by individuals with SUD in Norway. Ultimately, this presentation aims to foster dialogue that addresses the inequities entrenched in healthcare systems around the world. By advocating for a compassionate and inclusive approach to SUD care, we can strive towards a society where all individuals, regardless of their substance use history, can access the support and resources they need to lead healthy and fulfilling lives.

Intimate Partner Violence: Access to Protection Beyond the Pandemic

Civil protection orders are the most common legal remedy victims pursue in response to intimate partner violence (“IPV”). They are more empowering for victims than the criminal legal system because victims themselves, instead of prosecutors, drive the process, and they offer more flexible and tailored relief. This Article argues that victims should be able to choose how they file petitions and participate in civil protection order hearings, and that judges should be required to honor those preferences absent good cause. This conclusion is driven by two new, original sets of empirical data collected from IPV survivors who have sought civil protection orders and legal services providers who assist victims with navigating the process. The data from legal services providers provide a picture of court protective order procedures in jurisdictions across the country from before, during, and in the late stages of the COVID-19 pandemic, once public health restrictions were generally lifted. This complements the rich data about the lived experiences of survivors who sought a protection order against their abuser during the pandemic in one of New York City’s five family courts. 85% of participants in this study are women of color, whose lived experiences are especially important to understand because they comprise a population that is disproportionately impacted by IPV. The data indicate that IPV victims have diverse preferences with respect to method of participation in hearings, based on their varying needs, concerns, priorities, and circumstances. The current landscape of procedures across the country largely fails to account for this diversity by mandating a particular participation method or by allowing individual judges to do so in accordance with their own preferences. Based on the research results, this Article argues for codifying “accessible process pluralism” in state protective order statutes. This statutory framework would give petitioners the opportunity to indicate their hearing participation preference on the petition itself and require judges to follow these choices absent good cause, among other accessibility-focused provisions. By harnessing the innovations and lessons from the pandemic, this proposal promotes survivor empowerment and access to justice for both petitioners and respondents.

Curricular innovations to address inequalities in global health education

Abstract Background Global Health education (GHE) has expanded dramatically, with new degrees and expanded competencies in medical curricula. Yet, Global Health (GH) is also going through significant reckoning and debate around inequalities in the field. GH degrees are predominantly based in high-income countries and inaccessible to most global majority students. Some suggest GH education itself contributes to reproducing inequalities in GH. Thus, both educators and policy-makers require evidence and tools to support more representative and authentic educational experiences which can adequately equip our future graduates. Objectives To present educational innovations which gesture towards responding to the stark inequalities in Global/Public Health education. These include a unique project that experiments with disrupting current power dynamics through co-design and co-delivery of a curriculum on Syrian healthcare by colleagues with lived experience, and a student-staff partnership to integrate self-reflexivity and positionality (SRP) in curricula at Imperial College London (UK). Results Qualitative data shows that the Syrian Curriculum has resulted in enhanced student experience, being consistently cited as a highlight of the curriculum, whilst alsoenhancing inclusivity for many students. SRP supplemented this by providing students with tools to engage in open, respectful discussions and critically reflect on personal biases that impact class dynamics. Conclusions These projects provide tools for educators and policy-makers across European universities to address current challenges in GH education. Nonetheless, these innovations should principally be seen as tools to reflect and advocate for fundamental changes towards more representative structures in GH. Key messages • Curriculum innovations offer key tools to address inequalities in GHE, enhancing student experience/inclusivity. • Yet, these remain limited without fundamental change towards a more representative sector.

Supporting Long Covid Care: a webtool to facilitate help-seeking among people with Long Covid

