bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthy Eating Policy for a provincial health authority in Atlantic Canada
Authors: Kennedy L , Nicholson T , MacDonald B , Jago E , Mah C
Published: October 2020

Issue

Poor diets, the global leading cause of death and disability, are influenced by individual and community factors. Community health care settings have the potential to shape dietary behavior through food and beverage environments, and a healthy eating culture that supports the healthier choice as the easier choice.

Description of the Problem

The Nova Scotia Health Authority (NSHA) is a provincial government health authority in Atlantic Canada, responsible for delivering services to nearly 1 million people in 10 hospitals, 8 ERs, and 135 community locations. The NSHA employs over 23,400 health workers. In 2015, the NSHA centralized its governance, merging 9 regional health districts into one. Policies and procedures were re-written with a provincial focus, including a new Healthy Eating Policy (HEP) adopted in 2018. In this paper, we discuss the implementation of the HEP as a case study for how healthy eating can be fostered through continuous quality improvement.

Results

The policy upholds NSHA as a community leader working collaboratively with internal and external partners. To be a credible leader in changing the landscape around healthy eating, NSHA agrees to “walk the talk” and model an evidence-based healthy eating policy. A hospital in Halifax piloted pricing, placement and promotion interventions to further support healthier eating. These have been expanded to other sites across NS.

Lessons

1) Internal Capacity Building - A Healthy Eating Steering Committee promotes healthy eating across the health system, including initiatives in partnership with auxiliaries, foundations and staff. 2) Improving Evaluation Infrastructure- The interventions led to strategic thinking of future point of sale systems and ways to improve data collection for evaluation 3) Academic Partnerships - NSHA and Dalhousie University formed a collaborative partnership to strengthen evaluation capacity making use of the latest evidence and methods from food environments research.

Key messages

The Nova Scotia Health Authority’s Health Eating Policy supports healthy eating across the province, and promotes supportive environments where the healthier choice is the easier choice. A hospital site in Halifax, NS, implemented a variety of pricing, placement and promotion interventions to promote a healthy workplace environment for employees and community members.
Occupational exposure to pesticides and hematological neoplasms in southern Brazil
Authors: Lopes Gomide P , Portela de Assis M , Pereira Corrêa C S , Magedanz M C , Mocelin G , Sausen A G , Lisboa Riquinho D , Pollo Renner J D , Hedwig Pohl H , Frantz Krug S B
Published: October 2020

Background

Rural workers are highly exposed to pesticides, suggesting vulnerability to the development of hematological neoplasms. Thus, the relationship between the variables of the occupational profile of farmers exposed to pesticides with the presence of this disease was analyzed.

Methods

Retrospective, quantitative, descriptive cross-sectional study. Data were collected from farmers diagnosed with hematological neoplasms being treated at an oncology center. A questionnaire with occupational variables and exposure to pesticides was used. The data was analyzed using the Statistical Package for the Social Sciences software. Descriptive statistical analysis and Chi-square test were used, considering p < 0.05. The Research Ethics Committee of the University of Santa Cruz do Sul, under opinion 3.017.507, approved the study.

Results

Of the 72 farmers, there is a period of more than 30 years of exposure to pesticides (62.3%) and an early start in agricultural activities (95.8%). Failure to use Personal Protective Equipment (71.1%) and the use of 3 different types of pesticides (66.6%). Regarding cultivation, a greater proportion of tobacco producers (72.2%) and a smaller number of yerba mate producers (13.9%). A positive association between tobacco cultivation and the presence of the disease was identified (p = 0.040).The use of types of pesticides was compared and a significant difference was observed regarding the initial age in agriculture (p = 0.027), the daily workday (p = 0.035) and the cultivation of tobacco (p ≤ 0.01).

Conclusions

It is suggested a relationship between tobacco cultivation and the existence of the disease, since there was a statistical association between them. It is also suggested that the lower the age and the longer the workday, the greater the consumption of different types of pesticides.

Key messages

Actions to promote health are necessary, which may include educational actions, with the objective of stimulating changes in the lifestyle and work of the rural population. Rural workers are highly exposed to pesticides, suggesting vulnerability to the development of hematological neoplasms.
The voice of community: self-care from the perspective of vulnerable populations. Brazil, 2019
Authors: Kolchraiber F C , Santana C L A , Tanaka L H , Souza E S , Mayer I A S , Souza K M J
Published: October 2020

Background

Social vulnerabilities influence the beliefs and practices of people about care, resulting in worse health rates, including those related to self-care. Multidimensional care and the complexity of social vulnerability converge to lack of health resources and human rights violations. In this context, how do people perceive practices that promote individual and collective well-being?

