bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil
Authors: Luizeti B L O , Massuda E M M , Garcia L F G
Published: October 2020

In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty.

An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly.

In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%.

The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil.

Key messages

Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.
Addressing health inequities in Bologna: a mixed-method, multi stakeholder, action-research approach
Authors: Bodini C , Camplone I , Cavazza G , Di Girolamo C , Gentilini V , Marzaroli P , Pandolfi P , Perlangeli V , Pizzi L , Riccio M
Published: October 2020

Background

A large body of literature shows how lower socioeconomic classes have higher incidence of mortality and morbidity, and how worse health outcomes linked to barriers in accessing healthcare particularly affect the most vulnerable groups. Despite such evidence, in many a context health inequalities have continued to increase. Processes that better link knowledge with action are therefore needed.

Methods

An interdisciplinary, interprofessional, interinstitutional group was created involving the Public Health Department and the Center of International Health of Bologna. In 2017-19, the group carried out a project to document and tackle local health inequities, structured in two phases: a first one of quantitative analysis of health inequalities using routinely available data, and a second one of qualitative research in selected areas of the city. An action-research approach was embedded throughout the project, with periodic evaluations to ensure progress towards the intended results.

Results

Phase 1 results show significant differences in terms of disease burden and service use between the North, East and West periphery of the city compared to the center and South. These differences mirror the urban distribution of wealth/deprivation, measured through different indicators (education, income, presence of immigrant population). Results also show concentration of the worst health outcomes and healthcare access indicators in some areas of the city, which also have higher presence of social housing. Phase 2, started in January 2020, is using phase 1 results to inform both a qualitative analysis and a participatory process in 6 areas of the city selected among those with worst health indicators.

Conclusions

Our experience shows that addressing the issue of health inequities through a mixed-method, multi stakeholder and action-research approach may lead to greater integration of research findings and evidence into healthcare policy and practice, towards health equity.

Key messages

Working across disciplines, roles and institutions may bring added value to the complex field of health inequities, when approached with the aim of moving from knowledge to action. Relying on routinely available data may open a route for the replication of our experience and for its use to monitor the impact of interventions aimed at reducing health inequities.
Social inequalities in the consumption of beans and other legumes: a study with adults from Brazil
Authors: Medina L P B , Barros M B A , Barros Filho A A
Published: October 2020

Legumes have an effect on reducing risk factors for cardiometabolic diseases if consumed at least 4 times a week. In addition, they contribute to intestinal health, are a source of fiber and protein and represent an important instrument for the food safety of developing countries. It was intended to estimate the prevalence of consumption of beans and other legumes, in the diet of the adult population of a city in southeastern Brazil identifying inequalities of race, income and schooling. This is a cross-sectional study conducted in Campinas, São Paulo (ISACamp 2014/15) that evaluated 1889 people aged 18 years or older. Pearson's Chi-square test estimated the prevalence of bean consumption at least 4 days a week, as well as the prevalence of consumption of other legumes among those who stopped consuming beans in 3 days or more. The associations of these behaviors with the variables race, income and schooling were analyzed based on the prevalence ratios adjusted by gender and age. Among blacks and browns, in groups with incomes below 0.5 minimum wage and in those with up to 4 years of study, percentages higher than 66% were found in the prevalence of bean consumption in more than 4 days a week. Among those who stopped eating beans in at least 3 days, no more than 24% reported ingesting other legumes as a substitute. Among the whites, in the group of best income and in the best level of study the prevalence of bean consumption was lower and the intake of other legumes was more frequent. It is noteworthy, however, that the prevalence of bean replacement with another type of legumes did not exceed 34% even among the most favored strata. It is concluded that beans are strongly present in the diet of the less privileged groups of population and that the substitution of beans with other legumes, besides infrequent, can be considered a practice of whites and segments of better socioeconomic level.