Abstract Background Long Covid (also known as Post-COVID19 Condition or Post-COVID Syndrome) is characterised by persistent symptoms following SARSCoV2 infection not explained by other pathology. Some evidence suggests that people from marginalised communities are more likely to experience Long Covid but are less likely to be represented in post-covid care in England. Objectives Findings from the STIMULATE-ICP case finding and HI-COVE studies show that some people living with Long Covid struggle to get adequate healthcare and social support. Barriers to obtaining support include a lack of awareness of Long Covid and supports available, uncertainty around the cause and complexity of symptoms, as well as experiences and expectations of stigma. The new Supporting Long Covid Care (SLCC) webtool was developed based on these findings and aimed to both facilitate help-seeking for people with probable Long Covid who are not receiving care and raise awareness among professionals. Extensive engagement with people with lived experience and professionals shaped the webtool. SLCC content was then beta-tested with stakeholders. Results SLCC (long-covid-care.org.uk) was launched in March 2024. One of its features is the acknowledgement that Long Covid can be a stigmatising condition. SLCC includes real-life quotes to connect emotionally with users, highlights the shared experiences of people living with Long Covid and illustrates the difficulties faced when seeking recognition and support. It encourages conversations with professionals, friends, family and others who may be relied on for support and offers resources to facilitate those conversations and inform next steps. SLCC is also an informative tool for healthcare professionals around Long Covid stigma. Conclusions SLCC is open to use by members of the public. Real-world evaluation and translation to other languages are now needed to explore if this webtool is beneficial and contributes towards addressing health inequalities. Key messages • SLCC encourages people with probable Long Covid to seek help and support. • SLCC raises awareness among healthcare professionals about the barriers and stigma people, particularly those from disadvantaged backgrounds, may face when considering reaching out for support.

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

Understanding and addressing the needs of refugee and asylum-seeking children and young people

Abstract Issue/problem Europe is home to an increasing number of refugee and asylum-seeking children at risk of health and wellbeing needs due to their life experiences. They are frequently marginalised, impoverished, and face barriers accessing the healthcare and support they need. Bevan, an English social enterprise providing health and wellbeing services to Inclusion Health populations, carried out a needs assessment of migrant children registered at one of its General Practices to determine challenges and opportunities to ensuring their right to health. The knowledge and learning generated is relevant across sectors; organisations and geographical boundaries. Description of the problem The assessment included a literature review, audit of child new patient health checks, service mapping, multi-agency stakeholder interviews and a consultation event with unaccompanied minors. Findings informed Bevan’s Migrant Children and Young People (CYP) Strategy, local service development and system-wide recommendations. Results Key areas of concern identified included mental health; safeguarding; development; nutrition; and inter agency working. Challenges to meeting needs were complex and included national policies, poor provider understanding of rights and entitlements, language and cultural barriers, health service waiting lists, housing and silo-working. Lessons Responding to findings Bevan invested in an in-house CYP mental health service and CYP social prescriber, opened a drop-in clinic and wellbeing service for unaccompanied minors, and initiated orientation and health information sessions for new arrivals with peer advocate support. Bevan now hosts a city-wide cross-sector Migrant CYP stakeholder group and collaborates with regional and national partners to develop resources to promote the health of migrant CYP. Key messages • The needs assessment enabled development of a responsive integrated service for migrant CYP that meets their health needs and addresses their social determinants of health. • The Migrant CYP stakeholder group has improved inter-agency working, helped identify service gaps, increased advocacy opportunities, and facilitated co-creation of solutions to meet population needs.

5.Y.1. Refugees and mental health

Abstract Research suggests an elevated risk of mental health conditions (depression, posttraumatic stress disorder, anxiety) among refugees, due to exposure to trauma, displacement, and the challenges of adapting to new environments. Children and adolescents with refugee background face additional challenges, including family disruptions, education interruptions, and uncertain futures. However, the data are heterogeneous and more detailed data are needed. To address this gap, we present data on refugee’s mental health and resilience. First, data on resilience and mental health from Germany are presented. These data are adjusted for demographics and suggest that in case data are adjusted to the living situation in the host country the migrant status is less relevant. The second study presents the mental health of refugee adolescents and children in Greece. The third study presents results based on a Portuguese prospective cohort study Perinatal Health in Migrants: Barriers, Incentives, and Outcomes (baMBINO). This study investigates postpartum depression among refugee women in Portugal highlighting the need for access to care. Last, a systematic review and meta-analysis provides data on depression, anxiety and stress of 62,522 refugees from more than 30 countries. This data suggests that life experiences are critical for refugees’ mental health. Based on the presentations the audience will be engaged in discussion on how to better early prevent mental health conditions in refugees. Key messages • Mental health of refugees is a Public Health challenge. • Pre- and post migration experiences impact refugees and migrants mental health conditions.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

