bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic disease prevalence and patterns of comorbidities in people with intellectual disabilities
Authors: van den Bemd M , Schalk B , Bischoff EWMA , Cuypers M , Leusink GL
Published: October 2021

This study aims to examine chronic chronic disease prevalence in people with ID compared to those without ID in primary care settings and comorbidity patterns accompanying chronic diseases, by focusing on age and sex differences. With a focus on the four highest-impact chronic diseases worldwide and individually, ischemic heart disease, cerebrovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease (COPD), it is assessed to what extent these diseases affect people with ID. Two databases are linked, that of Nivel Primary Care Database, a large representative sample of Dutch citizens registered in general practices, and non-public microdata from Statistics Netherlands, containing information on indication of long-term care or supportive services for people with ID. With prevalence rates and odds ratios chronic disease prevalence and comorbidity patterns were established by total groups of people with and without ID and by sex and age groups. Results displayed differences in chronic disease prevalence in people with and without ID: cardiovascular diseases were less prevalent, and diabetes mellitus more prevalent in people with ID. At relatively young age (<50 years), people with ID not only had more chronic diseases, but also more often had multiple comorbidities compared to those without ID. The most common comorbidity in all chronic diseases was hypertension, while diabetes mellitus as comorbidity also occurred often. This study is the first to present chronic disease prevalence and comorbidity patterns across the groups of people with and without ID and by sex and age groups. It can therefore be used as source of accurate information on the health prevalence and patterns of people with ID compared to the general populations, and provides a novel insight into differences in the group of people with ID.
Mental health care for adults with mild intellectual disabilities: A retrospective database study
Authors: Pouls K , Cuypers M , Mastebroek M , Koks-Leensen M , Wieland J , Leusink GL , Assendelft P
Published: October 2021

People with mild ID suffer more mental health disorders (MHD) than people without ID. Practitioners working in mental health services (MHS) indicate limited knowledge and experience to provide the care needed. Besides diagnosing MHD, identification of the ID itself is a challenge and not all people with a ID are recorded in the MHS as such. These factors contribute to insufficient care and can result in chronic, more difficult to treat MHD. For this study, all adult users of Dutch MHS between 2015 and 2017 were enrolled in MHS databases of Statistics Netherlands. Presence of mild ID was established by linking MHS data with social services and chronic care databases. Characteristics of new cases of MHC were analyzed and compared between patients with and without mild ID. Linking databases identified 11,374 MHC patients with mild ID, and 525,162 patients without ID. A substantial proportion of patients with mild ID did not have this characteristic noted in their MHS records (60.6%). Preliminary results showed people with mild ID were younger, were more often man, had different diagnostic profiles, required more crisis interventions, and more psychiatric hospital admissions compared to people without ID. In addition, people with a mild ID and no ID record in MHS received less treatment compared to both people with mild ID and a ID record, and people with no ID. According to these findings, the prevalence of MHD and provided care between people with and without a mild ID, in MHS deviated. The Mild ID is potentially under recognized among MHS patients. The findings are a first step towards improving mental healthcare for patients with ID.
Is outsourcing healthcare to private providers associated with higher mortality rates in NHS England?
Authors: Goodair B , Reeves A , Rahal C
Published: October 2021

Background

Outsourcing services to for-profit organisations within a publicly funded healthcare service which runs parallel to private provision in a ‘two-tier' system aims to increase the competition between healthcare providers, driving up their performance. However, some worry that contracting out health services to for-profit providers may lead to cost-cutting and poorer outcomes for patients. We aim to assess whether increased outsourcing to the private sector is associated with changes to treatable mortality rates, and, therefore, with the quality of healthcare.

Methods

We construct a novel database compiling every procurement contract over 7 years (n = 646,938, total value = £204.1bn) across England's Clinical Commissioning Groups (regional health boards). We identify institutions registered on the Companies House registry which supply regional commissioners in England's NHS, and then aggregate this annually with local mortality data. By exploiting the commissioners' variation in spend on private sector providers, we estimate the association between outsourcing and treatable mortality rates in the following year. We account for year and individual fixed effects and control for multiple covariates, including average household income, Local Authority spending, and population size.

Results

Our sample comprised 173 Clinical Commissioning Groups between 2013 and 2020. In general, outsourcing increased over this period, but the extent of change varied substantially. Some areas, like East Riding of Yorkshire, saw very large increases but others saw reductions. We find an annual increase of one percentage point of outsourcing to the private sector corresponds with an annual increase in treatable mortality of 0.34% (95% CI 0·10% to 0·58%) in the following year.

