bluuebunny/crossref_metadata_2025 huggingface dataset:
Burnout and perceived stress among health visitors in Hungary
Authors: Gyulai A , Ötvös A , Kiss-Tóth E , Rucska A , Szokol P , Lakatos C S
Published: October 2024

Background

In Hungary, the health visitors are responsible for the health promotion of families and communities. However, as a consequence of the structural reorganization of the health visitors service and the emotionally situations (e.g. the war in a neighboring country, the economic crisis) that have arisen, there has been an increased prevalence of chronic stress, burnout and career abandonment among health visitors. The objective of the cross-sectional study was to ascertain the prevalence of burnout among health visitors and to examine the relationship between burnout and job stress.

Methods

The data was collected via an online questionnaire tool. In addition to questions pertaining to sociodemographic data, the questionnaire employed the Maslach Burnout Inventory (MBI Human Services Survey) and the Perceived Stress Scale (PSS). Hypotheses were tested using analysis of variance (ANOVA), Kruskal-Wallis test, Dunett test. The source population of the study was health visitors. A total of 178 health visitors constituted the target population.

Results

The average age of the study participants was 45.2 years. It can be observed that health visitors who perceive less appreciation from their colleagues, employers and caregivers are more likely to experience higher levels of burnout and stress (p < 0.05). The lowest levels of stress were observed in school health visitors, while the highest levels were seen in health visitors covering villages (p < 0.05). Those who remained in the field due to a passion for working with families and children, a sense of vocation, and a desire to help others exhibited lower levels of burnout (p < 0.05). The high number of clients served by health visitors was found to increase burnout and stress levels (p < 0.05).

Conclusions

The findings of this research will assist in the comprehension of the phenomenon of burnout among health visitors, thereby enabling the development of more efficacious methods for the treatment and prevention.

Key messages

• Preventing burnout among health visitors is a priority, as it affects their work and their relationship with the families they care for in the short and long term.

• Health visitors frequently encounter families in crisis during the course of their work, necessitating regular supervision to maintain their mental health.
Barriers and facilitators of implementing a health literacy-based intervention in Portugal
Authors: Gama A , Kinaan W , Marques P , Peruhype R , Dias S
Published: October 2024

Background

Despite the effectiveness of cervical cancer screening (CCS) in reducing mortality rates, disparities persist in access to screening among women with low health literacy, often termed ‘hard-to-reach women’. Health literacy-based interventions can help promote screening uptake. Based on a health literacy-based intervention for CCS implemented in Lisbon with the support of community workers, this study explores barriers and facilitators of the implementation process as perceived by these actors.

Methods

The intervention consisted of educational sessions on cervical cancer and CCS aimed at 246 women, implemented in community settings in 2023-2024. Within a mixed-methods approach, a pre-and post-intervention survey was applied to assess willingness to screen, and two focus groups were conducted with 10 community workers on their implementation experiences. Descriptive analysis and content analysis were performed where appropriate.

Results

Of the 665 women invited, 37% were enrolled in the sessions; 91% completed the follow-up. Community workers valued the informative content as adequate to raise awareness. Implementation facilitators included women’s trust in collaborating organisations and a complement of peer recruitment. Challenges included the additional workload of community workers, finding creative strategies to engage women, scheduling the sessions that best suited women’s time demands, and limited spaces to accommodate several group sessions. Proposed solutions to overcome barriers included increasing the time availability of community workers to support participants’ recruitment and session delivery, conducting itinerant and open sessions, and integrating the sessions within the organisation’s health-promoting activities.

Conclusions

Health literacy-based interventions are helpful in raising CCS awareness. Tailored interventions sensitive to context demands may contribute to successful actions.

Key messages

• Health literacy interventions can be key to promoting cervical cancer screening among hard-to-reach women.

• Tailored community-based interventions may help address barriers to cervical cancer screening.
Adapting, expanding and embedding community and culture into health ecosystems
Authors: Trigwell J , Gamsu M , Bagnall A M , South J , Mosteanu O , Redwood-Turner B , Bharadwa M , Harris J
Published: October 2024

Background

Community anchor organisations (CAOs) work with communities who experience health inequalities and disadvantage, providing a range of activities and services to meet individuals’ needs in an integrated way. This study explored how CAOs use art, cultural and nature-based activities as part of their work to respond to the needs of people facing inequalities and considered how activities can be scaled in this health setting.

Methods

This study used community-based participatory research within a case study approach to work with four purposively sampled CAOs. Participants were community members, volunteers, staff, trustees, partner organisations and commissioners. Data collection methods included: document analysis, interviews (n = 45), workshops (n = 5) and focus groups (n = 11). This study was also supported by data collected by trained community researchers (n = 18). Framework analysis was conducted for within- and cross-case analysis.

