bluuebunny/crossref_metadata_2025 huggingface dataset:
Ergonomic risk factors and physical fatigue among ambulance workers in Bulgaria
Authors: Samuneva-Zhelyabova M , Lyubomirova K , Kundurjiev T
Published: October 2020

Background

Ambulance workers' job is characterized by extended shifts, inconsistent shift patterns, poor sleep, non-ergonomic work places and work postures, high levels of physical and mental strain. Fatigue in the Emergency Medical Services (EMS) workplace may be related to high patient care loads, demanding work schedules, physical overload and associated stress. The impaired health of those workers can result in pressure on health and insurance systems for treating them as well as bad health care services for emergency patients.

Methods

The study was conducted among 468 workers in emergency healthcare centers in Bulgaria in the period from December 2017 to April 2018. A sociological method was used - a questionniare. The results of the study are presented using descriptive statistics and Chi-square test.

Results

The biggest part of participants complained from ergonomic hazards such as lifting, carrying weights have negative impact on their health: 71.1% of the ambulance drivers, 61.4% of the doctors, 53% of paramedics, followed by nurses with 52.4% and sanitarians with 51.9%. The distribution by positions show that high levels of physical fatigue are among paramedics 59.1%, followed by doctors - 58.3%, nurses 47.6%, medical orderly 33.3% and ambulance drivers 31.9%. The highest levels of the physical fatigue are among respondents at age up to 35 years. Risk reduction measures were developed and distributed among ambulance workers and their employers. Special stress coping strategies were implemented.

Conclusions

Work among ambulance workers is associated with a number of risks as among the main once are ergonomics and related high levels of physical fatigue at the end of the working day.

Key messages

The levels of ergonomic hazards are high among ambulance workers. Ergonomic hazards have negative impact on ambulance workers’ health and the prevalence of musculoskeletal disorders is very high.
Brazilian’s Health Policy and its misalignment with international guidelines for Health Promotion
Authors: Tristão F I , Gomes I M
Published: October 2020

Following the First Health Promotion Conference in Ottawa in 1986, several other global level Conferences were held, and Shanghai was the last City to host the 9th Health Promotion Conference in 2016, where several world leaders assume commitments that meet the common cause of the topic in question, presenting robust outcomes such as the Letters, Declarations and Implementation Guides.

This work aimed to analyze the coherence of the development of the current National Health Plan in Brazil in relation to the central axes of the most recent international documents, referring to the Shanghai Declaration and the Guide for the National Implementation of the Shanghai Declaration.

The results showed that Brazil presents a National Health Plan that definitely does not include the actions proposed in the most recent international documents, such as the Shanghai Conference report and the Guide for National Implementation of the Shanghai Declaration. Paradoxically, Brazil has other institutionally implemented instruments that consider the activities recommended from these international documents in a very satisfactory way. Among these instruments are a specific National Policy on Health Promotion, and several Health Care Programs and Networks aimed at some of the National Policy on Health Promotion strengthening axes, such as the National Tobacco Control Program, the Health at School Program, the Health Gym Program, in addition to other related National Policies, such as the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants and Herbal Medicines.

It is concluded that the National Health Plan is a symbolic instrument that is not in line with international recommendations and, contradictorily, it is also not in line with the own policies and programs that are successfully implemented and developed in national territory.

Key messages

There is a misalignment between the real meaning that a National Health Plan should present and its current content, what leads to an insuficent instrument for enhancing health promotion. While the national health plan is out of alignment with strengthening health promotion, other nationwide specific policies developed reinforce international guidelines.
Development of an instrument measuring Navigation Health Literacy in the Health Literacy Survey 2019
Authors: Griese L , Schaeffer D , Berens E , Nowak P , Pelikan J
Published: October 2020

Background

Complex and intransparent structures are the main reasons why it is difficult for patients to navigate the healthcare system. Thus, patients need specific competencies to deal with health information related to orientation and finding the right pathways through the healthcare system. The aim was therefore to develop an internationally applicable instrument for measuring Navigation Health Literacy (N-HL) within the European Health Literacy Survey 2019 (HLS19).

Methods

Item development was conducted by a working group within the HLS19 consortium. It consisted of a scoping review on definitions, concepts and instruments, development of a definition of N-HL, a concept mapping and first item formation. The items were further developed by an evaluation by 6 experts, 4 focus group discussions, and feedback from members of the HLS19 Consortium. Finally, the feedback was integrated into the instrument and pretested in 33 interviews.