Conclusions

The incorporation of private sector providers into England's NHS appears to be corresponding with a decline in the quality of healthcare services.

Key messages

The private provision of healthcare services has generally increased across England's NHS since 2013. Increased outsourcing of services to private sector providers is associated with increased treatable mortality rates.
Food industry shaping of the principles of scientific integrity
Authors: Mialon M , Ho M , Carriedo A , Ruskins G , Crosbie E
Published: October 2021

Background

There is evidence that food industry actors try to shape science on nutrition and physical activity. But they are also involved in the influence of scientific integrity principles. Our research objective was to study the extent of that involvement, with a case study of ILSI as a key actor in that space.

Methods

We conducted a qualitative document analysis, triangulating data from an existing scoping review, publicly available information, internal industry documents, and existing freedom of information requests.

Results

Food companies have joined forces through ILSI to shape the development of scientific integrity principles. These activities started in 2007, in direct response to the growing criticism of the food industry's funding of research. ILSI first built a niche literature on conflicts of interest (COI) in food science and nutrition at the individual and study levels. Because the literature was scarce on that topic, these publications were used and cited in ILSI's and others' further work on COI, scientific integrity, and PPP, beyond the fields of nutrition and food science. In the past few years, ILSI started to shape the very principles of scientific integrity then and to propose that government agencies, professional associations, non-for-profits, and others, adopt these principles. In the process, ILSI built a reputation in the scientific integrity space. ILSI's work on scientific integrity ignores the risks of accepting corporate funding and fails to provide guidelines to protect from these risks.

Conclusions

The activities developed by ILSI on scientific integrity principles are part of a broader set of political practices of corporations to influence public health policy, research, and practice. It is important to learn about and counter these practices as they risk shaping scientific standards to suit corporate interests rather than public health ones.

Key messages

ILSI, a group funded by corporations, shaped the very principles of scientific integrity. ILSI built a reputation in the scientific integrity space.
Hospital-level risk factors for healthcare-associated infections: insight from the Italian PPS Study
Authors: Garlasco J , Vicentini C , D'Ambrosio A , Quattrocolo F , Zotti CM
Published: October 2021

Background

In 2016-2017, a Point Prevalence Survey (PPS) was conducted by the European Centre for Disease Prevention and Control (ECDC) in 29 European countries to investigate healthcare-associated infections (HAIs) and antimicrobial use. The aim of this study was to identify significant determinants of HAIs at a hospital level according to Italian data.

Methods

Among variables considered by the ECDC Protocol for the PPS, those with most plausible relationship with HAI occurrence according to the literature were a priori selected. Hence, conceptual causal models were built for each reference variable, by adjusting for an established set of confounders (geographical region, hospital type and number of beds), and also considering the possible interaction of the number of blood cultures per 100 patient-days (a proxy of how thoroughly HAIs are searched). Direct effects were estimated in the form of risk ratios through multivariable log-binomial regression models.

Results

Data were available for 135 Italian hospitals participating in the survey. Factors with significant impact on HAIs resulted to be: percentage of single rooms (RR = 0.91 for every 5% increase, p = 0.013), presence of a plan for infection prevention and control (IPC, RR = 0.51, p = 0.007), routine production of an IPC report (RR = 0.50, p = 0.001), adoption of measures for HAI prevention (RR = 0.21, p = 0.002) and antimicrobial stewardship (RR = 0.50, p = 0.015). The interaction of the number of blood cultures was significant for the effect of IPC report (p = 0.038), number of measures for HAI prevention (p = 0.037) and antimicrobial stewardship (p = 0.02).

Conclusions

The results confirm the importance of HAI prevention and antimicrobial stewardship as means of lowering the occurrence of HAIs. Therefore, investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to provide useful insights to create a safer background for clinical practice.

Key messages

Adopting preventive measures and antimicrobial stewardship is crucial in lowering the occurrence of HAIs and ensuring safer care. Investigating, testing and correctly reporting the onset and evolution of HAIs is paramount to ensure better understanding of the phenomenon and to enable effective HAI prevention.
Gender inequality and population-level health outcomes: Panel data analysis of OECD countries
Authors: Veas C , Crispi F , Cuadrado C
Published: October 2021

Background

Gender plays a well-recognized role in many health inequalities. However, the population-level health consequences of gender inequalities have not been measured comprehensively. The goal of this study, therefore, was to evaluate associations between gender inequality and health indicators in OECD countries.

