bluuebunny/crossref_metadata_2025 huggingface dataset:
Who is responsible? Defining a hospital catchment population in the English National Health Service
Authors: Beaney T , Clarke J M , Coronini-Cronberg S
Published: October 2020

Background

There is a growing emphasis on National Health Service hospitals in England promoting population health. Patients can access any hospital, making it complex to define the population a hospital is responsible for. Defining this 'catchment' population is fundamental to provide a population denominator from which to evaluate service provision such as unmet need and the effect of prevention initiatives. Using Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), a large hospital in London as a case study, methods to define the population that has potential to attend the hospital were compared.

Methods

Inpatient, outpatient and emergency attendances were identified using Hospital Episode Statistics from 1st April 2017-31st March 2018. Lower Layer Super Output Areas (LSOAs), consisting of 1,500 people on average, were used as the geographic unit. Catchment populations were constructed using 3 different methods. Under First-Past-The-Post (FPTP), LSOAs were allocated if a greater proportion of patients attended CWFT than any other hospital trust. Under 30% Proportional Flow (30PF), LSOAs were allocated if more than 30% of patients attended CWFT, while under Stratified Proportional Allocation (SPA), patients were assigned in accordance with the proportion from each LSOA that attended CWFT, by gender and 5-year age strata.

Results

Under FPTP, 30PF and SPA, a total of 303, 326 and 10,636 LSOAs were assigned to CWFT, respectively, with corresponding populations of 530,980, 569,682, and 484,249 and median ages of 36, 36 and 29 years. Under FPTP, the catchment area did not overlap with that of any other hospital, while under 30PF, 13.2% of the LSOAs were also allocated to another hospital catchment. Maps were constructed for FPTP and 30PF.

Conclusions

The 3 methods produced different catchment populations, with differing characteristics. Understanding the relative merits of each method has implications for hospitals in how they engage in and evaluate population health.

Key messages

Engagement in and evaluation of public health activities requires knowledge of ‘who’ the baseline population denominator is, but there is no consensus on determining this at the hospital level. Comparing 3 methods to define a hospital catchment, these differ by total population, median age and geography, the choice of which impacts on how hospitals engage in population health.
Effectiveness of Oncology Network model in pancreas cancer surgery in Piedmont, IT: a survival study
Authors: Marengo N , Garlasco J , Bordino V , Vicentini C , Mamo C , Maganuco L , Viora T , Zotti C M
Published: October 2020

Background

The Oncology Network of Piedmont and Aosta Valley (North-West Italy) was started in 2000 and fully established in 2010 as a regional organisational model offering multidisciplinary care by experienced reference centres for cancer diagnosis and surgical treatment. In particular, the San Giovanni Bosco Hospital in Turin is the regional reference centre for pancreatic cancer since 2015 (50-70 oncologic surgery operations performed annually). The aim of study is to assess the effectiveness of this model for pancreatic cancer surgery by comparing survival outcomes before and after the adoption of the Oncology Network model.

Methods

The study included 178 patients, aged 37-84, who underwent duodenocephalo- or total pancreatectomy for ductal cancer in the years 2007-2019. Clinical data were retrieved from surgical records, whereas the vital status was ascertained through an application connected to the Regional Registry Office. The Kaplan-Meier method was used to estimate survival and the log-rank test was then used to compare survival rates between the two groups (before vs. after 2015). Cox's regression was employed to assess the difference between the groups, also adjusting for age, sex and ASA score.

Results

The median survival for included patients was 19 months. No significant differences were found between patients of the two groups (before vs. after 2015), neither considering all patients (p = 0.4) nor for any single ASA or age category (p-values ranging from 0.1 to 0.6). The multivariate Cox model accounting for ASA, age and sex confirmed absence of significant survival differences between the two groups.

Conclusions

Despite increased case complexity, due to the extension of surgery indication to more critical patients, the Oncology Network model allowed achieving an overall survival in pancreatic cancer surgery that is consistent with international literature and not inferior to survival outcomes previously reached in patients more strictly selected.

Key messages

This study found survival after pancreatic cancer surgery was similar before and after the center entered an Oncological Network, which led to include patients with an increased severity in case-mix. Promoting the implementation of Oncology Networks should be a public health priority as it allows to improve health outcomes and quality of care.
Differences in health care utilization by access policy among newly arrived refugees in Germany
Authors: Wenner J , Biddle L , Bozorgmehr K
Published: October 2020

Introduction

In the first few months after refugees arrive in Germany, access to healthcare in most states is granted via health care vouchers (HcVs) that are issued by local authorities. After 15 to 18 months or formal recognition of refugee status, access is granted via electronic health cards (eHC) issued by statutory health insurance funds. We analyze whether these access policies (HcV vs. eHC) are associated with differences in needs-based utilization.

