bluuebunny/crossref_metadata_2025 huggingface dataset:
Indicators of the clinical utility of genetic or genomic testing: a scoping review
Authors: Valz Gris A , Pezzullo A , Diego T , Porcelli M , Di Pumpo M , Scarsi N ,   WP3 PROPHET Collaboration Group, Boccia S
Published: October 2024

Background

Genetic or genomic tests are the cornerstones of personalized prevention. Previous reviews primarily focused on theoretical frameworks rather than actual assessments and assessed dimensions rather than specific indicators within these dimensions. Our scoping review aimed to review the dimensions and the specific indicators measured in the published assessment reports of genetic or genomic tests.

Methods

We selected formal assessments of genetic and genomic test used for prevention through PubMed, Web of Science, Scopus, websites of 20 different organizations, Google, and Google Scholar. Also, through a separate analysis we identified ten comprehensive dimensions of clinical utility through an analysis of 30 theoretical frameworks for genetic and genomic tests. From the included assessments, we extracted all the indicators, clustering them based on the comprehensive dimensions.

Results

From 3054 unique references and 12000 grey literature search results, we collected 57 assessments, all from high income-countries (in Europe (53%) and North America (47%)). The assessment methods were HTA (42%), EGAPP (25%), ACCE (21%) and other (12%). 951 disease-specific indicators were extracted from the assessments. Analytic validity (60%), clinical validity (79%) clinical efficacy (79%), economic impact (58%) were the most common dimensions (had at least one indicator). However, only 12 assessments (21%) include indicators that compared health outcomes between tested and untested groups. Equity, acceptability, legitimacy, and personal value were evaluated in less than 15% of the documents.

Conclusions

Our study illustrate that, although dimensions such as equity and acceptability, are significantly emphasized in traditional evaluation frameworks, these are often not considered in the assessments. Additionally, our study has underscored a significant dearth of primary evidence concerning the clinical efficacy of these technologies.

Key messages

• Our study highlights the prevalence of evaluations lacking indicators for equity, acceptability, and legitimacy dimensions and a lack of direct evidence of clinical efficacy.

• The catalog of indicators was openly provided as a resource for researchers and institutions working in evidence-based evaluations of personalized preventive healthcare.
Hemato-oncology services and COVID-19 Pandemic: The experience of Kazakhstan
Authors: Yerdenova M , Myrkassymova A , Iskakova B , Izekenova A , Izekenova A , Bukharbayeva A , Mergenova G
Published: October 2024

Objectives

The COVID-19 pandemic in Kazakhstan disrupted numerous healthcare services, including those critical for hemato-oncology patients, due to the strained healthcare system. This study examines how the COVID-19 pandemic has affected access to hemato-oncology healthcare services in Almaty, Kazakhstan.

Methods

We retrospectively analyzed patient data from two tertiary centers, City Clinical Hospital 7 (H7) and Kazakh Institute of Oncology and Radiology (KazIOR), from March 1, 2019, to February 28, 2022. Variables included age, gender, residence, hospitalization rate, treatment outcomes (discharged/deceased/transferred), diagnoses (acute leukemia, lymphoproliferative diseases, myeloproliferative diseases), and referral sources. The Statistical Yearbook of Kazakhstan provided comparative data.

Results

From 2019-2022, 6,763 hemato-oncology hospitalizations were registered: 3,583 in H7 and 3,180 in KazIOR. The mean age was 55.04 (SD = 16.07) for females and 51.2 (SD = 16.7) for males. Urban and rural patient proportions were 6,191 (92%) and 571 (8.4%), respectively (Chi-square 13.8, P = 0.001). Fewer patients were discharged in 2020-2021 (n = 2,047) compared to 2019-2020 (n = 2,387) and 2021-2022 (n = 2,081) (Chi-square 20.09, P = 0.003). The death rate was higher in 2020-2021 (3.5%) than in 2019-2020 (3.2%) and 2021-2022 (2.6%) (Chi-square 20.09, P = 0.003). Emergency admissions were 403 (19%) in 2020-2021, 368 (14.8%) in 2019-2020, and 394 (18.3%) in 2021-2022 (Chi-square 2,231, P < 0.001). Transfers from other hospitals increased by 12.4% in 2020-2021.

Conclusions

The COVID-19 pandemic negatively impacted access to hemato-oncology services, increasing mortality. Further studies are needed to understand the factors affecting hospitalization and mortality trends during healthcare crises. Funding: Grant No. AP09260497.

