Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe-primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

Background: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. Discussion: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance.

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Summary Psoriasis is a common skin disease affecting approximately 2% of the population. Psoriasis can have a negative impact on patients’ everyday activities and wellbeing. Dermatology Life Quality Index (DLQI) is a widely used measure to assess quality of life in patients with psoriasis. It consists of 10 questions covering symptoms and feelings, daily activities, leisure, work and school, personal relationships and treatment. Each question is scored as follows: ‘not at all’=0, ‘a little’=1, ‘a lot’=2 and ‘very much’=3. However, certain questions of the DLQI such as sports, sexual difficulties and working/studying are not relevant to every patient. As ‘not relevant’ responses are scored as if the item of the questionnaire had no impact on patients’ life at all (=0), they may artificially improve patients’ quality of life scores. For these patients, despite having severe psoriasis, it is more difficult to fulfil the DLQI threshold required by clinical guidelines to become candidates for stronger, systemic treatments such as biologics. This study, from Hungary, involved 242 patients with psoriasis. The authors developed a new scoring for the DLQI questionnaire, namely the DLQI‐R that corrects for the bias in the ‘not relevant’ response option, and proved its validity (i.e. that it works). The DLQI‐R scoring formula eliminates the items marked as ‘not relevant’ while increasing the weight of the relevant items in the total score of the questionnaire. It primarily strives to provide fair access to systemic treatments for psoriasis patients who cannot comply with the DLQI criteria in treatment guidelines because certain items of the questionnaire are simply not relevant to them.

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