Methods

We use data from a cross-sectional survey among newly arrived refugees and asylum seekers (n = 560; response rate 41.7%) in Germany's 3rd largest federal state to analyze differences in reported utilization of GP and specialist services in the last 4 weeks. We use logistic regression to calculate odds ratios (OR), adjusting for socio-demographic characteristics, health status, duration of stay and proximity of service providers.

Results

Fewer refugees with HcVs reported using GP or specialist services in the last four weeks compared to those using regular eHCs (GP: 52.76% vs. 61.48%; SP: 38.97 vs. 45.09%). For specialist use, this difference persisted after adjustment, with eHC users having significantly higher odds of needs-based utilization (OR: 2.00; 95%-CI: 1.01-3.95). After adjustment, odds for GP use are also higher among persons with eHC, but less significant (OR: 1.37; 95%-CI: 0.67-2.82). Furthermore, the lack of a HcV was the second most reported reason among HcV users to refrain from utilization (17.09% for specialist and 15.51% for GP use).

Conclusions

The access model is associated with differences in needs-based utilization for specialist (and partly for GP) use after controlling for important confounders. The lack of (timely) HcV provision constitutes a relevant access barrier. The results provide evidence that with equal needs, refugees with HcVs have more difficulties accessing services.

Key messages

Access policies are associated with differences in healthcare utilization among newly arrived refugees in Germany. Early access to health cards and the statutory health insurance is likely to facilitate need-based utilization of health services for newly arrived refugees.
Assessing continuum of trauma care for road accident victim in Jodhpur, Rajasthan
Authors: Rustagi N , Raghav P , Dutt N , Sinha A , Rodha M S
Published: October 2020

Background

Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. The present study was designed to assess the existing process of pre-hospital trauma care administered to road accident victims in a fast urbanizing city of Jodhpur, Rajasthan

Methods

A cross-sectional study was designed from 1st November 2018 to 30th June 2019. All cases who were admitted to tertiary level trauma care facility in the study period were reviewed and were analyzed for type of injuries suffered, prehospital care services availed and the time duration that elapsed before patient arrived at tertiary health facility. Geographic information system was used to identify clustering of accident hot spots in the Jodhpur district.

Results

A total of 137 patients or their caregivers were interviewed during the study period. A large proportion of patients 57(41.6%) were unconscious in post-crash phase. Private taxis contributed to maximum patient transfer (75.9%) and only 12.4% were transported through ambulance. Almost three fourth (78.1%) of patients received some form of pre-hospital care within 30 minutes of accident. About one third patients (35.7%) reached the trauma facility directly after the accident while majority (64.9%) were referred from other health facilities

Conclusions

Pre-hospital trauma care for road traffic accident victims is available in golden hour for majority of victims in Jodhpur district. Victims from rural area and tourists form a sizeable proportion of accident victims brought to trauma care facility. The primary health care facilities play a pivotal role in managing victims as first point of care. Future research is thus warranted to explicitly examine the role of health professionals at primary health care facilities in administering pre-hospital trauma care.

Key messages

The primary health care facilities play a pivotal role in managing victims as first point of care. In areas with evolving trauma systems, pre-hospital trauma care strengthening requires capacity building of all level of health professionals.
External classification for ethnicity in health survey to monitor Roma vs non-Roma differences
Authors: Sándor J , Janka E , Vincze F , Ádány R
Published: October 2020

Background

The Roma population of European countries is characterized by a poor and poorly described health status. The lack of detailed data on health loss among Roma can be partly attributed to legal limitations based lack of reliable methodology to effectively identify them. On the other hand, it is among factors responsible for restricted effectiveness of policy to narrow gap between Roma and non-Roma health status.

Objectives

We aimed to compare directly results from population based health survey on Roma vs non-Roma differences based on self-declared and observer-reported Roma classification.

Methods

In a population based health interview survey of random sample of 1849 subjects aged 18-64 years representing 965680 adults, both self-reporting and observer-reporting on Roma was applied. Data collection covered 52 indicators of morbidity, functional loss, health behavior, social capital, and use of health services. Health status differences between the self-declared Roma (N = 124) and the non-Roma (N = 1725) as well as the observer-reported Roma (N = 179) and non-Roma populations (N = 1670) were described by logistic regression models controlled for age, sex, education and employment.

Results

There was no significant Roma vs non-Roma difference in the respect of 33 indicators, and 14 indicators showed significant difference by both Roma definitions. Differences between the observer- and self-reported Roma ethnicity in statistical inference were observed for 7 indicators. In ascertaining significant Roma vs non-Roma difference, self-reporting was more effective for 2, and observer-reporting was for 5 indicators.

