bluuebunny/crossref_metadata_2025 huggingface dataset:
Territorial health inequalities in breast cancer mortality across France from 1968 to 2017
Authors: Lucio Garcia C A , Grimaud O , Leyland A H , Le Meur N
Published: October 2024

Background

Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, until 2016, included up to 8 departments. In this study, we analyze the evolution of between and within-region territorial inequalities in breast cancer mortality over 50 years.

Methods

We used direct and indirect standardization to analyze trends in breast cancer mortality for women aged 25 to 74 years between 1968 and 2017 in each department of metropolitan France. We analyzed the evolution of relative inequalities over time using standard errors of age-adjusted rates. We used multilevel Poisson regression to estimate how much the regional level contributed to territorial variation.

Results

Over the period 1968 to 1992, breast cancer standardized mortality ratios (SMRs) increased (+16%) while relative territorial inequalities decreased (-21%). After 1997, SMRs decreased (-23%) but territorial inequalities remained unchanged. In 18 out of 22 regions, inequalities were lower at the end than at the start of the study period. Period proved to be the most important determinant of variation in mortality. However, multilevel models also suggested that the regional level explained most of the remaining variation in each period (from 50% to over 80%).

Conclusions

Over the study period in most French regions, breast cancer mortality has decreased, and so have relative inequalities. Nevertheless, there is evidence that regions have performed differently. The proportion of variation explained by the regional level suggests the continued relevance of the health system on breast cancer mortality.

Key messages

• Territorial inequality in breast cancer mortality has decreased in France over the 1968-2017 period.

• In most regions, disparities between departments have decreased.
Socioeconomic inequalities in avoidable mortality: results from the Italian nationwide cohort
Authors: Ventura M , Petrelli A , Di Napoli A , Pappagallo M , Simeoni S , Frova L
Published: October 2024

Background

Inequalities in avoidable mortality have been well evaluated in many European countries. We aimed to assess the association between socioeconomic status and avoidable mortality in Italy.

Methods

The nationwide closed cohort of the 2011 Census of Population and Housing was followed up for 2012- 2019 mortality. Outcomes of preventable and of treatable mortality were evaluated among people aged 30-74. Exposures were education level and residence macro area (North-West, North-East, Center, South-Islands). Adjusted mortality rate ratios (MRRs) were estimated through multivariate quasi-Poisson regression models, by sex and group of causes, taking into account age at death and macro area of residence. Relative index of inequalities (RII) was estimated for preventable, treatable, and non-avoidable mortality and for some specific causes.

Results

The cohort consisted of 35,708,459 residents (48.8% men, 17.5% aged 65-74), 34% with a high school diploma, 33.5% living in the South-Islands; 1,127,760 deaths were observed, of which 65.2% for avoidable causes (40.4% preventable and 24.9% treatable). Inverse trends between education level and mortality were observed for all causes; comparing the least with the most educated groups, a strong association was observed for preventable (males MRR = 2.39; females MRR = 1.65) and for treatable causes of death (males MRR = 1.93; females MRR = 1.45). Highest RII were observed for HIV/AIDS and alcohol-related diseases (both sexes), drug-related diseases and tuberculosis (males), and diabetes mellitus, cardiovascular diseases, and renal failure (females). Higher risks of preventable and of treatable mortality were found for those living in the South-Islands.

Conclusions

We documented relevant socioeconomic inequalities in avoidable mortality in Italy, especially in the Southern regions. They represent a possible missed gain in health and suggest a reassessment of priorities and definition of health targets with the lens of equity.

Key messages

• An inverse socioeconomic gradient in avoidable mortality was observed in Italy, both for preventable and for treatable mortality, with geographical heterogeneity.

• Greatest social disparities were found in mortality for causes strongly associated with risk behavior and for which it is possible to identify risk factors on which to intervene.
Are health inequalities decreasing in Sweden?
Authors: Engström K , Fritzell S , Hemström Ö , Källberg H
Published: October 2024

Background

The overarching national goal for the Swedish public health policy is to create societal conditions for good and equitable health for all and to eliminate avoidable inequalities within a generation (until 2048). To know whether we are heading towards the public health policy goal, a surveillance system which follows a combination of several inequality measures over time, is needed.