Methods

Ecological study based on 1990-2017 panel data for Organisation for Economic Co-operation and Development (OECD) member countries. Gender inequality was measured using the Gender Inequality Index (GII). The population health parameters evaluated were: life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLL), years lived with disability (YLD), disability-adjusted life years (DALYs), and specific-cause mortality. Two way fixed-effects linear models were developed to assess the relationship between gender inequality and health outcomes. Models included potential mediating and confounding factors such as health spending, political model, and economic inequities.

Results

Greater gender inequality was associated with lower LE (-0·49%; CI95 -0·63%- -0·31%; p-value <0·0001) and HALE (-0·47%; CI95 -0·63%- -0·31%; p-value <0·0001) as well as less-favorable figures for YLL (6·82%; CI95 3·63%-10·75%; p-value <0·0001), DALYs (1·50%; CI95 0·48%-2·46%; p-value=0·0028), and YLD (2·59%; CI95 0·67%-4·77%; p-value=0·0063). The sensitivity analysis indicated that the results were robust to the various specifications of the causal models.

Conclusions

Our results suggest that gender inequality has a negative impact on the health of the population. Promoting gender equality as part of policy-making is vital for optimizing health on a population scale

Key messages

Reduce gender inequality can advance health outcomes on a population scale, resulting in increased LE and HALE and decreasing YLL, YLD, and DALY, in the general population, and in men as well as women. This information supports the need to develop gender-sensitive public policies, for the benefit of society as a whole.
Asylum seekers’ experiences with quarantine after arriving in Germany during the COVID-19 pandemic
Authors: Rast E , Perplies C , Biddle L , Bozorgmehr K
Published: October 2021

Background

During the COVID-19 pandemic, newly arriving asylum seekers undergo mandatory quarantine in many European countries. Quarantine is likely to amplify pre-existing strains associated with asylum seeking, including limited autonomy and barriers for care-seeking. Our objectives were a) to elicit asylum seekers’ experiences with quarantine regarding their mental health and needs and b) to explore how they assess the measure.

Methods

We conducted 9 semi-structured interviews with asylum seekers in a German reception centre (July-December 2020). Individuals with quarantine experience who spoke German, English or French were invited to participate. The interviews were recorded, transcribed and analysed thematically with an inductive-deductive approach. Funding: German Federal Agency for Health Education (BZgA).

Results

The participants (2 women, 6 men and a couple from Syria, Algeria, Yemen, Bangladesh and Cameroon) experienced the quarantine as a difficult situation and described feeling locked-in and bored. Obsessive thinking, loneliness, sleeping problems and feelings of abandonment were repeatedly reported. Unmet basic needs (e.g. special foods, cleaning tools, shampoo, Wi-Fi) and unclarity about access to social or emergency help further impaired wellbeing in some cases. In view of negative PCR test results, the rationale of mandatory quarantine was questioned by some. Assessments of the quarantine varied: Some favoured individual responsibility, physical distancing and hygiene measures over quarantine, while others considered it necessary for health protection despite the strains entailed.

Conclusions

Quarantine can be a considerable stressor for asylum seekers. In this explorative study, shortcomings in the provision of daily necessities and information were visible. Potential adverse impacts of quarantine on wellbeing should be minimised through ensuring its comprehensibility, the supply of daily needs and low-threshold access to psychosocial support.

Key messages

Quarantine can be a significant stressor for newly arriving asylum seekers. Quarantine-induced stress should be minimised through appropriate information, the provision of daily necessities and psychosocial support.
Parent emigration and physical health of children left behind: a systematic review of literature
Authors: Racaite J , Lindert J , Antia K , Winkler V , Sketerskiene R , Jakubauskiene M , Wulkau L , Surkiene G
Published: October 2021

Background

The aim of our study was to systematically review the literature on physical health and related consequences of internal and international parental migration on left-behind children (LBC).

Methods

This study followed the PRISMA guidelines. We searched relevant databases for studies published up to 15 May 2020. The quality of the studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results

We included 34 studies out of 6061 in the final analysis. Results from internal migration shows that compared with children of non-migrant parents, LBC were more susceptible to illness and had a higher prevalence of acute and chronic diseases, have a higher risk of getting injured, were more likely to engage risky behaviours such as unhealthy diet, physical inactivity, sedentary lifestyle, smoking, and drinking. Studies included in this review found a lower coverage of vaccination among LBC. Results from international migration found that left-behind adolescents reported poorer physical health than non-LBC. It was found that the prevalence of stunting (11.5% vs. 14.8%), wasting (18.1% vs. 21.5%), and underweight (24.3% vs. 26.2%) was lower among LBC as compared with non-LBC, respectively. Physical activity among LBC was lower than non-LBC. We provided comparative analysis of the outcomes of the internal and international migration. We found that, despite the type of migration/region, LBC suffer from poor general health, are at a higher risk of developing poor nutrition, overweight or obesity, addictive behaviours, physical inactivity, lower vaccination coverage, and more frequent injuries than non-LBC.

