bluuebunny/crossref_metadata_2025 huggingface dataset:
Organisation of medical care in large scale incidents: a practice-oriented research in Belgium
Authors: Cornelis J , Dauvrin M , Desomer A , Gerkens S , Primus-de Jongh C , Christiaens W
Published: October 2024

Background

CBRNe incidents are emergency situations involving the release of chemical (C) or biological (B) substances or radiological/nuclear (RN) contamination, sometimes through an explosion (e). They can result from intentional malicious acts (e.g. terrorism) or unintentional situations (e.g. accidents). In this context, people (victims, care providers, witnesses), equipment (infrastructure, vehicles), animals, objects and/or the environment (buildings, ambulances) may be contaminated by a substance that could pose a threat to health. CBRNe incidents can quickly overwhelm the response capabilities of the affected region and put the healthcare system under great pressure. This research investigated ways of improving the organisation of medical care in CBRNe incidents in Belgium.

Methods

this study involved a mixed method approach in 2022-2023 with scoping and in-depth interviews with actors at operational and strategic levels (public health, Internal Affairs, army, fire departments), participative workshops with stakeholders, contextual desk search, ad hoc literature review and international comparison completed with interviews with national experts (Norway, The Netherlands, France and United Kingdom, United States of America).

Results

hospitals need to be distinguished in type 1 specialized hospitals for decontamination, major trauma management and advanced care for severely burned patients and in type 2 hospitals managing spontaneous arrivals of victims and non-specialised care. All hospitals need to have a strict lock-down policy. On the incident site, an emergency medical mobile team needs to manage the decontamination with the firefighters before the transfer to the most appropriate facility. Additional conditions were found to improve the efficiency of medical care.

Conclusions

this practice-oriented research contributes to a better organization of medical care in case of CBRNe incidents, with the emergence of practical and feasible solutions.

Key messages

• Hospitals need to be distinguished according to the need for specialised care in case of CBRNe incidents.

• On site decontamination needs to be performed by health professionals and firefighters.
Innovations in residential treatment that promote multi-drug addiction recovery
Authors: Currie C L , Swisterski M
Published: October 2024

Background

As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada.

Methods

This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens.

Results

Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge.

Conclusions

The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery.

Key messages

• A stronger evidence base is needed to inform in-patient multi-drug addiction treatment.

• Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.
Barriers and enablers towards integrated care for sexual violence victims in humanitarian settings
Authors: Sawah E , Kielmann K , Michielsen J
Published: October 2024

Background

Sexual violence (SV) is a complex public health issue that necessitates a coordinated multisectoral response. Ideally, this response should be provided through an integrated care package to strengthen timely access and comprehensive care for victims. However, in humanitarian settings with high levels of SV, care is often offered through fragmented silos, exacerbating the burden on the health workforce and victims.

Methods

Using the Valentijn framework, a qualitative, real-time Delphi study was conducted with 17 SV care experts representing 7 geographical subregions to gain informed opinions on key contextual and health system barriers and enablers for integrated care for SV victims in humanitarian settings.

Results

Challenges and enablers reported across the diversity of the participants’ contexts showed consistency. Contextual challenges included volatile contexts, collapsed health systems, and poor infrastructure. Professional challenges included a lack of expertise among healthcare providers (HCPs), high staff attrition, and compassion fatigue among HCPs. Health systems challenges included poor referral and coordination mechanisms, insufficient resources, misaligned donor-programme priorities and low prioritisation of SV comprehensive care. Key enablers reported were effective networking, community engagement, capacity building, co-locating services, participatory management, promoting staff’s sense of ownership, digitalised information systems, and joint patient files.

Conclusions

The sustainability of integrated care for SV victims can be strengthened by ensuring HCPs access regular psychological support and training and are incentivised to provide quality care. Regular coordination among actors, including donors, can support integrating care that responds to patients’ holistic needs. Further research is needed to assess HCPs’ and SV victims’ experiences of current service delivery and how to optimise integrated care in humanitarian settings.

