bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring upstream determinants of dietary health to increase action on nutrition: The INFORMAS initiative
Authors: Vandevijvere S
Published: November 2019

Background

Efforts for tracking malnutrition in all its forms are increasing. The World Health Organization conducts regular surveys among Member States on implementation of policies to prevent non-communicable diseases (NCDs) through online databases and interactive maps. However, there are critical gaps. One of the main factors contributing to unhealthy diets is unhealthy food environments. Food environments are the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food habits and nutritional status.

Methods

The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was founded in 2013 and developed a new framework to monitor and benchmark the healthiness of food environments and policies in a standardized way internationally. The framework consists of 7 modules covering different aspects of food environments (e.g. food composition, labelling, marketing, provision) and two tools (focused on policies and business impact) to measure the extent of implementation of priority recommendations to improve food environments by governments and the private sector.

Results

To date about 30 countries implemented one or several modules or tools of the INFORMAS framework. INFORMAS has conducted several multicountry comparisons and has developed a blueprint country profile for measuring progress on creating healthy food environments. The proposed country profile aims to supplement similar efforts by the Global Burden of Disease in monitoring health risk factors and outcomes.

Conclusions

This monitoring fills a gap in the available evidence regarding food environments and policies internationally. Monitoring the healthiness of food environments using key indicators is important to strengthen accountability of governments and food companies, and evaluate the impact of their policies.
Example A: Using online respondent-driven sampling among men who have sex with men in Vietnam
Authors: Thorson A E , Rocha L E C
Published: November 2019

Men who have sex with men (MSM) represent a key population at enhanced risk of sexually transmitted infections including HIV. HIV incidence rates are increasing amongst MSM in Vietnam. The last prevalence rates estimates range between 4% and 12% in major cities (2014). High rates of syphilis, chlamydia and gonorrhoea have also been reported, including drug resistant gonorrhoea. MSM face a strong cultural stigma, especially predominant in rural areas, which make them hard-to-reach in relation to preventive activities. In this context, respondent-driven sampling (RDS) becomes an efficient solution for sampling as well as for testing health promotive interventions. The high Internet penetration rate makes web-based RDS to enable sampling as well as testing risk reduction interventions, an appealing alternative to reduce costs, increase data reliability and to facilitate project management of complex study designs. In this talk, we will present and discuss the implementation of a nation-wide webRDS study of MSM in Vietnam aiming to collect self-reported sexual health and risk behaviour information. Using the same web-RDS system, we combine RDS with a double-blinded randomised controlled trial to implement an online intervention based on the participants own responses to encourage self-reflection. The system allows us to follow up respondents for several months after the initial intervention to check the consequences of the intervention on individual behaviour over time.
Health in Environmental Impact Assessment (EIA): Gaining strength from the ‘Family of health assessments’ approach
Authors: Fehr R , Nowacki J , Martin-Olmedo P , Claßen T h , Fisher T h , Martuzzi M , Mekel O
Published: November 2019

Background

For connecting health-related “scientific knowledge” and “policy-making” with each other, there is a range of approaches, including health reporting, health needs / impact / technology / systems performance assessment as well as evaluative activities. The improved understanding of their communalities and differences provides opportunities for mutual learning and synergetic practice.

Goal and method

The goal is to strengthen the coverage of health within EIAs. We apply the “Family of health assessments” approach, as worked out by the EUPHA “health assessments” working group (EJPH 2017, pp.609-16), for connecting EIA to other approaches used to support decision-making.

Results

Applying this “family” approach leads to various insights, including the following: (i) Existing local health (or environmental) reports provide baseline information, as required in impact assessments. (ii) An existing Health Needs Assessment (HNA) can point to vulnerable populations, Health Systems Performance Assessment (HSPA) to specific weaknesses of local health care, potentially relevant for expected impacts. (iii) Where other impact assessments beyond EIA, e.g. Social Impact Assessment (SIA), are conducted, assessors need to be aware of potential overlap or even contradictions which could irritate decision-makers and the public. (iv) Ex-post evaluations of similar projects can inform prospective EIA. (v) The competencies required for assessing human health in EIA overlap with those required for other types of health assessments, e.g., health reporting or evaluation. Therefore, teaching modules might jointly be developed.