Key messages

• Access to healthcare services during COVID-19 pandemic for hemato-oncology patients.

• Impact of the pandemic on access to healthcare.
Perspectives on collaboration in maternity and child health: Patients and caregivers’ views
Authors: Hermans A , Franx A , Van der Kooy J
Published: October 2024

Background

The World Health Organization promotes people-centred organization of maternity care and preventive child healthcare (PCHC). However, globally and in the Netherlands, these services often operate separately, causing care discontinuity. We posit that this disproportionately affects vulnerable patients, hindering tailored-care. Our aim is to explore how collaboration between healthcare providers is perceived by mothers and providers, and understanding challenges and needs for integration.

Methods

We conducted 14 semi-structured interviews with mothers (n = 9) and healthcare providers (midwives, PCHC caregivers, n = 5). Women were categorized as non-vulnerable, potentially vulnerable, or vulnerable based on social situation, enabling comparison of care experiences.

Results

We found that the experienced interprofessional collaboration varied; most non-vulnerable women perceived the interprofessional collaboration as sufficient, whereas women from the potentially vulnerable group were uncertain who to turn to when help was needed. They expressed a need for expectation management to know what to expect from different healthcare providers. Furthermore, they were confused about which healthcare domain (i.e., maternity care or PCHC) ‘was in the lead’ in the postnatal period. Healthcare providers expressed a need for mutual understanding of expertise to foster trust and ease transitions between maternity care and PCHC. Themes emerged: organizational structures, support levels for collaboration, and trust among providers.

Conclusions

Our findings suggest the necessity for governance and shared ownership in healthcare collaboration in the maternity care and PCHC continuum to meet the needs of potentially vulnerable women effectively.

Key messages

• Experienced interprofessional collaboration varies among women based on vulnerability.

• Clear governance and shared ownership are crucial for meeting the needs of potentially vulnerable women in maternity and child health services.
The vital role of stakeholders and National Immunization Technical Advisory Groups (NITAGs)
Authors: Zavadska D , Ozolina K
Published: October 2024

To successfully implement comprehensive, multidisciplinary and interdisciplinary approaches, collaborative, cross-sectoral policy and strategies are essential. This is critical not only for addressing shared challenges but also for developing effective intervention strategies. One of the main hurdles in any collective action initiative is the ability to galvanize diverse stakeholders, each with their unique set of interests and capacity. EUVABECO is dedicated to conducting pilots, and developing implementation plans that are not only effective but also adaptable and sustainable across various healthcare settings in Europe. The healthcare environments across the pilot countries exhibit considerable variability, including differences in epidemiological trends, immunization information systems, vaccine nomenclature, and the dynamics of collaboration with National Immunization Technical Advisory Groups (NITAGs). Throughout implementation, the cooperation between these diverse stakeholders and NITAGs will be crucial, notably to share local vaccination policies for integration into the Clinical Decision Support (CDS) system. EUVABECO’s goal is to craft implementation plans that are flexible enough to be tailored to local needs, ensuring that interventions are both practical and effective in each unique context. This presentation will explore the vital role that stakeholders and NITAGs play in this process, highlighting the importance of their involvement for the success of EUVABECO’s initiatives.
The potential of non-clinical guidance alongside e-mental Health to overcome non adherence
Authors: Van Der Heijde C M , De Bruijn-De Goffau C E , Vonk P
Published: October 2024

Background

Mental health problems account worldwide for over an eighth of the global burden of disease and waiting lists nowadays are commonplace. E-Health has potential to reduce mental illness, whilst waiting for therapy or as a stand alone. A big problem with implementation of E-health in clinical practice is non adherence. Non-clinical guidance could make a difference as compared to the non guidance modus. Our research question is: what factors contribute to the potential of non-clinical guidance in overcoming non adherence for e-mental Health for patients with depressive, anxiety and stress symptoms?

Methods

We did a qualitative study in a Dutch general practice. The treatment consisted of several modules accompanied by non-clinical guidance by a healthcare assistant. Out of 190 invited patients, 31 patients participated. Eight weeks after being invited, 11 semi-structured interviews were conducted until data saturation. Thematic analysis was used with open, axial and selective coding.