Methods

All-cause mortality in age 25-64 and life expectancy at age 30, in the total population of Sweden, were used as measures of health and followed 2006-2022. Education (low, middle, high) was used to measure socioeconomic position. Both absolute and relative, and both simple and complex measures were used to analyse inequalities in mortality: rate difference (RD), relative risk (RR), population attributable fraction (PAF) and population attributable number (PIN). Life expectancy was analysed as absolute and relative difference in remaining number of years.

Results

Life expectancy has increased and mortality in age 25-64 have decreased in the Swedish general population. Comparing those with low and high education, both absolute and relative inequalities have increased, e.g. differences in life expectancy increased to > 6 years among men and almost 7 years among women, and relative inequality in mortality in age 25-64 increased to > 3 times higher risk (RR 3.1; CI 3.0-3.3). Inequality, measured with regard to all groups in the population, showed no noticeable changes over time.

Conclusions

The results show that Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25-64. To use a combination of health inequality measures strengthens the surveillance system and gives a more nuanced picture of the development. It enables, in parallel with universal health improving efforts, focus on the groups with the poorest health, where efforts have the greatest effect.

Key messages

• Sweden is facing a challenge in achieving the public health goal to eliminate avoidable inequalities by 2048, with regard to life expectancy and mortality in age 25–64.

• A more nuanced picture of inequalities is crucial to be able to parallel universal health-improving efforts with a focus on the groups with the poorest health, where efforts have the greatest effect.
Hospital design and planning in the line of foresight of health needs
Authors: Jevtic M , Bouland C , Polic D
Published: October 2024

The health needs of the population are increasingly difficult to plan and predict. Technological progress, artificial intelligence, new medicines, but also ecological disasters, humanitarian crises, energy crisis and other challenges (as a Covid 19 pandemic) represent the image of our time. New design of hospitals should be able to respond to the challenges of the future: comprehensive provision of health services taking into account the patient’s needs, working conditions taking into account the hospital staff, energy efficiency and construction in accordance with high standards and reduction of CO2 emissions (green hospitals), to ensure alternative sources of electricity and water supply bearing in mind potential emergencies. The big challenge of long-term construction in which advanced technologies and new procedures cannot simply fit into a rigid building structure that is several decades old (example Serbia), so it is necessary to apply precise planning and efficient and high-quality construction in the next generation hospitals, taking into account current modern equipment and that which will appear in the future. Designing hospitals involves anticipating future healthcare challenges, technological advancements, demographic shifts, and changes in patient expectations. Hospitals emphasis on patient-centered design principles, creating environments that prioritize comfort, privacy, and dignity for patients and their families, accessibility and inclusivity, infection control and prevention, sustainability and resilience. Modern hospitals should create collaborative spaces for interdisciplinary teamwork and communication among healthcare providers, research and innovation units, but also community engagement and health promotion activities. Future hospital design requires strong multidisciplinary and cross-sectional cooperation, in which priority is given to architects dedicated to this field and their cooperation with public health and health management experts.
Advancing immunisation information systems: a proposal for the “unvaccinated registry”
Authors: Vigezzi G P , Maggioni E , Clavario L , Clerico Mosina L , Marjin C , Raso E , Parrini A , Fugazza S , Carbone M , Odone A
Published: October 2024

Through a systematic review of 253 studies, we identified significant advancements in IIS functionalities including real-time data access, interoperability, and life-course vaccination records, crucial for robust public health responses. Our review reveals that vaccinations are vital for public health and societal welfare; however, vaccine hesitancy is a significant barrier, driven by complex factors. Most IIS implementations predominantly utilise web-based platforms focused on children’s vaccinations with features that enhance data interoperability and public health surveillance. Despite these advancements, gaps in vaccine coverage and hesitancy mapping persist due to suboptimal data integration and system interoperability. Parallelly, we propose a comprehensive registry that includes unvaccinated individuals, aiming to address vaccine hesitancy by integrating demographic and socio-economic data. This initiative promises to enhance health equity by providing actionable insights into vaccination gaps and facilitating targeted interventions. Ethical considerations, particularly data privacy, are paramount, as well as adhering to regulations such as GDPR to ensure the protection of personal health information. The integration of IIS with a registry that includes unvaccinated populations represents a transformative approach to public health, potentially increasing vaccine coverage and effectively informing policy decisions. This dual strategy leverages not only technological advancements but also incorporates essential behavioural insights, offering a path forward in the ongoing battle against vaccine-preventable diseases. This model aligns with the Italian National Vaccination Prevention Plan and underscores proactive, evidence-based strategies to enhance vaccination uptake, serving as a cornerstone for broader application in other national contexts.
Polypharmacy and associated factors in the older population in Germany: Results Gesundheit 65+ study
Authors: Sarganas G , Grams D , Ordoñez-Cruickshank A , Fuchs J , Neuhauser H , Gaertner B , Thuermann P
Published: October 2024

