What might Brexit mean for British tourists travelling to the rest of Europe?

Brexit will have profound implications for British tourists visiting the rest of the European Union, in particular because of the likely loss of coverage of healthcare should they be injured or fall ill. This paper compares the cost of travel insurance within the EU and in comparable countries outside it, asking how it varies by age and pre-existing conditions. Fictitious patients, differing by age, pre-existing condition, and destination (France, an EU Member State; Israel and Canada, two high income non-EU frequent destinations) were entered into an insurance price comparison website to assess the influence of these characteristics on prices quoted. Cost of travel insurance increases with age, pre-existing health conditions and by destination. In those with no pre-existing conditions, there is a marked difference between France, where the cost rises steadily with age, and Israel and Canada, where there is a sharp increase after age 75. For individuals with any one pre-existing condition, there is no similar jump in cost but rather a progressive increase with age, although the rate of increase accelerates as the individuals concerned get older. For all travellers, the cost of insurance is highest for Canada and lowest for France. At present, pre-existing health conditions in British tourists travelling in the rest of the EU are covered by the European Health Insurance Card. With the UK's probable exit from the EU and almost certain loss of this coverage, travellers in the older age groups may have to pay much more for their travel insurance, with some possibly tempted to forgo travel insurance coverage because of the cost. It is essential that health professionals understand how leaving the EU may impact on those seeking their advice.

Addressing Mental Health Needs for Deaf Patients Through an Integrated Health Care Model

Deaf individuals struggle with accessing mental health services because of language and cultural discordance. Our project's purpose was to design and pilot an accessible, integrated mental health program for the Deaf population, scalable for other health centers interested in serving these individuals. Our team addressed several identified barriers to care. The addition of a language-concordant mental health clinician and telemental health appointments helped us better manage Deaf patients' mental health needs. Individual and clinic level data were collected and analyzed. Results demonstrated a significant improvement in the patients' depression and anxiety scores from their baseline to their last documented visit. Patient satisfaction overall was high. Telemental health appears to be a feasible tool to address some of the mental health gaps in the Deaf community. Further studies are needed to demonstrate how this program can be effective within a larger geographical area.

Coping strategies and mental health outcomes of conflict-affected persons in the Republic of Georgia

AIMS

Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders.

METHOD

A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used.

RESULTS

Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed.

CONCLUSIONS

Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.

Gender violence, poverty and HIV infection risk among persons engaged in the sex industry: cross-national analysis of the political economy of sex markets in 30 European and Central Asian countries

Objectives

Persons engaged in the sex industry are at greater risk of HIV and other sexually transmitted infections than the general population. One major factor is exposure to higher levels of risky sexual activity. Expanding condom use is a critical prevention strategy, but this requires negotiation with those buying sex, which takes place in the context of cultural and economic constraints. Impoverished individuals who fear violence are more likely to forego condoms.

Methods

Here we tested the hypotheses that poverty and fear of violence are two structural drivers of HIV infection risk in the sex industry. Using data from the European Centre for Disease Prevention and Control and the World Bank for 30 countries, we evaluated poverty, measured using the average income per day per person in the bottom 40% of the income distribution, and gender violence, measured using homicide rates in women and the proportion of women exposed to violence in the last 12 months and/or since age 16 years.

Results

We found that HIV prevalence among those in the sex industry was higher in countries where there were greater female homicide rates (β = 0.86; P = 0.018) and there was some evidence that self‐reported exposure to violence was also associated with higher HIV prevalence (β = 1.37; P = 0.043). Conversely, HIV prevalence was lower in countries where average incomes among the poorest were greater (β = −1.05; P = 0.046).

Conclusions

Our results are consistent with the theory that reducing poverty and exposure to violence may help reduce HIV infection risk among persons engaged in the sex industry.

To act or not to act: responses to electronic health record prompts by family medicine clinicians

Objective

A major focus of health care today is a strong emphasis on improving the health and quality of care for entire patient populations. One common approach utilizes electronic clinical alerts to prompt clinicians when certain interventions are due for individual patients being seen. However, these alerts have not been consistently effective, particularly for less visible (though important) conditions such as hearing loss (HL) screening.

Materials and Methods

We conducted hour-long cognitive task analysis interviews to explore how family medicine clinicians view, perceive, and use electronic clinical alerts, and to utilize this information to design a more effective alert using HL identification and referral as a model diagnosis.

Results

Four key direct barriers were identified that impeded alert use: poor standardization and formatting, time pressures in primary care, clinic workflow variations, and mental models of the condition being prompted (in this case, HL). One indirect barrier was identified: electronic health record and institution/government regulations. We identified that clinicians' mental model of the condition being prompted was probably the major barrier, though this was often expressed as time pressure. We discuss solutions to each of the 5 identified barriers, such as addressing physicians' mental models, by focusing on physicians' expertise rather than knowledge to improve their comfort when caring for patients with the conditions being prompted.

Conclusions

To unleash the potential of electronic clinical alerts, electronic health record and health care institutions need to address some key barriers. We outline these barriers and propose solutions.