Results

In the context of CAOs, the delivery of art, cultural and nature-based activities were found to be an important mechanism for developing trusted relationships with marginalised groups, who may lack trust in statutory services and health focused activities. Other facilitators to community engagement were the CAOs’ longevity, localness and co-location of services within a trusted and familiar place that connect people to personalised support. Barriers to scaling up included funding models as well as insufficient dialogue and understanding between CAOs and the local public health ecosystem.

Conclusions

CAOs have long term trusted relationships with disadvantaged communities and are influential in connecting individuals with projects and services. Findings suggest that the effectiveness of action to address inequality through art, cultural and nature-based activities could be improved if the role of CAOs was recognised more coherently in place-based public health plans.

Key messages

• Creative activities enable meaningful engagement with disadvantaged groups within place-based settings.

• CAOs must be recognised more coherently in place-based strategies to reduce health inequalities.
Factors Influencing Quality of Life in the Disabled: Focus on Household Members Mental Health
Authors: Choi E H , Cho J H , Yeob K E , Kim S Y , Lee Y S , Park J H
Published: October 2024

Background

Household members of the disabled experience various difficulties such as social isolation and the burden of caregiving. These difficulties can lead to mental health problems, which in turn affect the quality of life(QoL) of the disabled. Research on the QoL of the disabled is ongoing, but there are few studies addressing the mental health of household members. We aimed to investigate the impact of household members’ mental health on the QoL of the disabled.

Methods

We used data from the 2021 Disability and Life Dynamics Panel(nationwide survey). On the base of Patrick’s model of disability health promotion, we analyzed the impact of household members’ mental health on the QoL of the disabled by using correlation analysis and multiple regression analysis adjusted for gender, age, income level, employment status, education level, activities of daily living, participation in social activities, type and severity of disability, presence of multiple disabilities, and health status.

Results

The level of depression(r=-.316, p<.0001) and self-esteem(r=.248, p<.0001) of household members were found to be significantly correlated with the QoL of the disabled. The level of depression of household members had a significant negative impact on the QoL of the disabled(β=-.153, p<.0001), while self-esteem had a significant positive impact(β=.144, p<.0001). It was found that the level of depression had a greater impact on QoL than self-esteem.

Conclusions

Lower levels of depression and higher levels of self-esteem of household members are associated with higher QoL for the disabled. Improving the mental health of household members is crucial in improving the QoL of the disabled, enabling them to interact more positively with society. Additionally, as 27% of household members experience depressive issues, enhancing their mental health positively impacts on the overall well-being of families with disabilities. Efforts to enhance household members’ mental health are crucial.

Key messages

• Household members’ mental health significantly influences the quality of life of the disabled.

• To improve the quality of life of the disabled, strengthening programs for promoting the mental health of household members and policy improvements are necessary.
Cardiac risk confrontation in primary care as a teachable moment towards improved health outcomes
Authors: Gefeke L M , Brust M , Van Hattum N E , Kiefte-de Jong J C
Published: October 2024

Background

Urgent life events, such as acute coronary events, can evoke a teachable moment (TM) for lifestyle change. This study aims to investigate whether less urgent events, such as being confronted with an increased risk of cardiovascular disease, can evoke a TM, what psychosocial factors are associated with it, and whether experiencing such a TM predicts improved health outcomes.

Methods

The study included 114 patients who were informed about their elevated cardiovascular risk during a primary care visit. Participants completed a survey assessing whether they experienced a TM and several psychosocial factors linked to experiencing it: perceived risk, affective impact, changed self-concept. Participants monitored their weight and blood pressure for six months using an at-home self-monitoring device. Univariate and multivariate regression analyses were conducted to examine the associations between the psychosocial factors and the lifestyle change intentions with changes in blood pressure and weight.

Results

Of the participants, 55.3% experienced increased lifestyle change intentions. Lower risk perception ((B = -0.27; CI = -0.39-(-0.15)) and higher change in self-concept (B = 0.34; CI = 0.23-0.44) were associated with higher intention to change lifestyle. Higher risk perception (B = 0.23; CI = 0.06-0.42) and higher change in self-concept (B = 0.54; CI = 0.37-0.72) predicted a lower weight reduction at six months. A higher change in self-concept predicted a higher blood pressure reduction (B = -3.32; CI = -6.55-(0.09)). Lastly, a higher lifestyle change intention predicted bigger reductions blood pressure (B = -5.04; CI = -9.08-(-0.29)).

Conclusions

Results suggest that less urgent cardiac events, such as a confrontation with an increased cardiac risk, can be experienced as a TM that urges lifestyle change intentions and affects health outcomes. Risk confrontations in primary care therefore offer a unique opportunity to provide lifestyle counseling at the right moment.

Key messages

• A confrontation with an increased cardiac risk in primary care can be experienced as a teachable moment.