Conclusions

The application of observer-reported ethnicity classification cannot increase the practical value of health survey on Roma to non-Roma differences, compared to the self-reporting based approach. Therefore, the use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified.

Key messages

Application of external classification for ethnicity cannot increase the effectiveness of population based health interview survey in monitoring Roma vs non-Roma differences. The use of observer-reported Roma ethnicity in health surveys to improve the reliability of Roma specific indicators seems to be not justified.
Cost–utility analysis of remote versus conventional monitoring of pacemakers in the Arctic Circle
Authors: Lopez-Villegas A , Catalan-Matamoros D , Peiro S , Lappegard K T , Lopez-Liria R
Published: October 2020

Introduction

Several studies have demonstrated that remote monitoring (RM) of pacemakers is safe, effective and cost-saving. The aim of this study was to perform an economic assessment and check whether RM offers a cost-utility alternative to conventional monitoring in hospital (CM).

Methods

This is a controlled, randomized, non-masked clinical trial. Fifty patients with pacemaker were assigned to receive either RM (n = 25) or CM (n = 25). Data were collected during the 12 months. A cost-utility analysis was performed in order to assess whether RM of pacemakers is cost-effective compared to CM in hospital in terms of costs per gained quality-adjusted life years (QALY). The analysis was performed from the perspectives of the Norwegian Healthcare System (NHS) and patients.

Results

Overall, total costs from the NHS perspective were higher in the RM group (€2,079.84 vs. €271.97; p = 0.147). The costs related to the patients perspective were higher in the RM than those in the CM group (€223.99 vs. €158.42, respectively; P = 0.429). Patients included in the CM obtained 0.04 QALYs less than those in the RM group over 12 months and the total costs per QALY comprised €1,784.10 (P = 0.175) per user with a pacemaker implant. The total number of pacemaker transmissions per patient year comprised 86.46% of minors in the CM group.

Conclusions

The follow-up costs were similar between both groups. Cost-utility analysis showed broad confidence intervals with ICERs ranging from potential savings to high costs for an additional QALY, with most ICERs lower than the usual NHS thresholds for coverage decisions.

Key messages

Total costs from the National Health System perspective were higher in the remote monitoring group, although there were not significant differences between both groups of follow-up. The costs related to the patient perspective were higher in the remote monitoring than those in the conventional monitoring group, without significant differences.
(Pharmaco)economic evaluations for mental health related services: the PECUNIA project
Authors: Simon J , Konnopka A , Brodszky V , Evers S , Hakkaart-van Roijen L , Serrano-Pérez P , vador-Carulla L S a l , Park A L , Hollingworth W
Published: October 2020

Background

Mental health disorders affect large proportions of the general public resulting in serious cost consequences even beyond the health care sector. The PECUNIA project (EU H2020 grant agreement No 779292) aims to establish standardised costing and outcome assessment measures for optimised healthcare provision in the EU for multi-sectoral, multi-national and multi-person (pharmaco)economic evaluations using selected mental health disorders as illustrative examples.

Methods

Harmonised Identification, Definition, Measurement and Valuation of service costs in multiple sectors (health care, social care, criminal justice, education, productivity, patient, family). Reviews and surveys of mental health related services and other resource use in six European countries (AT, DE, ES, HU, NL, UK) to develop a new harmonised costing concept and related tools.

Results

We identified many taxonomical and conceptual discrepancies which currently hinder harmonized costing efforts and comparability of economic evaluations/HTAs across countries and sectors. The 'PECUNIA care atom', a new multi-sectoral costing concept forms the basis of resource item classification and international coding of mental health related services using the DESDE-PECUNIA system. Linked, harmonized tools such as the PECUNIA-European Resource Use Measurement instrument and the PECUNIA-European Reference Unit Costing Templates have been developed and are currently deployed in six countries to establish a PECUNIA-European Unit Cost Compendium alongside pan-European outcome evaluation methods.

Conclusions

The PECUNIA tools will lead to better understanding of the variations in costs and outcomes of mental health services/interventions within and across countries, and improve the feasibility, quality, comparability and transferability of (pharmaco)economic evaluations and HTAs in Europe. They also allow the harmonized measurement of broader economic and societal impacts of mental health services.

Key messages

The PECUNIA project developed compatible European multi-sectoral, multi-national and multi-person costing and outcome assessment tools. Methods & tools allow the harmonised measurement of broader economic & societal impacts of mental health related services, and improve the transferability & comparability of economic evaluations/HTAs.
Patients’ experiences of remote communication after pacemaker implant
Authors: Lopez-Villegas A , Catalan-Matamoros D , Lappegard K T , Peiro S , Lopez-Liria R
Published: October 2020

Background

the concept of 'patient experience' has become central to how to improve healthcare. Remote communication with patients is today a frequent practice in healthcare services, showing similar outcomes to conventional monitoring at the hospital (CM) while enabling cost reduction in both formal and informal care. The purpose of this study was to analyse the experiences of people with remote monitoring (RM) of pacemakers.