Conclusions

This study found that both internal and international parental migration is mostly negatively associated with LBC general health, nutrition, weight and height, injuries, and immunization. However, in low- and middle-income countries parental migration might also prevent LBC from undernutrition.

Key messages

Internal and international migration parental migration is negatively associated with child physical health outcomes. Issue is well addressed in China, but there are substantial research gap from other migration affected regions of the world.
Personalisation and choice in psychiatric spaces Nachricht eingeben
Authors: Chrysikou E
Published: October 2021

In Europe psychiatric wards tend to be highly institutionalised settings, often lacking essential psychosocially-supportive elements which promote health, wellbeing and social interaction of patients and staff. This happens in the name of increased safety and anti-ligature standards or as a result of neglect and stigma often resulting from reduced opportunities of patients to actively participate in the decision making of their lives, the conditions of hospitalisation and the quality of their environments. Research on healthcare environments shows a profound impact of the built environment on therapeutic outcomes. While many recommendations derived from these studies, such as views to nature or single bedrooms, are difficult to implement in existing facilities, everyday objects potentially pose a powerful yet easily implementable resource for increasing therapeutic effects of the built environment. In this presentation we are going to briefly describe the hierarchies of psychiatric care affordances, as they derive from the SCP model –S stands for Safety and security, C for competence and P for personalisation and choice– that is a model especially developed for interpreting and evaluating psychiatric environments in relation to these principles. Then we are going to explore further the idea of personalisation and choice, its relationship with the psychosocial model of psychiatric rehabilitation and bring some implemented, practical examples of how this has been implemented in psychiatric settings across Europe and beyond. The aspects of co-design will be highlighted, as a key element of achieving personalisation and valorisation. This will help the audience come, who can be either from healthcare, policy or management backgrounds on the same page with members of the audience who come from a built environment background with concepts of institutionalisation vs ecopsychosocial concepts in relation to the built environment of the psychiatric wards.
On the psychological importance of control and valorisation in psychiatric environments
Authors: Müller H
Published: October 2021

When people suffering from severe mental illnesses are treated in psychiatric facilities, there appear conflicting priorities between security and individual control that are often skewed towards security. As a result, patients admitted to highly institutionalised psychiatric wards do not only suffer from mental illness but also from loss of control as a basic human need (Grawe, 2000). Through this loss of control (e.g., not being able to choose where to go), people become especially dependent on their immediate social and spatial surroundings. From a psychological point of view, the concept of control reflects in concepts such as self-efficacy (Bandura, 1977), internal vs. external locus of control (Rotter, 1966), or environmental mastery (Ryff, 1989), all pointing to a beneficial influence on well-being and health. Yet, depending on their current situation, psychiatric patients may also feel overwhelmed by an excess of choices. Increasing patients' sense of control by offering them small choices during their stay at a psychiatric environment, however, might increase well-being (cf. Langer & Rodin, 1968). This possibility of control has the potential to also activate the feeling of valorisation in patients: As a positive fundamental attitude towards another person, implying appreciation and respect, valorisation poses an important element of psychotherapy (e.g., Rogers, 1951). Especially as people with psychiatric disorders are still stereotyped and stigmatized (e.g., as a homogenous group of “the mentally ill”), actively searching for new ways to foster valorisation in psychiatric environments may further contribute to patients' well-being and individualisation. Transferring the concept of valorisation to physical objects as primes affords an opportunity to extend feeling appreciated beyond immediate social interaction.
Pre-exposure prophylaxis' knowledge, attitudes, practices amongst italian men who have sex with men
Authors: Voglino G , Gualano MR , Rousset S , Bert F , Siliquini R , Fraire I
Published: October 2021

Background

Pre-exposure prophylaxis (PrEP) is suitable for human immunodeficiency virus (HIV)high-infection-risk people, foremost amongst males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use.

Methods

An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour, knowledge on HIV and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify possible associations with PrEP knowledge.

Results

A total of 196 MSM completed the survey. Overall data showed very good HIV and safe sexual behaviour knowledge (94.4% of correct answers). Nevertheless, our sample rarely used PrEP because of existing barriers: high therapy price (26.9%)and fear of side effects (23.8%). Only 10.3% of partecipants were informed on HIV and PReP by institutional channels, even less (7.5%) from specialized physicians and general practitioners. The most significant association with PrEP knowledge was having regular HIV-tests (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29);

Conclusions

PreP's Knowledge was well established, but PrEP use was not widespread. It is necessary to improve communication on PrEP and to lower existing barriers in order to grant access to PrEP access.