Lessons

The “family” perspective helps to make best use of existing (local) knowledge (which is often embedded in diverse forms of health assessments); and to assure consistent practice across assessments. The inter-relationship of health assessments is a reason to reconsider training courses and to develop more integrated approaches.
Health literacy policies and activities: developments in the past five years
Authors: Rademakers J
Published: November 2019

Background

In the past five years, two inventory studies have been performed in which health literacy policies throughout Europe were described and analyzed: the ‘Study on sound evidence for a better understanding of health literacy in the European Union’(HEALIT4EU, 2015) and the recent HEN-synthesis report on the evidence on existing policies and linked activities and their effectiveness for improving health literacy (2018). In this presentation, data from these two studies will be compared to identify current developments regarding health literacy policy.

Methods

The descriptive data of both studies were, amongst others, compared with respect to the number of countries with policies or activities regarding health literacy, the geographical distribution over Europe, the content of the policies and level of implementation.

Results

More countries have developed policies and activities in the domain of health literacy, or are currently in the process of doing so. However, gaps remain in the geographical distribution of policy, and evidence on the effectiveness of policies and activities is still marginal.

Conclusions

Health literacy is more prominent on the European policy agenda. Rigorous evaluation is needed to demonstrate possible benefits of the policies for individuals, communities and society as a whole.
Ground pillars of a method for quality assurance of public health work
Authors: Magnusson M , Hallmyr M , Wretlind K
Published: November 2019

Socioeconomic position, expressed in terms like educational level, income, wealth or origin, is a strong predictor of most health outcomes. Sustainable efforts for good and equitable health need to draw on theories that consider power relations as well as scientific methods for health promotion, prevention and /or treatment. Systematic planning and documentation is required. The perspective should include not only life style habits but also issues like discrimination and stigmatization. Control and influence from participants are necessary to assure that goal-setting and measures taken are adequate.

Health inequity emerges from structural issues and is mediated by mechanisms on different levels, mechanisms of which some are difficult to describe and analyze. Regrettably, health care systems, including public health interventions, in many cases reinforce this inequity. Health care staff’s personal perspectives and prerequisites (e.g regarding education and income) often differ from the corresponding ones in groups with the less favorable health outcomes. That is one reason why efforts for equitable health need to involve perspectives, prerequisites and health motives of “targeted” individuals and groups as salient parts of interventions, from the planning stage and throughout. A complementary way to prevent intervention procedures from consolidating current positions of power is to allow for professionals to continuously perform critical reflection of their own presuppositions and prejudices in relation to actions and results.

The use of determinants from Social Cognitive Theory (SCT) (self- efficacy, observational learning, facilitating, expectations of outcome, reciprocal determination) enables planning that consider not only individuals and groups but also their social context. Systematic use of strategies from SCT, critical reflection and formative as well as summative evaluations allow for quality assurance and knowledge development.
Implementing HEM in the assessment of oral health promotion to families in underserved areas
Authors: Wretlind K , Magnusson M , Hallmyr M
Published: November 2019

The aim was to, in an oral health promoting setting in low socioeconomic areas, implement a method aiming at improving quality of work by assessing both formative and summative results. The overall aim is to decrease health inequity.

Methods

Five teams of dental hygienists (n = 5) and dental nurses (n = 3), who operated in socioeconomic low-status areas, participated. The teams were performing health promoting activities on arenas as for example family-centrals. These teams were introduced on how to report health promoting activities according to the Health Equilibrium Methodology (HEM), which is based on Social Cognitive Theory. Following questions were put and answered in every report: Which health determinants were targeted? Did any person seem to perceive him-/herself excluded? Did anything unexpected happen? What to think about next time? Quantitative data were also documented: Almost six-hundred individuals were included in a total of 36 reports. Of these 50% were adults/parents and the rest children, most of them between 1-6 years old. The reports were written directly into a database after every activity and then processed by a facilitator and later discussed with the teams in workshops every third month.

Results

Analysis of the reports shows that the implementation of health promoting activities according to HEM included the following: -Identification of important health determinants. - Attention on how to get everyone involved and if anything unexpected happened. - Suggestions for change for the next time. Throughout the workshops the team-members exchanged experiences.

