bluuebunny/crossref_metadata_2025 huggingface dataset:
Portrait of young Italian university smoker student
Authors: Gori F , Vonci N , Quercioli C , Rossi S
Published: October 2020

Background

Smoking is a widespread problem in all age and social groups. Number of smokers is increasing among students and the years of university are those in which it is most common to start smoking.

The aim of this study is to outline the profile of the smoker university student.

Methods

Between October 2018 and January 2019, a sample of 150 smoking students of Siena University were randomly selected. We administered the structured Fagerstrom test. This test contained six items to evaluate the dependence and the quantity of cigarettes consumption. We conducted a descriptive analysis and a linear regression using software Stata.

Results

The sample was composed of 75 males (50%) and 75 females (50%), with a mean age of 24.6 years (sd 3.1). About 45% of the participants smoked between 11 and 20 cigarettes a day. Fifty per cent of the respondents lighted the first cigarette after 1 hour since they woke up, indeed only about the 25% preferred to smoke just woke up and would hardly give up the first cigarette. About the 80% did not show difficulty to avoid smoking in forbidden places or when they were ill. The mean degree of dependence of cigarettes was 2.7 (sd 2.3), considered as medium-low level of dependence. The degree of dependence (0 -10) was correlated with every items of the test, resulting: time to lighted the first cigarette (r = 0.71, p < 0.005), difficulty to refrain from smoking in places where is forbidden (r = 0.41, p < 0.005), cigarette hate to give up (r = 0.32, p < 0.005), number of cigarettes smoked a day (r = 0.69, p < 0.005), smoking more frequently in the morning (r = 0.26, p < 0.005), smoking even if being sick (r = 0.27, p < 0.005). The gender did not show correlation with any variables.

Conclusions

The our sample showed a medium-low level of dependence from nicotine (11-20 cigarettes a day) with the time to light up the first cigarette after 60 minutes; as resulted from the linear regression analysis. The gender did not have correlation with the dependence from cigarettes.

Key messages

Outline the profile of the joung smoker university student. Smoking is a widespread problem in all age and social groups.
Translation and validation of a brief Health Literacy instrument for children into Danish
Authors: Bonde A H , Stjernqvist N W , Klinker C D , Maindal H T , Paakkari O , Elsborg P
Published: October 2020

Background

Evidence for health literacy (HL) as an important determinant of health and health behaviour is increasing. Brief and generic tools for measuring HL in children are few. One such tool is the Health Literacy for School-Aged Children (HLSAC) instrument, which is a 10-item theory-based tool developed in Finland for measuring HL in children aged 13-15. The aim of this study was to translate and validate the HLSAC-instrument among Danish children aged 12-14.

Methods

The instrument was translated into Danish by a recommended standardized forward-backward translation process, and then pre-tested for face validity with 61 pupils from four schools. Thereafter, the instrument was tested among 805 pupils from 15 schools. Structural validity was analysed with confirmatory factor analysis (CFA), predictive validity with regression analysis, and internal consistency with Cronbach's alpha.

Results

When HL was modelled as one latent factor with all 10 items loading on this factor, CFA showed standardized factor loadings from 0.52 to 0.75 (p < 0.001) and an excellent model fit (comparative fit index >0.95, Tucker-Lewis Index >0.95, standardized root mean square residual <0.08, and root mean square error of approximation <0.06). The predictive validity regarding food intake was good (p < 0.001, r2=0.027) and the internal consistency was high (Cronbach's alpha=0.86).

Conclusions

A valid and reliable version of the HLSAC-instrument is now available in Danish for measuring HL among children aged 12-14. This instrument is considered useful for future surveys to inform and guide public health policy, health promotion strategies and health education targeting children.

Key messages

A validated brief Health Literacy instrument for school-aged children is now available in Danish. The Health Literacy instrument’s ability to predict healthy food intake is promising for the utility.
Dietary guidelines made useful in migrant networks
Authors: Magnusson M , Bertolino C , Landmér R , Lustig E
Published: October 2020

Globally, many deaths and DALY:s are attributed to unhealthy diets. Short education, low income and migration are risk factors. Healthy food cost more and is less available while unhealthy food is cheaper and heavily advertised. Health guides (HG) speak Swedish and at least one more language and have networks among migrants. Their work draw on the Right to health framework - availability, accessibility, acceptability and quality for all (AAAQ). HG transfer viewpoints from their groups to health care and contribute to culturally accessible and acceptable information and support.