Methods

Using qualitative methods, theoretically based on the notion of care as a way of being-in-the-world, according to Leonardo Boff. We conduct 24 interviews with participants belonged to the Parelheiros region and from Non-Governmental Organizations, in a Center of Excellence in Early Childhood in São Paulo. For data collection, focus group technique was used with material transcribed, and analyzed with thematic content analysis.

Results

Two themes emerged (1) Meanings of self-care: related to sense of agency, self- perception and self-regulation (2) Practices to promote self-care: related to promote friendship, voluntary work, psychotherapies, spirituality, breathing exercise, emotional regulation and dialogue.

Conclusions

Social vulnerability sometimes normalize lack of self-care in people's daily lives and work, due to perpetual social injustice The perceptions of self-care are broad and plural, based on the concept of care as a particular way of being-in-the-world. These results have implications in the field of public health, with regard to teaching and health promotion practices, reflecting the living conditions of social subjects.

Key messages

The research contributes to reflection on how the vulnerable populations, especially in the contexts of social and political crisis, organize themselves to care for their own through self-care. Promotion of individual and collective well-being in social vulnerability scenarios is in line with Global Health and involves reflecting on sustainable interdependence to maintain life with equity.
Overcoming the gap between professional domains: A Dutch case study tackling childhood obesity
Authors: van de Goor L A M , van Mil M , SAA de Laat  , Jacobs M A M , van Mil E G
Published: October 2020

Background and Aim

In the Netherlands about one in seven 1- to 11-year-old children are overweight. The multifaceted nature of childhood overweight requires joining forces across the medical, social and public sector. This study evaluated an integrated network approach of preventive care (INPC) for overweight children focusing on the process of intersectoral professional collaboration.

Methods

Fourteen network partners from the three sectors were interviewed face to face with semi-structured topic lists to determine the extent of collaboration in and outside sectors, the perceived outcomes and the hindering and facilitating factors.

Results

Collaboration within each sector was adequately established and all partners were in contact with the central care provider who functions as linking pin in the INPC. However, collaboration across sectors was not optimally realized. Both the medical and public domain partners indicated to have minimal contact with professional partners from the social domain, while they were perceived important in the INPC. Main hindering factors were related to the complexity of the childhood overweight problem, a lack of knowledge about network partners, unclarity in referrals, feedback, roles and responsibilities. In addition, frequent changes in policy, in personnel, lacking a visible leader, funding and time, were also hindering. Facilitating factors were: a general positive attitude towards intersectoral collaboration, knowing each other, short communication lines, a shared vision, trusting each other's expertise, and also formalized agreements and local health policy, and periodic meetings with partners.

Conclusions

Realizing professional collaboration across domains to tackle childhood overweight requires specific attention to structural factors enabling professionals to do so in their daily work. Stable funding and policies, clear responsibilities on the one side, getting to know each other, trust and positive attitudes on the other.

Key messages

An integrated approach for childhood overweight requires professionals to work across borders. However, in daily practice professionals experience structural factors hindering such collaboration. The functioning of networks linking professionals from public health, medical and social domains, essential in preventing childhood overweight, requires specific attention for organizational aspects.
The profile of vulnerable students using the university psychosocial and medical care services
Authors: Papadakaki M , Sarakatsianou F , Tsismeli V , Lapidakis G , Karapiperaki M
Published: October 2020

Background

Increasing the capacity of higher education institutes to address students' vulnerabilities has been deemed necessary due to the financial crisis. Multilevel interventions have thus been initiated at the Hellenic Mediterranean University of Crete, as part of a project co-financed by Greece and the European Union (European Social Fund-ESF) through the Operational Programme <> (MIS 5045937). The project aims to offer support to students with low family income or a certified disability, monitor their bio-psychosocial needs, increase their accessibility to health and psychosocial care, and improve their academic outcomes.

Methods

As part of the project, a primary health care unit has been set up to offer medical and nursing care (medical unit) as well as psychosocial support (counseling centre) to students in need. An observatory has also been set up to monitor their health and psychosocial needs and their academic progress.

Results

A total of 228 eligible students used the services in the second half of 2019 (counseling centre 37; medical unit 191). Out of the 37 individuals who used the counseling centre, 30 (81.0%) were female and 16 (43.2%) were at the first 2 years of their studies. A total of 36 (97.3%) requested psychological support, 6 (16.2%) warranted social welfare services and 1 (2.7%) support for learning disabilities. As for the 191 individuals who used the medical services, 101 (52.8%) were male and 88 (46.0%) were at first 2 years of their studies. Most of them had a health examination to receive a health certificate (74.8%) followed by those who received emergency care (e.g. respiratory infection, allergic reaction, injury, etc), chronic disease management and medicine subscription, as well as vaccination.