Conclusions

The HEM-method facilitates depicting and discussing the process of health promotion with focus on health equity. Thereby the method has a potential to support development of high-quality health-promoting activities in populations with low socioeconomic status. It may also lead to a better professional self-confidence.
Austria: target country for care workers despite increased anti-migration policies
Authors: Falkenbach M
Published: November 2019

Background

Austria is facing workforce shortages in long-term care making the country an important destination for migrant care workers, particularly from Eastern European countries. Many of them are working in low-status positions as carers in 24-hours care, although they are often qualified professionals. These 24-hour care positions are often in private households with no regulated workplace safety or standard minimum salaries. Despite this steady flow of migrant carers, shortage of nurses and carers in the country persists and is likely to increase.

Methods

A rapid review of available data and research was undertaken.

Results

The migration of nurses to Austria has played a significant role for many years, as the training of certified nurses within the country has only risen marginally. The annual inflow of foreign trained nurses reached a high in 2016 as did the number of 24-hour care workers, most of which are women. The recent cuts by the government towards family allowances for children not living in Austria will hit this population hard. Current anti-migration policies thus take the risk of reducing the numbers of migrant carers, although the government does not have a plan in place on how to fill the gaps and develop more effective health workforce planning and management.

Conclusions

Growing nationalism, a government pushing towards stricter migration laws and a restrictionist policy stance of unions relative to migrants, all create new threats to a health system heavily dependent on migrant carers.
Panel: Care4Care: what is it about the migrant care workforce and how to improve inclusion?
Authors: Jacob G , Azzopardi Muscat N , Greer S L
Published: November 2019

A round table comprising three panelists will discuss the topic from different perspectives. Gabrielle Jacob, WHO: The WHO Global Code of Practice on the International Recruitment of Health Personnel. How far have we come, where are we now and what’s next?Natasha Azzopardi-Muscat, EUPHA President: The role of public health in raising awareness on the contribution of migrant workers to health systemsScott L Greer, European Observatory on Health Systems and Policies: Governance4Care of the migrant care workforce: what matters?
Risk factors associated with repeated voluntary termination of pregnancy in Tuscany, Italy
Authors: Napolitani M , Kundisova L , Serafini A , Lenzi D , Messina G , Nante N
Published: November 2019

Introduction

In Italy, voluntary termination of pregnancy (VTP) was introduced in 1978 with law n°194, it guarantees autonomy of choice and avoids the practice of unsafe abortions, health complications and death. The aim of this work was to analyse variables associated with repeated VTP.

Methods

A cross-sectional study was realized, with data relative to VTP acquired in the period 2016-2018 in Tuscany South-East area (Italy). Data on age, nationality, civil state, education level and n° of living children were extracted from the information system in April 2019. A descriptive analysis was conducted using Stata.

Results

The sample consisted of 3451 females (65% Italian). The average age was 31.1±7.3 years. The majority of females (53%) had medium-high education level (non-Italian females had more frequently low education level: 48% vs. 28%, chi-2; p<0.001). The 57% were unmarried, mostly Italian (64% vs. 43%). The majority (62%) already had child (26% one, 36% two or more). Females with repeated VTP represented 25% and were significantly older (32.1 ±6.4 vs. 30.7±7.6; p<0.001). The non-Italian females (OR = 2.15; 95%CI 1.8-2.6; p<0.001) and females that already have children (OR = 2.4; 95%CI 2.02-2.9; p<0.001) had higher probability of having a VTP in the past. The multivariate analysis showed lower probability of repeated VTP for married women (OR = 0.49; 95%CI 0.42-0.64) and women with higher education level in confrontation to those with an elementary education (OR = 0.3; 95%CI 0.18-0.62). The variables associated with higher probability of VTP were age (OR = 1.02; 95%CI 1.01-1.04), nationality (OR = 2.0; 95%CI 1.7-2.4) and children (OR = 2.4; 95%CI 1.9-3).

Conclusions

Females with repeated VTP were older, have already children and were more frequently of non-Italian nationality. The reduction of VTP should be one of major objectives of public health as in has negative consequences on women’s health. The targeted public health intervention could be a solution of this situation.