Background

Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany.

Methods

Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented.

Results

96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines.

Conclusions

Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use.

Key messages

• Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use.

• Strategies to promote appropriate medication use are needed.
Prevalence and Correlates of Cannabis Use among Cancer Survivors
Authors: Gupta S
Published: October 2024

Background

Delaware has legalized marijuana use for both medical and recreational use. This study identified factors associated with cannabis use among adults with chronic relative to individuals without a history of cancer in the First State.

Methods

Combined data (2020, 2021 and 2022) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for Delaware. Multivariable logistic regression examined individual-level demographic, socio-economic, clinical, and behavioral predictors associated with marijuana use stratified by history of cancer.

Results

Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (6.76% vs. 13.43%). However, a higher proportion of cancer survivors reported use for medical purposes (75.13% vs. 64.28%). Marijuana use prevalence decreased with age among cancer survivors. After adjusting for sex, age, educational attainment, self-reported race/ethnicity, mental health status and physical health status, current smoking (odds ratio [OR], 4.24 vs. 2.74) and binge drinking (OR, 2.45 vs. 1.75) were associated with cannabis use in both groups.

Conclusions

Adults with cancer were more likely to use marijuana. Marijuana use prevalence decreased with age. Public perceptions of marijuana is becoming more acceptable. Risk of medical conditions such as cancer increase with age. As such, older adults might also become consumers of marijuana. Clinicians should screen for marijuana use among patients and initiate open discussions with patients about the benefits and risks associated with marijuana.

Key messages

• Need for ongoing cannabis research to better understand and inform its use for medical purposes.

• Development of high-quality standardized education materials and clinical practice guidelines for marijuana use.
Organizational health literacy in hospitals and primary health care - developing innovative tools
Authors: Finbråten H , Levin-Zamir D , Straßmayr C
Published: October 2024

Background

Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement.

Methods

The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording.

Results

The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process.

Conclusions

The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.
Assessing primary healthcare quality through avoidable hospitalizations: a systematic review
Authors: Pierri F , Mercuri D , Di Lorenzo G , Soccodato V , Anniballo A , Forcella C , Renzi E , Villari P , Baccolini V , Migliara G
Published: October 2024

Background

Avoidable hospitalization (AH) for ambulatory care sensitive conditions (ACSC) has been widely used as a measure of the performance of primary health care. However, the lack of a standardized definition of these conditions and the absence of conclusive evidence regarding their efficacy across diverse healthcare settings remain significant challenges. This review aims to systematically identify and synthesize the utilization of AH for ACSCs as a metric for evaluating the quality of primary healthcare (PHC) and factors influencing such quality.

Methods

We conducted a systematic search for peer-reviewed studies on 3 electronic databases. Studies that used AH for ACSCs to investigate the quality of PHC were included. The following characteristics were extracted: study design, ACSCs definition, AH rates, intervention if applicable, PHC and or patients’ characteristics associated to AH rates, such as accessibility, continuity of care, demographics, socio-economic status, and comorbidities.

Results

73 relevant articles were identified, published between 1994 and 2023 and mostly in USA. Preliminary findings based on 56 articles indicate that the majority (48.2%) employed the list of ACSCs from the AHRQ (i.e. the prevention quality indicators) (48.2%). Meanwhile, 12 studies (17.9%) used lists developed or modified by the authors, and another 7 (12.5%) adopted lists previously utilized in other research. Studies conducted in Brazil, Canada and USA employed lists issued by relevant national institutions.