Public Health Unit of a local hospital initiated a project with the aim to develop a method to make information about healthy food accessible for a wider range of people. How to make food based dietary guidelines useful for recent migrants? How to avoid that official guidelines, when transferred by laymen, become distorted by personal experiences rather than being enriched by them? Systematic collection of viewpoints from inhabitants, helped of HG, implied that “shop walks” have potential to increase health equity. During a shop walk the guide shows healthy alternatives and transfers knowledge on different options. The intervention was developed during 2019. The first shop walks were conducted in February 2020.

Dietary guidelines were made useful by a process including cooperation between HG, nutritionally skilled staff and the communication department. A detailed manuscript and a participant folder were developed together with a mandatory education including theory and practice. 14 HG speaking six languages were included. During the first three weeks six shop walks were conducted. Qualitative evaluation implies that shop walks are functional arenas for strengthening AAAQ.

By structured shop walks HG can contribute to making dietary guidelines relevant for recent migrants. AAAQ is supported by participation of stakeholders in the population in collaboration with professional expertise.

Key messages

If food based dietary guidelines are to be made useful outside the majority population, methods that allow those most concerned to participate in planning, execution and evaluation should be used. Availability, accessibility, acceptability and quality - The Right to health framework – should be used when developing public health interventions that aim at health equity.
The association of positive mental health indicators and normal body weight, Belgian HIS 2018
Authors: De Ridder K , Drieskens S , Demarest S
Published: October 2020

Background

An important health promotion goal is to maintain a normal body weight. However, knowledge about positive mental health indicators that might be associated with normal weight is scarce. The aim is to study positive mental health indicators and normal weight in a cross-sectional national representative population sample.

Methods

Study participants included adults aged ≥ 18 year (n = 6643) of the Belgian Health Interview Survey (HIS) 2018. Mental health indicators were having no psychological distress (GHQ-12<2), no self-reported anxiety or depression (EQ_5D), medium to high vitality (SF-36 vitality scale) and high to medium level of life satisfaction. BMI was calculated on self-declared height and weight. The associations were assessed through logistic regression taking into account confounding and effect modification by age, gender, educational level, health status, physical activity, daily eating of fruit and vegetables and daily consuming sugared soft drinks or sweet/salty snacks.

Results

50.1% had a BMI≥25. In the crude models, all indicators were negatively associated with being obese, but there was no association between having a normal weight (versus overweight and obesity) and absence of psychological distress, absence of anxiety and depression, and medium to high vitality. Medium to high level of life satisfaction was associated with normal weight in the fully adjusted model (OR 1.3; 95%CI 1.0-1.6) but when stratified, medium to high life satisfaction was associated with normal weight only among high educated women (OR 1.8; 95%CI 1.1-2.9), but not among men and low educated women. Surprisingly, among low educated women, having no psychological distress was negatively associated with normal weight (OR 0.7; 95%CI 0.5-0.9).

Conclusions

These preliminary results showed a variable impact of gender and educational levels on the association between positive mental health indicators and normal weight. Trends and distribution in society should be further explored.

Key messages

Although unequivocal associations with obesity, positive mental health is not clearly associated with normal body weight in today’s obesogenic society. The effect of a shift towards a higher BMI in society on mental health needs to be further explored.
Does a work-stress intervention prevent sick leave? A randomized controlled trial in primary care
Authors: Hultqvist J , Bjerkeli P , Hensing G , Holmgren K
Published: October 2020

Background

Work-related stress (WRS) clearly presents a risk for sick-leave. A brief preventive intervention aiming to identify people at risk for WRS was tested in a RCT study in primary health-care centers (PHCC). At the 12-month follow-up there were differences regarding sick leave between the intervention and the control group, however they did not become statistically significant. Evaluating the intervention in a longer perspective is thus warranted.

Purpose

This study aims to evaluate whether a systematic early identification of work-related stress can prevent sickness absence over 18 to 24 months after the intervention.