Key messages

Females with multiple VTP were older, already had children and were more frequently of non-Italian nationality. Targeted public health interventions could be effective in reducing the number of VTP.
Health service provision for women 50+: the “Frauen 5.0” project in the north-east region in Germany
Authors: Dini L , Pruetz F
Published: November 2019

Background

A higher life expectancy for women in Germany coincides with shortages in health professionals. Besides gynecologists (Gyn), the main providers of ambulatory healthcare services for women 50+ are general practitioners (GPs), which are not providing any gynecological services. The project “Frauen 5.0” aims to identify strategies for improving health care provision for women 50+ in three north-east states of Germany by analyzing health system indicators and exploring the perspective of service providers, users, practitioners and policy makers.

Methods

Mixed-methods combined with participatory research including 1) secondary data analysis (Robert Koch-Institute and Zentralinstitut); 2) postal quantitative survey of all Gyn (n = 1.031) and of a randomized sample of 66% of GPs (n = 3.514); 3) qualitative interviews of women 50 + (n = 25); and 4) round tables with practitioners and policy makers.

Results

In Germany 25% of the population are women 50+, from which 41% do not use Gyn services. Users expressed the need that GPs/Gyn actively address women’s health issues during consultation. The survey (response rate 51% Gyn; 25% GPs) revealed a high willingness to collaborate among GPs and Gyn. Barriers and synergies in organizational, professional and user aspects were identified. Task-sharing between GP and Gyn, delegation to non-medical personnel and the introduction of financial incentives showed to be a key element to improve health care services for women 50+.

Dissusion

In the SDG era of “leaving no one behind” acknowledging and addressing the unmet needs of women 50+ is from a public health perspective an issue of utmost urgency as is closing the gap between research, policy and practice.

Conclusions

New strategies to improve health care services for women 50+ were developed by integrating the evidence from actual data in meaningfull dialogues between research, policy and practice.

Key messages

New models of health care provision are required to adress and improve the health of women 50+. Closer collaboration between research policy and practice can be achieved by participatory methods.
Surveillance of health and primary care of asylum seekers in reception centers: concept and results
Authors: Jahn R , Bozorgmehr K
Published: November 2019

Background

Reliable data on health and primary care among asylum seekers in reception centers are essential for the planning and provision of medical services, but haphazard care provision and lack of standards for health information systems in these centers preclude routine health monitoring. We aimed to establish a routine surveillance system in reception centers for asylum seekers in Germany, generating multi-center data on key health indicators.

Methods

To enable routine health surveillance, we established an electronic medical records system (RefCare©), a research network, and an IT-infrastructure for the automated analysis of health data in German reception centers. Within the network, 64 health and health care indicators on morbidity, care processes, quality of care and syndromic surveillance were identified. In November 2018, we analyzed 33 indicators using routine health data from nine centers in three federal states. We calculated single-center prevalence and pooled estimates for selected morbidity indicators stratified by age and sex, and process and quality indicators stratified by center.

Results

A total of 8,406 patients and 39,449 patient contacts were analyzed, with mean utilization of health services ranging from 2.33 (Standard deviation, SD: 2.0) to 11.49 (SD: 22.82). The morbidities with the highest prevalence were respiratory, digestive and certain infectious diseases, followed by consequences of external causes, musculoskeletal and mental health conditions. Irrational use of antibiotics was below the threshold for primary care settings.

Conclusions

For the first time in Germany, a harmonized infrastructure for the automated, anonymized surveillance of the health and health care of asylum seekers in reception centers was established in several federal states. The analysis of morbidity indicators shows a primary care-typical disease profile, with special needs regarding mental health and consequences of external causes, such as physical trauma.

Key messages

Routine health surveillance of asylum seekers in reception centers can be achieved through an innovative harmonized, cross-regional, multi-center, anonymous and automated surveillance system. Health issues of asylum seekers in reception centers in Germany mainly consist of primary care conditions with special vulnerabilities regarding mental health and consequences of external causes.
Treatment gap and mental health service use among Syrian refugees in Turkey
Authors: Fuhr D C , Ataturk C , McGrath M , Ilkkursun Z , Woodward A , Sondorp E , Roberts B
Published: November 2019

Introduction

Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey.

Methods

A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used.

Results

The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported.

Conclusions

To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness.