Methods

Patients were randomly allocated to either the RM or CM. Using the 'Generic Short Patient Experiences Questionnaire' (GS-PEQ), as well as an ad-hoc survey from the 'telehealth patient satisfaction survey' and 'costs survey', patients' experiences were measured six months after the pacemaker implant in a cohort of 50 consecutive patients. The mean age was 74.8 (±11.75) years and 26 (52%) patients were male of which 1 was lost in follow-up. Differences in baseline characteristics between groups were not found.

Results

Findings showed overall positive and similar experiences in patients in both groups. Significant differences were found in GS-PEQ concerning how RM patients received less information about their diagnosis/ afflictions (p = 0.046). We did not find significant differences in other items such as 'confidence in the clinicians' professional skills', 'treatment perception adapted to their situation', 'involvement in decisions regarding the treatment', 'perception of hospital organisation', waiting before admission', 'satisfaction of help and treatment received', 'benefit received', and 'incorrect treatment'.

Conclusions

The remote communication of pacemakers was met with positive levels of patients' experiences similarly to patients in the CM group. However, patients included in RM group received less information. Thus, improving the quality and timing of information is required in RM group in the planning and organisation of future remote communication healthcare services for people living with a pacemaker implant.

Key messages

Patients included in both groups of follow-up showed similar levels in their experiences with the use of the pacemakers. It is necessary improving the quality and timing of information required in remote monitoring of users in the planning of future remote communication healthcare services for people with pacemaker.
Disaster preparedness level of university hospitals of Sousse -Tunisia
Authors: Lamine H , Tlili M A , Aouicha W , Taghouti E , Chebili N , Zedini C
Published: October 2020

Background

Disasters, whether natural or man-made, are unpredictable. The health care systems, represented by hospitals, are on the front lines of the emergency and disaster response. Tunisian health structures, must be able to cope with a case of mass influx of victims following any disasters. Therefore, we conducted this study to describe the level of disaster preparedness of University Hospitals of Sousse - Tunisia.

Methods

A simple descriptive quote is the basis of a data collection, conducted between September and October 2019 and performed in both University Hospitals of Sousse - Tunisia (Farhat Hached and Sahloul). The measuring instrument used in this study is the 'Hospital Safety Index' designed by the World Health Organization in 2008.

Data was analyzed using the 'Module and safety index calculator' which calculates a specific score for each module (structural safety, nonstructural safety and emergency and disaster management) and an overall score for hospital safety, and assigns an appropriate classification which can be “c/C” corresponds to a score from 0 to 0.35, “b/B” from 0.36 to 0.65, or “a/A” from 0.66 to 1.

Results

The overall safety index class of both hospitals was 'B'. Sahloul University Hospital was classified as 'a' in both structural and nonstructural safety modules and classified as 'c' in the emergency and disaster management module, in the other hand Farhat Hached University Hospital was classified as 'c' in structural safety module and classified as 'b' in both nonstructural safety and emergency and disaster management modules.

Conclusions

The hospitals' current levels of emergency and disaster management needs to be improved. Actually, both patients and staff safety as well as the hospital's ability to function during and after emergencies and disasters are potentially at risk. In both hospitals, intervention measures are needed in the short term.

Key messages

Appropriate disaster management should be based on a clear plan, preparedness and collaborative and effective efforts on the part of the community and the different organizations involved. A safe hospital needs to assure that its services remain accessible and functioning at maximum capacity, before, during and immediately after the impact of emergencies and disasters.
COVID-19 and young Italians: results of a cross-sectional study
Authors: Lia L , Dorelli B , Marte M , Chiappetta M , Faticoni A , Lucaccini Paoli L , Grassucci D , Gelardini M , Ardizzone C , La Torre G
Published: October 2020

Background

At the end of 2019, a novel pneumonia-causing Coronavirus called Sars-CoV-2 was first identified in Wuhan, Hubei Province, China. It subsequently spread throughout China and elsewhere, becoming a global health emergency. In February 2020, WHO designated the disease COVID-19, which stands for Coronavirus disease 2019. The aim of this study was to evaluate the impact of the COVID-19 epidemic on the perception of young Italians and to assess their knowledge and attitudes about the disease.

Methods

An online survey was conducted on 3rd-4th-5th February 2020 with the collaboration of “Skuola.net”, an important Italian Website for students. Young people had the opportunity to participate in the survey by answering an ad hoc questionnaire created to investigate knowledge and attitudes about the new Coronavirus, using a link published on the homepage.