Methods

The RCT-study had follow-ups at 18 and 24 months. The participants (N = 271) were employed, non-sick-listed women and men (18 to 64 years) seeking care at PHCCs for mental and physical health complaints. 132 patients were allocated to the intervention and 139 patients were allocated to treatment as usual. The preventive intervention included early identification of WRS by the Work Stress Questionnaire (WSQ), general practitioner (GP) awareness supported by a brief training session, patients' self-reflection by WSQ completion, GP giving the patient feedback at consultation, and identifying appropriate preventive measures. Sick leave data from the Swedish Social Insurance Agency register constituted the outcome comparing the preventive intervention by the GP versus treatment as usual.

Results

The preliminary results showed that there were differences in median sick days between the intervention group (68, 72) and the control group (80, 81) at 18 months and at 24 months, however these differences did not become statistically significant.

Conclusions

The WSQ brief intervention was not proven effective in preventing sick leave in the following 18 and 24 months compared to treatment as usual. The study may have been under-powered and the lack of statistical difference between the groups might be due to a type II error.

Key messages

Work-related stress is a predictor for sick-leave. Further research on how to identify those at high risk for sick-leave, give advice and treat this group in primary health care is needed. A study of the WSQ brief intervention with a larger sample seems warranted.
Promoting physical activity-related health competences in people with intellectual disability
Authors: Bruland D , Mauro A , Latteck ÄD
Published: October 2020

Background

Physical inactivity is a global health problem. Physically active people show lower rates of chronic diseases or mortality. People with intellectual disabilities (PWID), a vulnerable group for health problems, have significantly lower levels of physical activity (PA) than general population. Due to reduced cognitive abilities, communicative and literacy skills, PWID have less access to health programs. Target-group-oriented interventions are rare.

Methods

Methodological triangulation to survey PA-related health competences in all 3 subcategories: 3 participating observations and 24 interviews with PWID (inclusion criteria for both: mild or moderate ID); staff online survey (n = 67), all in an integration assistance institution. Participatory approach: 2 expert groups with PWID advise researchers e.g. validating results.

Results

As expected, movement abilities and body awareness various highly from general population. An effect knowledge is widely spread (PA = health), but execution knowledge of PA is only marginally available e.g. not knowing how to increase PA healthy. Control competences as results from interview and observations: intrinsic motivation is highly present (unlike results from staff survey), but volition - self-efficacy and bring into action - is very poor, self-management and a lack of ideas are identified as a major problem. Low expectation of self-efficacy proved to be the biggest obstacles for PA, but caregiver are an own health resource. Expert groups confirm important of PWID perspectives on living environment.

Conclusions

To promote a PA lifestyle, health education with a focus on promoting self-efficacy orientated to the living environment (incl. caregiver) regarding own perspectives and health resources is needed. In this way, a vulnerable group for health problems can be empowered. Results indicate a successful approach to promote PA-related health competences in PWID to minimize health inequalities in relation to general population.

Key messages

Health inequalities among people with intellectual disability through promoting a PA lifestyle can be minimized. Intervention for people with intellectual disabilities must take into account the perspectives and the resources of the users.
Antimicrobial resistance: considerations on present and future strategies
Authors: Sironi V A
Published: October 2020

Antimicrobial resistance (AMR) is a global emergency that requires the use of short and long-term strategies. The existence of this phenomenon had been hypothesized by the discoverer of penicillin already in the first years in which this antibiotic drug began to be used, however the historical analysis on the onset and growth of the problem, together with an epistemological approach concerning its possible overcoming, suggest that research and production of new antibiotics cannot be its definitive solution.

This may represent the main short-term strategy, to be pursued also thanks to economic incentives in favor of the pharmaceutical industries and privileged institutional pathways in the health sector, but future strategies to combat AMR must be based on an evolutionary vision of biomedicine.

Approaches based on the evolutionary mechanisms of natural selection, the fight for existence and biological competition to occupy specific niches, represent the integrative methods of the present and above all the innovative ones of the future. The use of available vaccinations to combat specific bacterial and viral infections, the production of vaccines directed against resistant bacteria, therapies that use specific viruses capable of infecting and killing bacteria (phage therapies), non-chemical but biological sanitation systems of the surfaces in hospital environment (microbiological cleaning), biological therapies with the administration of populations of non-pathogenic bacteria capable of contrasting and eliminating pathogenic bacteria (microbiological therapy), microbiome transplants to transform the microbiological population of man in a means therapeutically useful against resistant bacteria (macrobiome transplant), are the strategies against AMR that will be discussed in this paper.