Key messages

Beans are strongly present in the diet of the less privileged groups of population. The substitution of beans with other legumes can be considered a practice of whites and segments of better socioeconomic level.
Factors associated to functional outcome after total hip and knee arthroplasty
Authors: Kundisova L , Sanguineti I , Resani G , Lentino C , Nante N
Published: October 2020

Background

An individual rehabilitation plan should guarantee a personalized approach to each patient. Identifying patients at risk of slower progression could help to implement a targeted approach. Aim of this study was to analyse patients characteristics associated to worse Functional Outcome (FO).

Methods

A cross sectional study of patients after Total Hip Arthoplasty (THA) or Total Knee Artroplasty (TKA) recovered in a Rehabilitation Clinic from January 2017 to December 2018 was performed. Patients characteristic: Age, Gender, Body Mass Index (BMI), Pain at admission (expressed in Numeric Pain Rating Scale: NRS), Cumulative Illness Rating Scale (CIRS) and Length of Stay in surgical facility (SLOS). Outcome tested: Active Flexion (AF), Barthel index (BI), Tinetti scale (TS), Pain at Discharge (PD). Patients were divided into two groups in relation to the achievement of target values in eight day of rehabilitation (AF = 84°, BI = 90, TS = 19 and PD ≥ 5). Statistical analysis was realized using Stata12.

Results

In total 1857 patients, 58% females, 56% after THA. Average age was 70.5±10.4, higher for females (72±9.7 vs. 68.3±11), average BMI 27.2±4.3, average SLOS 5.2±2.8. Regarding AF: 48% did not reach target value (38%THA; 55%TKA), for THA more likely older (OR 1.01) and females (OR 1.5) and for both THA and TKA higher NRS (OR 1.2). As for the BI target value was not reached by 24% patients (24.4%THA; 23.4%TKA); more likely older patients (OR 1.05), females (THA OR 2.1; TKA OR1.5), those with higher NRS (OR 1.13) and higher SLOS (THA OR 1.16; TKA OR 1.14). As for TS, 7% did not reached target (6.5%THA; 6.8%TKA), association with age (TKA OR 1.08; THA OR 1.04) and for THA also with SLOS (OR 1.13), pain (OR 1.16) and female sex (OR 2.16) was observed. As for the PD 17% not reached target (9.78%THA; 25.59%TKA), for TKA an association with BMI was observed (OR 1.08).

Conclusions

Worse FO was associated to not modifiable variables as age and gender but also with NRS, BMI and SLOS.

Key messages

Analysing patients characteristics associated to worse Functional Outcome allow to identify patients at risk of slower progression. The aim is to implement a targeted and personalized approach. The worse FO was associated to not modifiable variables as age and sex but also to higher NRS, prolonged SLOS and high BMI. Those conclusions help to manage an Individual Rehabilitation plan.
The impact of homeopathy in the treatment of bruxism in a Brazilian school
Authors: Simóes pires Gallois Ficht S , Thaise Unbehaum E
Published: October 2020

Description of the result achieved by homeopathy in a pilot project in the treatment of schoolchildren with bruxism in public health in Blumenau, SC (Santa Catarina - Brazil). In parallel with the treatment of the main complaint of the dental patient, we sought to list other benefits obtained during the course of this project. The children were selected through a questionnaire addressed to the parents of students at the Adelaide Starke Municipal School, verifying cases of tightening and / or involuntary grinding of their children's teeth. Thereafter, their treatment started and lasted four months. It was a process of monthly consultations accompanied by homeopathic prescriptions according to the needs verified at the time. At the end of the period proposed in this study, favorable results were found in all children involved in the process, in addition to a remarkable influence of treatment on the quality of life of these patients. The data showed that homeopathy in school dentistry, in addition to solving or minimizing cases of bruxism, improved the relationship of children with their environment: school, social and domestic. Most respondents reported additional benefits such as improved sleep quality, the elimination of phobic crises, improved self-esteem and students' school report cards.