Results

Three major themes emerged: 1) The patients were satisfied with the non-clinical guidance in almost all aspects: Negative comments arose from an urge for more contact or tailoring. 2) The form of the guidance (e.g. non-clinical; used interface) was subordinate to the amount and tailoring of it. 3) Adherence could further be improved through a more personal introduction, explaining the benefits of certain exercises and more time management.

Conclusions

The potential of non-clinical guidance in overcoming non adherence for e-mental Health can be improved by further tailoring and increasing the interactivity when needed. Further research is also needed, after the suggested improvements, whether the intervention is effective, compared to a therapist guided and a non guided version. This study needs to be repeated in other clinical settings.

Key messages

• Non-clinical guidance, alongside e-mental health has potential to help with non adherence, thereby decreasing the burden of waiting lists.

• Non-clinical guidance was positively received by patients who received e-mental health, although further tailoring could make online treatment even a larger success.
Referral and disease patterns of patients treated at the Nicosia General Hospital Breast Centre
Authors: Papadopoulos M , Loizidou M , Giannopoulou C , Nikolopoulos G , Yiallourou A
Published: October 2024

Background

Cyprus has one of the lowest mortality rates from breast cancer in Europe. The reasons behind this have not been investigated but it is speculated that the ease of access to Breast Centers in combination with an increased public awareness play a role. The aim of this study was to investigate referral and disease presentation patterns of patients treated at the Nicosia General Hospital (NGH) Breast Centre and define opportunities for effective public health interventions.

Methods

A retrospective study of all patients (585) with in situ or invasive breast cancer treated at the NGH Breast Centre between February 2017 and November 2023 was conducted. Data on referral sources, symptoms, and cancer stage at the time of diagnosis were analyzed using Stata 18.

Results

Most patients were referrals from the national population screening program (42.2%), followed by self-referrals (40.6%), and General Practitioner (GP)/or other specialist referrals (17.2%). Half of the patients (50.3%) were asymptomatic at diagnosis. In addition, 8% of the patients diagnosed with invasive breast cancer were Stage I, 65% Stage II, and 27% Stage III.

Conclusions

Our study provides important insights forming the basis of public health activities for the early detection of breast cancer based on the fact that 20% of newly diagnosed breast cancer cases in Cyprus receive treatment in NGH Breast Center. Although adherence to the national population screening program does not meet desired expectations, a significant proportion of breast cancers were detected via this program highlighting its effectiveness in early detection of asymptomatic cancers. A large proportion of patients were self-referred underlining the high degree of breast cancer awareness in Cyprus but also the media-induced anxiety which leads to early investigations.

Key messages

• Screening program and breast cancer awareness campaigns are effective in detecting breast cancers early.

• These activities should be sustained to further reduce breast cancer mortality rate.
Substitution of care through the eyes of Dutch health insurers: a qualitative study
Authors: Dros J T , Bos I , van Dijk C E , Meijboom B R , Verheij R A
Published: October 2024

Objectives

The objective of health policy measures in the Netherlands is to promote the substitution of care from hospitals to general practitioners (GPs), with reimbursement facilitating this shift. Given that health insurers are tasked with healthcare reimbursement in the Netherlands, understanding their experiences regarding care substitution is crucial.

Methods

First, informal interviews were held with employees from the Dutch Ministry of Health, Welfare and Sports, the National Health Care Institute and the Netherlands Institute of Health Services Research to construct the topic list. Then, we conducted semi-structured interviews with 15 employees from 7 health insurers, including healthcare purchasers, strategists, client relations executives, and business analysts, between February and April 2024. Transcripts were analyzed in MAXQDA by two researchers, after member checking.

Results

Insurers navigating substitution face a complex interplay of competition and collaboration, lacking a comprehensive framework. Long-term agreements with hospitals and GPs are seen as potential solutions, contingent on building trust. Diverse views on insurers’ roles emerge, from passive reimbursement to active infrastructure support. Budgetary constraints vary, with some insurers feeling constrained by national budgets for GPs and hospitals while others perceive more flexibility. Risks equalization and deductibles are identified as hindrances to substitution efforts, necessitating changes in financial incentives.

Conclusions

Overall, addressing these complexities requires aligning incentives and balancing collaboration and competition to optimize resource allocation to effectively meet evolving healthcare needs. A comprehensive framework to balance collaboration and competition might be helpful.

Key messages

• Understanding insurers’ views on care substitution is vital for healthcare policy in the Netherlands.