Key messages

• Addressing care providers challenges in humanitarian settings, such as high attrition, lack of training, psychosocial support, and burnout, can ensure proper integration of sexual violence care.

• Integration of sexual violence care demands systemic changes, including aligning donor-programme goals, building accountability mechanisms and the buy-in of political and community leaders.
Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America
Authors: Oturai O , Vargas I , Vázquez M L , Mogollón-Pérez A S , Eguiguren P , Torres A L , Peralta A , Rubio-Valera M , Dias S , Jervelund S S
Published: October 2024

Background

Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador.

Methods

This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination.

Results

In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador.

Conclusions

The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination.

Key messages

• Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors.

• Strengthening primary care and cross-level coordination is needed.
Reducing Emergency Room’s overcrowding
Authors: Pedrazzoli G , De Luca A , Messina G , Guerreschi E M , Lorenzini C , De Marco M , Baragatti L , Leoncini F , D’Urso A , Nante N
Published: October 2024

Introduction

The ageing of the population and the consequent increase in the epidemiology of chronic diseases pose numerous challenges at both hospital and territorial levels. In this context, one phenomenon that deserves particular attention is the frequent use of emergency services by ‘frail’ people. The aim of our study was to identify the most frequent users of the University Hospital’s Emergency Room (ER) of Siena, based on their care at territorial level.

Materials and methods

A retrospective study was carried out on the data of accesses to the ER of the University Hospital’s of Siena from June to September 2023. Patients were stratified according to the number of admissions, excluding those with only one admission during the study period. After identifying those with four or more accesses, the USL-TSE management system ‘Astercloud’ was used to check whether they were in integrated home care (ADI) or planned home care (ADP). Descriptive analysis was performed using STATA software.

Results

During the study period, 2347 patients were admitted to the ER, 78.95% had two admissions, 14.96% had three, 4.26% had four, 1.24% had five, 0.34% had six, 0.13% had seven, 0.09% had eight and, finally, 0.04% had eleven admissions. 93.1% of the sample had fewer than four admissions (2,204 patients), while 6.1% had four or more admissions (143 patients). Of the 143 patients studied, 16.1% were in home care, 13.3% in ADI and 2.8% in ADP. 36.8% of patients in ADI died within 4 months of the last admission during the period studied.

Conclusions

Our results suggest that the identification of people at risk of frequent use of the ER seems essential. Equally important is the existence of effective coordination and cooperation between hospitals and the community, with special attention to certain categories of patients. All of this is aimed to achieve overall appropriateness and therapeutic effectiveness, thus avoiding inappropriate admissions to the ER.

Key messages

• Significance of identifying individuals prone to frequent use of emergency services to underscore the need for proactive management strategies to address their healthcare needs.

• Coordination and cooperation between hospital facilities and community-based services to enhance appropriateness of care and reduce inappropriate Emergency Room admissions.
Factors influencing an advanced nursing practice service for people with intellectual disabilities
Authors: Schulenkorf T , Ilskens K , Nadolny S , Gröndahl A , Grunwald M , Palmdorf S , Borchardt N , Grebe C , Maaß A , Latteck Ä-D
Published: October 2024

Background

People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention.

Methods

We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA.

Results

Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary.

Conclusions

This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network.

Key messages

• APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients.

• Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.
Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study
Authors: Rijpkema C , Ramerman L , Peters L L , Muris JWM , Colde Hartman T , Homburg M , Bos I , Verheij R A
Published: October 2024

Background

The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care.

Methods

In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses.

Results

Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021.

Conclusions

Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics.

Key messages

• Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care.

• This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.
Managing no-shows in healthcare: insights from an urban Health District in Northern Italy
Authors: Ragusa P , Russotto A , Catozzi D , De Angelis A , Durbano A , Orecchia S , Siliquini R
Published: October 2024

Background

Non-attendance at healthcare appointments, known as no-show, poses significant challenges to healthcare systems, disrupting patient care continuity, exacerbating waiting times, and straining resources. Addressing this issue is crucial for optimizing health care delivery and containing costs. This study explores the phenomenon of patient no-shows and aims to identify factors associated in a densely populated healthcare district in Turin, Northern Italy.

