“How to publish”: the Journal of Health Policy and Economics’ first seminar

On May 4th, 2021, the Journal of Health Policy and Economics (JOHPEC) held its first seminar, “How to Publish”, coordinated and chaired by Amir Mohsenpour, an Assistant Editor of the JOHPEC. This blog shares an overview of the seminar, which welcomed guest speakers Dr. Edgar Whitley (Department of Management), Lucy Lambe (LSE Library, Houghton Street Press), and Hannah Boroudjou (LSE Library), as well as 44 attendees who tuned in from around the world. With consent from all speakers and attendees, the seminar was recorded. The link and password to the full recording can be found in the blog. If you have suggestions for future events, please fill in this form: https://forms.office.com/r/nN87zubvi

How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries

Bozorgmehr K, Goosen S, Mohsenpour A, Kuehne A, Razum O, Kunst AE. How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. 2017;14(8): 894.Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson's rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0-97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson's rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component "data sources and availability" was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future

Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany

Objectives: Few studies have assessed whether refugees’ health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses.Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward’s method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany.Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression.Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres

Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis

Mohsenpour A, Biddle L, Bozorgmehr K. Deterioration of housing environment and mental health of asylum seekers – a multi-level analysis. In: European Journal of Public Health. Vol 29. Oxford: Oxford Univ Press; 2019.Background Asylum seekers arriving in Germany are assigned to a local district and an accommodation centre wherein. We developed and validated a six-item questionnaire for rapid assessment of housing deterioration and investigated its association with inhabitant mental health. Methods Using cross-sectional data from a state-wide survey in Germany, we applied a random-effects modelling approach to estimate the exposure effect of housing deterioration on depression and general anxiety among a random sample of asylum seekers, using validated instruments (GAD2/PHQ2) for outcome variables. Housing deterioration was assessed on six items (windows/glass, walls/roof, garbage, graffiti, outside spaces, overall living environment) resulting in a deterioration score as exposure of interest. Additionally, we assessed the instrument’s intra- and inter-rater reliability and internal consistency. Results Of the 412 asylum seekers living in 58 accommodation centres, 45.7% reported symptoms of depression and 45.0% suffered general anxiety. Most centres (76.7%) were based in urban municipalities and 45.7% of inhabitants were living in an accommodation centre hosting ≥51 inhabitants. Preliminary adjusted odds ratio for accommodation centres with highest deterioration (Q 4) was 2.07 (0.67-6.40) for generalized anxiety, compared to 1.17 (0.45-3.08) for centres with lowest deterioration (Q 1). For depression, preliminary odds ratio was 1.92 (0.87-4.27) compared to 1.26 (0.63-2.50). The validation study confirmed inter-/intra-rater reliability (Brennan-Prediger coefficient: 0.81 and 0.92, respectively) and internal consistency (Crohnbach’s α: 0.80). Conclusions There are higher odds ratios for generalized anxiety disorder and depression among asylum seekers based on higher deterioration of housing environment. A questionnaire for rapid deterioration assessment and identification of accommodations needing further evaluation has been developed and successfully validated. Key messages Deterioration of small-scale housing environment is associated with poorer mental health for asylum seekers living in accommodation centres. A highly reliable new tool has been developed for rapid assessment of deterioration status of accommodation centres and identification of those needing further evaluation

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state.

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates

Monitoring the health and healthcare provision for refugees in collective accommodation centres: Results of the populationbased survey RESPOND

To date, the integration of refugees in German health surveys is insufficient. The survey RESPOND (Improving regional health system responses to the challenges of forced migration) aimed to collect valid epidemiological data on refugee health status and healthcare provision. The core elements of the survey consisted of a population-based sampling procedure in Baden-Württemberg, multilingual questionnaires and a face-to-face approach of recruitment and data collection in collective accommodation centres with multilingual field teams. In addition, data on the geographical locations of accommodation centres and their structural quality were obtained. The results indicate a high overall health burden. The prevalence of depression (44.3%) and anxiety symptoms (43.0%) was high. At the same time, high unmet needs were reported for primary (30.5%) and specialist (30.9%) care. Despite sufficient geographical accessibility of primary care services, frequent ambulatory care sensitive hospitalisations, i.e. hospitalisations that could potentially have been avoided through primary care (25.3%), as well as subjective deficits in the quality of care, suggest barriers to accessing healthcare services. Almost half of all refugees (45.3%) live in accommodation facilities of poor structural quality. Collecting valid data on the health situation of refugees is possible through a combination of targeted sampling, multilingual recruitment and survey instruments as well as personal recruitment. The presented approach could complement established procedures for conducting health surveys and be extended to other federal states

SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: Systematic review and meta-analysis

Background People experiencing homelessness (PEH) may be at risk for COVID19. We synthesised evidence on SARS-Cov-2 infection, transmission, outcomes of disease, effects of non-pharmaceutical interventions (NPI), and the effectiveness of strategies for infection prevention and control (IPC). Methods Systematic review of articles, indexed in electronic databases (EMBASE, WHO-Covid19, Web of Science), institutional websites and the Norwegian Institute of Public Health's live map of COVID-19 evidence, and published from December 1st, 2019, to March 3rd, 2021. Empirical papers of any study design addressing Covid-19 and health(-related) outcomes in PEH or shelters' staff were included. (PROSPERO-2020-CRD42020187033). Findings Of 536 publications, 37 studies were included (two modelling, 31 observational, four qualitative studies). Random-effect meta-analysis yields a baseline SARS-Cov-2 prevalence of 2•32% (95% Confidence-Interval, 95%CI=1•30-3•34) in PEH and 1•55% (95%CI=0•79-2•31) in staff. In outbreaks, the pooled prevalence increases to 31•59% (95%CI=20•48-42•71) in PEH and 14•80% (95%CI=10•73-18•87) in staff. Main IPC strategies were universal rapid testing, expansion of non-congregate housing, and in-shelter measures (bed spacing, limited staff rotation, reduction in number of residents). Interpretation 32% of PEH and 15% staff are infected during outbreaks of SARS-Cov-2 in homeless shelters. Most studies were conducted in the USA. No studies were found quantifying health-related outcomes of NPI. Overview and evaluation of IPC strategies for PEH, a better understanding of disease transmission, and reliable data on PEH within Covid-19 notification systems are needed. Qualitative studies may serve to voice PEH and shelter staff experiences, and guide future evaluations and IPC strategies