Conclusions

Complex bio-psychosocial needs have been identified, recorded and analyzed to explain the academic progress of socially vulnerable students.

Key messages

The students’ journey through medical and counseling services is being mapped to offer important information for educational policy. Assessment and monitoring of students’ complex needs are important to achieve quality in higher education.
The Italian well-being: a race against time
Authors: Cuccaro C , Bezzini D , Vaccaro M C , Coletta V , Messina G , Battaglia M A
Published: October 2020

Background

Well-being is the result of many factors such as health, happiness, expectations, values. Italy has been one of European countries that in recent years has suffered most combination of economic, political and social stress, with consequences on well-being. The aims of study are i) to examine health and happiness perceptions of young adults ii) to compare actual results with a previous survey conducted in 2004.

Methods

A descriptive cross-sectional study was conducted between Jan-Dec 2017. A validated questionnaire was administered from the Italian Centre for Social Investment (CENSIS) to 1,003 young Italians, aged 18-40. The anonymous questionnaire investigated emotional aspects, health status, social life and socioeconomic status. The statistical analysis (chi-square p < 0.05) was carried out to evaluate the association between the items of the questionnaire and variables such as age, sex, education level, income, work status, Marital Status (MS), Self-Confidence (SC), social-life.

Results

The sample resulted quite happy (2017 vs 2004:56.1% vs 63.7%), the happiness increasing with the socio-economic level and appearing to be related to work status, MS, SC and income (p < 0.05). Good or excellent health were reported by 89.8% (2004:86.1%) with a decrease in older age, and significant differences for all studied variables (excluded MS). Although the majority declared to be satisfied with their social life (2017 vs 2004:73.4% vs 85.7%) and economic status (2017 vs 2004:49.8% vs 70.7%), the future still seems uncertain, with respondents unabled to make predictions about work (2017 vs 2004:49.9% vs 19.8%) or when having children (2017 vs 2004:44.6% vs 61.2%).

Conclusions

Quality of life of Italians is still satisfactory, with a good degree of happiness and health, despite a clear decrease compared to 2004. The survey highlights that young people continue to perceive the future as uncertain, mainly due to job instability, with difficulty planning their lives.

Key messages

In ten years the Italian well-being has been reduced, despite the perceived level of happiness and health still being positive. The lack of job opportunities, the awareness of employment instability are the main causes of the lack of confidence in the future.
Pilot test of a train the trainer programmes on Road safety education
Authors: Papadakaki M , Kounali V , Lioliou S , Christoforidi E , Chatzidrosou D , Vasilakis E , Tamoutsidou A , Vagionaki K , Vasilaki I , Chliaoutakis J
Published: October 2020

Background

Road injury is the leading cause of death for young people aged 5-29 years worldwide. As the human factor has been shown to be responsible for more than 3/4 of road incidents, changing safety attitudes and driving behaviours among youth is crucial to combat this public health issue. The current study is part of a project implemented by the Laboratory of Health and Road Safety (LaHeRS), in collaboration with the Lead Authorities of Primary and Secondary Education of Crete and with the financial support of the Region of Crete. The project started in 2019 and aims at promoting a road safety culture among school teachers of primary and secondary education in Crete Region through improving their competence in designing and implementing road safety education in class.

Methods

The program consists of three phases: a) 20 hours face-to-face training (e.g. needs assessment techniques, teaching approaches and techniques addressing risky driving, evaluation methods, practical training using the advanced technology of the driving simulator of LaHeRS Lab <> etc), b) 30 hours distant learning using an online training program and appropriately designed training handbooks to support personalized training and, c) small-scale pilot projects of road safety education in classrooms, upon the scientific guidance and supervision of the LaHeRS research staff. For the purposes of the evaluation a questionnaire was completed to detect changes in teachers' competence to design and implement road safety education as well as their knowledge and attitudes (e.g. DSI, DBQ questionnaires) towards road safety.

Results

A total of 160 teachers participated in the 2019-2020 training programme, including 129 women, 109 primary and 51 secondary education teachers with a mean age of 43.4 years and a mean teaching experience of 16.5 years. The programme met high acceptability and raised significant teachers' confidence in delivering road safety education.

Key messages

The project proved to be efficient in addressing the pedagogical gaps in road safety education. Road safety education should be part of health promotion initiatives targeting children and adolescents.
“Sagen – Fragen – Verstehen” – Towards health literate health organisations in Vienna
Authors: Zillmann N , Novosad H , Hübel U
Published: October 2020

The concept of health literate health care organisation (HLHO) was introduced in 2012. Organisational health literacy is defined as an effort to transform and develop organisations (in the health sector) to enable users and employees to navigate, understand and use information and services to take care of their health.