Methods

Data were extracted from the healthcare management system covering outpatient care appointments in the health district in 2022 and 2023. The analysis included various patient and service-related variables. Missing information on key variables were managed with listwise deletion. Descriptive statistics provided an overview of missed appointment rates, while multivariate analysis explored various patient and service-related variables.

Results

A 5.1% (n = 6198) no-show rate was observed out of 120,405 records. The total cost incurred due to missed appointment fees amounted to €127,244. Several factors were associated with a significantly increased likelihood of no-show (p < 0.05), including initial visit (OR = 1.11), deferred priority (OR = 1.22), non-exempt status from healthcare co-payments (OR = 1.36), exemption based on income (OR = 1.82), age under 18 (OR = 2.46) and under 65 (OR = 2.32), male gender (OR = 1.17), residency outside the Piedmont Region (OR = 1.31) and outside Italy (OR = 2.46), and longer waiting time (OR = 1.01).

Conclusions

This study sheds light on the widespread issue of patient no-shows and its economic implications. It provides clear direction for implementing tailored interventions in healthcare settings. As a response to these findings, a telephone recall project was launched. Its efficacy will be evaluated in subsequent assessments to determine if it can effectively alleviate the burden of no-shows, thus enhancing healthcare efficiency and ensuring continuity of care for patients.

Key messages

• The no-show phenomenon has important implications both organizationally and economically.

• The magnitude and major determinants of patient no-shows must be recognized to guide the deployment of tailored interventions in a real-world setting.
Cost-effectiveness analysis of Chagas disease screening in pregnant women and their infants in Italy
Authors: Nurchis M C , Heidar Alizadeh A , Raspolini G M , Marraffa P , Dentato M , Olivo L , Gianino M M , Damiani G
Published: October 2024

Background

Currently, Chagas disease (CD) is widespread in European nations that host notable populations from Latin America. Vertical transmission is a pathway for the spread of the disease in countries where it is not endemic. Due to socio-economic disparities, CD is a public health concern in non-endemic regions, raised by migration phenomena in vulnerable population groups who face similar hindrances as those most at risk in endemic areas. The aim is to evaluate the cost-effectiveness of CD screening versus no screening in pregnant women and their infants in Italy.

Methods

A Bayesian Markov model was employed to compare the CD screening versus the no screening alternative. Model parameters were sourced from pertinent scientific literature. A lifetime perspective was adopted, aligning with the perspective of the Italian National Health Service. The Eurozone threshold was applied. Costs and benefits were discounted at a rate of 3%. Gibbs sampling served as the algorithm for Bayesian inference. Uncertainty was addressed through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI), depicted via the Cost-Effectiveness Acceptability Curve (CEAC) and Expected Value of Perfect Information (EVPI). Results were presented as the Incremental Cost-Effectiveness Ratio (ICER).

Results

The base case results showed that CD screening was cost-effective, with an ICER of €5,112 [€1,850 - €10,043]. Furthermore, according to the CEAC, the screening option exhibited the greatest probability of being cost-effective across all thresholds. Additionally, the EVPI per mother was €818 based on a threshold of €50,000/diagnosis.

Conclusions

Implementing a structured CD screening program also in non-endemic countries has the potential for early detection and treatment. This contributes to SDG 3 by improving access to healthcare, preventing transmission, and reducing the disease burden as well as informing public health policies for marginalised populations.

Key messages

• This study proves that screening for CD in pregnant women and their infants in a non-endemic area is a cost-effective strategy and possibly cost-saving in the long term.

• Study findings could support a wider implementation of CD screening in Italy by informing health policy-makers in their decision-making process.
Documenting the availability and accessibility of reproductive health services for youth in Albania
Authors: Doci F , Foster A M
Published: October 2024

Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth.