• A comprehensive framework is needed to balance collaboration and competition, aligning incentives effectively.
The WHO health system performance assessment applied to child healthcare in Luxembourg, 2011-2022
Authors: Ducomble T , Seuring T , Berthet F
Published: October 2024

Background

Health System Performance Assessments (HSPAs) evaluate health systems in terms of their objectives and their overall goals, such as access to quality services and health improvement. Beyond the overall health system assessment, HSPA can evaluate performance in providing care to specific populations. We assessed the response of the Luxembourg health system to children’s particular health needs, by populating the WHO HSPA framework for universal healthcare with child-specific indicators.

Methods

We searched international databases, guidelines, policy documents, and the scientific literature to identify child-specific indicators suitable for assessing the health system objectives as defined by the WHO HSPA framework. To select the most relevant indicators, we conducted expert appraisal regarding feasibility, validity and actionability. Those indicators were calculated based on available national data. To explore inequities within the system, we performed socioeconomic stratifications.

Results

Twenty-nine indicators were used to populate the framework, sourced from social security databases (n = 15), monitoring and surveillance (n = 11), and surveys (n = 2). For effectiveness assessment, we used 11 indicators and found that preventive services performed best for children under two years. Five indicators showed good accessibility to primary and secondary care. Another five indicators assessed safety indicating a recent increase in the relative use of broad-spectrum antimicrobials and an overuse of caesarean sections. Additional disaggregation of three indicators didn’t expose socioeconomic inequities in service delivery. Data gaps exist to assess children’s user-experience and financing of child health services.

Conclusions

The WHO HSPA framework proved valuable for evaluating the Luxembourg health system’s performance for children. We identified good performance in accessibility and effectiveness for young children, alongside data gaps to assess user-experience.

Key messages

• The application of national child-specific indicators to the WHO health system performance assessment, highlighted strengths in accessibility and effectiveness while also pointing to key data gaps.

• We used the WHO health system performance assessment (HSPA) to evaluate the health system for children in Luxembourg. This exercise enhances the development of a tailored national HSPA framework.
The meaning of organizational culture and structure for interprofessional collaboration
Authors: Redzewsky L , Thielhorn U , Wallesch C , Körner M
Published: October 2024

In Germany, early neurological rehabilitation (ENR) acts as a link between acute inpatient care and rehabilitation, aiming to restore patients’ ability to rehabilitate amid their complex clinical conditions. Interprofessional cooperation (IPC) is crucial for harmonized treatment due to patients’ vulnerability. An interprofessional team comprising medical, nursing, and various therapy professionals is essential for this purpose. To explore the meaning of organizational culture and structure to IPC, 15 group discussions in 5 clinics were conducted with n = 76 participants.

1. Weekly team meetings are used to coordinate treatment goals and outcomes, but their implementation varies from clinic to clinic. Two types of meetings were identified: those that focus primarily on billing compliance and others that address patients’ long-term perspectives. However, both require additional social service involvement and are not sufficient to adequately address daily tasks, requiring additional IPC coordination. Some clinics have therefore introduced daily meetings to improve the coordination of IPC tasks. 2. Therapy planning and therapist assignment shape IPC and task fulfillment. Three therapy planning methods were observed: centralized, block-based, and flexible, each with different therapist allocation strategies. Centralized planning with flexible allocation leads to appointment pressure and interprofessional communication challenges. Block therapy reduces therapist turnover and promotes better interprofessional coordination in patient care. Flexible therapy planning is conducted through daily interprofessional meetings with shared task allocation and planning leads to a shared understanding.

Initial analysis underscores the meaning of organizational structure on interprofessional task fulfillment in ENR, emphasizing the importance of enhancing different cooperation formats which can balance stability and flexibility and integrate social services effectively in patientcare.

Key messages

• Morning interprofessional meetings on the ward facilitate flexible responses to daily changes in patients’ health conditions and promote interprofessional collaboration.

• The consideration of occupational group-specific processes in ward organization is a necessary structural prerequisite for successful interprofessional collaboration.
Health care provider payment schemes in Central and Eastern European countries
Authors: Ndayishimiye C , Tambor M , Dubas-Jakóbczyk K
Published: October 2024

Background

Health care provider payment schemes are key elements of the health care system that influence providers behavior, quality of care, and efficient use of resources. In recent decades, Central and Eastern European (CEE) counties have implemented various reforms that have changed payments methods and other elements of the purchasing process. The aim of the study was to provide an overview of the current provider payment schemes within the public health system in selected CEE countries and identify the main directions of their reforming.