To support hospitals and long-term care facilities in Vienna to become HLHO the Vienna health promotion (WiG) has set up a project (2017 - 2021) with 11 pilot units from 5 care institutions. Starting with an interprofessional self-assessment tool (SAT) on HLHO, most modules, like employee and patient/next of kin empowerment, trainings to improve the quality of staff-patient communication as well as workshops on health literacy are being carried out concurrently and similarly by all pilot units. In addition, pilot units implement local organisational development projects addressing issues identified in their SAT. As part of process monitoring pilot unit project leads meet regularly in workshops to discuss their learnings and project progress.

Preliminary results show that health literacy workshops in participating institutions are well-received, also the joined learning in the regular project lead workshops. Many employees in the participating institutions took part in project-associated evaluation measures. Communication trainings were very popular, especially the use of simulated patients was rated highly. Project impact on doctor-patient-communication is currently being evaluated.

Health literacy workshops seem appropriate to sensitise employees for the importance of patient-staff communication, but are challenging in terms of organisation. The SAT was considered useful to approach the topic of HLHO, but was perceived as somewhat lengthy. The interprofessional approach to the SAT could be a barrier for some institutions. Developing handouts in cooperation with persons concerned can be challenging but is highly gainful.

Key messages

As result of this project the 11 participating pilot units are one step closer to becoming HLHO. The concept of HLHO seems useful in improving health literacy.
Family vulnerability to support the organization of demand for public dental health service
Authors: Peres Neto J , Laura Cortellazzi Mendes K , da Luz Rosario Sousa M
Published: October 2020

The objective of this study is to analyze vulnerability/family risk instruments with socio-demographic and dental care factors, and to approach spatially the instrument. This was a cross-sectional study carried out in 2017 that included 114 families from Ubirajara, Sao Paulo, Brazil. The dependent variable was vulnerability/family risk instruments proposed by Coelho and Savassi, classified as “no risk” and “presence of risk”. The independent factors were selected based on theoretical model of access concept proposed by Andersen and organized into three hierarchical blocks: predisposing factors, facilitators and perceived needs. We conducted a bivariate analysis and estimated hierarchical logistic regression model, which was adjusted and evaluated using the Akaike's information criterion (AICC), remaining in the final model a p ≤ 0.05. The Kernel density estimation was used for spatial analysis of concentration of families. In bivariate analysis, vulnerability/family risk was associated with less years of formal education (OR = 2,42; 1.13-5.19), household with more than 4 individuals (OR = 3.25; 1.47-7.20), lower family income (OR = 2.53; 1.04-6.13), dissatisfaction with oral health (OR = 3.18; 1.45-6.98), shame to smile and to speak (OR = 4.08; 1.52-10.94) and inability to sleep (OR = 2.90; 1.10-7.60). Household with more than 4 individuals (OR = 3.46; 4.66-8.16), individuals who were unsatisfied with oral health (OR = 2.38; 1.00-5.67), and who had shame to smile and to speak (OR = 3.03; 1.01-9.13) had more chance of “familial risk”. Spatial analysis enabled to observe great concentration area “familial risk”, which indicated that this area has priority for development of actions. The association of the analyzed instrument, by including socio-demographic and dental care factors, in addition to help to observe and determine the most vulnerable areas, also helped us to conclude that such instrument may be adopted by oral health care teams in order to promote high equity access

Key messages

Help to observe and determine the most vulnerable areas. The instrument may be adopted by oral health care teams in order to promote high equity access.
Moving out of the silos through interprofessional education: what do we know and where do we go?
Authors: Bonello M
Published: October 2020

Interprofessional education (IPE) is increasingly being recognised as one way how to develop a collaborative health workforce better equipped to deal with the diversity and complexity of future healthcare contexts [1]. IPE could also contribute towards blurring some of the institutionally demarcated professional boundaries and silos, so widespread in most health professional education and health systems. However, despite the rhetoric of IPE, the development of this pedagogy remains variable worldwide. The challenges of developing, implementing and sustaining interprofessional education are often underestimated or overlooked. Achieving an interprofessional agenda is a wicked problem [2] and is at odds with the prevalent and privileged medical narrative, sharp professional domains, traditional curricula and scarce resources.

This presentation which stems from primary research and a systematic search and review of the literature, aims to de-construct IPE by moving beyond the rhetoric of this pedagogy; precisely by acknowledging its complexity, and the myriad of micro, meso and macro level determinants that influence its development. It will map out key recommendations of what is needed to move IPE forward. It is only when we reflect and engage in such dialogues that we can start to develop a range of context-specific IPE curricula aspiring towards a collaborative health workforce. Kuhlmann, E., Batenburg, R., Wismar, M., Dussault, G., Maier, C. B., Glinos, I. A., ... & Groenewegen, P. P. (2018). A call for action to establish a research agenda for building a future health workforce in Europe. Health research policy and systems, 16 (1), 52.Varpio, L., Aschenbrener, C., & Bates, J. (2017). Tackling wicked problems: how theories of agency can provide new insights. Medical education, 51(4), 353-365.