Results

10 publications providing concepts and instruments assessing navigational aspects were identified, but the process of dealing with information was scarcely considered. Therefore, based on the HL definition by Sørensen et al. (2012) N-HL was defined as difficulties in finding, understanding, appraising and applying health information for navigating the healthcare system. In total, 10 tasks at system, organization and interaction level emerged within this definition, on which the final instrument is based. Of 15 initial items, 3 items were assessed as not relevant by experts. The feedback from focus group and HLS19 discussions lead to further revision and addition of items. The final instrument consists of 12 items which proved to be applicable in the pretest.

Conclusions

The instrument can be used to assess N-HL in international population studies and has been used within the HLS19 study to generate internationally comparable data on N-HL for the first time. By that it can form a basis for intervention development and monitoring.

Key messages

An instrument for measuring navigation health literacy (N-HL) is important to assess and monitor difficulties of patients to navigate the healthcare system and to underpin intervention development. The N-HL instrument of HLS19 can be used to assess N-HL in international population studies and provides internationally comparable data.
Point-of-care testing and counseling at community pharmacies
Authors: Sevikyan A , Kazaryan I , Vardanyan L , Amirkhanyan A
Published: October 2020

An increasing number of patients seek advice at community pharmacies in terms of prevention, detection and initial management of certain conditions and diseases. Some countries have introduced pharmacy-based screening programs and counseling. The objective of this work was to analyze the situation on providing screening and counseling at community pharmacies in Armenia.

The staff of randomly selected community pharmacies located in various regions of Armenia was asked to complete pre-tested questionnaire. The data were analysed with SPSS statistical software, version 22.0.

62.9% of 353 responded professionals reported availability of conditions for monitoring blood pressure, 14.4% - for monitoring glucose level, 11.3% - for doing pregnancy test, 9.6% - for testing cholesterol, 2.0% - for monitoring asthma using peak flow meter. 86.7% indicated accessibility of conditions for private discussion with patients. Small number of pharmacy professionals reported that during the last year they were engaged in diabetes management (10.2%) and HIV/AIDS/TB management (7.9%). 7.4% of respondents were involved in family planning activity. 97.5% of pharmacy professionals considers that being active in providing general health information to patients is important and 89.2% reported about being active. The number of professionals who are active in providing general health information to patients is significantly higher among those who attended continuing education courses than among those who did not (p = 0.003).

Only part of community pharmacies is able to provide point-of-care testing. Professionals are rarely involved in disease management. They are active in providing general health information. Continuing education improves situation with engagement of pharmacy professionals in public health activity.

Key messages

There is need to improve the situation with providing point-of-care testing at community pharmacies. Training increases involvement of community pharmacists in public health.
Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area
Authors: Vivas T , Duarte M , Pitta A , Christovam B
Published: October 2020

Background

The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs.

Methods

This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform.

Results

The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years.

Conclusions

Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges.

Key messages

Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.
Adult mental health centre – A case study report from Slovenia
Authors: Makivić I , Tomšič V , Rešeta M , Mahne N , Selak Š , Švab V
Published: October 2020

Issue

There are two main public mental health problems in Slovenia: suicide and harmful alcohol consumption. The average suicide rate (25 per 100.000 people) is above the European average. There are substantial differences in the accessibility of mental health services and socio-economic and demographic differences within individual geographical areas. To address those challenges the establishment of comprehensive and accessible mental health centres within local environments were planned.

Description of the Problem

First ten adult mental health centres (AMHC) were established last year, one covering population of approximately 80.000 people. The implementation process is well established, while the evaluation process has just begun and assessment of characteristics of the population covered by one of the first AMHC serves as the basis.

Results

There were 74 people in medical treatment in one of the rural AMHC in Slovenia in 2019, mostly women (68.9%) and older people (x ̅=61.9). The income of people included is very low (x ̅=523 EUR). The number of hospitalisations were higher before inclusion (x ̅=1.2 before; x ̅=0.2 after). Beside regular treatment patients receive non-pharmacological therapies such as health education (90.5%) and occupational therapy (47.3%). Within first patients’ assessment mostly the physical health needs, psychological distress, daytime activities and safety to self were not met, which changes after the second assessment (p < 0.05, t > 2.000).