Key messages

Description of research carried out with children and adolescents attending a dental practice at a Brazilian public school submitted for four months to homeopathic treatment for bruxism. Benefits that homeopathic therapy.
Prescription of physical activity: knowledge and needs among general practitioners of Ile-de-France
Authors: Astruc A , Blanchard J C
Published: October 2020

Background

Physical inactivity is the fourth leading cause of death in the world. The concept of medical prescription of physical activity (PA) adapted now appears in a law, which specifies the central role of the family physician. The needs of the general practitioners (GP) about prescription of PA have not been studied.

Aim

To assess the knowledge and needs of GPs regarding the medical prescription of PA.

Methods

This is a transversal observational epidemiological study of GPs working in the departments of Hauts-de-Seine (92) and Val-de-Marne (94) near Paris. A questionnaire was sent by mail or email.

Results

One hundred and fifty-eight physicians were included. A total of 72.2% of GPs rated their knowledge in PA as average to very poor. The initial training in PA is estimated as unsatisfactory by 84.2% of GPs. A total of 81.6% haven't done a postgraduate additional training in PA. A specific skill in sports medicine, the individual practice of PA as well as the speaking about PA in more than 50% of consultations are significantly associated with a feeling of competence in PA prescription (P < 0.01). Among the measures favoring the prescription of PA, GPs told that they need information brochures to give to the patient (60.8%), a website of help to the prescription of PA which can be used in consultation (60.1%), or the organization of a specific training on the medical prescription of AP (50.6%).

Conclusions

The lack of training seems to be the major obstacle to the generalization of prescription of PA. The organization of training or the creation of specific tools for the attending physician seems to be promising solutions.

Key messages

The lack of training seems to be the major obstacle to the generalization of prescription of PA. Organization of training or the creation of specific tools for the attending physician seems to be promising solutions.
Health literacy levels and related factors of patients admitted to an outpatient clinic in Malatya
Authors: Pehlivan E , Ozdemir K
Published: October 2020

Background

This study was conducted to determine the health literacy levels and related factors of the patients who applied to a health unit.

Methods

The population of this cross-sectional study was the patients who applied to a district outpatient clinic in the center of Malatya. Power 80% and in the 95% confidence interval based on the mean of health literacy scale of Turkey (29.5 ± 5.7) the sample size was determined as 317. In the first three months of 2019 outpatients and 384 randomized patients who agreed to participate in the study, developed by the Ministry of Health Literacy Turkey Health Questionnaire-32 (THLQ) was applied. The score obtained from the scale is considered to be insufficient of 25 and below, limited to > 25-33 points and a score of < 33 and above is sufficient. In the analysis of the data, Kolmogorov Smirnov, Mann Whitney U, Kruskal Wallis and Chi-Kare tests were used and p < 0.05 was chosen as the level of error.

Results

49.9% of the participants were male and 50.1% were female. The average age is 35.94 ± 13.8. While 24% of the participants have secondary or lower education, 40.6% are graduates of higher education. In this study,the health literacy scale mean score of the participants is 15.85 ± 11.07. According to the results of THLQ-32, 78.1% of the participants were in the “insufficient” health literacy category, 14.0% in the “limited” category, only 7.9% in the “sufficient” category. Gender, age, educational background, frequency of applying to the health institution were determined as factors affecting the level of health literacy (p < 0.05). However, the presence of a disease causing regular drug use was not identified as a related factor (p > 0.05).

Conclusions

In this study, although of have a high education level of the participants were found to be inadequate of health literacy levels according to Turkey average value reflects the general.

Key messages

According to these results, it may be difficult for the groups that are insufficient in terms of health literacy to benefit from health services. Raising the health literacy level of the society can be an important component of health promotion.
Building health promoting sports clubs: A participative concept mapping approach
Authors: Johnson S , Van Hoye A , Donaldson A , Lemonnier F , Rostan F , Vuillemin A
Published: October 2020

Background

Sports clubs offer a unique position to increase performance and physical activity but may also provide additional health promoting opportunities. Research is limited on support clubs need to increase health promotion efforts. This study took a participative approach to gather French stakeholder ideas on perceived assistance sports clubs need to increase health promotion efforts and prioritized them based on ratings of importance and feasibility.