Key messages

Promote the production of new antibiotics in the present to win AMR. Evolutionary medicine is the key for futures strategies against AMR.
Efficacy of online nutrition professional development for Early Childhood Education Care staff
Authors: Wallace R , Lo J , Sambell R , Devine A
Published: October 2020

Background

Early Childhood Education & Care (ECEC) services are a public health setting that influences the lifelong eating habits and health of young Australians. Over 1.3 million children attend ECEC for 30 hours/week. Overweight/obesity, a risk factor for chronic disease, has been associated with this setting. Research reports sub-optimal food provision, poor role modelling and a lack of nutrition training and confidence. Online nutrition education training was provided to ECEC staff, aiming to increase nutrition knowledge/confidence.

Methods

Training was evidence-based, informed by stakeholders and developed by tertiary nutrition experts. ECEC staff were recruited and randomised to intervention or control groups. The intervention group completed an online short course about whole-service approach to healthy eating of 2-3 hours duration. Nutrition knowledge/confidence were measured pre/post-intervention via a pre-validated, online survey. GLM was used to determine differences within and between groups adjusting for years of experience.

Results

Participants (n = 116) were mostly female, aged >36 years, with >10 years industry experience. Post-course, compared to the control group, intervention participants significantly increased confidence to offer 2 serves of grains/day and unsweetened cereals, a variety of vegetables and low-sodium foods, and solid fats were avoided. Confidence to avoid serving discretionary foods did not change and cakes/biscuits were offered frequently.

Conclusions

Following course completion, intervention participants demonstrated increased confidence to serve foods from core food groups, but both groups reported offering discretionary foods frequently. Some results are promising and may improve the nutritional value of food offered at ECEC, but it appears discretionary foods continue to be overprovided. Further research is required to identify the depth of training required to embed important nutrition education concepts in ECEC settings.

Key messages

Evidence-based nutrition education adopting a whole-service approach is effective in increasing ECEC staff nutrition knowledge and confidence to provide foods from core food groups. Further research is required to establish the level of nutrition education appropriate for ECEC staff to avoid the continuing overprovision of discretionary foods to young children.
Health Promotion in the National Health Plan in Brazil and the incompatibility with global objectives
Authors: Tristão F I , Gomes I M
Published: October 2020

The First International Conference on Health Promotion held in Canada in 1986 resulted in the Ottawa Charter, which objectively presents the goals to be achieved by the year 2000, which would contribute to the progress achieved since the Declaration of Alma-Ata and with the debate that took place at the World Health Assembly, in order to contemplate the goal of “health for all in the year 2000”.

Obviously, even with all the advances, the goal expected for the year 2000 is far from being reached, which requires a continuous effort by the government and an engagement of the global population for the changes to occur in a sensitive and effective way. Thus, it is necessary to monitor the actions that should be developed so that health promotion is an issue that is increasingly present in health services.

This work aimed to analyze the current Brazilian National Health Plan to verify if the proposed actions are in line with what has been recommended in the official international documents for the development of health promotion.

The results demonstrate that the Plan is composed of epidemiological data, incidence rates about the monitoring of mortality and comorbidities, demographic indicators and issues based in the surveillance of endemic diseases, in addition to thirteen objectives and seven thematic axes that guide disease control and issues related to the structure of the Health System and its organization. In its entire content, there is no mention of the goals defined in the report of the 9th Global Conference on Health Promotion or even the Ottawa Charter, and the expression 'health promotion' appears only once, in a context of mentioning the surveillance and violence prevention actions.

It is concluded that the Plan is a mere formal instrument that does not include actions for the development of health promotion, prepared according to the braszillians protocol and bureaucratic requirements, following the procedures to be approved by the National Congress.

Key messages

The National Health Plan presents a global overview about brazillians health situation, but doesn’t bring factive solutions and do not support the engagement to health promotion. The National Health Plan is not in line with the Global engagement for enhancing Health Promotion and the Sustainable Development Goals.
Local health contracts as instruments of cross-sectoral collaboration: the French CLoterreS study
Authors: Breton E , Le Bodo Y , Diallo D , Harpet C , Hudebine H , Jabot F , Sherlaw W
Published: October 2020

Background

Although recognised as essential, the role of local governments in promoting health remains under investigated. Yet their mandate directly impacts living conditions and promotes SDGs. In France, 'local health contracts' (LHCs) mobilise local decision-makers in 4 areas: health promotion, prevention, health care and social care. The CLoterreS study assesses the extent to which LHCs foster health-promoting actions through cross-sectoral collaboration.