Lessons

Multiple needs of the patients seem to be well addressed through comprehensive, multidisciplinary team work and intersectoral collaboration at local level (e.g. with social work centres, family physicians, non-governmental services).

Key messages

Patients’ needs are well addressed through patient-centred approach at local level. Comprehensive, multidisciplinary team work and intersectoral collaboration at local level can address multiple needs of the patients.
Assessment of the occupational health and safety system in local health centers in Metro Manila
Authors: Uezono D , Medina B , Reario A , Salcedo T , Borromeo L , Camacho V
Published: October 2020

The environment of health care workers (HCWs) is considered as one of the most hazardous settings due to the nature of their work. In the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and effective monitoring and assessment of interventions.

This study assessed the OHS system in 13 barangay health centers in a selected city using the 6 building blocks of a health system framework. Assessment was done through walk-through surveys, documents review, and key informant interview. Qualitative data from the interview were coded using NVivo while quantitative data were summarized using EpiInfo.

Results showed that there remains to be gaps in terms of improving occupational health and safety in local health centers. In terms of leadership and governance, a general policy on OHS for all local health centers was found to be lacking and in effect, an absence of health and safety committees. In terms of financing, the lack of a separate budget specific for OHS programs and services was also found to be a limitation. As a result, there was no OHS personnel identified and only one staff had valid training on OHS among all 13 health centers. There was also no established information system for OHS in place. Only 2 out of 13 health centers have Safety Inspection Reports while only three have Workplace Environment Monitoring Report.

Based on the results of the study, there is a general need for improvement in terms of the occupational health and safety system in the city where the health centers were situated. Among all the elements of the occupational health and safety system, the lack of an overarching policy on OHS resulted in the absence of health and safety committees, inadequate budget and worker specific services for OHS, lack of related trainings and workshops, and poor information and reporting system.

Key messages

Data on conditions of OHS systems in the local health center setting are limited, thus the study provides information on areas of improvement for health systems strengthening. There is a need for policies on OHS in the local health center setting to strengthen the system for improved service delivery, information management and financing for OHS.
Nurse students develop the Intervention Wheel in a Swedish context
Authors: Carlén K
Published: October 2020

Background

Teaching experience, including nine years in Public Health courses given in a nursing program, has shown difficulties in explaining public health issues and their relevance for nursing students. The Intervention Wheel (IW) for Public Health Nurses was a tool developed in Minneapolis 2001, which has been used in educational settings in the US, in Ireland, United Kingdom, and Norway, among others.

Objectives

The aim was to adapt the IW into a Swedish context, with learning activities for nurse students. Before the nursing students (n = 250) in Sweden left for a clinical practice period, they got lectures concerning the IW. They were tasked with a written assignment about the model's utility in health care settings. In the middle of the period, there was a seminar to discuss their experiences and how the model helped explain these experiences from child health care, school health care, primary health care, and elderly care. In a final seminar, the students discussed with each other examples of what they had experienced about each part of the model. They were able to reflect on their experience concerning the model, found new Swedish terms and culturally-relevant experiences to describe their learning in relation to the IW.

Results

The IW helps nursing students to connect theory and practice during their clinical studies and clarifies the meaning of public health work in their language and context.

Conclusions

The IW is a useful tool for education about public health work in the nursing program. By reflecting on experiences from clinical practice, the nurse students could adapt and bring in Swedish language terms and culturally-relevant experiences for the different interventions.

Key messages

The IW is a well-developed tool to improve understanding of the practical meaning of public health in the nurse’s profession. Nurse students are able to participate actively in developing the concepts into a Swedish context.
Qualitysaude: assessing the experience of using SUS by translating knowledge from experts and users
Authors: Moita G F , Raposo V M R , Barbosa A C Q , Hartz Z M A
Published: October 2020

Background

Nationally-based opinion polls showed population dissatisfaction ranging from 54 to 93% and increased from 61% in 2011 to 75% in 2018 (1). The user satisfaction is multifaceted and difficult to measure a field of interest for health decision makers. There is no standardization of quality and satisfaction measurement systems in SUS (1). So, what is the value of SERVQUAL questions for the construction of a SUS satisfaction scale?

Methods

The research is observational, transversal, using a mixed method of evaluation, within the PhD from the University of Coimbra. The Likert scale (1 to 5) was used to valuation of 195 professionals and 506 users that were assessed by descriptive and inferential statistics.