Key messages

• Lack of knowledge and awareness prevent youth from accessing SRH services.

• Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.
Mapping patient pathways for NCDs from a policy perspective: a novel multinational initiative
Authors: Danhieux K , Monnet F , Safadi H , Surján C , Varga G , Lám J , Van Olmen J , Wouters E
Published: October 2024

Background

Chronic diseases like CVD and DM pose global health challenges. Understanding patient pathways is vital for effective disease management and reducing morbidity and mortality. However, until now, comprehensive multinational mapping of patient pathways from a policy or regulatory perspective in the context of chronic disease has not been undertaken. Previous investigations into patient pathways mainly focused on the perspective of individual patients, assembling trajectories of those patients, but did not delve into how these pathways were designed.

Methods

Patient pathways for CVD and DM will be mapped across 11 countries: Belgium, Finland, France, Hungary, Iceland, Italy, Latvia, Poland, Romania, Slovenia, and Spain. Using a survey tool, detailed descriptions and diagrams of healthcare pathways will be collected, stratified by Kaiser Permanente health pyramid strata. Stakeholder interviews on policy and practice level will refine mappings and identify gaps in the policies.

Results

Preliminary findings reveal diverse healthcare trajectories and identified multiple gaps in disease management across countries. For many countries, a complete well-developed patient pathway was not found; instead, the pathways were rather fragmented and lacking for some strata of the health pyramid. These insights underscore the need for tailored interventions and enhanced care coordination to optimize continuity of care and patient outcomes.

Conclusions

Comprehensive patient pathway mapping offers a strategic framework to address gaps in chronic disease management. Our study emphasizes the importance of collaborative efforts in developing context-specific interventions and strengthening healthcare systems to improve public health outcomes.

Key messages

• Comprehensive patient pathway mapping reveals numerous gaps in global chronic disease management, prompting the need for enhanced strategies.

• Collaborative efforts are key to addressing gaps in chronic disease care.
Assesing health needs of women with breast cancer in a Regula Hospital Dispensary in Crete, Greece
Authors: Markakis G , Maniou M , Neofitos K , Ioannou N , Papadakaki M
Published: October 2024

Background

Understanding the health needs of women with breast cancer is essential for tailor-made care. Socio-economic factors impact care access and outcomes. Previous research has indicated variations in healthcare experiences based on factors such as education level, employment status, and income. However, specific insights into the health needs of women with breast cancer in Crete, Greece, remain limited.

Purpose

The current study aimed at assessing the health needs of women with breast cancer.

Methods

A total of 161 women were surveyed between June 2023 and December 2023 in a regular Hospital Dispensary at a General Hospital in Heraklion, Greece.

Results

The majority were married (46%) and had an average of 2 children. 16% were graduates of secondary education and 42 % graduates of higher education, 33% retired and 19% full-time employees. Most participants (45%) reported a family income between 10,001 to 20,000 €, 29% under 10000 € and 26 % between 20001 to 30000 €. The majority had received additional medical treatment (75%), with surgery being the most common (30.6%). Other treatment included radiation therapy (28%), chemotherapy (23%), and hormone therapy (18%). Prevalence of comorbidities was high, with hypertension (97%), coronary heart disease (92%), cholesterol issues (43.5%), arrhythmias (82%), thyroid disease (81%), diabetes mellitus (79.5%), and bleeding disorders (43.5%) being reported. Smoking was also prevalent among participants (79.5%).

Conclusions

This study highlights the complex health needs of women with breast cancer in Crete region, Greece and emphasizes the prevalence of comorbidities and the importance of tailored support services and comprehensive care approaches for this population.

Key messages

• Considering socio-economic factors is critical in healthcare planning and intervention strategies.

• Emphasizing the importance of tailored support services and comprehensive care approaches for this population.
Associations between bedtime media use and sleep outcomes in an adult population-based cohort
Authors: Schrempft S , Baysson H , Chessa A , Lorthe E , Zaballa M-E , Stringhini S , Guessous I , Nehme M
Published: October 2024

Background

We aimed to extend existing research on associations between bedtime media use and sleep in adults by taking relevant covariates into account and testing hypothesised mediating and moderating pathways.