Key messages

Interprofessional education could contribute towards a collaborative health workforce. The road map for sustainable IPE curricula needs to be context-specific acknowledging both enablers and challenges.
Medical students’ knowledge of their future supervisory role of a new cadre
Authors: Wolvaardt L , Koortzen M , Biggs L W , Turner A C , Bac M , Volpes M
Published: October 2020

Background

Clinical associates (ClinAs) are mid-level health professionals in South Africa who must practice under the supervision of a medical doctor. Not only are they a new category of health professional, but it is the first time that medical doctors are directly responsible for the clinical work done by some-one else. By extension medical students should also be prepared for this responsibility. This study explored whether final-year medical students at one university were aware of their future supervisory role, felt prepared and were aware of the ClinAs' scope of practice.

Methods

This descriptive cross-sectional study used a questionnaire adapted from an American study. Final year medical students (n = 151) were invited to participate. Data were analysed with Stata and Microsoft Excel. Ethical permission was granted (53/2017).

Results

The response rate was 77.4% (n/N=117/151). The majority of participants (76.1%, n = 86) had worked with a qualified ClinA or ClinA student before and they were positive (81.4%, n = 70) about working together. Almost half (47.8%, n = 56) thought that ClinAs' scope of work was similar to registered nurses rather than a doctor's (38.2%; n = 44). Most (65.8%; n = 77) were unaware that they would be required to supervise ClinAs once qualified. Among the few who were aware of this future supervisory role (12.8%; n = 15), almost half (46.7%; n = 7) felt adequately trained. A 20-item 'knowledge test' on the ClinAs' scope of practice revealed that on average, participants selected 12/20 treatments or procedures that a ClinA may legally perform.

Conclusions

Despite having worked with ClinAs, participants appeared largely unaware of their future legal obligation. Knowledge of the scope of practice was variable in this study. Main messages: Adequate clinical supervision is based on the knowledge of the scope of practice. Working with ClinAs is not adequate preparation for supervision and formal training is needed to prepare future doctors.

Key messages

Working with ClinAs is not adequate preparation for supervision. Formal training and preparation is needed to prepare future doctors for this new role.
Interprofessional collaboration and chronicity management: a systematic review of clinical trials
Authors: Pascucci D , Riccardi M T , Sapienza M , Nurchis M C , Ricciardi W , Morano C , Damiani G
Published: October 2020

The increasing prevalence of chronic disease generates significant financial, social and psychosocial burden for patients, families and healthcare system. Interprofessional collaboration (IPC) is becoming recognized as a discipline among health and social care professionals and medical training institutions worldwide. Literature research suggests that following interventions could be particularly useful in the management of chronic patients. The objective of this systematic review was to assess the impact of IPC on chronic patients compared to standard health-care practice.

The PICO model was adopted and three electronic databases (Medline, EMBASE, Web of Science) were searched using appropriate keywords. Selected trials were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analyzed using descriptive statistic, and comparison of outcomes among teams with or without pharmacist was performed using t-Student test (p < 0,05).

Out of 11.128, 24 studies met the inclusion criteria and 58 indicators were identified: 62% improved significantly, 38% did not show any variation, no indicator worsened after intervention. In particular, systolic blood pressure (SBP) showed a statistically significant improvement in 70.0 % of trials in which was considered while did not show any difference in the rest. The presence of a pharmacist in the team show a statistically significant improvement on SBP (p = 0,002) in patients with hypertension while no statistically significant effect is observed on glycated hemoglobin (p = 0,193) in diabetics.

The results support that IPC contributes to positive patient, provider and institutional level outcomes, in particular for chronic conditions. Future research should focus on the inclusion of patient/caregivers in the collaborative team, and on the role of interprofessional education (IPE) on collaborative practice in the management of the patient with chronicity.

Key messages

IPC is an innovative strategy to address the complex health needs of chronic populations. Further studies are needed to evaluate the role of IPE in achieving better IPC and improving chronic patients’ outcomes.
Mortality amenable to health care services and health inequalities across the regions of Italy
Authors: Adja Y , Reno C , Lenzi J , Fantini M P
Published: October 2020

Background

Amenable mortality is an indicator that measures the extent to which health services contribute to the improvement of the health of a population. It can also highlight geographical and socioeconomic inequalities. Therefore, it is used to assess quality and performance of health care systems, both at national and subnational level. The Italian National Health Service sets the essential levels of care (Livelli Essenziali di Assistenza, LEA), a health-benefit package for all citizens. Because every region is responsible for providing the LEA and can offer additional health care, monitoring the performance of the Regional Health Services (RHSs) is of increasing interest.