Results

5234 responses were received of which 3262 were females and 1972 were males, aged from 11 to 30. 82,4% were students (50,4% high school students) while 17,6% did not attend school or university. Regarding knowledge, 80% of the participants knew that the infection occurs through droplets from infected people; 63% knew that symptoms can appear up to 14 days after exposure; 80% knew that a vaccine has not yet been discovered. Regarding attitudes, 36% admitted that their attitude towards Chinese tourists has significantly worsened; 26% did not buy from Chinese run stores and 24% avoided Chinese restaurants.

Conclusions

Although most of the participants seem correctly informed about COVID-19, young Italians are at risk of assuming irrational behavior due to psychosis.

Key messages

The global emergency of COVID-19 needs adequate information to avoid the spread of dangerous psychoses. Young people, usual users of social networks as a means of information, are more at risk of being influenced by fake news and adopting wrong behaviors.
Readiness of the nurses employed by Bezmi-alem Vakif University hospital for disasters
Authors: Karakoç M , Erdoğan Ö , Zeren H
Published: October 2020

Background

This study is intended to increase disaster awareness of the nurses so as to increase the survival rate during disasters.

Methods

The research was done via a total of 430 nurses, consisting of 360 nurses employed by Bezmialem Vakıf University (BVU) Medical Faculty Hospital and 70 nurses employed by the BVU Dragos Hospital from 01.11.2018 to 01.02.2019. Data was collected by using the Introductory Information Form and the Scale for Basic Qualifications for Readiness of the Nurses for Disasters. IBM SPSS Statistics V23 program was used for evaluation of the data.

Results

For the nurses, it was determined that the average age was 26.06±6.05 and the average working hours was 6.24±5.86. It was found out that 60.6% of the nurses did not have any training in relation to the disasters. It was found that the average point for perception of readiness for the disasters by the nurses was 5.03±2.38 (0-10) while the average point for perception of disaster plan information at hospital was 4.27±2.53 (0-10). It was established that the nurses consider the disaster management course as the course required most for disaster preparation with a rate of 47.9%. It was found that the average point achieved via the Scale for Basic Qualifications for Readiness of Nurses for Disasters was 141.46±32.48, and the lowest average sub-dimension point was 11.49±3.42 as critical thinking abilities while the highest average sub-dimension point was 48.23±12.21 as technical abilities. A positive weakly significant relationship was found between critical thinking abilities and evaluation of readiness for disasters.

Conclusions

Nurses have technical knowledge and abilities on topics related to their field, but they need to participate in educational activities for increasing the level of knowledge in terms of disasters.

Key messages

The role of nurses in emergency health services during disasters is great. Thus, disaster awareness of all the nurses worldwide must be increased so that they are ready for the disasters.
Social integration of migrant physicians in inpatient rehabilitation
Authors: Jansen E , Haenel P
Published: October 2020

Purpose

In Germany, numerous inpatient rehabilitation facilities employ migrant physicians. Yet the remote location of many such institutions makes it difficult for migrant physicians to establish social relationships and networks near their place of employment. This lack of social resources has implications for employee retention, quality of life, and quality of care. In this light, our study examines the following questions: what social relationships do migrant doctors have access to? What challenges and opportunities do these relationships represent? Our aim is to provide concrete recommendations for stakeholders to improve the social integration of migrant physicians.

Methodology

Semi-structured interviews with 58 migrant physicians and their colleagues. Braun & Clarke thematic analysis.

Results

Migrant physicians' social relationships fall into four broad categories: friends and acquaintances in general, family, community of origin, and working team. Migrant physicians in our sample face difficulties in each of these four categories.

Implications

Establishing social relationships in rural and semi-urban areas is more difficult for migrants in general, and migrant physicians in particular. We propose a number of recommendations to overcome these challenges on several levels: individual, work team, institution, regional, and trans-regional.

Key messages

The integration of migrant physicians in inpatient rehabilitation facilities is challenging. Specific measures can help the retention of migrant physicians.
Workload pressure of nurses at an emergency satellite hospital in Peshawar Pakistan
Authors: Khan H M
Published: October 2020

Introduction

Health managers face challenges to respond to the demands of the population with limited resources. Balancing the health workforce is of high concern as the health workers are indispensable resource in a health system. The objective of this study was to determine the workload pressure of nurses working at an Emergency Satellite Hospital for efficient planning and management.

Methods

The Workload Indicators of Staffing Need (WISN) method was used for this study which is a human resource management tool which determines the number of health workers required to cope with the workload and asses the workload pressure by using the available service statistics. It calculates the level of staff shortage or surplus in a facility and the ratio of actual to the required number of staff determines the workload pressure with which the staff is coping.