Methods

Frequency of bedtime media use and sleep outcomes were examined by questionnaire in 4188 adults (59% women, aged 19-94 years) from the Specchio cohort in Geneva, Switzerland. We tested: 1) associations between bedtime media use and sleep (bedtimes, sleep latency, sleep duration, sleep quality, insomnia symptoms, and daytime sleepiness), adjusting for prior sleep, mental health, and health behaviours (physical activity, binge drinking, smoking, total leisure screen time), 2) whether bedtime media use mediates associations between individual susceptibility factors (age, chronotype, and mental health) and sleep, and 3) whether individual susceptibility factors moderate associations between bedtime media use and sleep.

Results

Often using a screen in the 30 minutes before going to sleep at night was associated with a late bedtime (≥midnight; OR [95% CI]=1.90 [1.44, 2.51], p < 0.001), short sleep duration (<7 hours; 1.21 [1.01, 1.46], p < 0.05), and excessive daytime sleepiness (Epworth score >9; 1.47 [1.25, 1.74], p < 0.001) after adjustment for all covariates. Bedtime media use partly mediated the association between younger age and an evening chronotype and these sleep outcomes. Mental health moderated the association between bedtime media use and sleep quality/insomnia, such that the former was associated with poorer sleep quality/insomnia among individuals with better mental health, but not among those with poorer mental health.

Conclusions

Frequent bedtime media use was associated with various sleep outcomes, independently of relevant covariates. Limiting the use of screens at bedtime is important to promote sleep among adults. Individuals with poorer mental health likely require additional support to improve their sleep quality.

Key messages

• Frequent bedtime media use is associated with a late bedtime, short sleep duration, and more daytime sleepiness in adults, and these associations hold after adjustment for relevant covariates.

• Frequent bedtime media use mediates the association between individual susceptibility factors and sleep outcomes. Mental health moderates the association between bedtime media use and sleep quality.
Exploring methodologies and frameworks for best practice transfer at the primary care level
Authors: Petelos E , Vafeiadi M , Papadakis S , Anastasaki M , Marketou M , Tornero Patricio S , Carriazo A M , Angelaki A , Maganaraki A , Lionis C
Published: October 2024

Background

In Feb 2023, the EU’s Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched with the objective of effectively transferring and implementing six best practices (BPs) among Member States (MS). Transferability from one primary care (PC) setting to another can be challenging given organizational, legal, cultural, social, economic, and environmental factors, requiring robust a methodological framework to guide the transfer process. A scoping review was conducted to identify conceptual models and methodological frameworks for context-relevant and evidence-informed BP transfer in PC settings.

Methods

The study aimed to identify models or frameworks to guide BP transfer in PC settings, whilst maximizing transferability. The JBI methodology was used, and an extensive search was conducted in PubMed (time limit: Jan ‘13-May ‘23). All publications of original research, systematic reviews, and text and opinion papers in English were eligible for inclusion. Key exclusion criteria were set, i.e., intervention type, level of care and reporting quality. The search was supplemented by gray literature review.

Results

From a total of 369 publications, 9 met eligibility criteria, reporting on 10 conceptual and methodological models/framework largely varying. These included transfer models applicable to all BPs as well as elements specific to some BPs, i.e., addressing integration, patient-centered care, care coordination, and health promotion. Strengths and weaknesses were identified for all.

Conclusions

Transferability of health interventions is complex, requiring systematic consideration of setting and intervention characteristics to inform and support local adaptation, implementation, and decision-making. Key elements identified can support the CIRCE-JA BP transfer and are largely relevant for further BP transfer across PC settings in EU MS, incl. for local adaptation, stakeholder engagement and effective implementation monitoring.