Conclusions

Although preliminary, these findings highlight two main trends. Firstly, in countries where health authorities have established a standardized set of ACSCs, a notable uniformity is observed. Conversely, in the absence of such standards, variability in defining these conditions is likely to increase. This variation could hinder the comparability across different Primary Health Care (PHC) service organizations and affect the analysis of care quality.

Key messages

• Most studies used established indicators for the measuring of primary healthcare quality.

• Diverse ACSC definitions across countries impair the generalizability of healthcare quality analysis.
Are early emotional and behavioral problems related to subsequent asthma in preschool children?
Authors: Fabian H , Durbeej N , Dahlén J , Dahlberg A
Published: October 2024

Background

The most common mental health problems in preschool children are emotional and behavioral problems, and one of the most common chronic inflammatory diseases in children is asthma. Most research on the relationship between emotional and behavioral problems and asthma includes school-aged children. The current study aimed to explore the association between emotional and behavioral problems during preschool years and the risk of asthma in a Swedish context.

Methods

The study was a longitudinal cohort study, with 6954 children aged 3-5 years for which data on emotional and behavioral problems through the Strengths and Difficulties Questionnaire were collected in Uppsala Region, Sweden, between 2013 and 2017. The cohort was followed with data from the National Patient Register from 2013 to 2022. Asthma was defined as having at least three diagnoses (ICD-10 codes: J45-J46) during follow-up. Unadjusted and adjusted cox regression models were used to analyze data.

Results

A total of 269 children (3.9%) had diagnosed asthma during follow-up. Preliminary results show that children with emotional symptoms, rated separately by mothers (HR: 1.62, 95% CI: 1.20-2.20), fathers (HR: 1.49, 95% CI: 1.10-2.03), and preschool teachers (HR: 1.53, 95% CI: 1.08-2.16) had increased risk of being diagnosed with asthma according to unadjusted cox-regression models. In addition, children with total emotional and behavioural problems, rated by fathers (HR: 1.51 95% CI: 1.10-2.07) were also at higher risk of being diagnosed with asthma. These associations remained significant when adjusting for background and sociodemographic factors.

Conclusions

Our findings point to the significance of a clinical awareness of the relation between emotional and behavioral problems and asthma in young children. Our findings highlight the importance of also considering somatic problems, including asthma, in children with early signs of emotional and behavioral problems.

Key messages

• Emotional and behavioral problems in preschool children is related to being diagnosed with asthma.

• Somatic problems, as asthma, needs to be considered in children with emotional and behavioral problems.
Public health innovation labs framework development: a design study of GGD West-Brabant Netherlands
Authors: Essafi S , van Eck E , Tabeau K
Published: October 2024

Introduction

Innovation Labs are spaces that encourage the creation, development and testing of novel ideas within organizations.While there are known frameworks for the organization of such labs in the private sector, current literature does not reflect a framework for developing a public health Innovation Lab (PHI-Lab) specifically.The aim of this study was to develop an evidence-based framework for a PHI-Lab together with the Dutch Municipal Health Service(GGD).

Methods

Our design thinking study consisted of 4 phases: Discovering, Defining, Creating and Evaluating.An initial framework was developed based on the public and public health sectors in the literature.To create and evaluate the framework,a document analysis of the GGD was performed,and co-creation and testing sessions were organized with 11 internal and 11 external stakeholders of the GGD.

Results

The final PHI-Lab framework is composed of: rationale, enablers and barriers, environment, approach, outcomes and values. Findings emphasized practical reasons for investing in a PHI-Lab, such as the shortage of health professionals.Stakeholders highlighted that proactive leadership and innovation culture are crucial enablers for the setup of the PHI-Lab.The right space and human resources (environment) and methods including design thinking and cross-collaboration (approach) were highlighted as important strategies for overcoming innovation challenges.Despite barriers such as bureaucracy and resource limitations, tailoring solutions to organizational objectives is key to the PHI-Lab’s success and sustainability, with added values of inclusiveness, adaptability and fun.

Conclusions

This study highlighted some practical additions to the initial framework that are specific to the public health setting, although mostly an adaptation from the public sector.Findings emphasize that there isn’t a one-size-fits-all solution to develop a PHI-Lab.This framework has the intention of benefiting other public health organizations.