Results

According to the findings of the study there were 1966 available working hours for the nurses in a year. Out of this time 33.33% was taken by support activities of all nurses, 18.75% by additional activities of some of the nurses and 47.92% by health services activities of all the nurses. At the time of the study there were 4 nurses working in the in the hospital but according to the calculations based on WISN 3 nurses were required to carry out the activities identified by the experts working group. The study shows that there was no workload pressure on the nursing staff as the WISN ratio was 1.33 and one nurse was surplus.

Conclusions

The study found that there was no workload pressure on the nursing staff and one nurse was surplus who can be adjusted in any other unit where there is more need of nursing staff. This can increase the overall productivity and the demands of the population for health services can be responded to in an efficient way.

Key messages

Balancing the health workforce in any institution is of high concern as the health workers are the most costly, least readily available and indispensable resource in a health system. Efficient planning and management of health workforce is essential for better productivity.
Motivations for choosing a specialty among the residents in the Congo
Authors: Mbou Essie D
Published: October 2020

Background

Congo is experiencing a greater shortage of doctors for certain specialties, in order to help reduce this disparity, we have studied the motivations for choosing specialties.

Materials and Methods

A descriptive, prospective crosscutting survey. All interns in a calendar year were interviewed between July and August 2019. Gender and age, specialization choice and motivation were studied. Specialties were: surgical, medical, pediatrics, gynecology obstetrics, ORL, ophthalmology, imaging, psychiatry, public health, occupational and legal medicine, medical biology and general medicine. Age mean, frequencies were calculated and compared by Odds ratio and Fisher Khi2 at p < 0.05; on Epi info 7.2.

Results

Out of 137 interns, 62.77% were men, middleaged 25 years, all want to specialize. The choice of specialties was: Medical (38.6%), surgical (20.5%), gynecology-obstetrics (9.4%) and pediatrics (7.9%). Psychiatry (1.46%) and medical biology (no choice) were the last. The majority of women chose the gynecology-pediatric block (OR = 9.37, IC 95% = [3.767-23.326], p < 0.0001), surgery attracted more men without significant difference (OR = 1.6384, IC 95% = [0.54 79 - 4.8994], p = 0.3771). The main motivations were: the passion for the organ or specialty theme (53.52%), vocation inspired by the masters (37.32%), social prestige (28.1%), career opportunity (21.83%).

Conclusions

Specialties for which there are more masters were the most popular. The main motivations for choice could be related to teaching and teachers. Student preferences were not in line with national health priorities. Incentives are needed to fill medical deserts in some areas.

Key messages

The motivations of speciality choice is mostly linked to teaching approaches. Actions must be implemented to match specialities choice with public health issues.
Perception and attitude of medical students in UNEC towards Community Medicine as a career choice
Authors: Ugwunna N C , Okeke A J , Okeke C P , Okafor C P , Ezeoke U , Chinawa J , Anusiem C , Ibiok C N , Umeobili A k , Ugwunna O C
Published: October 2020

Community Medicine tends to study health and disease in a population of a defined community and it provides comprehensive health services ranging from preventive, promotive, curative to rehabilitative services. Understanding the perceptions and attitude of medical students towards Community Medicine will be a great tool in planning a sound medical labour force for a better healthcare delivery

Objective

This study was carried out to ascertain the perception of medical students towards Community Medicine as a specialty.

The study was carried out in UNEC with a total of 204 respondents who were in their fifth and final year classes. Data collection was by means of self-administered close ended questionnaire. Two hundred and four medical students returned their questionnaires and they displayed good knowledge of the discipline and its role in the society; majority 195(95.6%) perceived Community Medicine as vital part of medicine. While 150(73.5%), disagreed with living and working in rural area. However, only 90(44.1%) would choose Community Medicine as a specialty. Among the 114 who would not specialize in Community Medicine, 101(49.5%) were of the opinion that 'it was not interesting'.

Medical students in UNEC showed good knowledge of Community Medicine but majority would not specialize in the discipline mainly because they did not find it interesting. Continuous education of stakeholders, students, parents and general populace as to what really constitutes Community Medicine might be useful. Also curriculum should be redesigned to lay emphasis on the peculiarly interesting rural community-based postings.

Key messages

Continuous education of stakeholders, students, parents and general populace as to what really constitutes Community Medicine might be useful. Curriculum should be redesigned to lay emphasis on the peculiarly interesting rural community-based postings.
How do managers and physicians reconcile between financial and clinical considerations in hospitals?
Authors: Waitzberg R , Quentin W , Gottlieb N , Busse R , Greenberg D
Published: October 2020

Background

Hospital managers and physicians may face dilemmas due to their role as dual agents, committed both to their hospitals and their patients. We aim to pinpoint situations where economic and clinical considerations are aligned or conflicting; and to explore how managers and physicians reconcile different considerations in their decision-making in Germany and Israel.