Methods

We conducted 49 semi-structured interviews with staff from all Regional health agencies (RHAs) and local stakeholders. We analysed the action plans of a stratified random sample of 53 LHCs from the 165 signed between 2015 and March 2018. We used a validated multidimensional coding tool based on WHO's Essential Public Health Operations and other consensus documents.

Results

LHC's contribution to health promotion through cross-sectoral collaboration depends on a mix of factors. Among barriers, the improvement of access to health care is often a primary driver for local elected officials. However, political will and past experience in establishing 'win-win' relationships with other sectors is an advantage, as well as the fact that RHAs generally make LHCs an instrument to coordinate health promotion efforts instead of ad hoc funding of isolated actions. Overall, 73% of LHCs' actions address living conditions, health promotion or primary prevention. LHCs frequently target behavioural determinants such as physical activity or diet (44 out of 53) with an emphasis on individual or interpersonal targets. A few innovative actions situated at the intersection of urban planning, transportation, recreational or food environments illustrate the potential for further cross-sectoral action on living conditions.

Conclusions

LHCs are vehicles for health promotion. Reinforcing cross-sectoral action implies leadership, resource mobilisation, training and coordination of sectors whose health is not a core priority.

Key messages

In France, Local health contracts (LHCs) are significantly used for health promotion. Cross-sectoral collaboration in this area implies further capacity building beyond the health care sector at the regional and local levels.
Factors associated with nicotine dependence in a Brazilian rural town
Authors: de Lime Gomes K , Coelho A , Pinto de Figueiredo R , Soares de Morais Freitas C H , Santos Martiniano C
Published: October 2020

Introduction

Nicotine dependence is a serious global health issue. Over a billion people are estimated to smoke in the world. Withdrawing from smoking contributes significantly to reducing morbimortality. Low income, poor education and smoking from a young age are some of the factors that contribute to the prevalence of tobacco use and to smoking cessation. In Brazil, the National Programme of Tobacco Control is responsible for helping smokers undergoing treatment in primary care units.

Objective

To highlight the association between the results of a nicotine dependence treatment in a Brazilian town, its sociodemographic factors and smoking habits of patients.

Methodology

A cross-sectional study in Santa Cecília, Paraíba, a town in the northeast of Brazil in 2016, relying on data from the medical history of 85 smokers who received treatment in primary care units. Dropout rates and successful results were both considered. Pearson's chi-squared test with 95% significance level was used to assess the association between variables.

Results

51.8% of patients quit smoking while 37.6% abandoned treatment. Around 4.7% of patients smoked fewer cigarettes after treatment and 5.9% did not have a successful result. Among the successful cases, the majority were women (54.4%). Considering smoking habits of those who quit smoking, the following was observed: 29.4% smoked 20 cigarettes per day, 27% were highly dependent on nicotine, 33% spent 20 to 40 years smoking and 18.9% underwent nicotine replacement therapies. Income, marital status and number of cigarettes were variables that showed significant differences (p < 0.001) after treatment.

Conclusions

Smoking cessation after treatment indicates the effectiveness of the programme. The engagement of healthcare professionals is paramount to successfully implement such treatments in primary health care. Further qualitative research is recommended to investigate other Brazilian cities and to assess patient progress individually.

Key messages

This work analyses factors related to nicotine dependence in groups of smokers undergoing treatment developed by the National Programme of Tobacco Control in a Brazilian rural town. Analysing the prevalence of smoking cessation and its related factors among patients undergoing treatment by the National Programme of Tobacco Control in a Brazilian rural town.
E-platform as an innovative approach to workplace health promotion for ageing workforce
Authors: Rozman N , Širok K
Published: October 2020

Issue

Dissatisfaction of workers with working conditions often leads to a reluctance to extend the working period. In the STAR-VITAL project, we encourage stakeholders to address the challenges of an aging workforce, prolonging work activity, maintaining health and work ability, based on the concepts of salutogenesis, healthy organization and WHO Healthy Workplaces model.

Description of the Problem

E-platform is an innovative approach to promote and monitor healthy lifestyles of employees and companies' management in the areas of ergonomics, stress, communication, nutrition, sleep, age management and absenteeism. The E-platform addresses the challenge of low levels of employee participation in health promotion programs offered to employees by companies. The E-platform builds upon the Customer relationship management (CRM) and brings a push approach to actively engage employees with customized campaigns to encourage behaviour change.