Key messages

This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.
Participatory practice with queer refugees in Germany
Authors: Gangarova T
Published: November 2019

Evidence shows that queer refugees in Germany neither have equal access to the health system, information, HIV-Testing and treatment, nor are they involved in HIV-Prevention. The community-based participatory health approach provides a valuable tool for building capacity and enabling queer refugees to create knowledge and develop appropriate prevention tools for their communities.

“Your health, your rights” (2017-2018) is a 2-year community-based participatory health project, which aims to improve the involvement of queer refugees in HIV-Prevention, as well as to create appropriate prevention media in collaborative way. It is conducted by the National AIDS Organization in collaboration with partners from different immigrant organisations, queer refugees and AIDS service organisations - all based in Berlin.

The components of the project include a multilingual participatory need assessment workshop, a series of capacity-building methodological workshops, a community-led art-based project and a participatory evaluation.

12 queer refuges choose to take part in the project and have been supported to document their lived experiences using community and concept mapping. Key topics and needs connected to sexual health have been jointly identified. Based on these results and in the framework of an art-based workshop participants created a design of multilingual website for queer refugees which delivers helpful information in appropriate way (www.queerrefugeeswelcome.de).

The involvement of queer refugees in HIV-Prevention is possible, if it is enabled. The usage of participatory visual methods has opened up ways of participation of even highly traumatised refugees who otherwise are not able to verbally express their thoughts and enabled the communication between participants who don’t share the same language.

Key messages

The resources of queer refugees are identified and mobilised and community building processes are supported. The participants improved their competencies (empowerment). Service providers are able to tailor their services better to the needs of queer refugees.
Multiple interventions to strengthen immunization services in an Angolan district
Authors: Fattorini M , Raguzzoni G , Cuccaro C , Nante N , Quercioli C , Ndilimondjo J M N , Caresia C , Putoto G
Published: November 2019

Background

Immunization represents one of the most effective intervention in public health. In the Sustainable Development Goals era, adequate vaccination services are still crucial for the prevention of infectious diseases and the reduction of under-5 mortality. However, in 2017 WHO estimated that children <1 year who did not receive the third dose of Diphtheria-Tetanus-Pertussis (DTP3) vaccine were 19.2 million globally, and 600000 of these were located in Angola, a Sub-Saharan country with an estimated DTP3 coverage of 52%. Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activity of the hospital of Chiulo in the commune of Mucope (district of Ombadja, south of Angola). Aim of the study is to describe the interventions implemented to strengthen the immunization services performed by the hospital Public Health Staff (PHS).

Methods

In May 2018 the NGO started to implement multiple interventions to enhance the number of vaccine doses administered. Firstly, outreach immunization sessions were reorganized and reinforced, for example involving local Community Health Workers in the identification of villages with a high burden of unvaccinated children. Other actions were the continuous training of the PHS in data collection and the increased collaboration with the Ombadja District Health Department in order to develop a more efficient vaccine supply chain at local level.

Results

In 2018, among children <1 year the PHS administered 19746 doses, with a 22.3% growth compared to 2017 (15349 doses). Doses administered during outreach sessions increased by 35.4% (6597 versus 4259 doses). Estimated DTP3 coverage in Mucope commune was 71% (2017, 59%).

Conclusions

The WHO “Reaching Every Community” strategy emphasizes the importance of high quality immunization services in hard-to-reach areas. The organisation of well-functioning immunization services requires a multifaceted approach by the involved stakeholders.

Key messages

In 2017, globally 19.2 million of children <1 year did not receive the recommended three DTP doses. Six-hundred thousand were located in Angola. To obtain and sustain an adequate vaccination coverage, especially in hard-to-reach areas, multiple and well-coordinated actions should be implemented by all the involved stakeholders.
Towards a deliberative approach in public health policy making
Authors: Van Hoof W , Mayeur C
Published: November 2019

The time when public health policies could be based solely on expert opinion has gone. Public opinion has a real impact on the effectiveness of public health policy. However, for complex issues such as vaccination, screening, GMO’s, privacy and data governance, public opinion is divided. How to integrate divided public opinions into a well-structured health policy? In Belgium, as in many other countries, policy makers have started to turn to deliberative processes to guide policy making with citizen involvement, especially in ethically contentious areas.