Results

Have been validated the 20 questions, 13 sub-dimensions and the five original macro-dimensions (Tangibility, Reliability, Responsiveness, Empathy, and Assurance) by high averages - professionals (>3, IC 3.72-4.69) e users (∼ 4, IC 3.8-4.49). There was mediation (p ≤ 0.005) of the variables level of attention and level of complexity (Users). In the inferential analysis, the reliability and validity of the five Servqual macrodimensions with convergent validation were ensured (AVE > 0,40), adequate reliability (A.C. > 0,60 ou C.C. > 0,60), unidimensionality and discriminant validation (VCM < AVE), but only 15 subdimensions (factor load > 0.50) made up the final model

Conclusions

The collaborative process, which can be expanded to other contexts or countries, validated a SUS quality assessment model with 20 proposed and validated questions, aligned with the five dimensions of the Servqual scale. Moita GF et al - uma adaptação transcultural multicêntrica dos constructos da escala Servqual de satisfação para o SUS... Rev Serv Público. 2019:325-64.

Key messages

An innovative SUS quality and satisfaction assessment scale was validated and applied to a web prototype (QualitySaúde), referring to the user experience and SUS management items. The collaborative process validated a SUS quality assessment model with 20 proposed and validated questions, aligned with the five dimensions of the Servqual scale.
Cost-effectiveness analysis for preventing hepatitis B virus reactivation-related death in Japan
Authors: Fujita M , Kusumoto S , Sugiyama M , Fujisawa T , Mizokami M , Hata A
Published: October 2020

Background

There is no worldwide standard recommendation for preventing hepatitis B virus (HBV) reactivation for patients with resolved infection treated with an anti-CD20 antibody for B-cell non-Hodgkin lymphoma. This study aims to compare the cost-effectiveness between two commonly used strategies to prevent HBV reactivation-related death.

Methods

The two strategies compared were prophylactic antiviral therapy (Pro NAT) and HBV DNA monitoring followed by on-demand antiviral therapy (HBV DNA monitoring) using entecavir (Entecavir, a generic drug for Baraclude). Effectiveness was defined as the prevention of death due to HBV reactivation and costs were calculated under the health insurance system of Japan as of April 2018 using Markov model. A cost-minimization analysis, one of the cost-effectiveness analyses, was applied, since the effectiveness was the same between the two strategies according to a meta-analysis. To consider the effect of uncertainty for each parameter, probabilistic sensitivity analysis (PSA) was performed. In the scenario analysis, costs were calculated using lamivudine (Zefix) or tenofovir alafenamide (Vemlidy) instead of entecavir. All analyses were done using TreeAge Pro 2019 (TreeAge Software, Inc., MA, USA).

Results

Estimated costs per patient during the 30 months after initiation of chemotherapy for lymphoma were 1,513 USD with Pro NAT and 1,265 USD with HBV DNA monitoring. A PSA revealed that HBV DNA monitoring was more consistently cost-effective compared with Pro NAT when some parameters were set randomly according to probability distributions. In our scenario analysis, costs of Pro NAT and HBV DNA monitoring were calculated as 2,762 and 1,401 USD using lamivudine, 4,857 and 1,629 USD using tenofovir alafenamide.

Conclusions

Our cost-effectiveness analysis shows that an HBV DNA monitoring strategy using entecavir should be recommended for preventing HBV reactivation-related death in Japan.

Key messages

Cost-effectiveness analysis demonstrated that HBV DNA monitoring was more cost-effective compared to Pro NAT; this result was consistent with PSA. HBV DNA monitoring strategy should be recommended to prevent HBV reactivation-related death for the patients with resolved HBV infection in Japan.
Socioeconomic impact of informal care provided to patients with remote monitoring of pacemakers
Authors: Lopez-Villegas A , Leal-Costa C , Catalan-Matamoros D , Robles-Musso E , Lappegard K T , Bautista-Mesa R , Peiro S , Lopez-Liria R
Published: October 2020

Background

The aging of the population leading patients with pacemakers to exhibit more comorbidities and, consequently, a greater need for both formal and informal care. The objective of this study was to assess personal characteristics, associated problems, workloads, time, and costs related to informal care provided to patients with pacemakers under remote monitoring (RM) vs. conventional monitoring (CM) at hospital, five years after implantation.