Entrepreneurial well-being of expatriate entrepreneurs: self and world

PurposeThis paper explores the Entrepreneurial Well-Being (EWB) of expatriate entrepreneurs in China. Through the analysis of their contextualised lived experience across the entrepreneurial journey, the paper proposes a novel theorisation of EWB.Design/methodology/approachThis study adopts an interpretivist approach of abductive reasoning to analyse the data from 50 in-depth interviews conducted with expatriate entrepreneurs in China. Expatriate entrepreneurs are confronted with enhanced challenges in their host country, leading to particular emotional engagement with the entrepreneurial journey.FindingsFindings show the importance of life situations, emotions and relatedness in the entrepreneurial process and the EWB of expatriate entrepreneurs. Theorising from their lived experiences, the paper presents EWB as a dynamic process. It further theorises this process as a constant, ongoing interaction and integration between the self and world, in an interplay of being and becoming. Such theorisation contributes first to advancements in the EWB literature, with a stronger emphasis on the entrepreneurial aspect. The paper also contributes to discussions on contextualised entrepreneurship by stressing the role of emotions and relatedness in the pursuit of EWB.Originality/valueEntrepreneurship is a global phenomenon, which is often presented as a suitable alternative career path for migrant and expatriate individuals. However, the importance of EWB for entrepreneurs requires further attention from policy-makers, support institutions and entrepreneurs themselves. By theorising EWB as a processual journey of being and becoming and the relation between the self and world, this paper opens avenues for innovative support policies and practices aiming at developing the full potential of individuals in entrepreneurship and promoting both the happiness index and the global index of society.

1.Y.1. Navigating choppy water for global health competencies, education and innovation in Europe

Abstract Global health is rapidly evolving against a backdrop of increasingly complicated, intersecting challenges and crises across health, socio-economic and ecological systems. Interconnected social justice movements call for greater acknowledgement, accountability and qualified responses to address inequities and their structural drivers. The field of global health is going through a period of reckoning and debate about how colonial legacies and structural inequities pervade the sector and how activities of global health professionals across research, policy and practice are complicit in and perpetuating them. Simultaneously, global health education (GHE) is growing, with new speciality degrees and core or elective courses integrated into degrees in medicine, health and other disciplines. Thus, GHE holds great potential as a space to train future professionals with competencies and aptitudes to confront inequalities through innovative, evidence-informed and sensitive approaches. Yet it is also a space in which inequalities may be reproduced through material and epistemic injustices. To address these paradoxical tensions, transformation in GHE is needed in terms of what is taught, how it is taught and who is involved in teaching. This Pecha Kucha workshop will contribute to this discourse by exploring perspectives on issues including: i) What key competencies and content should be included in GHE across different disciplines and Bachelor, Master or Doctoral level?; ii) How can we better practice and develop in educators and students critical perspectives and capacities to be equipped for and responsive to inequities and social injustice?; and iii) How can we ensure meaningful engagement and partnership in education with countries across varied contexts and communities with direct lived experience of marginalisation and deprivation? Four panellists with diverse backgrounds and perspectives will provide insights on their initiatives to tackles such issues within their own institutions and European alliances, followed by a short discussion with the audience. The presentations will emphasise the need to progressively build affective, practical and cognitive competencies to critically engage with historical, geopolitical and structural inequities and injustices, including how they manifest in local contexts. Panellists will highlight examples of innovative methods and approaches to build these capacities, including through co-design in education that fosters self-reflexivity in students and builds alliances and partnerships with non-academic stakeholders, such as civil society and people with lived experience. The Pecha Kucha workshop aims to inspire exchange across institutions and countries, and with the audience, about how we can collaboratively set our compasses and our sails to navigate the choppy waters of tackling pervasive colonial legacies and sailing towards an equitable, inclusive and effective future for education and action in global health. Key messages • Transformation is urgently needed to ensure that global health education builds curricula and competencies that are sensitive and responsive to historical injustice and structural inequities. • Equitable partnerships across institutions and with diverse stakeholders, and innovative educational approaches such as gamification and co-design, can address tensions in global health education. Speakers/Panelists Henrique Barros ASPHER, Porto, Portugal Victoria Saint Bielefeld University, Bielefeld, Germany Francisco Mboufana Department of Community Health, School of Medicine, Eduardo Mondlane University, Executive Secretary, Maputo, Mozambique Mariam Sbaiti Faculty of Medicine, School of Public Health, Imperial College London, London, UK

Predictors of adolescent well-being around the globe: are students from Confucian East Asia different?