Deliberative processes aim to involve citizens in policy making in a setting where individual opinions and interests are weighed honestly and fairly, so that through well informed deliberation common ground can emerge. Participants are informed by a neutral information package, a variety of experts and facilitated discussions. In a very transparent way, these positions are molded into tailored policy inputs. In Belgium, such initiatives have recently been organized on biobanking, genomics, e-health, reimbursement policies and more. In France, the government is obliged by law to organize a comprehensive deliberative public consultation on bioethical issues every seven years.

Especially in areas that require a large degree of trust, a deliberative approach ensures policies that can be supported by people with diverse views. They offer a viable alternative to traditional models of power and conflict that is more suitable to governance in 21st century democracies. They allow citizens to make a meaningful contribution to topics they may not have been familiar with beforehand, but that do touch on their private lives and interests.

The most recent Belgian initiative resulted in nine concrete policy inputs for the implementation of genomics in health care, presented directly by the citizens to the Minister of Public Health. The French initiative is the basis for the current review of the law on bioethics in parliament.

Key messages

Public health issues touch the interests of all citizens: citizen deliberation should be regarded as an important input for public health policies. A deliberative approach enhances public trust, especially in areas of social or ethical contention.
Health is not for sale, is it?
Authors: Plochg T , Hinrichs-Krapels S , Keijsers J
Published: November 2019

Issue/problem

Health is not for sale, given that one cannot buy health as a guaranteed commodity. Human beings co-produce their health every day together with their (social) ecosystems. As such, being healthy is a co-adaptive, complex, and self-organizing enterprise. However, our current economies thrive on citizens who consume themselves ill, and buy health care to fix their diseases. With spiralling costs of healthcare, a shift is urgently needed towards making a business case for health.

Description of the problem

From 2014 onward, the Dutch Federation for Health invested in the development of a business case for health. They explored the following questions: 1) Why is a business case for health warranted? 2) What could such a business model theoretically look like? 3) How could it be co-created in practice?

Results

We found there is a business case to keep diseases going, driving healthcare expenditure up. Literature suggests that this business case for disease is untenable. Inevitably we need new incentives that keep ‘health’ going rather than disease. We need a mechanism to make the business care for health. We have begun to model one approach named the ‘vitality contract’, featuring 10 organizational principles which provide guidance on how to construct the right market structure for health to be co-produced and sold on the premises of an ecosystem. The Federation for Health has been championing this vitality contract, and succeeded to get it on the national policy agenda. However, co-creation is essential for it to work: only few coalitions have risen to the challenge to make such a ‘vitality contract’ work in practice.

Lessons

The business case for health is needed. The vitality contract might provide one approach to demonstrate how it could be co-created in different local contexts and different public health systems. To be more impactful, further co-creation and collaboration from national coalitions and other European countries may be required.

Key messages

With spiraling costs of healthcare, a shift is urgently needed towards making a business case for health. The Dutch ‘vitality contract’ might provide one approach to demonstrate how a business case for health could be co-created.
Importance and feasibility of implementing child and parent centeredness in routine care
Authors: Eichinger M , Goerig T , Georg S , Philippi H , De Bock F
Published: November 2019

Background

Child and parent centeredness (CPC) are important determinants of the quality of care for children with chronic health conditions. However, little is known about the perceptions of healthcare professionals on the importance and feasibility of implementing CPC in routine care, although both might be key for the successful implementation of CPC. We therefore assessed the perceptions of healthcare professionals concerning this matter and analysed, how familiarity with the International Classification of Functioning, Disability and Health (ICF) might strengthen CPC.

Methods

Cross-sectional data was collected in 12 specialized interdisciplinary outpatient centres providing treatment for children with chronic health conditions in Germany. The standardized questionnaire covered (1) the importance of implementing child (CC) and (2) parent centeredness (PC) as well as (3) the feasibility of implementing CC and (4) PC in routine care (based on Arnetz et al. 2008, Patient Involvement Subscale) and (5) the prior use of the ICF. Bivariate associations were assessed with permutation tests.

Results

In total, 206 healthcare professionals were surveyed (response rate: 47 %). The perceived feasibility of implementing CPC fell short of their importance (p < 0,001). Moreover, CC was ranked lower than PC in terms of both importance and implementation feasibility (p < 0,001, respectively). Prior use of the ICF was associated with higher importance of CC (p < 0,001) and PC (p = 0,01).