Methods

This is a controlled, non-randomised nor masked trial conducted with information obtained from the perspective of informal caregivers. The “Disability, personal autonomy, and dependency situations survey” was administered to collect information on sociodemographic characteristics, time, care difficulties, health status, professional aspects, and impact on economic, family, or leisure aspects of main caregivers providing care to patients with pacemakers.

Results

of the 50 patients who reported having informal caregivers, 42% belonged to the RM group. The average age was 63.14 years, 96% were women, and 72% was married. Informal caregivers lived in the homes of the patients in 70% of cases, and 88% indicated that they had to provide care six to seven days a week. The average cost per patient during the monitoring period studied was 13.17% lower in the RM group than in the CM group, and these differences were not statistically significant (p = 0.35).

Conclusions

This study found similar results in both groups of follow-up with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and relatives. The costs associated with care were higher in the CM group.

Key messages

There are not significant differences between both groups of follow-up with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and relatives. The average cost per patient during the monitoring period studied was 13.17% lower in the Remote Monitoring group than in the Conventional Monitoring group.
Developing a roadmap for Health Technology Assessment implementation in public health decisions
Authors: Di Macio F , Caricato M , Primieri C , Favaretti C , De Waure C
Published: October 2020

Issue

Although the recognized importance of Health Technology Assessment (HTA) in fostering health policy and management, little is known and differences emerge in the state of the art of HTA development and use in public health decisions.

Description of the Problem

HTA applied to public health interventions could lead to improved population's health, risk factor reduction and high quality services. All these factors represent the basis of health care system sustainability. Nevertheless, there is a lack of evidence about the application of HTA to public health. In this light, the Section on HTA of the European Public Health Association (EUPHA) is conducting a Delphi process in order to define a shared roadmap for the implementation of HTA in public health.

Results

A literature search was first performed on PubMed to identify useful documentation for drafting the roadmap. Taking clues from Kalò et al., who drafted an HTA roadmap scorecard to support HTA implementation in Central and Eastern Europe, a preliminary core set of actions and pillars to pave the way for the implementation of HTA in public health, was identified. Then, a group of HTA experts was invited to participate to the Delphi process with the aim to build consensus on the final set of actions and pillars to include in the roadmap.

Lessons

Evidence on the ways to strengthen the role of HTA in public health decisions is scant and the development of a shared roadmap could be useful to identify milestones to do it.

Key messages

HTA applied to public health could promote an efficient, sustainable, equitable and high-quality health system. Nevertheless, the role of HTA in taking public health decisions should be strengthened. As evidence on the application of HTA in public health is scant, the development of a shared roadmap could enhance fostering its use in taking decisions on public health interventions.
Parental and offspring psychopathological disorders after the 2012 Italian earthquake
Authors: Panciroli G , Forresi B , Soncini F , Botosso E , Di Pietro E , Scarpini G , Scaini S , Aggazzotti G , Caffo E , Righi E
Published: October 2020

Background

Parental mental health can affect offspring Post-Traumatic Stress Disorder (PTSD), but up to now few data focused on families exposed to natural disasters. Thus, this study aimed at investigating the association between parental and youth psychopathology after the Italian earthquake of 2012.

Methods

In this cross-sectional study, 1162 parents and 682 children and adolescents (9-14 years) living in two districts, earthquake area (EA) and control area (CA), were assessed for psychopathological distress two years after the earthquake. Children filled in the UCLA PTSD-Index for DSM-IV, an exposure questionnaire, and the Strengths and Difficulties Questionnaire (SDQ); parents the Symptom Checklist-90 (SCL-90).

Results

Parents in EA showed a higher frequency of psychopathological difficulties than those in CA (28% vs 17.5% had a SCL-90 global score over the cutoff, p < 0.001). Sleep disturbances were the most prevalent disorder, followed by obsessive-compulsive disorder, depression, somatization and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample.

Both SCL90 total and symptom domain scores correlated with PTSD total and clusters scores, especially for hyperarousal and re-experiencing. Parental anxiety, depression and somatization showed the highest correlations. Considering SDQ, mothers' psychopathology resulted to be associated mainly with offspring's emotional and peer problems, while fathers' disorders affected mainly children's hyperactivity.