Key messages

• The framework has the intention of benefiting other public health organizations within established networks and partnerships.

• Proactive leadership and innovation culture are crucial enablers for the organizational setup of the innovation lab.
Organizational health literacy strength and learning opportunities in Italian hospitals
Authors: Lorini C , Bonaccorsi G , Capecchi L , Biagi C , Zanobini P , Unim B , Lombardo C , Cacciuttolo M G , Paladini A , Palmieri L
Published: October 2024

Background

Organizational Health Literacy (OHL) implies responsiveness and friendliness of healthcare organizations. In the context of the WHO Action Network M-POHL, Italy evaluated OHL in a hospital as a pilot.

Methods

The international self-assessment tool OHL-Hos explores 8 standards using 141 items. It was firstly translated and culturally adapted to Italy, and then tested to assess OHL in the public general hospital of Pistoia (Central Italy). A physician, 6 staff members of the healthcare management unit, and 3 medical residents in public health from the Florence University were involved in the pilot. The Pistoia hospital has 1,300 employees (44% nurses, 24% physicians) to face 18,000 hospitalizations per year.

Results

Completing the questionnaire took more than 5 hours. A comprehensive agreement was reached, even though different approaches aiming at improving HL in healthcare and non-healthcare staff emerged. Scores resulted acceptable/good for standard 5 (communication with patients) and 7 (promoting staff HL with regard to occupational risks and personal lifestyles), low for standards 1 (implementing OHL overall the hospital), 2 (involving stakeholders in developing documents, materials, services), 3 (staff training for personal and organizational HL) and 8 (contributing to local population personal HL improvement), which would apply more peculiar for other settings than hospitals.

Conclusions

The participation of the hospital working group in the assessment using the OHL-Hos raised interest toward this matter. It results time consuming for its excessive length, and some standards do not fit to the Italian hospital context, resulting more useful to assess the territorial organization. Reduction of the number of items and revision/reformulation of some of them are suggested. Nonetheless, the tool proved to be useful in indicating the most critical areas needing ad hoc interventions, such as training all the hospital staff.
Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland
Authors: Romanova A , Oetterli M , Landis F , Balthasar A , Käppeli P , Messerli N , Mantwill S
Published: October 2024

Issue/problem

Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care.

Description of the problem

Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders.

Results

The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions.

Lessons

Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions.

Key messages

• Co-creation with stakeholders is a promising way to develop innovative solutions for health systems.

• Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.
Collection and use of patient-reported experience measures: approach to improve health care
Authors: Zile-Velika I , Mavcutko V , Cudina E , Liepina I , Gavare I
Published: October 2024

Background

Patient experience is one of the fundamental determinants of healthcare quality. There is progress in the collection of PREM in national level for hospitalized patients since 2020 in Latvia.

Aim

Analyze (2020.-2022.) in-patients Top-box rates about communication, share-decision making, patient safety and Net Promoter Score (NPS).

Methods

Project starting point was 2019. Agreement with EC, Sant’Anna School, Ministry of Health and Centre for Disease Prevention and Control of Latvia. Since 2020, the collection of PREM has been taking place regularly in hospitals (around 40% from all hospitals) and on average 20% response rate of those who agreed to participate in the survey. PREM questionnaire according to HCAHPS (Consumer Assessment of Healthcare Providers and Systems) standards, including Picker Institute patient experience questions. In line with OECD (Organization for Economic Co-operation and Development) recommendations, patient safety issues are also included. Top-box rates (most positive response) and percentiles (25th - 75th) were calculated.

Results

Totally 17019 adult (18 years and more) patient responses were analyzed with response rate 20.3% (n = 83983). 74.6% (67.5-78.2) during hospital stay doctors always explain things in a way you could understand and sufficiently involved in the decision-making process of treatment - 75.0% (70.1-81.4). During hospital stay 4.1% (n = 601) experienced patient safety incidents which were patient-reported. The most common groups were wrong patients, medication errors, incl. adverse drug reactions and falls. Hospitals achieved a NPS of 61 for 3 year period (2020.-2022.).

Conclusions

Collecting information about the patient experience may be the starting point for engaging patients and moving to more patient-centered health care. The results of these in-patient PREM data can be used to identify areas of improvement and make changes to better meet the needs and expectations of their patients.