Conclusions

While the importance of CPC to healthcare professionals was high, the active involvement of children and the routine implementation of CPC were perceived as challenging. Interventions to facilitate the implementation of CPC should therefore comprise hands-on implementation strategies and put a special focus on how to involve children in routine care (e.g., through special communication techniques). Including the ICF as a conceptual framework in interventions to foster CPC could be a facilitator.

Key messages

While child and parent centeredness are important to healthcare professionals, their implementation in routine care and the active involvement of children are challenging. Interventions to foster the implementation of child and parent centeredness should include concrete practical implementation strategies and put a special focus on the involvement of children.
The necessity of applying Rasch measurement theory in questionnaire-based public health research
Authors: Finbråten H S , Kleppang A L , Steigen A M
Published: November 2019

Background

Questionnaires are frequently used in public health research. In order to provide valid and reliable results to generate recommendations for practice and policies, scales with sound psychometric properties are required. Classical test theory such as factor analysis is most frequently used to assess the psychometric properties of scales. However, classical test theory may have limitations in confirming the validity of scales. Only Rasch measurement theory meet the requirements of fundamental measurement, such as additivity, invariance, sufficiency and specific objectivity. The objective is to exemplify how Rasch measurement theory can be used to evaluate the psychometric properties of a scale. Validation of the Hopkins Symptom Checklist-10 is used as an example.

Methods

This study is based on cross-sectional data from the Youth Data Survey. In total, 6777 adolescents responded to a web-based questionnaire. Data collection was carried out in lower and upper secondary schools in Norway during 2018. The data were analysed using the partial credit parameterization of the unidimensional Rasch model.

Results

Preliminary results indicated that the scale had acceptable reliability (person separation index: 0.82). However, one pair of items shows response dependence. The targeting could have been better (mean person location: -1.445). All items had ordered thresholds. Three items under-discriminated. Several items displayed differential item functioning with regard to gender and school level.

Conclusions

Applying Rasch measurement theory measurement problems that would go undetected using classical test theory approaches were observed. Scales used in public health research should be thoroughly validated applying Rasch measurement theory before the data are used to support claims about public health and used to provide recommendations for policy and practice.

Key messages

Public health practice and policy should be based on information from valid and reliable scales. Rasch measurement theory should be used to evaluate psychometric properties of scales used in public health research.
Impact of the Govan SHIP case management project on emergency hospital admission and GP interactions
Authors: Levin K , Crighton E
Published: November 2019

Background

The Social and Health Integration Partnership (SHIP) project was implemented in Govan, a deprived area in Glasgow in 2015. This involved multidisciplinary teams, including GPs and social workers, identifying and supporting vulnerable patients at risk of attending A&E and GP surgeries. This study measures the impact of SHIP on A&E presentations and GP interactions.

Methods

Rate of A&E presentations per 1000 population in 3 participating GP practices in Govan was compared before and after onset of the service, using segmented linear regression with 9-month pre- and 36-month post- intervention periods. Rates of GP interactions were also compared, using 21-month pre- and 36-month post- intervention periods. Rates of A&E presentations and GP interactions for practice population in Drumchapel- an area with similar rates of deprivation - were used as a control. Models included autoregressive and moving average terms, and a fourier term to adjust for seasonality.

Results

Govan had a lower rate of A&E presentations than Drumchapel. A&E presentations did not change significantly over time prior to SHIP in either area. At April 2015, SHIP onset, a level change of -4.34 (-7.44, -1.24) A&E presentations per 1000 was observed in both areas, however , onset of SHIP was not associated with a reduction in level or trend in A&E presentations. Rate of interactions with GP was greater in Govan than Drumchapel prior to SHIP, increasing over time in both areas. After SHIP implementation there was a significant level change of 33.78 (19.57, 47.99) per 1000 across both areas. GP interactions in Govan however saw a further reduction of -1.48 (-2.87, -0.09) per 1000 per month. This is equivalent to SHIP being associated with an absolute reduction of 37 GP interactions per thousand and a relative reduction of 7.2% by March 2018.

Conclusions

The Govan SHIP initiative was associated with no significant change in A&E presentations and some small reduction in GP interactions.