Results

As the project runs in multiple waves, we present the findings of the first group of 31 (out of 110) companies that began with the management, ergonomics, stress and nutrition campaigns. The output indicators show high participation rate of 65% - 20 companies out of 31 are actively participating in the program and high levels of user satisfaction (with a rating 4.5 out of 5). The impact of the intervention will be evaluated with the propensity score matching. The average share of readings of the received contents of all campaigns is 50%.

Lessons

Regardless of the potential of modern work health promotion solutions, it is very important that project contractors maintain close personal contacts and intensive communication with companies. Where such interaction has been established, there is a noticeable shift in the intensity of health promotion activities and the proportion of employees who voluntarily participate in these activities.

Key messages

The salutogenic push approach promises a improved impact of workplace health interventions. The E-Platform, besides informing, enables support and empowerment of workers for personal intervention and its higher impact.
The application of the complexity theory to public health interventions: a review of the literature
Authors: Contu P , Breton E
Published: October 2020

Background

There is a growing recognition of the limitations of a linear cause-and-effect rationality in planning and evaluating public health interventions. Although this perspective is amenable to programme planning and evaluation, it leaves aside a whole array of mechanisms of change triggered by interactions taking place in complex social systems. Generative causality is one and recognized under a number of works referring to the complexity paradigm. Here we review the state of knowledge on what is often referred to as the complexity theory (CT), and present the results of a review of the literature on its application in public health.

Methods

We searched PubMed for articles, commentaries, editorials published in English, French and Italian, using the keywords 'Complexity Theory' (also plural). We categorized the fields of application of the CT according to the three core WHO's Essential Public Health Operations, i.e., Health Promotion, Prevention and Protection. All papers addressing issues related to health care services (but not prevention) were included in the category “health care services” while others were tagged as “others”.

Results

We found 203 papers meeting our inclusion criteria. The largest share of the research output applying the CT was in health care services (n = 167), followed by Health Promotion (5), Prevention (3) and Protection (2). 26 papers were labelled others. In health promotion/ prevention, applications of the CT have yet to integrate most of its concepts. Most authors tap into both the linear and generative rationality perspectives.

Conclusions

Although regularly deemed as promising in uncovering mechanisms for change triggered by public health intervention, applications of the complexity theory remain uncommon and has made little inroads in the public health domain. This is particularly the case for health promotion where one would assume that participatory community-based interventions would be an incentive to integrate this perspective.

Key messages

Although deemed promising the complexity theory has made little inroads in public health. Health promotion with its participatory community-based interventions can benefit from its application.
Tai Chi and workplace wellness for health care workers
Authors: Cocchiara R A , Dorelli B , Mannocci A , La Torre G
Published: October 2020

Background

Several studies show the positive effects of new non-medical therapies known as complementary and alternative medicines (CAMs). In this context, the discipline of tai chi is obtaining a wider consensus because of its many beneficial effects both on the human body and mind.

Objective

The aim of this study was to perform a systematic review of the scientific literature concerning the relationship between tai chi practice and wellness of health care workers (HCW) in their professional setting.

Methods

The research was performed in September 2019, investigating the databases Cinahl, Scopus, Web of Science, and PubMed. Full-text articles, written in English language and published after 1995, were taken into account. No restrictions regarding the study design were applied. A quality assessment was developed using AMSTAR, Jadad, Newcastle-Ottawa Scale, INSA, and CASE REPORT scale. Six papers were finally included: Three clinical trials, one observational study, one systematic review, and one case report. The methodological quality of the included studies was judged as medium level.

Conclusions

This systematic review suggests the potential impact of interventions such as tai chi as tools for reducing work-related stress among healthcare professionals.

Keywords: Tai chi, Workplace Wellness, Nursing

Key messages

Tai chi, Workplace Wellness, Nursing. Health Professional, Stress, Workplace Wellbeing.
Evaluation of the impact of intra-operative distractions on teamwork, stress and workload
Authors: Aouicha W , Tlili M A , Limam M , Snéne M , Ben Dhiab M , Chelbi S , Ajmi T , Said Latiri H , Ben Rejeb M , Mallouli M
Published: October 2020

Background

Within the OR, distractions occur on a regular basis, which affects surgical workflow and results in discontinuation of urgent tasks. In addition, engaging into distractions in the OR may not only increase stress and workload, but also impair teamwork performance. This study aimed to observe the occurrence of intra-operative distractions in ORs and to evaluate associations between distractions, teamwork, workload and stress.