Key messages

• It is a good practice for the implementation of new health care quality data - patient experience reported measures at the national level.

• Feedback about the patient experience on regular basis provides insight into patient needs, preferences and values, which can help to improve the quality and safety of care.
Aedes aegypti surveillance under the International Health Regulations - experience at Madeira Island
Authors: Fialho M , Peixoto B , Moreno J , Carrapatoso M , Moreira J , Melim M
Published: October 2024

Problem

Aedes aegypti was first identified on Madeira Island in 2005, persisting since then. This mosquito transmits various haemorrhagic diseases and caused a Dengue outbreak in 2012-2013. The island has two seaports and one airport that may serve as points of entry or dissemination of these diseases, potentially leading to a new outbreak or international disease spread. We aimed to assess Ae. aegypti presence at the island’s seaports and airport during 2023.

Description

Data was collected from 52 entomological panels produced by the Regional Health Department throughout 2023. This data is publicly available on the Institute of Health Administration’s website. Ovitraps capture eggs, larvae, and pupae of Ae. aegypti, and BGtraps capture adult mosquitos. Positivity refers to the proportion of times an ovitrap recorded eggs in the entomological cycle.

Results

In 2023, there were 204 active ovitraps at the island (17 at the airport, 9 at Funchal’s seaport 8 at Caniçal’s seaport) and 24 BGtraps (2 at the airport, 2 at Funchal’s port and 1 at Caniçal’s port). Weekly reports revealed a median of 2243 (0-14448) eggs and 14 (0-234) mosquitos in all traps. Positivity was higher in the second semester. On average, ovitraps’ positivity at the airport (avg 6.4%; 0-59%) and at Caniçal’s port (avg 2.8%; 0-47%) were lower than the positivity of the island (avg 14.8%). Funchal’s port had a higher positivity than the island (avg 15.9%; 0-67%). Per-ovitrap, the average weekly positivity rate rose by 15%, 10% and 5% at Caniçal’s port, airport and Funchal’s port, respectively, compared to 2012-2022.

Lessons

Ae. aegypti’s eggs prevalence increased in 2023. The high positivity of eggs suggests an increased likelihood of mosquitos nearby. The detection of immature forms triggers actions to prospect the surrounding area for identification and elimination of breeding grounds, as well as the placement of salt in water accumulation areas. This is particularly important at high-traffic areas such as seaports and airports.

Key messages

• The increase in Ae. aegypti egg positivity in 2023 on Madeira Island suggests a higher risk of disease transmission.

• It is essential to prioritize vector control measures at seaports and the airport in Madeira Island.
Usability Insights from the BUMPER Cancer Prevention App Pilot Study: A Mixed-Methods Approach
Authors: Ahmed F , Carbó M , Pinto P , Comesana H , Jarm K , Kuusela H , Rozványi B , Krini M , Zeeb H , Brand T
Published: October 2024

Introduction

As the second leading cause of death in the EU, cancer is expected to see a 55% rise in new cases globally over the next two decades. The European Code Against Cancer (ECAC) and the EU’s Beating Cancer Plan (EBCP) provide resources for understanding and preventing cancer. The BUMPER project aims to develop a cancer prevention App to make the ECAC more accessible to the public.

Objectives

Understand the factors influencing the use of a cancer prevention app among users with different digital health literacy levels and to evaluate the app’s usability.

Methods

Mixed-methods approach was used to gather user feedback. FGDs explored user perspectives on app usage, while a cross-sectional survey assessed usability through task completion on an initial app wireframe. The pilot was conducted across seven EU countries in late 2023.

Results

77 participants participated in the pilots and FGDs across seven EU countries. The average task completion time was approximately 79 seconds. Participants rated their confidence to complete the tasks at 3.96 and difficulty at 2.28 on a scale of 1 to 5. The average task pass rate was 92.11%. Qualitative findings highlighted the need for evidence-based content, user-friendly design, language accessibility, offline functionality, and data security. Participants also stressed the importance of clear instructions, regular updates, and robust tracking features. Despite some challenges, the app was generally well-received, with users appreciating its educational potential and tracking capabilities.