Methods

Qualitative, thematic analysis based on 47 in-depth interviews with managers, ward directors and physicians in five hospitals in Germany and five in Israel.

Results

Economic and clinical considerations are aligned when gaps between hospital payments and costs are small, and economic incentives do not distort clinical considerations or when good medicine avoids complications while saving costs. Dilemmas arise when procedures are underpriced, resulting in financial losses to the hospital, and represent barriers for adoption of new, costly, medical equipment. In many instances, managers and ward directors choose one of the principals (hospital or patient), yet sometimes they develop reconciliation strategies that include: (1) improving coding of activities and diagnoses to assure higher payments; (2) reducing costs per case by choosing cheaper supplies with the same quality, bulk purchasing or reducing unnecessary lengths-of-stay; (3) providing clear treatment guidelines that support decision-making. Hospitals in Germany increase efficiency through specialization, and try to find alternative, less costly, care settings such as rehabilitation facilities. In Israel, hospitals balance the amount of unprofitable cases with many other profitable cases.

Conclusions

While sometimes one principal prevails, agents reconcile economic and clinical considerations. In Germany, a high-expenditure hospital market, there is some flexibility to change the character of hospitals activity, while in Israel, a middle-expenditure market, agents balance activities within the existing framework.

Key messages

Dilemmas exist regardless of the amount of hospitals’ funds. In Germany there is flexibility to change hospitals’ activity, while in Israel agents balance activities within the existing framework.
Challenges of health workforce in the next decade in Bulgaria
Authors: Vladimirova M , Kostadinova K r , Velikova D , Tzolova G , Kamel I
Published: October 2020

Issue

The sustainable development of human resources is essential for the effective functioning of the health system and the quality of health services. The analysis of the human resources available in the European region proves serious problems in this area, which requires the adoption of strategic documents with measures to overcome the negative tendencies

Description

The solution of the existing and expected and future shortage of health professionals is essential to protect the health of the population globally. In this regard, the international migration of health professionals and the shortage of skilled health workforce, as well as the growing disparity between population needs, health care supply and demand, is a topical problem for health systems.

Results

The mobility and shortage of highly qualified specialists are characteristic of the top of the pyramid. There is a significant shortage in the medium and low levels of the pyramid of healthcare professionals and some non-medical majors. In both cases, there are internal and external imbalances, most often caused by increased migration to economic centers in the country or countries with a high standard of living. A severe shortage of nursing professionals -Bulgaria has the second-lowest ratio of nurses to population and the lowest nurse to physician ratio among all member states. (1:1,2 compared to 1:2,3). The emigration of young doctors and nurses and the ageing of all health professionals - especially well pronounced with nurses and general practitioners - is a threat to the health system.

Lessons

The research of Human Resources in Healthcare is necessary to diagnose the managerial, financial and socioeconomic problems that arise in their formation and development. A key point - changing the system of postgraduate training. The regulatory standards and limits introduced in outpatient and hospital care and the specialization system do not help to link the incomes of medical staff to the quantity and quality of work.

Key messages

By the number of medical specialists, Bulgaria still holds positions well above the EU average. However, the age structure of workers implies increasing deficits in the future. Bulgaria should invest and support investments in the development of human capital in the health care system.
Who manages health workforce in the States of India: Profile, knowledge and perceptions of the team
Authors: Khurana S , Roy S , Gupta M
Published: October 2020

Problem

Human resources in the public health sector is of prime importance in a limited resource setting country, who at times work in a high-pressure, limited resource environment and where skilled staff continue to remain in short supply. The role of Human Resource for Health (HRH) team responsible for managing this health workforce is crucial. They play an important role in improving the human resource practices and creating an enabling organizational culture for optimal resource utilization. The paper explores the profile of the HRH teams of the states of India, their knowledge levels, and perceptions of their role.

Methods

The participants were HR Managers from 29 states of India who look after HRH in National Health Mission and State Health Departments. Cross-sectional survey tool was used for data collection. Quantitative data analysis included univariate and bivariate analysis. One Way ANOVA test of significance and post-hoc tests using Tukey's method was used to ascertain the groups with significant difference.

Results

Most of the HRH team members are postgraduates or have management background. Their experience varies from <1year to > 25 years. Mostly of them perceive their role to be limited to implementing bare essential HRM practices, mostly administrative. The educational qualification of the members did not have any significant bearing on their technical knowledge related to HRM practices; but their experience in public health sector showed a significant association.