Methods

This observational cross-sectional study was conducted in Sahloul University Hospital; more specifically in four different surgical units: orthopedic, urology, emergency and digestive surgery and over a period of 3 months in 2018. Using validated observation sheets, distractions and teamwork were recorded and rated in real-time during the intraoperative phase of every case. Besides, stress and workload of OR team members were measured at the end of each operation. All ethical considerations were taken into account.

Results

Fifty cases were observed and 160 participants were included in this study. In total, we recorded 933 distractions that occurred once every 3 minutes, on average. The mean global teamwork score was 3.85 (SD = ±0,67) on a scale of 0 to 6, the mean workload score was 58.60 (±24,27) and the mean stress score was 15.29 (SD = ±4,00). The highest rate of distraction was significantly related to external staff entering or exiting the OR during non-teaching cases (M = 9.43, SD = 3.56; p = 0.006). Surgeons also experienced significantly higher workload with a mean of 66.88 (SD = 25.98,p<0.01).

Conclusions

This study highlighted a serious problem which is, often, ignored or underestimated. Taking into consideration the results, we recommend the implementation of systemic interventions on a daily basis to reduce the number of distractions in the OR.

Key messages

Distractions happened in all of the included operations. Stress and workload among nurses got higher as work environment distractions increased.
Outcomes and conditions for sustaining changes of Participatory Action Research interventions
Authors: Vargas I , Eguiguren P , Mogollón-Pérez A , Samico I , Bertolotto F , López J , Vázquez Navarrete M L
Published: October 2020

Background

Finding new strategies for care integration has become a priority for many health systems in Latin America. Although the implementation of interventions through a participatory action research (PAR) approach is considered effective, its application in health services is scarce.

Aim

to analyse impact of PAR interventions on care coordination, and aspects for sustainability and transferability in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.

Methods

A qualitative, descriptive-interpretative study was conducted in each healthcare network. Focus groups and individual semi-structured interviews were conducted to a criteria sample of Local Steering Committee (29), Platform of professionals (28), professionals (49) y managers (28). A thematic content analysis was conducted, segmented by country and themes. Different interventions were designed and implemented through a PAR process: joint meetings to discuss clinical cases and/or training; shared care guidelines; offline virtual consultations; a (back) referral form; and an induction program.

Results

Informants highlighted that joint meetings based on reflexive methods contributed substantially to improving contextually relevant elements of clinical coordination - communication in patient follow-up, clinical agreement, appropriateness of referrals - and administrative coordination. The meetings, alongside the PAR process, helped to improve interaction between professionals, fostering willingness to collaborate. No significant contributions were identified in the remaining interventions due to the low uptake. A necessary condition for the sustainability and replicability of the interventions was that the PAR process had to be used appropriately in a favorable context.

Conclusions

Evidence is provided on the significant contribution of interventions to improving locally relevant clinical coordination elements and professional interaction when implemented through an adequate PAR process.

Key messages

It contributes to fill the gap regarding the impact of PAR interventions on care coordination. A key aspect for impact and sustainability is an adequate use of PAR approach in a favourable context.
Challenges to effective governance in developing health systems: a qualitative study in Malawi
Authors: Masefield S C , Msosa A , Grugel J
Published: October 2020

Effective governance is vital in maintaining and improving health systems but has received little attention in research, especially in developing countries. All United Nations (UN) members have committed to Universal Health Coverage (UHC) by 2030. Malawi, a member and one of the five poorest countries in the world, is highly dependent on donor contributions. Recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The government identifies the need for better oversight to improve health system efficiency and achieve UHC. This study contributes to a better understanding of the relationship between governance and health systems in developing countries moving towards UHC by identifying stakeholder perceptions of the challenges in this area, using Malawi as a case study.

Interviews were conducted with 22 representatives of non-government organisations, civil society groups, local government and government-funded organisations and governance bodies and the transcripts and field notes were analysed using inductive thematic analysis.