Key messages

Barriers to access PrEP have to be lowered. Healthcare personnel has to be involved in PrEP's benefits communication.
Effectiveness among MSM of an HIV PrEP program developed in a Parisian sexual health center
Authors: Thomas B , Piron P , de La Rochebrochard E , Segouin C , Troude P
Published: October 2021

Background

HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' adherence and follow-up. To enhance follow-up quality and care engagement, the PrEP program developed in our Parisian sexual health center offers accompanying measures throughout the patients' course of care, relying notably on an identified and easily accessible referent. This trained paramedic counselor in sexual health provides support in organizing appointments, phone and email follow-up to answer daily questions, as well as one-on-one sessions of therapeutic support and counseling. This study aimed to assess the effectiveness of such a PrEP program among men who have sex with men (MSM).

Methods

This retrospective observational study included all MSM who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal hospital sexual health center, Paris, France. Sociodemographic characteristics, sexual practices including very high risk situations (chemsex practice and/or sexually transmitted diseases at initiation and/or history of post-exposure prophylaxis [PEP]) and course of care during the first year were described. A novel metric developed by Hendrickson et al., the PrEP success ratio at 12 months, was used to assess effectiveness of PrEP.

Results

Among the 125 MSM included in this study, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of PEP. During the first year, patients attended a median of 3 visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) of patients had a successful PrEP course, with no reported seroconversion.

Conclusions

This experiment highlights the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures set up in our sexual health center could explain the effectiveness of our PrEP program in comparison with previous studies.

Key messages

In a Parisian sexual health center that developed an HIV PrEP program with a trained paramedic counselor in sexual health, 96% of MSM achieved a successful PrEP course at 12 months. Accompanying measures for PrEP users could play a key role in achieving high PrEP success among MSM.
Lessons learned from One Health practices in Sweden and Italy
Authors: Humboldt-Dachroeden S
Published: October 2021

Background

One Health provides an approach to tackle health threats like zoonotic diseases and antimicrobial resistance. It is crucial to establish coordinated surveillance activities and to engage in productive collaboration. Swedish and Italian experts were interviewed to provide insight into barriers and opportunities for integrating One Health practices.

Methods

Semi-structured interviews with experts from Swedish and Italian veterinary, food, public health and environmental agencies were conducted. Interviews were examined via a thematic content analysis using inductive coding in NVivo.

Results

Between the countries, there are clear differences pertaining to structure like different jurisdictions that affect legislations and responsibilities. Barriers and opportunities occur in terms of cooperation with the environmental sector and regarding the understanding of One Health. There are legislative-related challenges and barriers for science to policy translations. Similarities between Italy and Sweden were identified as personal challenges during collaborations and the need to recognise all disease outbreaks as an opportunity for integrating One Health.

Conclusions

In both countries, a One Health strategy developed on institutional level can facilitate to define One Health and clarify responsibilities. Further perspectives are to push One Health onto the political agenda and to prepare clear legislations. To overcome practical challenges, countries can learn from each other in terms of coordination across disciplines and by implementing One Health training activities. Experiences with One Health projects must be disseminated to scientific field and the public to raise awareness for One Health. Understanding this can benefit One Health surveillance in Sweden, Italy and in other countries and contexts. Implementing cross-sectoral surveillance will aid the early detection and prevention of diseases, and promote health of humans, animals and the environment.

Key messages

Integrating One Health practices in health, veterinary, environment and food agencies is crucial to establish comprehensive surveillance to promote human, animal and environmental health. For successful implementation, science to policy translations for One Health needs to improve, the topic must reach the political agenda and legislations need to be prepared clearly.
How easy to eliminate cervical cancer; examples of developed and developing countries and Turkey
Authors: Topal E , Akin A
Published: October 2021

Issue

Cervical cancer has the 4th highest incidence rate among women in the world. WHO made a global call for action to eliminate cervical cancer and and set targets to be achieved by 2030.

Description of the problem

The aim of this study to review the current situation in some countries with different development levels and made some suggestions to attain the targets. Turkey was assessed in detail to develop suggestions for elimination program which could be an example for some other countries. In this descriptive study; The issue were evaluated in Finland, the United Kingdom, Australia, Cuba, China, Uganda and Turkey between February and April 2021 by literature review.