Conclusions

This study showed a significant association between parental mental health and both PTSD and emotional/behavioral problems among offspring after earthquake. These results should be carefully considered when planning mental health support interventions in areas affected by earthquakes.

Key messages

Parental psychopathology and PTSD and other emotional/behavioral difficulties in children tend to cluster in families exposed to natural disasters, especially earthquakes. Parental and offspring psychopathological disorders should be considered when planning mental health support interventions in areas affected by earthquakes.
Preparedness for transplantation during COVID-19 outbreak: how to manage?
Authors: Valdi G , Varadi G , Panzera A , Parpinel M , Peressutti R
Published: October 2020

Problem

When WHO declared COVID-19 “international”, it was important not to damage some critical patients who need emergency procedures like organ transplantation, due to end stage organ disease. In 2003 SARS outbreak demonstrated the vulnerability of organ transplantation services o network.

Descritption

If transplantation is required as a life-saving procedure, it can be conducted with appropriate risk infection assessment. It is crucial during these emergencies to assess donor pool, as it is expected to decrease. A crucial point is to organize and evaluate the surge capacity, in terms of understaffing and lack of supplies, especially in ICU. The research methods were literature review using Pub Med, CDC, ECDC, WHO, TTS, searching as key words “SARS-CoV-2”, “COVID-19”, “transplantation”, “preparedness”. The analysis has been conducted between Feb 26th 2020 and March 5th 2020.

Results

As happened during SARS breakout in 2003, it is essential to establish a task force for crisis, currently updated and skilled for this particular management. Preparedness should regard especially the adoption of donor safety assessment procedures, ICU capability, the availability of covid-19 test for all the donors, and the adoption of specific post-transplant care. It is essential in this case establish preparedness in several points: education and training of the staff, practice drills, inspection of supplies, evaluation of surge capacity, relocation of patients.

Lessons

SARS-CoV-2 imposed in public health to establish new protocols and guidelines, which should be regularly updated to be useful in other epidemics outbreaks or other emergency situation. These protocols should focus on donor pool and ICU capability in order to carry on transplantation activities.

Key messages

This outbreak has tested the resilience of the whole system by day-by-day updating for transplantation teams and preparedness of the staff involved in transplantation management. During outbreak, seems to be useful a task force for crisis in order to support organ transplantation services.
COVID-19: knowledge and attitudes of hospital staff of a large Italian teaching hospital
Authors: Moro M , Vigezzi G P , Capraro M , Biancardi A , Nizzero P , Signorelli C , Odone A
Published: October 2020

Background

During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy).

Methods

One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours.

Results

A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19.

Conclusions

We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities.

Key messages

During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection. Our data can inform planning of these preventive measures.
Evaluating quality variation of emergency departments
Authors: Oschmann L , Geissler A , Nimptsch U
Published: October 2020

Background

Germany introduced a graduated system of emergency levels (0 non-participation; 1 for basic up to 3 for comprehensive infrastructure) to overcome various inefficiencies of hospital emergency care. For each level, detailed requirements must be met, however, the case volume of conditions treated in the levels is unclear. Moreover, the relationship between emergency level and outcomes needs evaluation to analyse if patients are directed to the most appropriate hospital.

Methods

We selected three major emergency conditions - Stroke, AMI and Hip fracture - and matched risk-adjusted outcome and process indicators on hospital level to the hospital respective emergency level. Descriptive statistics such as distribution and correlation are used to examine the allocation of cases to emergency levels and to analyse the effect of structural differences on health outcomes.

Results

We saw large variations in quality for all clinical conditions regardless of the emergency level. Hospitals with a small case number showed greater fragmentation; hospitals that did not meet the requirements nevertheless performed interventions for AMI and stroke. In detail, 30-day mortality of AMI shows high variation of quality results in level 1; for stroke it is underperformed with almost 10% in hospitals with level 0. Pre-operative LOS for hip fracture is above the acceptable average in any level (tolerance range ≤ 15%), and the ratio O/E in mortality is noticeable for 40% of hospitals with level 0.

Conclusions

Many cases are treated in low volume hospitals with wide quality variation and subpar results. Therefore, the definition of emergency levels should be integrated to emergency pathways which might help to direct patients to the most appropriate hospital. Moreover, many emergency symptoms are not captured by available quality metrics and current classification systems which shows that emergency service provision is to a large extent not covered by current measurement initiatives.