Four main issues emerged: accountability; resource management; power dynamics; non-government actors. We conclude that political, structural and financial challenges are seen as barriers to effective health governance at all levels (national, local, service provider). These include little monitoring of health policy implementation, little accountability of the government to the public on health policies and spending decisions, and poor resource management, especially in the drug supply chain. In response to the government's perceived disinterest, non-government initiatives (often supported by donors) advocate for greater governance and monitor the health sector, including progress towards UHC. Poor governance adversely affects health system functioning and may prevent developing countries achieving UHC by 2030.

Key messages

There are political, structural and financial challenges at all levels of the Malawian health system (national, local, service provider) that are perceived as barriers to effective health governance. Poor governance adversely affects health system functioning, limiting the services and resources available, and may prevent the goal of Universal Health Coverage by 2030 in developing countries.
Evaluation of teamwork and its associated factors in the emergency rooms of Sousse - Tunisia
Authors: Lamine H , Tyss M , Tlili M A , Taghouti E , Aouicha W , Zedini C , Ben rejeb M , Chelbi S
Published: October 2020

Background

In recent years, patient safety has become a priority and a major target for improvement especially in the emergency rooms. According to the French National Authority for Health, 1/3 of serious adverse events could be avoided thanks to better coordination and better communication between the teams. Thus, this study aimed to describe the perceptions of healthcare professionals in the emergency rooms of Sousse-Tunisia regarding teamwork, and to determine the factors influencing it.

Methods

It is a descriptive cross-sectional study, conducted between December 2018 and April 2019. It included all the caregivers working in all the emergency rooms of Sousse-Tunisia. The measurement tool used in this study was “Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)” Teamwork Perception Questionnaire. Data were coded and analyzed by The Statistical Package for Social Sciences (SPSS 20.0).

Results

A total of 110 participants were recruited with a participation rate of 72.36%. Nurses represent more than half of the respondents (56.4%). Average work experience was 7.27 years. The Teamwork overall score was 2.5±0.5. The most developed dimension was leadership (2.7±0.8) and the less developed dimension was communication (2.3±0.7). Women had a significantly higher overall score than men (2.6±0.5, 2.4±0.3, p = 0.017). Results also showed that emergency technicians have significantly higher overall score than doctors and nurses (p = 1 × 10-5). The overall score also varied significantly across the hospitals (p = 0.016).

Conclusions

Our results showed that the level of teamwork still needs to be improved. Furthermore, various factors are associated with teamwork, and that should be taken into consideration to guide the future interventions.

Key messages

There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to focus on the affecting factors of teamwork, in order to prevent adverse events.
Tracking the progress of primary care reforms in Kerala India: Findings from a baseline assessment
Authors: Negi J , Nambiar D
Published: October 2020

The south Indian state of Kerala has a legacy of gains in population health at a low cost. Kerala's recent health reform initiative has emphasized increasing the scope and quality of primary care services. Beginning in 2017, 171 of 848 Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs) by increasing staff, training, infrastructure and working hours. In support of this process, we carried out a baseline assessment to assess differences between upgraded FHCs and PHCs

We undertook a cross-sectional study in four districts randomly selected from clusters made using data from the latest National Family Health Survey (2015-16). One FHC and PHC per district were randomly chosen. Monitoring indicators were selected through a modified Delphi process; a structured questionnaire was shared with health staff to report data for the financial year 2018-19.

The eight facilities jointly served a population of 2,79,992 (60% in FHC). The proportion of average monthly outpatients to the population served was 8.3% in FHCs as against 7.9% in PHCs. The patients screened for high blood pressure and blood sugar in FHCs was nearly double that in PHCs. FHCs were better equipped with patient amenities, laboratory and staff. Coverage indicators like full antenatal care, full immunisation were higher than the national average but not appreciably different in PHCs versus FHCs, nor were health outcomes like low birth weight among infants and acute diarrhoeal diseases among under-fives. Findings were presented to the facility, district and state officials and feedback sought.

Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators. A robust monitoring process benefits from periodic surveys providing valuable insights to the program implementation

Key messages

Health care reforms in resource poor settings need to be monitored rigorously and constructing a base line data is vital in measuring the change. Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators.
Global Trigger Tool methodology to detect adverse events: pilot study at Academic Hospital of Udine
Authors: Scarpis E , Degan S , De Corti D , Mellace F , Cocconi R , Farneti F
Published: October 2020

Introduction

Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE.

Methods

The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP).

Results

CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%).

Conclusions

The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed.

Key messages

Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.