Methods

We used Nolte and McKee's list of amenable conditions to analyze the temporal trend of the standardized mortality rate (per 100.000) in Italy from 2006 to 2015, overall and by gender. We also examined the standardized rate at regional level by comparing the two-year periods 2006/7 and 2014/5, overall and by gender.

Results

Between 2006 and 2015, the overall mortality rate decreased from 81 to 68 per 100.000 population; this reduction was more pronounced in men (91 to 76 per 100.000, -16.5%) than in women (72 to 62 per 100.000, -13.9%). The decreasing trend in amenable mortality affected Italian regions differently, with northern regions showing steeper reductions as compared to southern regions. As a result, 2014/5 was the first time men's mortality in North Italy (68 per 100.000) was lower than women's mortality in South Italy (72 per 100.000).

Conclusions

The overall reduction of amenable mortality shows that Italy's health care services keep contributing to the improvement of population health. Nevertheless, by analyzing RHS performance we saw that differences in organization of care lead to differences in health care quality and performance across regions. Deaths amenable to health care services contribute to inequalities between Northern and Southern Italy.

Key messages

Because universal health coverage is necessary but not sufficient to reduce health inequalities, investing into better-quality services should be recognized as a priority. Amenable mortality can highlight areas of intervention to reduce inequalities in the provision of health care services.
Old-aged patients’ experiences with patient-centered primary health care in Serbia
Authors: Vojvodic K , Wolf G W
Published: October 2020

Objective

The population in Serbia is getting older, with the population aged 65+ increasing from 17.2% to 19.6% (2007-2017). As people age, their health needs become more complex and health services must be adopted to their needs. Patient-centeredness is regarded as the basis for modern healthcare services. Patients' satisfaction surveys are widely used to identify experiences of patients, including old ones. The aim of this study was to assess old-patient centeredness of primary healthcare (PHC) in Serbia according to patients' experiences with healthcare workers.

Methods

Between 2009 and 2015 cross-sectional studies were conducted in 169 Serbian PHC centers (160.948 patients), thereby using a questionnaire referring to socio-demographic characteristics, preventive care counseling, experiences with general practitioners (GPs) (knowledge of patients' health status, listening, giving clear explanations concerning illness and medicines), nurses (friendliness and provision of information), co-payment for healthcare and the overall satisfaction with PHC. Non-parametric tests (Chi-square and Kruskal-Wallis) were used for statistical analyses.

Results

A large portion of the respondents asserted to be satisfied or very satisfied with the obtained PHC services, the majority had positive experiences with GPs and nurses. About one third (32.7%) of patients were 60 years or older. Significant differences concerning the number of positive experiences in contact with GPs and nurses were found between age groups. In both domains patients 60 years or older, had more positive experiences and were overall more satisfied with PHC services than younger (p < 0.001).

Conclusions

The results show that old aged patients have positive experiences with GPs and nurses in Serbian PHC. Primary health care meets their needs and can be regarded as patient-centered. The main limitation of the study was the lack of a questionnaire specific for old aged, which could better explore their needs and experiences.

Key messages

Patient-centeredness is regarded as the basis for modern healthcare services and doctors and nurses have leading role in providing patient-centered healthcare. Old aged patients have specific healthcare needs and health systems have big challenge in obtaining adequate health care with good health outcomes.
Integrating PET/CT unit into the NHS of a small sized EU state: A financial cost efficiency study
Authors: Giannakou K , Kefallonitou D , Polycarpou I , Souliotis K
Published: October 2020

Background

According to the Ministry of Health in Cyprus, since 2009, every year more than 3.000 new incidents with neoplasm are diagnosed. The National Health System (NHS) of Cyprus aims to offer adequate health services, comparing them with European Union standards. However, it is lacking a Positron Emission Tomography-Computed Tomography (PET/CT) unit. The present study aims to examine whether an investment by the Cyprus NHS of a PET/CT unit can be financially sustainable.

Methods

A financial analysis of the operating revenues and expenses of a departmental PET/CT with F18-FDG was performed taking into consideration all related parameters. A detailed estimation of the unit's operation expenses (PET/CT unit supply, overheads, salaries, etc.) and incomes was produced for a 15-year period. This initial scenario was not financially viable and therefore two alternatives are also examined.

Results

After performing a detailed analysis and projection for the evaluation of the feasibility study in the initial scenario, the overall outcome is estimated negative deriving to a €2,2 million losses in the cumulative results by 2035. The second scenario concluded that the required number of incidents to reach a neutral cash flow after a 15-year period should increase from 8.971 to 23.430. The third scenario reached the conclusion that a parallel investment to the purchase of the PET/CT unit by installing a cyclotron unit in the Cypriot NHS provides cumulative results positive of €1,7 million for the PET/CT, in the same period, that can finance the largest part of the €2,5 million required for the installation of the cyclotron unit.