Lessons

This study lends evidence to the principle that professionals who have been in the system for long, know about HRH and the associated policies better, and hence may be better equipped to handle HRH and establish good HR Management (HRM) systems. Better role clarity among the HRH teams, expansion of their current scope of work to include advanced practices of HRM and continuous capacity building mechanisms are needed to help strengthen the development and management of HRH.

Key messages

This study, a first of its kind in the country, lend evidence related to the principle for deciding the profile of team who should be entrusted with managing and development of HRH. The Study gives evidence to focus on the role clarity of HRH to zero down their knowledge and skills gaps and enhance their competencies through better capacity building.
GH:ADT Project: developing a framework of Global Health concepts and a learning objectives catalogue
Authors: Stratil J , Rehfuess E A , Geffert K
Published: October 2020

Background

Global Health (GH) is receiving increasing attention, in Germany, Europe and internationally. Despite an increased demand, teaching on GH remains fragmented and heterogeneous in the university landscape in German-speaking countries. Moreover, there is a lack of common understanding of GH and interpretations range from GH as tropical medicine to GH as everything related to health. This project aims to develop (A) a framework of different GH concepts, as a basis for (B) a set of GH learning objectives for German-speaking countries.

Methods

A review of publications providing GH definitions was carried out. Following a concept analysis approach, we developed a general framework of different and partially overlapping GH understandings. Building on these results we conducted an overview of reviews on learning objectives and curricula for GH to develop a set of learning objectives.

Results

The general framework distinguishes between GH concepts describing GH as (1)a set of global health issues (e.g. COVID-19), (2) a global ideal to strive for, (3 + 4) any activities relating to said global health issues or ideals (e.g. all activities contributing to health equity), and (5) sets of activities meeting various characteristics (e.g. being transdisciplinary and transnational). Within each concept, multiple sets of axes allow a more granular distinction of the concepts (e.g. regarding the relation to public health and tropical medicine). The list of key learning objectives shows considerable overlap with widely accepted public health core competencies. Differences include e.g. a (stronger) emphasis on intercultural and interdisciplinary collaboration, globalisation and transnational determinants of health.

Conclusions

A systematic reflection on commonalities and differences in the understanding of GH is important for a shared understanding. Based on the GH learning objectives we will develop core competencies for GH, including through an online survey of GH experts.

Key messages

The GH:ADT framework of global health concepts supports a systematic reflection on and recognition of the multi-dimensional nature of Global Health. The learning objectives identified in the GH:ADT project can be a valuable tool for curriculum development.
Emerging cross-disciplinary profiles: The Geomatic Epidemiologist
Authors: Recchioni M , Castello V , Del Vecchio S , Ciaccio V , Donia A M , Fabiani L
Published: October 2020

Issue

Geographic information systems (GIS) and remote sensing technologies are increasingly used in Public Health epidemiology, showing a great potential in anticipating and responding to actual and future challenges for the public health system and in improving health services' excellence. According to the evidences collected within a wide meta-research carried on of relevant literature (”GIS geographic information system” and “GIS geographic information system and training” on Pubmed; “epidemiologist use of GIS and training” and “epidemiologist use of gis” on Google Scholar),GIS and new sensing technologies are mostly used to: map air and water pollution, map diseases prevalence, predict infection diseases and vector-spread diseases in big areas, study health service coverage and preparedness in emergencies, map cities and study urban health, study climate changes for decision making.

Description of the Problem

Specific skills and training are required to address the use of GIS and new sensing technologies.The specific aim of our study is to identify the professional profile of a new figure, called 'Geomatic Epidemiologist' and to define its professional and educational standards, as well as the relevant training programs.

Results

Data collection and analysis of INAPP and ESCO databases about existing professional profiles (starting from 2016) has allowed drafting a first qualification schema and profile. The profile has been defined according to the 4C model (elaborated by Univaq) distinguishing between Hard Skills (technical knowledge and skills),Soft Skills (cognitive, individual and social) and interpersonal behaviors.

Conclusions

Profile will be validated with relevant stakeholders and Public Health professionals in order to deepen the understanding of the main competences required to study health issues with GIS and related technologies; to this extent, a questionnaire has been elaborated to evaluate relevance, frequency and complexity of each component of the profile

Key messages

Developing cross-disciplinary profiles, (i.e. the Geomatic Epidemiologist) integrating clusters of competences (holistic approach). Public health research challenges and excellence.
Do long-term care services meet the minimal requirements for the elderly?
Authors: Gomes F A , Lopes D G , Cunha I , Duarte S , Pereira M B , Moreira A , Gil M M , Esteves H
Published: October 2020

Background

As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.

Methods

A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.

Results

Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).

Conclusions

Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.

Key messages

In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.