Methods

Based on existing literature, a theoretical framework and data collection form were first developed. Next, desk research was conducted to collect data on provider payment methods and other elements of the purchasing process in primary care, outpatient specialized care, hospital care, and long-term care. The collected information was verified and supplemented though consultations with national experts. Nine countries were included: Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. The study was conducted in 2023.

Results

Capitation, fee-for-service, and case-based payments are the most commonly used methods in the analyzed countries. The countries are increasingly using blended payment methods. Primary and hospital care have the most diverse payment method mix and have experienced the most substantial changes in their payment schemes since 2010. The most common changes focused on modifying existing methods (detailing payment categories, changing the principles of tariff valuation), and introducing additional methods to pay for specific services or performance (fee-for-service, bonus payments).

Conclusions

CEE countries are following similar directions in reforming provider payment systems, with the goal of strengthening primary health care, shifting emphasis from inpatient to outpatient care and improving cooperation between health care providers.

Key messages

• CEE countries largely use output-based methods to pay for health care services.

• Provider payment systems are becoming more blended as countries look for the most effective payment method mix to meet policy objectives.
Productivity and consultation times in Portuguese primary care: trends and payment model variations
Authors: Madeira F , Pestana J , Perelman J
Published: October 2024

Background

Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models.

Methods

6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics.

Results

FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p < 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p < 0.05).

Conclusions

USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration.

Key messages

• Effective workforce management is crucial given the current primary care professionals shortages.

• Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.
Marketing Harm to Children: Children’s exposure to unhealthy commodity marketing using body cameras
Authors: Signal L , Worters T , McKerchar C
Published: October 2024

Background

Sophisticated, persuasive and extensive product marketing is a key driver of unhealthy commodity (UHC) consumption. This study aims to identify the nature and extent of children’s exposure to UHC marketing.

Methods

The study is a secondary analysis of Kids’Cam, a cross-sectional study in which 168 New Zealand 12-year-old children wore body cameras that automatically captured images of their environment every 7 seconds over four days. Images were analysed for exposure to UHC, Healthy and ‘Other’ marketing.

Results

Children were exposed to UHC marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘Healthy’ marketing. Exposure included: unhealthy food marketing (68.4/day), alcohol (5.7/day), gambling (2.1/day) and tobacco marketing (0.1/day). These exposure rates align with the level of statutory regulation each UHC faces in NZ. Food outlets were the most common setting for UHC marketing exposures, while product packaging was the most common medium. Coca-Cola (6.3/day) was the most common UHC exposure, followed by Cadbury, Tip Top, Bluebird and Powerade. Over half of children’s unhealthy food (54.9%) and alcohol (51.9%) marketing exposures were attributed to multinational corporations. In contrast, statutory bodies are responsible for almost all (97.4%) of children’s gambling marketing exposure.

Conclusions

Children currently grow up in an environment in which they are constantly persuaded to consume products that directly harm their health - an environment in which the profits of corporations are favoured over public health. Statutory regulation of UHC marketing is urgently needed to protect children from harm.

Key messages

• Children were exposed to unhealthy commodity marketing on average 76.2 times/day, nearly 2.5 times their daily exposure to ‘healthy’ marketing.

• Statutory regulation of unhealthy commodity marketing is urgently needed to protect children from harm.
Telemonitoring activities of daily living in home healthcare services to support aging in place
Authors: Aboujaoude A , Lussier M , Filiou R-P , Couture M , Kenfack Ngankam H , Giroux S , Paré G , Bottari C , Da Cunha Belchior P , Bier N
Published: October 2024

Context

Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons.

Methods

A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system.

Results

HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management.

Conclusions

There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place.

Key messages

• To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts.

• By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.
Workplace health promotion measures and use of medical services in the German Federal Armed Forces
Authors: Seeland U , Hauck M , Roehle R , Dickob C , Ucar J , Arnold L , Willich S N , Reinhold T , Ludwig S , Roy R
Published: October 2024

Introduction

Workplace health promotion measures (WHPM) are among recommended options for maintaining employees health, important for the German Federal Armed Forces as an employer. In order to detect associations between WHPM and health care utilization, we recorded the number of outpatient visits and hospital stays, differentiated according to gender, military or civilian activity.