Conclusions

Our findings show that an investment of a sole PET/CT unit is not a financially viable. Alternative possibilities such as usage of a PET/CT operated by the private sector or supporting patients to travel to another country are within the economic terms recommended.

Key messages

From a financial viewpoint, the scenario of investing in a PET/CT unit by the Cyprus NHS is not viable. Examining alternative options for patients in need of a PET/CT unit, where the initial investment cost for the state is not financially viable.
Team-based care intervention: views and perspectives from patients and healthcare professionals
Authors: Pais B , Wuerzner G , Chiolero A , Schaller P , Cloutier L , Paradis G , Burnier M , Santschi V
Published: October 2020

Background

Blood pressure (BP) control is poor in European countries. Team-based care (TBC) intervention involving different healthcare professionals has the potential to improve BP control. Within a patient-centered approach, we evaluated patients' and healthcare professionals' opinion about a TBC intervention involving nurses, pharmacists, and physicians (MD).

Methods

As part of the TBC study, a pragmatic randomized controlled study to evaluate the impact of a TBC interprofessional intervention on BP control, we collected opinion of patients and team-based members (nurses, community pharmacists, and MD) at the end of study period using specific questionnaires. A mean TBC-satisfaction score was computed, assessing various aspects of the intervention, and ranged from 0 to 60, where a higher score represents a greater satisfaction.

Results

All patients (100%), pharmacists (100%), MD (92%) and nurses (80%) were satisfied with TBC intervention. Most patients considered that TBC can help improving BP control (92%), drug intake (71%), and lifestyle habits (84%). Furthermore, patients reported that TBC improved their relationship with nurses (66%), pharmacists (55%), and MD (50%). Patients also reported that their discussion with nurses (95%) and pharmacists (89%) helped improve medication intake. Healthcare professionals considered that TBC improve the quality of care (91%) and an added value for the management of chronic disease (79%). Mean TBC-satisfaction score was higher among MD [42 (SD: 9)] and pharmacists [45 (SD: 6)] compared with nurses [36 (SD: 9)].

Conclusions

Overall, patients and healthcare professionals were highly satisfied regarding TBC engaging different healthcare professionals in a primary care setting.

Key messages

TBC intervention seem to be well appreciated by patients and healthcare professionals. Favourable patients’ and healthcare professionals’ perspectives will help implementing TBC intervention.
Challenges and innovations in Primary Health Care in the Amazon: A Scoping Review
Authors: Sousa A , Wallace C , Farmer J , Herkrath F J , Bousquat A
Published: October 2020

Background

The Amazon region crosses the territorial borders of nine countries with a vast complexity of ecological and social relations. Outside of large and medium cities, this region comprises a mosaic of ranches, villages, farms, isolated houses and small towns scattered over a vast territory, in large part accessed only by waterway. Working with health in this region requires specific strategies that respect the dynamics of this place. This research aimed to reveal the challenges and innovations of Primary Health Care (PHC) in places outside the largest cities in the Amazon.

Methods

The scoping review methodology was applied to peer-reviewed articles. Six databases were searched to identify scientific papers published in English, Spanish and Portuguese between January 2000 and November 2019. The analytical strategy was to combine descriptive statistics and qualitative content analysis to extract from each article all the content related to the research questions.

Results

This review included 26 papers. The most frequent challenges reported in the studies were related to the way of working (8), specific training for professionals (5), leadership and governance (4) and infrastructure improvement (2). A smaller number of studies were dedicated to innovative experiences, which approached training and methodologies for health agents recruited in the communities (4), technologies to the services (2) and a river unit as a model to work in Amazon(1).

Conclusions

The challenges presented in this review indicate the need to build services that are more sensitive to Amazonian locations and the need to train professionals for this region. Also, it revealed innovations with positive impacts which can be taken as key lessons regarding the functioning of PHC in the Amazon.

Key messages

This research fills a knowledge gap about PHC in the Amazon. The challenges and innovations presented in the review provide insights to assist PHC policy makers and managers with the design and delivery of health services in the Amazon.
External causes in women assisted by the Mobile Emergency Service - SAMU, in Espírito Santo, Brazil
Authors: Machado E , Almeida F , Neto C , Barbosa R , Sogame L , Oliveira J , Pinto H , Duarte S , Vieira L
Published: October 2020

Background

External causes are events that lead to traumas, injuries and any health problems, whether deliberate or not, with sudden onset and with immediate consequence, which may or may not lead to death or incapacitating injuries. Studies show that the main causes of death of women in fertile period are external causes, and they associate this fact with the change in habits and lifestyle adopted by this group in modern times that make them more vulnerable to the risks of becoming ill or dying from such causes. The objective of this study is precisely to analyze the prevalence of the main external causes in women assisted by SAMU 192 in Espírito Santo, Brazil, and in this way, assist in the development of accident and violence prevention strategies and also contribute to the scientific society through the description of the profile epidemiological profile of these events.