• Experiencing a teachable moment after a cardiac risk confrontation in primary care affects health outcomes.
Comparing Italian hospital discharge and mortality data: implications for epidemiological research
Authors: Logan K , Corbetta A , Ieva F , Di Angelantonio E
Published: October 2024

Background

In Italy, regional governments maintain data warehouses of linked administrative health data (AHD) linked to demographic information including mortality. Legal reporting pathways for death certificate detail bypass the Region, resulting in significant amounts of missing data on cause and location of death in regional AHD warehouses and limiting epidemiological research on mortality and incidence. In this study, we determine for the first time in Italy the degree of agreement between last hospital diagnosis and primary cause of death, and how that agreement changes over time. Previous studies have found agreement ranging from 40% to 60%.

Methods

The COV-CVD cohort is comprised of 7.3 million adults aged 30+ from the Lombardy region of northwest Italy, representing all Lombardy residents registered with the health system as of 31 December 2019. Concordance was assessed using the first three characters of the reported cause of death (ICD-10 codes) and primary diagnosis at last hospitalization (converted from ICD-9CM).

Results

In the COV-CVD cohort there were 401,085 deaths between 1 January 2020 and 23 June 2023. Cause and location of death is missing for 50% and 54% of these deaths, respectively. 60% of deceased individuals had a hospitalization in the year before their death. Agreement between primary diagnosis at last hospitalization and cause of death was 27% overall and 40.5% for deaths in hospital. Missing location of death was reduced from 54% to 26%.

Conclusions

When using AHD from Italy, primary diagnosis at last hospitalization prior to death is not an appropriate proxy for cause of death, even when the death occurred in hospital. Different coding systems (ICD-10, ICD-9CM) further complicate comparisons and definitions in observational studies.

Key messages

• In Italy, primary diagnosis at last hospitalization before death is not an appropriate proxy for cause of death.

• Poor linkage of mortality and health data limits epidemiological research.
Supporting Long Covid Care: a webtool to facilitate help-seeking among people with Long Covid
Authors: Clutterbuck D , Smyth N , Begum F , Chew-Graham C , Mcgowan A , Pantelic M , Ridge D , Tran H , Williams R , Alwan N A
Published: October 2024

Background

Long Covid (also known as Post-COVID19 Condition or Post-COVID Syndrome) is characterised by persistent symptoms following SARSCoV2 infection not explained by other pathology. Some evidence suggests that people from marginalised communities are more likely to experience Long Covid but are less likely to be represented in post-covid care in England.

Objectives

Findings from the STIMULATE-ICP case finding and HI-COVE studies show that some people living with Long Covid struggle to get adequate healthcare and social support. Barriers to obtaining support include a lack of awareness of Long Covid and supports available, uncertainty around the cause and complexity of symptoms, as well as experiences and expectations of stigma. The new Supporting Long Covid Care (SLCC) webtool was developed based on these findings and aimed to both facilitate help-seeking for people with probable Long Covid who are not receiving care and raise awareness among professionals. Extensive engagement with people with lived experience and professionals shaped the webtool. SLCC content was then beta-tested with stakeholders.

Results

SLCC (long-covid-care.org.uk) was launched in March 2024. One of its features is the acknowledgement that Long Covid can be a stigmatising condition. SLCC includes real-life quotes to connect emotionally with users, highlights the shared experiences of people living with Long Covid and illustrates the difficulties faced when seeking recognition and support. It encourages conversations with professionals, friends, family and others who may be relied on for support and offers resources to facilitate those conversations and inform next steps. SLCC is also an informative tool for healthcare professionals around Long Covid stigma.

Conclusions

SLCC is open to use by members of the public. Real-world evaluation and translation to other languages are now needed to explore if this webtool is beneficial and contributes towards addressing health inequalities.

Key messages

• SLCC encourages people with probable Long Covid to seek help and support.

• SLCC raises awareness among healthcare professionals about the barriers and stigma people, particularly those from disadvantaged backgrounds, may face when considering reaching out for support.
‘HepGenç’: A youth festival to promote health and well-being via films, photography, music, and arts
Authors: Karadag O , Orhon E N , Karabey S
Published: October 2024

Background

The ‘Lifelong Health’ framework of WHO emphasizes that investing in health during young ages fosters better health and higher quality of life in later years. When working with and for youth, using innovative and participatory approaches have become more important for effective health communication, especially in an era of increased environmental stimuli, digitalization, and decreased attention span for many young people, who are less attracted with traditional/ didactic health education and communication methods.

Objectives

This paper aims to share practical experiences of a multidisciplinary team of professionals with backgrounds in public health, psychiatry, communication, music, and arts, in collaboration with young people to organize a series of youth health festivals in different cities of Turkiye to promote youth health literacy and access to health care, with a special focus on mental health and well-being.