Methods

Prospective longitudinal observational substudy with cross sectional analysis of items regarding use of medical services at T0 (6-9/2022). Analysis for T1 (2023) and T2 (2024) follow. Data were obtained with a web-based employee survey to record self-reported endpoints. A total of about 224.000 employees by the German Armed Forces were addressed.

Results

Survey participation rate was 10.5% (n = 23.568) of all employees in T0, 29.1% were women and 0.3% reported being diverse, 43.2% of the participants were <40 years of age. Independently of taking part in WHPM, we did not detect differences in the proportion of male soldiers receiving treatment in hospitals of the German Federal Armed Forces. Among female soldiers without WHPM, 37.5% stayed in hospitals and with WHPM 30.5%. Higher % of women (84%) than men (78%) presented to the military - or family physician (w: 81%, m: 73%), independent of participation in WHPM and assignment for civil or military. In last 4 weeks, more women (81.3%) than men (65.6%) were prescribed medication. Female employees in civilian w.p.(84.8%) took more medications than those in military w.p (77.7%). Oral contraception was used by 20% of women in both civilian and military w.p.

Conclusions

There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital. More women than men recieved regular outpatient medical care and more women than men take medication regularly.

*Ludwig S and Roy R share last authorship

Key messages

• There are no gender differences nor difference for civilian or military employees concerning the number of days staying in hospital.

• More women than men recieved regular outpatient medical care and more women than men take medication regularly.
The trajectory of frailty index among spousal caregivers: longitudinal evidence from China
Authors: Pikhart H , Peasey A
Published: October 2024

Background

Very few studies have investigated the association between providing unpaid caregiving to a spouse and the frailty of caregivers. This study aims to examine the impact of providing spousal care on frailty among the middle aged and older Chinese population.

Methods

Data were derived from the 2011, 2013, 2015, and 2018 waves of China Health and Retirement Longitudinal Study (CHARLS) including 4,008 participants aged 50 and above. Frailty was assessed using a composite mean score based on 41 indicators according to Rockwood frailty criteria, including self-reported health, medically diagnosed conditions, medical symptoms, functional activities assessment, Activities of Daily Living (ADLs), and Instrumental Activities of Daily Living (IADLs). A growth curve model was employed to investigate the differences in frailty among caregivers and non-caregivers.

Results

Compared to non-caregivers, spousal caregivers were more likely to have a higher frailty when adjusted for all covariates (Beta=0.010, SE = 0.003, p < 0.001). Furthermore, female caregivers exhibited a higher rate of change of frailty index over time (Beta=0.002, SE = 0.001, p < 0.05) compared to female non-caregivers, while no such effect was found in males.

Conclusions

The findings of this study reveal that providing unpaid care to a spouse is associated with an increase in the frailty index over time particularly among female caregivers. These insights underline the necessity for Chinese policymakers to develop and implement targeted interventions aimed at reducing burden on spousal caregiving, thereby preventing an increase in frailty among these caregivers. Such measures would also align with the broader objective of promoting healthy ageing.

Key messages

• Chinese policymakers need to develop and implement targeted interventions to reduce the burden on female spousal caregivers and prevent increased frailty.

• Focusing on the frailty of female spousal caregivers is crucial for promoting healthy aging.
Core set of indicators to evaluate healthcare workers support programmes: a consensus-based approach
Authors: Guerra-Paiva S , Carrillo I , Mira J J , Fernandes J , Strametz R , Gil-Hernández E , Sousa P
Published: October 2024

Objectives

Considering the widespread implementation of support programmes for healthcare workers (HCWs), there is an urgent need to establish a standardised set of indicators for their ongoing assessment. This study seeks to develop a consensus framework for evaluating interventions aimed at supporting HCWs affected by patient safety incidents (PSIs) or other distressing situations, commonly referred to as second victims (SVs). Having a core set of indicators it is crucial for facilitating comparative analyses across different organisations and time periods.

Methods

A qualitative study was conducted from June 2023 to March 2024. The study involved a multidisciplinary group of members part of the European Researchers Network Working on Second Victims. The consensus-building process utilised insights from a scoping review (phase 0) and a nominal group technique (phase 1) to develop a questionnaire for Delphi Rounds (phase 2). Indicators were rated on a scale of 1-5, with consensus reached if over 70% of participants rated an indicator as both feasible and sensitive scoring above 4. A consensus conference was subsequently organised.