Key messages

The Govan SHIP initiative was associated with no significant change in A&E presentations and a small significant reduction in GP interactions. A cost effectiveness analysis of the project is recommended, given the relatively small benefits observed.
Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach
Authors: Prytherch H , Kasymova Z , Lechthaler F , Kiefer S , Yarbaeva S , Hojimatova Z , Farrukhzoda A , Wyss K
Published: November 2019

Background

For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas.

Description

Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements.

Results

For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits.

Lessons

The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan.

Key messages

Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.
Patient safety incidents in ambulatory care in Germany
Authors: Geraedts M , Krause S , Schneider M , Leinert J , de Cruppé W
Published: November 2019

Background

In contrast to the inpatient sector, reliable data on the epidemiology and public health impact of patient safety incidents (PSI) are hardly found in the outpatient sector. Thus, this study focusses on the incidence of PSI; the distribution among the various specialist groups; the harmful consequences; the causes and how affected patients deal with PSI in Germany.

Methods

We conducted a cross-sectional study using a newly developed computer-assisted-telephone-interview survey tool. Based on random telephone numbers, citizens >39 years were asked to report whether they had experienced a PSI in the last year or since their 40th birthday; whereby the PSI happened, what consequences the PSI had for them and if they reported the PSI back to their physician. We performed descriptive and multivariate analyses and extrapolated the results to the total population >39 years in Germany.

Results

10037 citizens were surveyed (response rate 13%): 8841 had an outpatient visit last year, of whom 1570 (18%) had experienced at least one PSI. In total, 2832 PSI were reported. General practitioners caused 43% of PSI. Among specialists (54%), most PSI were found among orthopedists (15%) and internists (9%) and arose in connection with anamnesis and clinical examination (61%) as well as drug prescriptions (15%). 72% of the PSI caused health related harm. The most frequent harm was a deterioration in health (23%) and persistent pain (22%). 54% of those affected described the harm as severe or very severe. 27% considered doctors’ stress and lack of time or poor communication (18%) as causes for PSI. 32% of PSI were reported back to the treating physician.

Discussion

Extrapolated to the total population >39 years in Germany (47.2 million), an incidence of 12 million PSI per year must be expected with around 6.6 million affected outpatients. Thus, PSI in the outpatient sector are of immense public health importance in Germany.

Key messages

Patient safety incidents (PSI) often happen in the German outpatient sector. Outpatient PSI can also be accompanied by severe harm for patients.
The use of ICT to increase vaccination uptake: state of the evidence from experimental studies
Authors: Odone A , Balzarini F , Frascella B , Oradini Alacreu A , Signorelli C
Published: November 2019

Background

Information and communication technology has a great potential to improve vaccine uptake by increasing the demand of vaccines and the supply of life-course immunization services. The EUVIS (EUrope Vaccines ICT Strategies) project aims at assessing the current use of ICT in European countries’ immunization programs to inform the planning and implementation of ICT-based intervention models to increase vaccine uptake. Here we present the output of Part I of the EUVIS Project, the state of the evidence from experimental studies at the global and regional level.

Methods

We conducted a systematic review following the PRISMA guidelines to analyze the available evidence from experimental studies on the impact of ICT-based interventions to improve: i) vaccine uptake (primary outcome), and other associated outcomes, including knowledge and attitudes towards immunization in infants, adolescents, adults, elder populations and at risk groups.

Results

We included 68 RCTs. Informative websites significantly increased vaccination uptake among adolescents. Among young adults, none of the assessed interventions was successful in increasing vaccination uptake. The tools targeting parents that increased uptake were SMS, automated phone calls or messages, websites and online decision aid platforms. For pregnant women, combinations of more types of ICT were more effective in increasing uptake. In the adult population, both SMS and videos proved to be successful, while in elder populations and at-risk groups, the use of more traditional methods as short phone calls proved to be more efficient than ICTs.

Conclusions

Technological innovations have made significant contributions to healthcare, but our results shows that the interventions must be tailored to target populations’ specific characteristics and needs. These data are of crucial importance to identify which ICT-based interventions are more effective in each target group, to plan and implement immunization programs.

Key messages

Information and Communication Technology-based interventions to increase vaccine uptake are more successful when planned tailoring target populations’ specific characteristics and needs. ICT can significantly improve healthcare delivery but its role to increase vaccine uptake is controversial. Results from this systematic review are fundamental to plan tailored ICT-based interventions.