Conclusions

The BUMPER project’s pilot study demonstrated the cancer prevention App being developed as a potential tool for cancer education and awareness. Despite navigational and language challenges, the app was favorably received by a diverse user base, underscoring the need for ongoing improvements in user guidance, comprehension, and functionality to enhance accessibility.

Key messages

• BUMPER project’s cancer prevention app shows promise in pilot study, enhancing cancer education and awareness.

• Despite challenges, the app was well-received, highlighting the need for ongoing improvements to enhance accessibility.
AAL for independent aging: Practical guidelines for smart living environment development
Authors: Bin Noon G , Abhari S , Morgan G , Manning F , Teague J , Morita P P
Published: October 2024

Background

Active Assisted Living (AAL) refers to the use of IoT devices to support quality of life, independence, and healthier living for care recipients. AAL-enabled smart homes have particular potential to help older adults reach their health and independent living goals, but there is a dearth of guidance on practical implementation. Additionally, different technology companies have each developed their own practices, leading to confusion and inconsistency. The objective of this work is to explore requirements for use of AAL in smart living environments for older adults, providing suggestions for best practice for AAL use considering their unique circumstances.

Methods

A review of academic and grey literature was performed to identify existing best practices and gaps for development of AAL-enabled environments. A technology review was also performed on 156 unique devices to understand the AAL tech ecosystem.

Results

Little guidance exists regarding designing smart living environments for older adults, though it exists for the two elements separately. The distinguishing elements are how AAL may connect the older adult to their care network, how the home may accommodate changing health needs, and older adults’ unique vulnerability. Furthermore, a large issue is a lack of interoperability and communication, which must be addressed in order to make AAL systems as low-effort and aligned with older adults’ preferences as possible.

Conclusions

As both tech and older adults’ needs evolve, key requirements of AAL-enabled smart living environments are robust data sharing pathways, planning for modifiability, and protecting the privacy of residents. The findings of this work will be used to identify opportunities for AAL standards development.

Key messages

• AAL-enabled smart homes must be able to accommodate an older adults’ shifting care needs and preferences over time.

• It is necessary to establish how AAL smart home data may be shared with and used by care partners and providers.
Characteristics predisposing to the utilization of Internet websites offering e-prescriptions
Authors: Wojcieszko M , Smoła P , Duplaga M
Published: October 2024

Background

The introduction of e-prescriptions in the Polish healthcare system was accompanied by the emergence of websites offering easy access to medication without adequate medical assessment. This study aimed to analyze the characteristics of Polish users of such services.

Methods

The analysis presented here is based on the online survey conducted in June 2023 among 1661 adult Internet users. The multivariable logistic regression model (MLRM) was developed for the variable reflecting the use of e-prescribing web services (EPWS). Sociodemographic variables, self-assessed health status, the presence of chronic disease (CHR) and disabilities (DIS), the frequency of Internet (IU) and social media use (SMU), and finally, digital health literacy (DHL) were included in MLRM as independent variables.

Results

The percentage of respondents who used EPWS was equal to 18.2% (n = 303). MLRM revealed that age, vocational and income status, CHR, SMU, and DHL were significant predictors of EPWS use. Older respondents were less likely than younger ones to use EPWS (odds ratio (OR), 95% confidentiality interval (95%CI): 0.97, 0.97-0.99. Persons suffering from the chronic disease, when compared to those without such disease, used EPWS less frequently (OR, 95CI: 0.59, 0.43-0.80) and unemployed when compared to employees (OR, 95%CI: 0.53, 0.32-0.88). A higher likelihood of using EPWS was observed among respondents with the highest income in comparison to those from the group with the lowest income (OR, 95%CI: 1.52, 1.02-2.52) and among more frequent social media users (OR, 95%CI: 3.88, 1.90-7.93). Finally, the increase of DHL score by 1 unit was associated with the increase of the likelihood of EPWS use by 9% (OR, 95%CI: 1.09, 1.05-1.12).

Conclusions

A significant number of adult Internet users utilize EPWS in Poland. Lower age, unemployment, and chronic diseases are negative predictors of EPWS use. More intense SMU and unexpectedly higher DHL predispose to the use of such services.

Key messages

• Even persons with high e health literacy are inclined to use web portals offering e-prescriptions.