Results

From an initial pool of 91 indicators, 55 were rated online, with 35 progressing to the Delphi rounds. A total of two Delphi rounds were performed and achieved response rates exceeding 60% and 80% respectively, resulting in consensus on 11 indicators for evaluating SV’ support programmes. These indicators encompass various aspects such as awareness and activation of the programmes, organisational processes and structures, institutional training provisions and assessment of the impact of the programme in the SVs.

Conclusions

This study endeavors to provide guidance for future SVs’ programs namely in the critical areas of programme’s awareness and activation, structural and process enhancements, and programme’s impact on SVs. Moreover, these indicators are suitable for multiple healthcare contexts and levels of implementation.

Key messages

• The priorities for evaluation of second victim programmes’ include their impact on healthcare workers, awareness and activation, organisational processes and structures and institutional training.

• Utilizing a multidisciplinary consensus approach, we defined a set of indicators that are adaptable to diverse contexts that provide care and varying levels of second victim support implementation.
Racism in inpatient settings in Germany: professionals’ perspectives
Authors: Tezcan-Güntekin H , Stüwe E , Papadopoulou S , Meshkova K , Merz S
Published: October 2024

Background

Experiences of racial discrimination during healthcare encounters have increasingly been recognised as a source of health inequity. Narrative accounts by racialised healthcare users have dominated research in the field but it is equally important to capture the perceptions and practices of professionals to understand how racism operates in healthcare provisioning. This presentation asks: how does racism manifest in the German inpatient healthcare system (hospitals, rehabilitation facilities), and are there areas or phases of healthcare provisioning where racism is observed more frequently?

Methods

Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002).

Results

Racism occurs widely in German inpatient settings. It manifests both structurally, e.g. in the absence of professional translators for healthcare users with limited German skills, and interpersonally, e.g. in the form of microaggressions and stereotyping but also the witholding of treatment and verbal abuse. Targets of racism are both patients and staff, especially internationally recruited healthcare workers. Respondents thereby identify night shifts, psychiatric settings and the emergency ward as contexts where racism is more likely to occur. The hierarchical nature of and pervasive power asymmetries in hospitals thereby prevent effective interventions against racial discrimination.

Conclusions

Racism in German healthcare institutions requires multiscalar public health interventions, particularly at the level of the institutions themselves. These include the establishment of a robust and low-threshold complaints structure, spaces for self-reflection for professionals, and mandatory anti-racism training rather than a focus on diversity-sensitive competence.

Key messages

• In future research approaches, structurally determined reproductions of racism should be investigated using a multi-method approach.

• Experiences of powerlessness are reported by both those affected by racism and those professionals who observe racism and should be addressed by the institutions.
The association between cancer literacy and cancer screening behaviours: a systematic review
Authors: Isonne C , Pistollato A , Sinopoli A , Iera J , Sciurti A , Marzuillo C , Villari P , Baccolini V
Published: October 2024

Background

This study aimed at investigating the association between cancer literacy (CL) and adherence to cancer screening programs.

Methods

PubMed, Scopus and Web of Science were searched. Any study, published until March 2024, that investigated the associations between CL and cancer screening intention or uptake in any target population were eligible. For CL measurement, both validated and ad hoc tools were considered. For each outcome, articles were grouped according to the type of cancer investigated and results were narratively synthesized.

Results

A total of 3426 records were retrieved. After deduplication and screening process, six studies were included. Population enrolled was heterogeneous as well as the tool used to measure CL. Four studies explored the relationship between CL and screening uptake, one focused solely on screening intention and another investigated both intention and uptake. Significant association was found between CL and screening intention in the two studies included, with higher literacy levels correlating to increased intent for screening. A significant association between higher CL and skin cancer screening uptake was reported, while the uptake of prostate cancer screening was not significantly associated with CL levels. By contrast, mixed results were obtained investigating breast, cervix and colorectal screening uptake.

Conclusions

Higher levels of cancer literacy appeared to be associated with screening intention, while its association with screening uptake was found barely significant for any screening type, suggesting that other factors influence the actual screening uptake. However, the scarce number of studies, along with the absence of validated tools and the heterogeneity of target populations, limits the generalizability of the results. Further research, differentiating screening types and timelines and using multivariate models, is needed to clarify the role of CL in screening behaviours.