Results

HepGenc (ForeverYoung) Festivals are organized by academics and youth from different universities in Turkiye, in collaboration with NGOs and local municipalities of cities, where the events take place. These events encourage young people to think about health and well-being, including social and environmental determinants of health via short films, photography, music, and arts. The series of festivals use creative workshops to introduce different health and well-being topics to youth, who may not always find these issues ‘attractive.’ Social and mental health, including resilience and ability to adapt are also addressed, which help young participants to build a holistic and comprehensive look on health and its determinants.

Conclusions

Organizing health-focused festivals using films, photography, music, and arts encourages young people to be creative and productive, while raising their awareness on healthy lifestyles and healthy cities, and how they can be agents of positive change.

Key messages

• Using films, music, and arts help with greater engagement of young people and facilitates their learning, as well as their creativity and productivity.

• Collaboration of health, communication, and arts professionals strengthens health communication/ education programs, with additional beneficial outcomes for all disciplines including shared learning.
Association between fitness levels and physical activity in apparently healthy Colombian men
Authors: Morales Eraso N S , Caviativa Castro Y P , Murcia Doncel M P , Rubiano Espinosa O F , Jaramillo Guzmán V
Published: October 2024

Physical condition (PC) such as strength and endurance favor functional independence and disease prevention (Melo, 2014). Objective: To characterize the levels of Physical Activity (PA) and CP in apparently healthy men who practice PA in different settings in Bogotá-Colombia. This study is observational cross-sectional, 485 Men (M) participated, mean age 42±17.8 years. To measure the levels PA the IPAQ (International Physical Activity Questionnaires) was applied. The Confidence Interval (CI) and Standard Error (SE) were taken into account. For PA levels, data were analyzed with Rstudio v2022.12.0, with empirical distribution tests, Kolmogorov-Smirnov normality and independence with Chi-Square (χ²), in addition, mean (X¯), percentage (%) and standard deviation (±). 90.6% of the H met the overall PA recommendations (Leisure Time+Active Transportation) with 95% CI (88.0-93.0) and SE (0.012). The PC variables such as; Body Mass Index (BMI), Body Adiposity Index (BAI), Abdominal Circumference (AC), Grip Strength (GS) and Maximal Oxygen Consumption (Vo2max). The results showed that 35.6% (26.9±1.48) of H were Overweight (Ow) and 10.6% (32.7±2.39) were Obese (Ob), 39.7% (98.4±6.8) with Cardiovascular Risk (Rcv) by AC and 24.3% (29.7±3.45) with risk by BAI. As for GS 41.5% (27.1±6.39) is weak and 32.3% (33.3±6.3) is low Vo2max. According to independence tests with χ² there is association between the G and BMI (χ²=1452.1, df = 1427, p-value=0. 315), G and AC (χ²=394.9, df = 382, p-value=0. 313), G and Vo2max (χ²=155.5, df = 6, p-value<2.2e-16), G and BAI (χ²=2970.3, df = 1502, p-value<2.2e-16), G and GS (χ²=6015.5, df = 1502, p-value<2.2e-16). This project was approved by the bioethics committee.

Conclusions

149 men corresponding to 30.7% of the sample present an increased possibility of Rcv, despite compliance with global PA recommendations. It is recommended that PA programs reinforce the improvement and promotion of PC to prevent possible Rcv.

Key messages

• The capacities that define physical fitness (FC) such as strength and endurance favor functional independence and disease prevention (Melo, 2014).

• Apparently healthy men in Colombia present a higher possibility of Cardiovascular Risk due to low levels of physical fitness, despite compliance with global BP recommendations.
Training for migrant live-in care workers in Austria: results from an online survey
Authors: Wojczewski S , Adler V , Bagheri R , Ernst A , Durisova S
Published: October 2024

Background

In Austria, almost 60.000 migrant “24-hour” live-in caregivers work in two- or four-week shifts, travelling between Austria and their countries of origin (mostly Romania, Slovakia, Croatia, Hungary and more) to care for frail older people at home. As opposed to other social and healthcare professions, live-in care workers do not require any formal training at all to be able to work in Austria.

Methods

With the aim of gaining an in-depth insight into the working conditions of live-in caregivers and with the aim of recording their problems and needs, an online survey including 40 questions was conducted from 15 July to 15 September 2023 in four languages (Slovak, Romanian, Bulgarian and German). The study is part of the MigraCare project which focuses on improving working and living conditions for migrant live in care workers.

Results

Results show that many live-in caregivers are not fully aware of their job profile: what are nursing and medical tasks they are only allowed to do when delegated by professional healthcare staff? Most respondents have to take on tasks that are outside their job profile. Many state that it is difficult to care for people with dementia. In addition, some caregivers report physical and psychological violence and sexual harassment. Most wish for training possibilities regarding topics like dementia, communication with client and family, legal framework regarding their job in the long-term care sector and others.