PurposeUsing rich data from nearly 400,000 15-year-olds across 70 middle- and high-income countries and economies participating in PISA 2018, this study investigates (1) global predictors of adolescent subjective well-being (SWB), and (2) differences in adolescent life satisfaction, its predictors and endowments with predictors across world regions and cultures. A particular focus lies on comparing Confucian East Asia (CEA) with other world regions.MethodsData were analyzed using multiple linear regressions and Blinder-Oaxaca decomposition. As measures of adolescent well-being, this study employs life satisfaction, affective well-being, and meaning in life.ResultsGlobally, adolescent well-being outcomes are found to be most strongly linked to gender, personality, relative SES, relationship quality, peer SWB, autonomy and the learning environment, as well as local cultural factors. Estimations by world region reveal several culture-specific explanations for interregional well-being gaps. In particular, notoriously low levels of life satisfaction among students from CEA countries are found to be associated with low self-efficacy, low peer well-being, as well as with high emotional interdependence compared to other world regions. Emotional interdependence is more strongly experienced among CEA adolescents compared to adolescents from any other world region. Moreover, it is found to be more strongly associated with life satisfaction in the CEA region than in any other region. In line with the former, CEA students show stronger links between other relational factors (parents’ emotional support; sense of belonging at school) and life satisfaction compared to most other regions.ImplicationsThis study suggests that among the environmental factors that shape the experience of adolescent lives, relationship and cultural factors play key roles and are closely intertwined. Parents, educators and policymakers around the world should focus on creating a positive school environment that promotes well-being, student self-efficacy, a sense of belonging, and a safe space in which failure is accepted as part of the learning process. This is particularly needed in Confucian East Asian countries.

EUROPEAN SCEPTICISM AND ANTI-AMERICANISM IN THE EURO-ATLANTIC POLITICAL PROCESS IN THE EARLY TWENTIETH CENTURY

The article is devoted to a comparative analysis of the development of European scepticism and anti-Americanism in the public political process in the United States and the European Union. In the countries of the European Union, the term European scepticism refers to a negative attitude towards the process of European integration and its functional result in the form of the European Union. In the United States, mostly in ultra-conservative circles, European scepticism refers to a critical attitude towards the EU as the embodiment of the liberal democracy project. Anti-Americanism as an ideological attitude is present not only in European far-left political circles, but also in European far-right political circles. In the United States, the ideology of anti-Americanism was clearly manifested in the Black Lives Matter movement. European scepticism and anti-Americanism are actively used by Russian and Chinese propaganda as signs of an allegedly inevitable crisis of the ‘collective West’ and a ‘natural transition’ to a multipolar world in which Western democracies will not be crucial for further development. The conclusions emphasise that populist diseases of liberal democracies are actively used by autocracies to discredit the democratic experience of political life. At the same time, Russia, Iran, and China are trying to take advantage of discourses on scenarios of the US isolation from active foreign policy and the European Union's self-restrictions in pursuing its own common foreign policy and impose their own versions of ‘hybrid wars’, pushing Western influence out of key regions of Eastern Europe, the Middle East, and Southeast Asia. In view of this, the transfer of ideas of anti-Americanism and European scepticism from the circle of leading trends in public political life to its deep periphery can actually ensure greater stability not only for liberal democracies, but also for modern international relations.

Eating habits of students of health colleges and non-health colleges at the Northern Border University in the Kingdom of Saudi Arabia.