Results

In 2020, in Finland, United Kingdom and Australia, HPV vaccine is provided in the national programs: cervical cancer screening coverage is between 52-75%; The incidence rates, are between 5.2-9.9%; mortality rates are between 1.1-1.9%. There is no HPV vaccine in the national program in Cuba, China and Uganda, and cervical cancer screening coverage is between 5-67%; the incidence rates are between 10.7-56.2%, and mortality rates are between 5.3-41.4%. Whereas in Turkey; the incidence rate of 4.8% and 2.2% mortality rate; HPV vaccine is not provided in the national program and screening coverage is 27%. The budget that should be allocated for the elimination program in terms of target groups for vaccination and screening total of 4.038.684.000 TL which is around 491.340.824 US$. The health infrastructure in terms of facilites and workforce is not enough in crowded areas.

Lessons

For Turkey, the concrid recommendations including the current health and education systems were made. Cervical cancer elimination would be possible even in developing counries as the main cause and risk factors are scientificaly known. For the success realistic planning, prioritisation of preventive health measures, advocacy programmes and competent management are the key issues.

Key messages

The elimination of cervical cancer in Turkey is possible with current potentials. However, existing problems must be overcome and an elimination program must be well planned. Countries that are struggling with cervical cancer and countries that are successful in the elimination, should have partnerships as indicated in the 17th Goal of the SDGs.
Help! Working with change: An organizational change process model and online registry of resources
Authors: Read K , Dhaliwal B , Dobbins M
Published: October 2021

Background

The health system is continuously undergoing change in response to various internal and external drivers. The organizational change literature is complex and multi-disciplinary, making it challenging for health professionals to utilize efficiently. To support practitioners through times of change, The National Collaborating Centre for Methods and Tools (NCCMT) developed a health sector-specific model of organizational change, by synthesizing existing models and frameworks, and developed an online registry of resources to help guide practitioners through the change process.

Objectives

Existing change process models were identified through a scoping review of reviews published from 2000-2015, supplemental searches using a snowball method, and contact with key informants. A thematic analysis identified key themes and activities. To support the use of the model, a search of the academic and grey literature was conducted to identify practical organizational change tools. Resources were tagged with specific stages in the model and added to an online interactive Registry.

The online Registry is available for practitioners to gain knowledge and understanding of processes of change relevant to the health sector, identify facilitators and barriers to change, and use methods and tools to support practitioners throughout the change process.

Results

A total of 30 organizational change process models were identified and synthesized to create a new five-stage model: assessing the NEED for change; PLANning for change; IMPLEMENTing change initiatives; SUSTAINing change within the organization; and EVOLVing to continuously meet drivers for change. The easy to use and interactive platform hosts over 100 practical tools linked to stages in the model to support organization and systems change.

Conclusions

This new resource will support the implementation of evidence-informed practices, policies and programs in public health and the broader health care system.

Key messages

The health system is continuously undergoing change and can be challenging to navigate. A health sector-specific organizational change process model and online registry of resources can help guide public health professionals throughout the change process.
Set-up of GoLBeT, a pragmatic clinical trial of podoconiosis management in a low-resource setting
Authors: Erber A , Ewing V , Turner M , Molla M , Murbe G , Davey G , Lang T
Published: October 2021

Clinical trials are often perceived as being expensive, difficult and beyond the capacity of academic groups and healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the WHO World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with reasons for delays. A qualitative approach using the Global Health Research Process Map as a framework was used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the operational team and a group discussion. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design (definition and measurement of the study endpoint, and assuring statistical power); recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration was essential to successfully setting up the trial. Other important aspects were a team and process perspective, staff training, community engagement, and data quality e.g., through data management. Lessons learnt from this trial might guide in planning pragmatic trials in settings where research is not common, allowing researchers to anticipate challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.

Key messages

Pragmatic clinical trials are essential to drive improved outcomes in public health in low-resource settings, but are perceived as challenging to set up and initiate. Our analysis of the Gojjam Lymphoedema Best Practice Trial found that factors for a successful set-up were collaborations, a team perspective, staff training, community engagement and data management.
Contest of best practices tackling social inequalities in cancer prevention: an iPAAC initiative
Authors: Hernandez-Garcia M , Salas-Trejo D , Anttila A , Lipponen S , Vanaclocha-Espí M , Pinto-Carbó M , Molina-Barceló A
Published: October 2021

Issue

Many cancer risk and protection factors have socially determined conditions. In general, those who pertain to lower socioeconomic groups are more exposed to cancer risk factors and less to protective ones.