Conclusions

Live-in care workers wish for continuous education activities and for a better relationship with the family relatives and the care recipient. Based on the results of the survey short multilingual training videos have been developed easily accessible on a video platform for live-in care workers. Also, a connection to community nurses has been established in order to improve communication between care recipient, family members and live-in care workers.

Key messages

• Results from an online survey show that live-in care workers face challenges at work which are partly due to an unclear job profile as well as communication problems with the care recipient.

• Results of an online survey show that live-in care workers wish for education and training opportunities (mother tongues) in the field of dementia care, communication with family or legal framework.
Virtual Children’s Hospital for Learning Pediatric Nursing
Authors: Nicolaou C , Kolokotroni O , Menikou J , Middleton N , Asi M , Matikainen P , Vesanen K , Treiman-Kiveste A , Läänelaid S , Toivonen M
Published: October 2024

Background

In the context of a funded Erasmus+ program, a platform of a Virtual Children’s Hospital for Learning Pediatric Nursing - VLPN is being developed. The education of nurses working with children, adolescents and families, needs to include specialized knowledge, skills, attitudes and behaviors that will empower them to provide optimal and high-quality care. The virtual platform enables the improvement of pediatric nursing competences of the nursing students through interactive and self-paced activities and content.

Objectives

1. To develop an immersive and interactive virtual reality learning environment (VRLE), a virtual children’s hospital and new teaching and learning methods and practices, utilizing virtual reality and simulation in teaching. 2. To promote the international collaboration of students and lecturers through the VRLE

Results

The results are preliminary. 1. The VRLE includes educational materials developed to be integrated in the pediatric nursing studies, easy to access and use by the students and teachers with innovative self-pace learning material i.e. videos, 3D-models, interactive tests. Digital patients can react to the provided care with speech, movement, facial expressions and gestures, something that is not possible with the manikins in the Labs. 2. Nursing students and lecturers from different countries can participate in joint remote seminars or workshops in the VRLE, sharing and comparing their country and culture-specific differences and similarities in the nursing practices. VRLE and digital materials enables synchronous and asynchronous learning.

Conclusions

VRLE is highly conducive to clinical and procedure-focused training by enabling simulation. VR methods offer nursing students the opportunity to practice skills in a safe and risk-free environment in an immersive way. It can be accessed by multiple students, teachers or nurses at the same time from different locations in different countries.

Key messages

• New innovative VRLE enhances nursing students’ knowledge and skills that are needed when working with sick children and their families.

• International collaboration, interaction and mobilization are enabled by using a virtual platform instead of traveling, thus strengthening the co-operation in European higher educational institutes.
Leadership opportunities to mitigate challenges and barriers of precision health
Authors: Osti T , Porru F , Russo L , Rodriguez-Ayllon M , Corona V F , Valz Gris A , Terzikhan N , Bramer W M , Pastorino R , Boccia S
Published: October 2024

Background

Precision health, encompassing personalized and proactive health solutions, aims to address this gap by integrating genetic, behavioral, and environmental factors. However, challenges persist in its integration, necessitating new healthcare competencies, particularly in leadership, to expedite the transition. Our goal is to identify barriers and solutions for the implementation of precision health and build a core curriculum of leadership competencies to mitigate challenges and barriers for the implementation of precision health.

Methods

A systematic literature review of qualitative primary studies on barriers and facilitators to precision health implementation was conducted. Data extracted from included articles were analyzed thematically, adapting leadership competencies outlined in the CanMEDS Physician Competency Framework. This approach identified key leadership traits crucial for precision health implementation.

Results

51 articles meeting inclusion criteria yielded 985 barriers and facilitators. Thematic analysis identified 9 primary leadership competencies essential for precision health implementation: application of quality improvement science (30%); fostering a culture of patient safety in data use (10%); advocacy for innovative data management (4%); resource allocation advocacy (9%); evidence-based cost management (4%); driving practice change (8%); prioritization and time management (11%); and optimization of healthcare workforce practices (14%).

Discussion

The synthesized leadership competencies provide a useful framework for addressing barriers and fostering precision health implementation among healthcare professionals. The high representation of competency related to quality improvement science is emblematic of how cultural elements specific to leadership and management in medicine could represent a strategic asset to foster the implementation of innovative solutions, like precision health, in healthcare.

Key messages

• Leadership skills are a crucial element in the curriculum of health professionals to support the implementation of precision health in clinical practice.

• Incorporating elements of ‘quality improvement science’ in the healthcare professionals education emerged as essential to foster precision health implementation.
Indicators of primary health care workforce equity for attaining health equity
Authors: Šantrić Milićević M , Scotter CDP , Bruno-Tome A , Scheerens C , Ellington K
Published: October 2024

Background

Healthcare workforce crises are often the result of inequities faced by healthcare workers. This study aims to discuss the primary policy questions related to health equity regarding the primary healthcare (PHC) workforce indicators.