Methods

This is a cross-sectional study of primary care provided by SAMU 192, in the state of Espírito Santo, in 2015, in which only women victims of traffic accidents, aggression or falls were selected.

Results

Among the women assisted by SAMU 192, 23.5% were victims of accidents and violence. Of this total, 48.6% received assistance for falls, 46.6% for traffic accidents and 4.9% for aggression. Adulthood was the most frequent, with an average age of 44.9 ± 22.7 years.

Conclusions

External causes involving women represent a major problem in Brazil and worldwide. In Espírito Santo, falling was the most common type of external cause and mainly affected the elderly woman, while the traffic accident mainly affected the adult woman. As for the aggressions, these occurred mainly at night with association with the use of alcoholic beverages. Thus, it is immensely necessary to develop actions to promote and prevent external causes of harm to women's health in the state of Espírito Santo.

Key messages

Knowing what affects the most women's health in an emerging country like Brazil, is essential for public policy actions aimed at reducing the femininity, sexism and the death of women in general. Violence against women is an underreported event because of several factors, leading to the concealment of violence, emphasizing once again the importance of public policies for this purpose.
Experiences of using Cochrane systematic reviews by local HTA units
Authors: Poder T G , Rhainds M , Bellemare C , Deblois S , Hammana I , Safianyk C , St-Jacques S , Dagenais P
Published: October 2020

The aim of this study is to evaluate the utilisation of CSRs by Quebec's local health technology assessment (HTA) units to promote efficiency in hospital decision-making. A survey was conducted using a structured online questionnaire to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by two independent evaluators (TGP and CAB). Ten HTA units participated. Mean number of staff was 6.3 [2-18], producing about 4.7 reports per year [2-7.3]. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well known and HTA units were highly satisfied with CSRs (80-100%). However, only 24.7% (21/85) of topics were searched with success. As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (e.g. brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context (lack of contextualisation); Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. HTA units generally use other articles from the literature or produce an original systematic review in complement with CSRs. These results led to some suggestions to improve the use of CSRs by HTA units. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation.

Key messages

The main limit for the use of CRS in local HTA will remain its lack of contextualization. Context and scientific data are complementary.
Anti-meningococcal B vaccination in Italian adolescents: a cost-effective health opportunity
Authors: Panatto D , Landa P , Amicizia D , Lai P L , Lecini E , Bechini A , Bonanni P , Boccalini S
Published: October 2020

Background

Invasive disease due to Neisseria meningitidis (Nm) is a serious public health problem even in developed countries, owing to its high lethality rate (8-15%) and the invalidating sequelae suffered by many (up to 60%) survivors. As the microorganism is transmitted via the airborne route, the only available weapon in the fight against Nm invasive disease is vaccination. Our aim was to carry out an HTA to evaluate the costs and benefits of anti-meningococcal B (MenB) vaccination with Trumenba® in adolescents in Italy, while also considering the impact of this new vaccination strategy on organizational and ethics aspects.

Methods

A lifetime Markov model was developed. MenB vaccination with the two-dose schedule of Trumenba® in adolescents was compared with 'non-vaccination'. Two perspectives were considered: the National Health Service (NHS) and society. Three disease phases were defined: acute, post-acute and long-term. Epidemiological, economic and health utilities data were taken from Italian and international literature. The analysis was conducted by means of Microsoft Excel 2010®.

Results

Our study indicated that vaccinating adolescents (11th year of life) with Trumenba® was cost-effective with an ICER = € 7,912/QALY from the NHS perspective and € 7,758/QALY from the perspective of society. Vaccinating adolescents reduces the number of cases of disease due to meningococcus B in one of the periods of highest incidence of the disease, resulting in significant economic and health savings.

Conclusions

This is the first study to evaluate the overall impact of free MenB vaccination in adolescents both in Italy and in the international setting. Although cases of invasive disease due to meningococcus B are few, if the overall impact of the disease is adequately considered, it becomes clear that including anti-meningococcal B vaccination into the immunization program for adolescents is strongly recommended from the health and economic standpoints.

Key messages

Free, large-scale MenB vaccination is key to strengthening the global fight against invasive meningococcal disease. Anti-meningococcal B vaccination in adolescents is a cost-effective health opportunity.