Description of the problem

Current programmes on health promotion and early detection of cancer yield different results according to social group, perpetuating health inequalities. Contest of best practices tackling social inequalities in cancer prevention is an initiative emerged in the framework of Innovative Partnership for Action Against Cancer (iPAAC). This contest identifies interventions proven effective to reduce social inequalities in cancer prevention, with the aim of sharing lessons learned and facilitating replication. Best practice is defined as an intervention implemented in a real life setting which has been favourably assessed in terms of adequacy, effectiveness, and equity. Assessment was conducted on a peer-review basis. To be accepted for evaluation, practices ought to meet compulsory criteria: relevance, equity, and effectiveness; they were further assessed according to gender perspective, efficiency, ethics, sustainability, inter-sectors collaboration, transferability, innovation, evidence based, and public engagement.

Results

Overall, 15 proposals were submitted from: Belgium, France, United Kingdom, Italy, Slovenia, and Spain. Six out of fifteen (40%) fell under the scope of health promotion; eight proposals (53%) addressed cancer screening. One single practice (7%) approached both primary and secondary prevention. Eleven proposals (73%) were considered best practices. Full details are available at www.ipaac.eu/en/contest-best-practices.

Lessons

These results suggest that a combination of public health universal interventions together with targeted interventions is effective in preventing cancer in the whole population, integrating specific actions for specific groups otherwise not reached by universal prevention activities.

Key messages

This contest contributes to provide insight on effective strategies that can be translated to other settings and adapted into more equitable new procedures. Tackling inequities should be included in future best practices criteria.
The perception of the professionalism of the doctor by the population Veracruz-boca del rio, Mexico
Authors: Lopez Santiago NL , Villegas Dominguez JE , Perez Juarez M , Marin Leal A
Published: October 2021

Introduction

Medical professionalism not only encompasses the face-to-face aspect where the doctor-patient relationship is maintained in a care manner, it goes beyond the doctor's office. During the COVID19 pandemic in Mexico, many doctors were attacked indicating their lack of vocation and professionalism, even though the patient had not dealt with the doctor at any time.

Objective

To analyze the perception of the professionalism of doctors by the population of the Veracruz-Boca del Río

Material and methods

A quantitative study was carried out with a non-experimental, observational, analytical and cross-sectional research design We include men and women between the ages of 20 and 70, residents of Veracruz, Mexico. A virtual survey was carried out to identify the attitudes that patients consider to be unprofessional in doctors, however, all the attitudes evaluated were actions that the doctor performs outside of his working hours or that he registers in his personal social networks.

Results

1339 subjects were included, with an average age of 33.6 (± 12.7). The use of vulgar language (30.9%), publication in social networks against feminism (36.2%) or sexual content (73.3%) is perceived as unprofessional for both sexes. Regarding female doctors, 34.5% of patients indicate as unprofessional the publication of alcohol on social networks (34.5%), being at an informal party (29.6%) or smoking tobacco (34.2%), while for a male doctor the publication in social networks of drinking alcohol (40%) or being in an informal party (36.1%) consider it unprofessional. Less than 20% of those surveyed consider their position on cannabis use, feminism or abortion, type of clothing, sedentary lifestyle, religion, age, tobacco or alcohol consumption unprofessional in their daily life.

Conclusions

The patient perceives the professionalism of the doctor from social networks in actions that are not directly related to how professional he can be when performing his work as a doctor.

Key messages

The patient perceives the professionalism of the doctor from social networks. The patient perceives the professionalism of the doctor from social networks in actions that are not directly related to how professional he can be when performing his work as a doctor.
The impact of Covid-19 on behavioural attitudes in Malta: A year into the pandemic
Authors: Cuschieri S
Published: October 2021

Background

The Covid-19 pandemic has affected everyone's life as the viral spread dominated the globe, and a number of restrictive measures were instituted. Behavioural attitudes are expected to have been impacted by such measures including the lockdowns. The aim was to explore any behavioural changes since the onset of the pandemic among the adult population of Malta.

Methods

An observational study was conducted through the dissemination of an anonymous survey by using Google Forms on social media (between 1st to 26th of February), targeting the adult residents of Malta. The survey's questions assessed for the increase in smoking and alcohol habits, decrease in physical activity and changes in body weight since the onset of the pandemic. Qualitative and quantitative analyses were performed.

Results

The majority of the participants (n = 1034) did not recall an increase in their smoking (91.30% CI95%: 89.41-92.87) and alcohol (88.68% CI95%:86.60-90.48) habits since the onset of Covid-19. However, 49.32% (CI 95%: 46.21-52.37) reported a decrease in physical activity with a common consensus of: “I used to go to the gym more frequently. But now I go less frequently to avoid people” and “More online meetings at home so my physical activity has decreased”. Indeed, 43.23% (CI 95%: 40.24 - 46.27) recalled an increase in their body weight as: “My food intake increased drastically” and “My eating habits have deteriorated as I now tend to turn to comfort eating”.