Methods

Following the purposive review of published literature on HWF equity in PHC services, we applied an intersectional analysis of the compendiums of HWF indicators (e.g., supply, flows, skill mix, working conditions, promotion, training, funding, governance, etc.) to strategically link them to PHC policy issues for health equity and categorized qualitatively under each policy pillar against HWF crises.

Results

The proposed indicators address the measurement of multiple dimensions of health workforce equity. These include financial and non-financial incentives to monitor worker attrition reduction, gender pay gap, fairness in employment arrangements, remuneration, and working conditions. By monitoring the minimum wage for financially vulnerable health workforce groups, we can identify the need for potential increases to support well-being, reduce turnover, and increase productivity. Equally important is monitoring equity in health workforce education, planning, and management, which is crucial for achieving population health equity. By implementing indicators of health workforce diversity to address rural and underrepresented communities, primary healthcare managers can effectively plan the reduction of their unmet needs and minimize avoidable referrals.

Conclusions

To ensure equitable access to primary healthcare, we must measure workforce equity and its impact on population health. Monitoring the indicators of equitable health workforce policies and evaluating the improvement in retention and recruitment processes can more effectively address workforce crises.

Key messages

• Health workforce crises often stem from healthcare workforce inequities.

• Health workforce equitable policies require a clear set of indicators.
Hospital employees’ perceived racism, ethnically offensive behavior, and patient violence
Authors: Inchi L , Gur A
Published: October 2024

Background

Hospitals are sensitive environments with complex interactions between employees and patients. Israeli society is ethnically diverse, and Israeli hospitals reflect this diversity and may create opportunities for rapprochement between different ethnic groups or might raise conflicts between them. In radical situations, such encounters might lead to violence. The phenomenon of physical or verbal violence towards caregivers and hospital employees exists. However, the uniqueness of this study is in examining whether the origin of the violence stems from racist reactions and how offensive behavior on an ethnic background could develop into actual violence.

Methods

Data were collected through an online close-ended survey among 370 hospital employees. 83% were Jewish, 68% were female, and 38 years old on average, with a mean hospital tenure of 6.5 years. The survey explored respondents’ perceived racism toward them, their exposure to offensive patient behavior based on ethnicity, and their exposure to general violence. Data were analyzed by SPSS 28.

Results

Preliminary results suggest positive correlations between study variables (r=.42-.52, p< .001). Regression analysis revealed that perceived racism contributed to general violence (β=.43, p< .001; R²=.19). Next, ethnic-based offensive behavior was added to the model (β=.36, p< .001). The analysis shows that general violence can be explained by these variables [F(2, 359)= 70.42, p< .001; R²=.28]. The R² of the general model increased significantly by 9.6%. The weight of perceived racism dropped yet is still significant (β=.24, p< .001). These results indicate that patients’ ethnic-based offensive behavior partially mediates the relationship between employees’ perceived racism and general violence.

Conclusions

The results suggest that employees who suffer from racism experience patients’ offensive behaviors based on ethnicity, which finally results in higher exposure to general violence in the workplace.

Key messages

• Understanding the phenomenon of violence in hospitals and examining the relationship between it and racism may amend policy and improve the quality of care and working conditions in the health sector.

• The hospital environment involves diverse groups of society. Hence, the awareness of offensive behavior on an ethnic background is a condition to reduce racism and violence proactively.
Elective placements for medical students in a regional Public Health Department in Ireland
Authors: Kelly C , Gorman I , Carroll C , Fallon U , McCarthy N , Cooney F
Published: October 2024

Exposure to different specialties during medical school influences the subsequent career choice of students. We describe the development of elective student placements in Public Health in a regional Public Health Department (PHD) in Ireland which serves a population of just over one million. In September 2023, a collaboration to oversee the electives was established between our PHD (HSE Dublin and Midlands) and an academic institution (Trinity College Dublin (TCD)). An Elective Working Group (WG) was formed which developed learning objectives and an elective plan. The electives were scheduled for October and November 2023. The key learning objectives were for students to: • Develop an understanding of the role of Public Health across all domains, in our regional PHD and in Ireland; • Develop an understanding of the career pathway in Public Health Medicine in Ireland; • Contribute to a public health project within the PHD. The elective plan included approximately 15 1:1 tutorials across the public health domains, attendance at PHD meetings and a literature review-based project. Between October and November 2023, two students (one per month) were attached to the PHD. At the end of each elective, students presented project findings to the WG for discussion. Debrief sessions gathered feedback from the students, the WG and the TCD partner. Student feedback was overwhelmingly positive. Feedback suggested taking pairs of students at the same time may increase efficiency and capacity for future electives in our PHD. A collaborative approach to planning and coordinating the electives was crucial to its success. We are building on this experience to expand the electives with an increased number of students being facilitated by our PHD in 2024, providing students with greater opportunity to gain exposure to Public Health Medicine during medical training. Application and evaluation materials were refined which can be shared.