Eating habits are important determinants of health. Young adults who have recently transitioned to university life experience stress and lack of time, which are major risk factors for poor eating habits. This study's objectives were to identify and compare eating habits between students at health and non-health colleges at Northern Border University (NBU), Saudi Arabia and to determine the relationship between students' eating habits and their sociodemographic, lifestyle, and psychological factors. This comparative cross-section study was conducted on 480 students equally from health and non-health colleges at NBU from March to April 2023. A pre-designed electronic questionnaire was used to collect data on students' sociodemographic characteristics, eating habits, and diet-related psychological factors. Statistical analyses were carried out using STATA/SE version 11.2 for Windows. Unhealthy eating habits were reported by 44.6% and 41.3% of students at health and non-health colleges, respectively. Most students had irregular meals, skipped breakfast, ate fast food frequently, and consumed insufficient amounts of vegetables, fruits, and water. Parental separation, living away from family predisposed to unhealthy eating habits. Being 21-23 years old, playing sports, and high body mass index were linked to healthy eating habits. Psychological factors such as overeating until the stomach hurts and eating to feel happy were associated with unhealthy eating habits. Unhealthy eating habits were prevalent among students at NBU irrespective of the type of study. Thus, implementing initiatives to promote nutrition and healthy eating habits within the university environment is crucial for health promotion and well-being among students.

What Makes a Home.Evaluating a Novel Low Support Homeless Accommodation Model Using Co-design Methods

Abstract Background Homelessness is a global challenge, with a prevalence of 4%; the problem is underestimated due to limitations in data collection. In Ireland, 1% of the population, including children, adults, and families, experience homelessness due to housing shortages and systemic complexities. Homeless accommodation is defined as emergency and temporary; the wording is used interchangeably. The ETHOS typology of homelessness comprises two dimensions - housing-focused and support-focused. Supports range from high to low levels. This study evaluated an emergency housing accommodation with low support to assess its feasibility and impact. Methods Previous residents of an urban residential area with low support [introduced in August 2021] and key stakeholders, including policymakers and health and social care professionals, were invited to collaborate in a half-day co-design workshop [February 2024]. The workshop modified Stanford D’s five-stage design thinking processes to consider ‘How might we harness strengths and abilities to create a home and beyond’. Qualitative data were captured on flip charts, post-its, and via photographs over three rounds of activities following initial reflection regarding 1) identifying emerging challenges, 2) exploring potential solutions, and 3) considering resources for advocacy and success. Results Data analyses from 16 participants highlight 1)Personal insights: silence, freedom in decision-making, feeling overwhelmed, valuing independence and understanding accommodation transitions; 2)Organisational insights: developing and promoting independent skills, managing resident preferences and personalities, balancing regulations within emergency accommodation, and staff training. Space was critical in fostering therapeutic well-being and a sense of home environment. Conclusions Effective organisational structures are required to facilitate coherent transfers and transitions. Using co-design methods enabled real-world partnerships and engagement. Key messages • Homelessness is a significant public health challenge, and a model of low support emergency accommodation has value in supporting transition through and out of services. • Engaging with people with lived experience of homelessness is essential for developing supported accommodation models.

Eight year Follow-Up Data on a Leadless Pacing System Real life experience in comparison to data of the prospective trial

Abstract Introduction The Micra leadless intracardiac pacing system has been introduced and implemented into clinical routine in 2015, with its next generation MICRA AV in 2020. Feasibility, implantation safety, and acute success have been proven in the setting of controlled studies. Even apart from controlled studies, this new technology was beneficial for the individual patient. We aimed to report our single center follow-up (FU) data with a follow-up of up to six years. Methods In 292 patients (146 men; age: 81±5,7 y), Micra implantation was performed. Pacemaker interrogation was performed one to seven days after implantation and during FU (1; 3; 6, then every 6 month) up to 84 months. Data were assessed in a real-life setting and compared with existing data of a controlled prospective trial. Results The implantation was successful in all 292 attempts with only one pericardial effusion as major complication. During follow up there were two patients developing severe heart failure symptoms resulting in an implantation of a CRT-device and switching of the leadless pacemaker system. The average acute thresholds, sensing and impedance after system release were: 0.57±0.34V@0.24ms; 10,02±3,96mV and 752±1201Ohm. During follow up of up to 8 years neither, pacemaker failure, nor infections were reported. Measurements were reevaluated for long-term thresholds, sensing and impedance: 0.75 ± 0.38V @ 0.24 ms; 18,38 ±2,75 mV and 525 ± 102 Ohm. During eight years, no significant changes from acute to long-term measurements were detectable. In comparison to the controlled trial, our measurements of this real-life cohort were very similar. Conclusion In a real-life setting, the implantation of the leadless Micra system demonstrates a high rate of implantation success without major complications. We were also able to show stable long-term system parameters in the clinical setting of up to seven years of follow up with a very good battery longevity of about 12,3 years.