Key messages

• Higher levels of cancer literacy appear to be associated with screening intention, suggesting its importance in promoting motivation for early cancer detection.

• Association between cancer literacy and screening uptake was found barely significant for any screening type, suggesting that other factors influence actual screening uptake, urging further research.
How to measure the general Environmental Health Literacy
Authors: Lopez Lumbi S , Masciangelo L , Liebig-Gonglach M , Duda A , Rodenkirchen J , Hoyer A , Hornberg C , Mc Call T
Published: October 2024

Background

Many environmental factors, both natural or man-made, are associated with health risks. To make informed decisions about these potential risks, certain skills and competencies are necessary. The concept of Environmental Health Literacy (EHL) which integrates aspects of Science Literacy, Health Literacy and Environmental Literacy encompasse these competencies. To assess to what extent individuals or groups are environmental health literate, a general Environmental Health Literacy Scale is necessary. To the best of our knowledge, there is no validated instrument to measure general EHL.

Methods

Two phases of scale construction were conducted: 1) Item development with deductive methods which includes a literature review and assessment of existing scales resulting in two suitable studies for scale construction. Included items were translated to German language. 2) Scale development with pre-testing of items followed by applying potential items (n = 38) to a sample of of 454 students. Internal consistency (Cronbach’s alpha), Kaiser-Meyer-Olkin Criterion (KMO), Bartlett’s test, Velicer’s minimum average partial (MAP) test for number of underlying factors and Exploratory Factor Analysis using Principal Component Analysis with oblimin rotation and stepwise item reduction were assessed.

Results

Velicer’s MAP identified 3 factors, Cronbach’s alpha = .92, KMO = .92, Bartlett’s Test revealed significant correlation. Seven items were removed from the scale due to low factor loadings (< .3). Factor 1 (access) explains 18% of variance, factor 2 (knowledge) 12% and factor 3 (reflection) 10%, respectively. Overall, the model explains 40% of variance. Model fit represented by RMSEA index = .05.

Conclusions

A new general EHL scale has been developed and proven to be suitable for a students sample. This marks the first step towards a validated tool for multiple purposes. Cultural adaptation as well as multiple language validations are in process.

Key messages

• The process towards a general Environmental Health Scale has started.

• The development of a validated EHL scale will improve understanding on whether the general population or subgroups are able to gain, understand and act upon information regarding environmental health.
Measuring Vaccine Literacy in Switzerland: How is the situation after COVID-19?
Authors: Jaks R , De Gani S M
Published: October 2024

Background

Vaccinations are one of the most effective medical health interventions and one of the most important preventive measures. However, the population is often unsure about vaccination, and the roles and responsibilities of the key actors seem often unclear. To adequately protect the population against vaccine-preventable diseases, the Swiss Confederation, the Cantons and other stakeholders have developed the National Vaccination Strategy and an associated action plan. For its implementation, studies on the population’s knowledge, attitudes, skills, and vaccination behavior are crucial. Thus, the Swiss Federal Office of Public Health launched a study to assess vaccine literacy and its relation to vaccination readiness and behavior in the adult population in Switzerland.

Methods

A representative sample of 2,500 people living in Switzerland will be surveyed in summer 2024. The online questionnaire will include validated instruments, e.g. the HLS19-VAC Instrument to measure vaccine literacy or the 7C Vaccination Readiness Scale, as well as questions on correlates of vaccine literacy, vaccination readiness and behavior.

Results

The results of the survey will be presented, with a focus on vaccine literacy, vaccination readiness and behavior and their correlates. Specifically, differences among the three main language regions and between specific population groups will be shown. Further, a comparison with data from previous studies will be presented.

Conclusions

Despite having an advanced healthcare system, to date Switzerland has only partially reached its objectives in terms of vaccination, both for individual protection and collective immunity. New data on vaccine literacy, vaccination readiness and behavior as well as on the influencing factors are needed, especially after the pandemic, to guide effective future actions and measures to improve the vaccine coverage and public health in Switzerland.

Key messages

• Due to the COVID-19 pandemic the topic of vaccination in general has received increasing attention and may has changed people’s knowledge and attitudes towards vaccination.

• Newest data on vaccine literacy, vaccination readiness and behavior are necessary to inform future, targeted actions and increase vaccine uptake.