Key messages

Emergency service provision is fragmented and not related to emergency levels. Development of emergency quality indicators is needed.
Patient health engagement model: explaining citizens noncompliance and maladaptive behaviors
Authors: Graffigna G , Barello S , Palamenghi L , Savarese M , Castellini G
Published: October 2020

Background

At the end of February 2020 a new case was diagnosed with COVID-19 in north Italy, suddenly followed by new cases. Italian health authorities decided to enforce restrictive measures. Northern areas of Italy were identified as “red areas” to slow down the epidemic and its impact on the healthcare system. From this perspective, the COVID-19 epidemic in Italy constitutes a testing ground for the assessment of the ability of consumers to cope with this health risk.

Methods

A cross-sectional study on a representative sample of 1000 Italian citizens was conducted over the period 27 February- 5 March exploring the following hypotheses: 1) less engaged individuals are more concerned for the health emergency and feel more vulnerable; 2) less engaged have higher probability to develop negative attitudes and dysfunctional behaviors.

Results

only the 16% the interviewees presented a high level of engagement. Lower levels of engagement were measured in the southern parts of Italy (not yet touched by the epidemics at the time of data collection). People with lowers levels of engagement reported higher fears for the contagion and sense of vulnerability. Furthermore, they showed the lower levels of trust in the Public Health Authorities, in medical research and in vaccines. Finally, they appeared more dismissive in their preventive behaviors and more disorganized in the fruition of the healthcare services.

Conclusions

A psychological analysis of processes of attitudinal and role change in the direction of becoming more engaged in health prevention is worthy in order to forecast potential dysfunctional reactions to restrictive health prevention measures and to orient personalized education initiatives to consumers with different level of engagement.

Key messages

Profiling based on the levels of health engagement is important in order to plan more effective healthcare measures during epidemics. Targeted educational initiatives should take into account citizens' engagement profiles.
Evaluation of a project on Nursing education of refugees and other persons in need of support
Authors: Winkelmann C , Helmer-Denzel A
Published: October 2020

The European Social Fund, in cooperation with Baden-Württemberg, Germany, supports projects to attract people to care. Results of the project New paths in training occupations of the nursing assistant in Ulm (PfAU) (01.02.2017 to 31.03.2019) are presented. PfAU is divided into a) recruit interested persons, b) two-month preparatory course, c) one-year training in care for elderly or nursing with special support from school and care facilities. Focus is on individual participation in employment, non-discrimination and equality.

The evaluation was formative and summative. A milestone discussion and semi-structured interviews with participants, project team and leader in care facilities were used. Data of participants were provided for evaluation.

There were two rounds involving 40 people (f = 17, m = 23); shown following categories:

I_Refugees (mainly men under 30, for religious reasons resistances against care for elderly); II_Economic migrants (mainly women under 30, preparing for migration in their home country); III_Non-European migrants (mainly women from different countries of origin, Au-pair employment or partnership in Germany); IV_Persons with learning disabilities and/ or individual difficulties from Germany (women and men mostly under 33 years).

Reasons for leaving PfAU are motivational or language gaps, cognitive limitations, religious reasons, error expectations, health problems, child care, single parenting. Reasons for staying are financial support for the family, image, meaningful task, social network through chain migration.

PfAU works, but long-term perspective and financial resources are necessary. Future funding should be based on the identified categories, with special attention to their individual support needs. Important are motivation and the idea of nursing activity. Preparation course should be extended. There should be an individual selection for the training. Existing teams in the care facilities must be supported in the integration.

Key messages

PfAU is just a pilot project. In future, permanent implementation is necessary to close the gap due to demographic change and skill shortages. Existing teams in the care facilities must be supported in the integration.
Patient satisfaction with the quality of nursing care: A cross-sectional study
Authors: Skhvitaridze N , Lobjanidze T , Papidze A , Barjadze E , Landia N
Published: October 2020

Aim

To evaluate patients' satisfaction with the quality of nursing care and examine factors which affect their decision.

Design

A retrospective, cross-sectional, descriptive survey study.

Methods

Data were collected using a structured questionnaire in Georgian language was administered to the patients. The response rate was 93% and the final sample was composed of 173 patients who enrolled consequently after taking written informed consent. One hospital and one outpatient department in the capital city of Georgia were selected for the study setting. Data were collected during one month. Data on demography was collected. Descriptive and inferential statistics were applied accordingly using STATA version 17. Eligible criteria: Adults, capable of independent communication and who talk Georgian language, did not have any severe process or complications, were in the recovery stage, with no referral and discharging to home.