Key messages

• The success of the Public Health electives in our regional Public Health Department was underpinned by a collaborative academic partnership and a structured, coordinated approach.

• Availability of Public Health electives during medical school training can support students to gain exposure to this specialty in a time when they are considering future career choices.
Honors Track in Global and Occupational Health: a students’ perspective from Humanitas University
Authors: Ferrante L , Ertmer J , Pagano M , Oyedele I O , Serazzi F , Lopedote L , Barbic F , Stranges S
Published: October 2024

Background

To meet an increasing interest in global health, more opportunities for medical students should be created. Humanitas University (Milan, Italy) has debuted a new extracurricular activity called “Honors Track in Global and Occupational Health” (HT-GOH), to allow students critical insights into the field at the beginning of their career.

Objectives

HT-GOH is a two-year programme, led by expert professors in the field. The main aim is to circumvent limitations of global health education at individual institutions, achieved through a combined presence and online approach that allows for international collaboration with experts and attendance of online lectures and travel abroad for practical experiences. Complemented by monthly meetings, participation to workshops, seminars, conferences, and the discussion and literature review of crucial global health topics.

Results

The six participating students are actively promoting discussions, exchange of ideas, and literature findings on many global health issues. They audited courses in other universities and are building connections within the field. The active involvement of the students and their increasing interest in the global health debate can be seen by their participation in this abstract and the conference. The effectiveness of the programme is being evaluated through monthly feedback by students.

Conclusions

The programme allows for an initiation to research work, promoting collaboration between students and exploration of a variety of topics under the guidance of experts. The nature of a specific programme allows for a more individualized approach and greater development of skills unique to each student. This HT represent a valid approach to global health education, especially in settings in which this field is only taught in the context of a public health course.

Key messages

• A new programme at Humanitas University offering an innovative approach to the field of global health to interested students.

• The students’ perspective towards an integrated approach to global health in medical schools.
Opportunities for nursing and midwifery research in Bulgaria
Authors: Saleva M , Mineva-Dimitrova E , Anov A , Draganova M
Published: October 2024

Background

The training of nurses and midwives today is at university level and follows established standards. The 2009 Global Standards for the basic nursing and midwifery education of the World Health Organization requires that the curricula should include basic knowledge and skills for scientific research to implement evidence-based health care. In Bulgaria, scientific research among nurses and midwives began in 2000 and has seen more serious development in the last 5 years.

Methods

A content analysis of normative documents was carried out, to regulate the conduct of scientific studies and the curricula for the two specialties.

Results

In all documents on the activities of graduate nurses and midwives, activities related to conducting scientific studies are regulated. No mandatory discipline for these competencies is included in the basic education. In Bulgaria, there is a bachelor’s and master’s program only in Health Care Management, in which sociology, statistics, and research methodology are studied. From 2000 to 2016 nurses and midwives defended doctoral dissertations in a program for medical doctors. The first doctoral program for nurses and midwives is from 2016. There are no legal norms for stimulating and provide conducting clinical research, and to ensure evidence-based practice by nurses and midwives.

Conclusions

The normative regulation of scientific activity among nurses and midwives in Bulgaria corresponds to international and European requirements, but the opportunities for training are limited. The responsibility of nurses and midwives to modern society is to ensure high quality in health care provided by: a. providing opportunities for clinical studies; b. implementation of evidence-based health care and practice; c. developing programs for training for research in health care.

Key messages

• In Bulgaria, there is a legal norms for conducting nursing research, but not for evidence-based practice.

• There is a need for more opportunities to train and encourage clinical nursing research.
Addressing the complexities of evaluating comprehensive sexuality education: an Italian case study
Authors: Martinelli D , Paparatto G , Ubbiali M , Bonaldo L , di Nino M , Mortari L , Chinelli A , Tavoschi L
Published: October 2024

Background

Existing evaluation methods for assessing sexuality education programs may not be suitable for Comprehensive Sexuality Education (CSE) interventions, which are globally indicated as the most effective approach for promoting sexual health and preventing STIs. This holds particular significance in countries, such as Italy, where CSE is not integrated into school curricula. In a pilot project funded by the Italian Ministry of Health since 2019 (EduForIST), we aimed to develop a composite evaluation framework to test the CSE intervention we implemented in lower and upper secondary schools over the past 4 years.

Methods

Based on the latest available evidence, evaluating a CSE intervention requires addressing various dimensions. These include assessing the quality of programs and their implementation, as well as measuring outcomes and impact. Through iterative consultations with experts and providers, methods, criteria, and metrics were chosen and tested for each dimension.