Key messages

• Innovative BPs are successfully deployed in many EU MS. To best support transformation for strong EU primary care and resilient health systems, it is important to ensure evidence-informed BP transfer.

• This review reports on the selection of appropriate frameworks and models, and key elements thereof, to allow successful transfer of CIRCE-JA BPs and other BP transfer across PC settings in Europe.
Improving the healthcare response to migrants landing in Lampedusa through a multimodal strategy.
Authors: Sisti L G , Canzone G , Scorsino F , Napoli C , Camponi C
Published: October 2024

Issue

Lampedusa island is a crucial Italian entry point for migrants and the only health facility is the outpatient clinic that relies on the helicopter transfer to the mainland for urgencies. When the influx of migrants -and of tourists- increases, the health demand burden rises. Moreover, the plurality of the actors involved in migrants’ reception and assistance makes healthcare organization complex. In 2023, 115.000 arrivals were recorded with an increase of pregnant migrants transferred by helicopter; moreover, the lack of an EMTs-equipped ambulance and coordination gaps between actors were raised.

Description of the practice

Also paving on law 50/2023, in 2023 INMP and other institutions promoted a multimodal strategy to support healthcare in Lampedusa. A needs assessment grounded on settings and processes field observation and key stakeholders’ structured interviews was designed. Hence, an equipped ambulance service was set in September 2023 and an obstetric triage (ObT) procedure for pregnant migrants was tested. Further, operational protocols for migrants’ health have been drafted and enclosed in a MoU signed between key institutions, and a dedicated Committee monitoring protocol implementation was also set.

Results

Until now the ambulance has carried out 242 operations, mostly in response to community requests and ObT has led to using helicopter solely for real Ob urgencies. Also, the MoU has improved the coordination between actors, and the monitoring Committee-just settled-has already identified new priorities such as of defining a procedure for pregnant migrants requesting pregnancy termination.

Lessons

A multimodal strategy based on field assessment, enhancing coordination between actors and rolling-out of shared procedures has improved the effectiveness, efficiency and appropriateness of healthcare in Lampedusa, requiring a slight increase in resources. Remarkably, the healthcare reinforcing results in beneficial also for the general population.

Key messages

• Massive influx of migrants in Lampedusa has required strengthening health services on the island.

• Evidence-based interventions based on needs assessment have improved healthcare for both migrants and the general population.
Life course prevention - challenges for public health lying ahead
Authors: Albreht T
Published: October 2024

Issue/problem

Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults.

Description of the problem

The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention.

Results

Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages.

Lessons

Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children.

Key messages

• Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention.

• Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.
Utilization patterns and preferences of telemedicine services in the post-Covid-19 era in Israel
Authors: Samuel H , Norman T , Myers V , Ziv A , Wilf-Miron R
Published: October 2024

Background

While telemedicine can streamline healthcare delivery, suboptimal use may compromise care quality and access. Given the increased adoption of these services during and after the Covid-19 pandemic, understanding best practices through examination of utilization patterns and patient preferences is crucial. This study estimated utilization rates, patient preferences and perceptions of response received for different physician-encounter channels for common clinical and administrative scenarios.

Methods

Cross-sectional telephone survey in Hebrew or Arabic of 519 Israelis who contacted a doctor in the past year for clinical or administrative needs. Data collected during April-June 2023, focused on chosen contact channel, reasons for choice, perceived response adequacy, and hypothetical future preferences.

Findings

78% of encounters with family physician for clinical need were in-person, with lower rates for phone (16%) or messaging (6%); in-person dominated with encounters with specialists (94%). Conversely, for administrative needs, more used phone (15%) or messaging (48%), though 37% still preferred in-person encounter. Video usage was negligible (<1%). Main reasons for in-person choice were perceived need for physical exam, habit, or negative perception of remote service quality. Convenience/exam-free needs drove phone/messaging use. While most patients were satisfied with their chosen channels, phone consultations had lower future preference rates.