• The high prevalence of the utilization of e-prescribing websites requires awareness campaigns warning about related potential risks.
How advanced is your digital public health system? A qualitative analysis of suitable indicators
Authors: Maaß L , Badino M , Iyamu I , Holl F
Published: October 2024

Background

Revealing the full potential of digital public health (DiPH) systems necessitates a wide-ranging tool to assess their maturity. Essential domains that need to be considered include the literacy and interest in DiPH tool application by society and the workforce and the legal and ICT maturity of DiPH systems. No review has investigated indicators on these national DiPH system maturity (DiPHSM) domains yet. Our narrative review and qualitative analysis aimed to map the landscape of indicators related to DiPHSM measurement and rank them based on their importance for such assessments.

Methods

As original indicators were not published in scientific databases but as grey literature, we used DuckDuckGo to apply a pre-defined search strategy for 11 countries from all continents classified as having reached level 4 of 5 in the Global Digital Health Monitor. Of the 1484 identified references, 137 were included which named 15806 indicators. Consensus on importance was defined as at least 3 or 4 authors rating an indicator as important.

Results

We recognized 180 indicators on different constructs with importance for DiPHSM analysis, including the availability and use of Smartphones, computers, the Internet or the DiPH intervention, the existence of skilled workforce, infrastructure (investment), and interoperability between interventions, the secondary use of health data, a DiPH strategy and controlling agency, or the application of big data and artificial intelligence for health data collection, analysis, and sharing.

Conclusions

Our study holds the potential to develop more comprehensive tools for DiPHSM assessments. Further examination is required to analyze the suitability and applicability of all identified indicators for diverse healthcare settings. By working towards a uniform evaluation of DiPHSM, we foster informed decision-making among healthcare planners and practitioners, improve resource distribution, and continue to drive innovation in healthcare delivery.

Key messages

• Maturity assessment tools need to consider the complexity of DiPH systems. Thereby, DiPH system evaluations need to be accompanied by analyses of the legal, ICT, and literacy perspective maturities.

• New methods are needed to systematically assess and use multidisciplinary grey literature for research.
Integrating an AI-powered symptom assessment application (SAA) in a hospital network in Portugal
Authors: Kini N , Cotte F , Pereira M P , Pimenta A , Schmude M , Nevell J , Lourenço F D , Besarab A , Monteiro M S , Flores P S
Published: October 2024

Introduction

Patients often struggle to understand medical information and healthcare worker shortage strains health systems. Integrating SAAs that guide patients and provide diagnostic decision support (DDS) to doctors can help. This study evaluates the impact of the SAA ‘Ada’, a class IIa medical device, after its integration into the patient portal of a Portuguese hospital network, CUF, on clinical workflow and patient health.

Methods

This on-going post-market quality improvement study, started in Nov 2023 and has enrolled 664 participants. Participating doctors complete a baseline survey. Consenting patients conduct symptom assessments and answer survey questions within the app. The patient’s symptom report is shared with their physician, who then completes a post-consultation survey.

Results

After using Ada, 86% of patients could enter all their symptoms, 79% felt more prepared for their consultation, and 39% felt less health anxiety (N = 664). In the baseline survey, most doctors utilize online resources (96%) in the absence of a symptom checker, followed by discussions with colleagues (65%) for challenging cases (N = 26). In the post-consultation survey, 95% of doctors found Ada’s condition suggestions reasonable, with only 10% disagreeing with its triage classification. Doctors reported time saving and increased consultation efficiency (64%), and 59% felt more confidence in their diagnosis. A majority said that Ada provided them with additional information about patients (77%). Ada also improved consultation efficiency (74%), preparation (78%), patient engagement (82%), and health knowledge (77%; N = 22).

Conclusions

By providing personalized health information, Ada prepares patients for their consultation, resulting in improved patient engagement and facilitation of clinical conversation. Incorporating a SAA into routine patient care enhances quality of consultation, reduces consultation time, increases efficiency, and provides DDS to doctors.

Key messages

• Digital health enhances patient engagement, clinical efficiency, and diagnostic decision support for doctors in healthcare settings.

• Ada’s personalized health information empowers patients, improves consultations, and reduces health-related anxiety.