Results

Program quality was evaluated by an expert advisory board. Instruments for implementation quality assessment included: satisfaction survey among students; reflective journals and SWOT analysis drawn up by educators delivering intervention, exploring their perceptions, practices, and attitudes; surveys among teachers and parents, measuring knowledge, attitude, and practice on CSE, and observed changes among adolescents. A four-arm, Solomon, cluster design study was designed to evaluate outcomes in terms of changes in students’ knowledge. Clinical and behavioral indicators in the short, medium and long term were selected as measures of the impact of the intervention.

Conclusions

In the field of CSE implementation research, a multi-component approach to evaluation is needed to provide a solid basis for informing policymakers. The involvement of providers, recipients and contextual adults is essential in evaluating CSE interventions. However, assessing long-term impact requires long time frame.

Key messages

• Assessing CSE interventions requires a multi-component evaluation approach, considering the impact on the personal and emotional development of individuals in order to sustain behavior changes.

• The proposed evaluation framework may inform scientific community, professionals, and decision-makers on effectiveness of interventions in settings where CSE is not yet included in school curricula.
Which diversity factors influence the attribution of competences and co-operation in nursing teams?
Authors: Schneider A , Khouri A M , Peppler L , Feißt M , Apelt M , Schenk L
Published: October 2024

Background

Diversity within nursing teams increases due to staff shortages in Germany, nurse migration and the current academization of the profession. Quality of patient care is associated with intraprofessional teamwork. Little is known about how nurse’s own diversity factors and those of team members impact nurse’s perception and behavior in team situations.

Methods

A quasi-experimental, cross-sectional study with a factorial online survey with fictional case studies (vignettes) was conducted in two German hospital operators in 2023. Nurses of legal age working in hospitals or nursing homes were eligible to participate. Associations of diversity factors, i.e., gender, age, migration background, and qualification, on the participant and vignette level on perceived competences and willingness to cooperate were preliminary analyzed via multi-level fixed effects models in SPSS.

Results

N = 684 nurses participated (76% female; mean age: 44.2 years; 88% born in Germany; 75% completed vocational training). Competency of team members in patient’s personal hygiene was rated higher by respondents born in Germany (.36), when fictional colleagues were of middle age (.06) compared to higher age and were from Germany (.22) or France (.08) compared to China. Competency in inserting infusions was rated higher by respondents born in Germany (.56), when fictional colleagues were from Germany (.29) or France (.20) compared to China and when one worked together for months compared to days (-.39). Willingness to swap shifts was affected by the fictional length of collaboration (-.08). All significance levels were p<.02.

Conclusions

How nurses perceive their colleagues’ competences is mainly influenced by their own and the other’s migration background, while willingness to cooperate is only affected by length of collaboration. Improving the onboarding process of new nurses in teams, and providing the time and space for professional exchange might improve mutual trust and teamwork.

Key messages

• Diversity in German nursing teams increases due to nurse migration and plurality of qualifications.

• Facilitating professional exchange about individual competences might improve team work in nurses.
Empowering Educators: Integrating Sustainable Health in Healthcare Professionals’ Training
Authors: Niemi M , Valcke J , Viberg N , Guidetti S , Mölsted Alvesson H , Tariro Tanaka Hungwe F , Hellden D , Alfven T
Published: October 2024

Despite efforts to realize Agenda 2030, the sustainable development goals (SDGs) may not be achieved. This already now impacts public health and healthcare, including the training of providers. “Sustainable health” addresses this urgency by emphasizing health as key to achieving the SDGs. While the UN developed a competency framework for teachers in 2011, the specific competencies needed to train in sustainable health remain unclear. Transformative learning (TL) is crucial to integrating sustainable development in higher education (HE), yet its application in the education of health professionals is limited. TL entails a profound transformative journey that reshapes perceptions and experiences, necessitating a shift in the educator’s role from information provider to facilitator of transformative processes. According to a 2019 literature review on TL for healthcare students, teachers need detailed and practical guidelines on how to implement TL. We aimed to develop an evidence-based matrix outlining a) the educational strategies needed to ensure that students develop sustainable health competencies, and b) the competencies teachers need to use these strategies in a quality-assured way. We conducted a literature review to identify key dimensions of teacher competencies and educational strategies for sustainable health. We surveyed teachers at Karolinska Institutet to assess the relevance of these competencies and teachers’ confidence in using them. Focus group discussions were conducted, to explore barriers and enablers to develop competencies and use educational strategies. We present a competency framework for HE teachers, accompanied by recommended educational strategies and self-assessment tools to gauge further training needs. To be used by teachers and educational developers, it will be openly accessible in Swedish and English. This study contributes to enhancing competencies in training health professionals to contribute to achieving sustainable health for all.

Key messages

• Educators need to be equipped with competencies to lead transformative learning processes to enable future generations of health professionals to achieve sustainable health for all.

• Educators need to be supported to transform their role and practice to provide relevant training for future health care providers.