Conclusions

Matching channel to need is crucial. Physical exams require in-person visits, though they are not always required and many stick with in-person out of habit; remote options like messaging can streamline administrative tasks. Patient education could address habits and help familiarize patients with new options. Optimizing phone visits and promoting video options could enhance adoption due to their benefits.

Key messages

• In-person visits are preferred for clinical needs, while messaging/phone are underutilized for administrative tasks, highlighting missed opportunities for convenient telemedicine options.

• Addressing patient habits and perceptions around remote healthcare channels is crucial for optimizing telemedicine adoption and streamlining care delivery.
The evaluation of an eHealth tool to prevent and alleviate migraine complaints in adults
Authors: Van Der Heijde C M , Jurgens F , Tempelman D , Altink-van den Berg WMM , Vonk P
Published: October 2024

Background

Migraines attacks cause great suffering in individual patients. There is great unfulfilled potential to increase patients’ knowledge about various personal triggers and subsequent treatments. The objective of this study is to pilot test an e-Health tool that aims to increase migraine patients’ knowledge. It takes into account personal preferences and contributes to informed decision-making in choosing the appropriate method. Considering the shortage of primary care physicians and other health care providers, such an e-Health tool could be of great value.

Methods

lessmigraine.nl consists of a website with information plus an electronic decision aid. It was evaluated on its content, development process and effectiveness, and its contribution to the patients’ empowerment process. A first round of usability testing was done using semi-structured interviews and thematic analysis with 12 patients from a Dutch General Practice until data saturation. After minor improvements to the e-tool, in a first implementation step subsequently 85 patients used the e-tool.

Results

Patients’ expectations were exceeded in terms of the content of the e-Health tool, as all patients discovered new potential migraine triggers. Most patients found the tool effective in the sense that it provided enough information to decide on an appropriate treatment. The implementation was successful in the sense that all 85 participants completed the e-tool. Most important triggers were stress, sleeping problems, changes in weather and flickering or bright light.

Conclusions

The majority of the migraine patients were satisfied with the e-Health tool. It enlarged their knowledge of prevention and treatment options and therefore empowered them in their decision-making process and communication with their GP. Other aspects of implementation need to be studied. This study needs to be repeated in other clinical settings.

Key messages

• Migraines cause great suffering in individual patients: Considering the shortage of primary care physicians and other health care providers, an e-Health tool could be of great value.

• The e-Health tool increases patients’ knowledge about migraine, including personal triggers and subsequent treatments.
How can we support the development of health literacy in young people?
Authors: Smith C , Belton S , Meegan S , Behan S , Goss H R
Published: October 2024

Over the past two decades, there has been an increased interest in Health literacy (HL) to improve health behaviours and health outcomes. Due to its potential impact, HL is considered one of the major issues in public health and is increasingly being recognised in recent policies and initiatives. Although, the research justifying the importance of HL continues to grow, there is a lack of research focusing on strategies to improve HL and challenges that are faced when supporting HL, particularly in young people. Thus, this study aimed to explore, from the point of view of international academics and community-based practitioners, (i) key considerations when supporting young people’s HL; (ii) major challenges to supporting young people’s HL; and (iii) possible solutions to overcome such challenges. A stakeholder mapping exercise was used to recruit academic and community-based practitioners to take part of in a one-to-one interview (n = 29). Reflexive thematic analysis was used to analyse the data. The preliminary findings suggest that: the participants feel the use of participatory approaches is essential when designing a HL-focused program; the importance of embedding HL education and awareness into schools; the value in using interactive style learning; and the importance of targeting those ‘hardly reached’ populations. The participants highlighted that accessibility to schools; difficulty in engaging young people; and ensuring programs are sustainable as major challenges. Solutions to overcome which challenges were posited, including professional development for teachers; the development of engaging and context specific programs that target the young person’s physical and social environment; and importance of influencing national policies to value HL. These findings can be used to inform interventions and policies to target the HL of young people.

Key messages

• The importance of adopting participatory approaches when developing health literacy interventions.

• The importance of developing feasible, context specific and engaging health literacy curricula within schools.