Results

Majority of respondents were aged between 56-65 years (50%), males (52.5%), residents of the capital city (70%), having higher education (80%) and employed (75%). Overall, 89% of patients described provided nursing care as an excellent. The most important factors, which affect patients' satisfaction are the waiting time before admission, safety of services, comfortable environment along with the proper level of care and attentiveness. These results can be generalized and may be useful in comparative studies of patient satisfaction.

Key messages

Permanent evaluation of nursing care is important to evaluate patients satisfaction. Factors as waiting time, safety of services, comfortable and friendly environment, and attentiveness are key for high level of satisfaction.
Why do nurses stay? A positive deviance study of nurse turnover
Authors: Hølge-Hazelton B , Berthelsen C B
Published: October 2020

Background

Nursing shortage is a global problem and high turnover of nurses has negative effects on health care organizations and patients. In Denmark, the highest nursing shortage is found in the Zealand region, where an effort to recruit and retain nurses is urgently needed. However, not all departments are equally challenged, despite covering the same clinical areas. The aim of this study was to investigate nurses' experiences and descriptions of practices in hospital departments with low nurse turnover compared to similar departments in the same region: 1) How do nurses experience and describe the culture and work environment in their department? 2) How do nurses experience and describe practical nursing in their department? 3) How do nurses experience and describe the meaning, importance, or significance of nurse management?

Methods

A constructivist design with a positive deviance theoretical approach was chosen. 21 nurses from four different departments (medical, surgical, acute and psychiatric) with the lowest turnover of nurses participated during focused observations (N = 8) and focus group conversations (N = 13).

Results

The results revealed a sense of community between nurses and department managers; nurses identified these close relations as the reason for not seeking 'greener pastures' elsewhere. The results were presented as four categories: collaborative fellowship, professional pride, embracing management, and 'as green as it gets'.

Conclusions

Even though the nurses' daily practice was exhausting, they did not consider leaving their jobs due to the special culture in the departments, which brought the nurses closer together

Key messages

Due to the centrality of nurse managers as a reason for nurses’ retention, future attention should focus on the cultural and strategic perspectives and actions of nurse leaders. Collaborative fellowship and professional pride can not be underestimated as means to retention and recruitment of nurses.
Medical certificate of disability: a descriptive analysis of Aveiro region, from 2010 to 2016
Authors: Sá R , Matos J
Published: October 2020

Background

In Portugal, Public Health Physicians attribute the medical certificate of disability (MCD). This document is mainly used for fiscal benefits or from other kind, as priority parking card and non-medical public services are increasing its requirement. The threshold to determine benefits is 60% of incapacity by law. Oncological, musculoskeletal and psychiatric diseases account for most of the cases. This activity is highly time-consuming and is not part of the Essential Public Health Operations or the competences of Public Health Physicians according to the Medical Professional Order. The aim of this study is to characterize the evolution of this procedure and the obtained incapacity values from 2010 to 2016 in the Public Health Unit of Baixo Vouga Primary Healthcare Cluster.

Methods

A descriptive analysis was made with the registers of production of MCD in four municipalities of the Aveiro Region from 2010 to 2016.

Results

An increase in the number of MCD was verified, going from 274 in 2010 to 550 in 2016, in a total of 3087. Two thousand and fifteen was the year with the greatest frequencies, with 632 certificates. The median value of incapacity was 60% (64% of total MCDs), with an interquartile amplitude of 12, varying from 6% to 99%. Incapacity values have an increasing tendency over the years, showing a cohort effect.

Conclusions

The increase of MCD reflects an enormous burden for the Public Health Services that consequently have fewer resources to deal with Essential Public Health Operations. Human resources or task distribution should be rethought in order to respond to population's needs. Cohort effects might be explained by the law-fixed re-evaluation, required every 5 years for oncological cases. In fact, this incapacity is the main cause of requirement of the MCD. Further studies should address this problematic in order to better organize the health services and understand the effectiveness of this procedure.

Key messages

The number of issued MCD is growing, overloading Health Services. The median incapacity is 60%, which is the threshold to attribute benefits. Further investigation is needed to address this issue.