Conclusions

The pandemic appears to have had negative effects on risk-associated behaviours. There is an enhanced risk for the development of obesity, a disease that is already highly prevalent within Malta. It is recommended that public health advice and promotion for healthy eating and physical activity, even if under lockdown, is strengthened to prevent the development of prospective health diseases and complications.

Key messages

There is a high risk of an enhanced obesity epidemic with increased sedentary lifestyle since the onset of Covid-19. Action strategies to encourage healthy eating and physical activity are recommended.
Experience Report: A Community Approach During The Covid-19 Pandemic
Authors: Schettino R , Lopes K , Lacerda S , Takeshita I
Published: October 2021

Introduction

The slum areas present precariousness in terms of habitation, high populational concentration, lack of sanitary infrastructure, violence, and lack of water supply. This scenario makes it difficult the caring to prevent COVID-19 contamination. Belo Horizonte, like other Brazilian capital cities, presents this scenario, which calls society's attention.

Objective

Experience report made by Nursing academics who took basic food baskets to a slum during the COVID-19 pandemic.

Methods

Social action by three Nursing students who collected and delivered basic food baskets to a community in Belo Horizonte. It became an opportunity to social assistance and to the understanding of how these slum dwellers face COVID-19. A local leader prepared a list of families facing vulnerable situation. These families received the baskets. At the time of the deliveries, there was an opportunity to answer some doubts about COVID-19 and health.

Results

The dwellers moved around on the streets without masks, maybe because of lack of resources. The dwellings did not favor social distancing and hygiene care. There were small rooms, excess of people, little ventilation, and deficient sanitation conditions. The people who were infected with the virus suffered retaliation because the other people were afraid of COVID-19 transmission. The infected people became cloistered at home to avoid the community retaliation. Everyone thanked the delivery of basic food baskets saying that this delivery would be a relief during the pandemic.

Conclusions

By observation and contact with the dwellers, it was possible to notice the scarcity of resources and the need of financial and informational help about COVID-19 and other health topics. The basic food basket donation was relevant to the families, but the number of donations did not supply the local necessity. Other social and governmental actions are needed to promote local health.

Key messages

Financial aid from the government must be implemented so that people on the street can have the basics to survive. Government support and an example model is important for the population to follow as a reference. Our current government has not been a good example, leading to chaos in public and private health.
Systematic review of health workforce surge capacity during COVID-19 and other viral pandemics
Authors: Gupta N , Balcom SA , Gulliver A , Witherspoon RL
Published: October 2021

Background

Healthcare decision-makers need comprehensive evidence to mitigate surges in the demand for human resources for health (HRH) during infectious disease outbreaks, in terms of both short- and longer-term impacts. This study aimed to assess the state of the evidence to address HRH surge capacity during COVID-19 and other outbreaks of global significance in the 21st century.

Methods

We systematically searched eight bibliographic databases to extract primary research articles published between 01/2000-06/2020, capturing temporal changes in HRH requirements and responses surrounding viral respiratory infection pandemics. A systems approach was used, considering providers in hospitals, out-of-hospital systems, emergency medical services, and public health. We narratively synthesized the evidence following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) standard.

Results

Of the 1,155 retrieved records, 16 studies met our inclusion criteria; of these, 5 focused on COVID-19, 3 on H1N1, and 8 on a hypothetical pandemic. Different training, mobilization, and redeployment options to address pandemic-time health system capacity were assessed. Few governance scenarios drew on observational HRH data allowing for comparability across contexts. Notable evidence gaps included occupational and psychosocial factors affecting healthcare workers' absenteeism and risk of burnout, gendered considerations of HRH capacity, evaluations in low- and lower-middle income countries, and policy-actionable assessments to inform post-pandemic recovery and sustainability of services for noncommunicable disease management.

Conclusions

This research emphasized the critical need for timely, internationally comparable, and equity-informative HRH data and research to enhance preparedness, response, and recovery policies for this and future pandemics. Full paper is available at: https://doi.org/10.1002/hpm.3137

Key messages

The COVID-19 pandemic has highlighted the critical need for enhanced health workforce data and research, including better tracking of demographics, exposures, infections and deaths of health workers. Although women comprise 70% of the health workforce in many countries, gender-blindness persists in the global literature on health workforce research and governance in public health emergencies./bodyt