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Mohsenpour A, Biddle LR, Bozorgmehr K. Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state. bioRxiv. 2022.**Background** Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. **Methods** We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany’s 3rd largest federal state. Individual-level data on depression (PHQ2) and anxiety (GAD2) symptoms as well as sociodemographic- and asylum-related covariates, was collected and linked to contextual geo-referenced data on housing environment (‘Small-area Housing Environment Deterioration’ index, number of residents, remoteness, urbanity and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. **Results** Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with >=50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. The accommodation-level median odds ratio for GAD2 was 2.10 with contextual-level variance of 16%. For odds of reporting GAD2 / PHQ2, the highest degree of deterioration (OR 2.22; 95% CI 0.52-9.59 / 1.99;0.55-7.18), large accommodation size (1.34;0.59-3.06. / 1.12;0.56-2.26), remoteness (2.16;0.32-14.79 / 3.79;0.62-23.18) and district urbanity (3.05;0.98-9.49 / 1.14;0.46-2.79) showed higher, but statistically not significant, point-estimates. District deprivation demonstrated higher odds for GAD2 (1.21;0.51-2.88) and, inversely, lower odds for PHQ2 (0.88;0.41-1.89). **Conclusion** We found tendencies for, but no significant, contextual effects of housing environment on ASR mental health in accommodation centres. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates

Contextual housing environment and mental health of asylum seekers - a multi-level analysis

Mohsenpour A, Biddle LR, Bozorgmehr K. Contextual housing environment and mental health of asylum seekers - a multi-level analysis. In: 16th World Congress on Public Health 2020. Public Health for the future of humanity: analysis, advocacy and action. European Journal of Public Health. Vol 30. Oxford: Oxford Univ Press; 2020

Covid-19 in Refugee Shelters: The German Public Health Service Needs Strengthening Now

Razum O, Penning V, Mohsenpour A, Bozorgmehr K. Covid-19 in Flüchtlingsunterkünften: ÖGD jetzt weiter stärken. Gesundheitswesen (Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes). 2020;82(05):392-396.Zusammenfassung Die Covid-19-Pandemie stellt für das Management von Sammelunterkünften für Geflüchtete eine große Herausforderung dar. Social Distancing und Hygienemaßnahmen sind aufgrund der oft dichten Belegung nur unzureichend umsetzbar. Eine adäquate Informationspolitik sowie ein rasches, effizientes Management von vermuteten sowie bestätigten Fällen von Covid-19 sind essenziell. Eine Evidenzbasis für Maßnahmen fehlt aber weitgehend. Neben teilweise bereits umgesetzten Lösungen wie Isolationsbereiche oder Clusterquarantäne sollten auch Pläne zur Evakuierung dicht belegter Unterkünfte erwogen werden. Dem Öffentlichen Gesundheitsdienst (ÖGD) kommt im Rahmen der Covid-19-Pandemie eine zentrale Rolle zu. Um einerseits Routineaufgaben des Infektionsschutzes wahrnehmen zu können, andererseits ein effizientes gesundheitliches Management von Flüchtlingsunterkünften zu unterstützen, sollte der ÖGD dringend personell wie materiell gestärkt werden. Wege für einen schnellen, Bundesländer übergreifenden Austausch von Best-Practice-Beispielen zu Covid-19-Maßnahmen, sowie Kapazitäten und kollaborative Strukturen innerhalb des ÖGD für operative Begleitforschung wären wichtig. Geflüchtete, ihre Unterbringungssituation sowie ihr Zugang zur Gesundheitsversorgung sollten adäquat in die Pandemieplanung einbezogen werden. Nur ein integratives Gesundheitssystem kann regionale und internationale Zielstellungen zur Kontrolle von Covid-19 und anderen Infektionskrankheiten erreichen.The Covid-19 pandemic poses a major challenge for the management of collective accommodation centres for refugees. The often-overcrowded facilities hinder satisfactory implementation of social distancing and hygiene practices. Adequate information policies as well as a rapid, efficient management of suspected and confirmed Covid-19 cases are essential. However, scientific evidence on this is largely lacking. Besides partially implemented approaches, such as isolation areas or cluster quarantine, plans to evacuate overcrowded facilities should also be considered. The German Public Health Service (OGD) plays a vital role in the current Covid-19 pandemic. In order to fulfil their routine tasks of infection control and support health services management for refugee accommodation centres, the OGD urgently needs to be strengthened in terms of personnel and material. Additionally, means for a rapid exchange of best practice examples of Covid-19 interventions across federal states as well as collaborative structures and capacity within the OGD for accompanying operational research are needed. Refugees, their housing situation and their access to health care need to be included in pandemic plans. Only an integrative health care system can achieve regional and international targets for the control of Covid-19 and other infectious diseases. © Georg Thieme Verlag KG Stuttgart · New York