Methods

This concept mapping study had 4-steps: 1) drafting a focus prompt to a key issue, 2) brainstorming ideas in response to the focus prompt, 3) sorting ideas into themed piles and 4) rating ideas (1-6) based on two indicators. French stakeholders (45) in sports and health organizations were invited to respond using the groupwisdom™ platform. Researchers produced visual cluster maps of themed piles and Go-Zone graphs displaying ideas perceived as important and feasible.

Results

Participants generated 62 ideas responding to the focus prompt: 'What assistance would benefit sports clubs to become health-promoting settings?'. Once researchers edited ideas, 78 were available to sort. Final sorting formed 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic & Financing, Awareness & Mobilization, Advocacy, Policies & Methods, Sharing & Networking, Communication & Dissemination. Importance and feasibility ratings produced Go-Zones with 34 ideas above the mean for both indicators. Top focus areas include: increasing awareness of health promotion benefits, mobilizing actors, advocating for support and educating club actors.

Conclusions

Understanding support stakeholders need to increase health promotion efforts in sports clubs is a crucial step to plan and implement policies. Including stakeholders' perceptions helps establish effective interventions by increasing the possibility of integration into current or emerging policies and acceptance from those working in clubs.

Key messages

Generating and organizing stakeholder ideas gives insight into perceptions of what support is needed to develop and implement health promotion interventions in the sports club context. Based on importance and feasibility, sports clubs can increase health promotion efforts by focusing on: increasing awareness of health promotion benefits, mobilizing actors, advocacy and education.
First year of implementation of a drug consumption room in Lisbon: the client’s profile
Authors: Pinto de Oliveiraa A , Gautier D , Nunes P , Correia V , Leite A , Taylor H , Pinto de Oliveira A , Curado A
Published: October 2020

Issue

Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon.

Description of the Problem

These Programs are aimed at high risk users with a very fragile social and health situation and for that reason usually they adopt a integrate model of care, offering other services behind supervised consumption: basic healthcare, social support, rapid testing and referral to other services. In context of the first year of implementation of a mobile DCR in Lisbon, we intend to investigate if the program was able to reach those at higher risk. Service data collected between April and December 2019 was used to define the client's profile.

Results

The data collected by the program indicates that the vast majority of registered users are men, over 40 years old and homeless. Most users have already been tested for HIV and viral hepatitis in their lifetime, however, there are still barriers in accessing and utilizing specialized care. We also observed high risk practices: injecting in public spaces, groin injection and high rates of benzodiazepine injection.

Lessons

The mobile DCR in Lisbon was able to reach those users at greater risk, both by the pattern of consumption, and by the social and health situation in which they find themselves.

Key message

DCR combined with other harm reduction responses and health services can contribute to improve the health of a very marginalized group of users.
Co-created training program to promote active ageing in people with Down syndrome
Authors: Fornes-Romero G , Llop-Medina L , Doñate-Martinez A , Garces-Ferrer J , Anaya S , DeToro J
Published: October 2020

Background

Population ageing is a current challenge for the European society. Specifically, People with Down Syndrome (PDS) are living longer than before, reaching some of them around 60 years old. However, it is known that they show premature ageing that in some cases may be misled with Alzheimer first signs. Hence, it is crucial to promote an Active Ageing (AA) and healthy living in this specific population by keeping their cognitive, physical and emotional functions, and also promoting social activities such as community participation. In such way, their Quality of Life (QoL) will be increased.

Objectives

The main objective of this study was to co-design a Training Program (TP) to promote AA in PDS, professionals, relatives and/or caregivers, on the framework of the DS-AGEING project (2018-1-ES01-KA204-050733).

Results

Co-creation sessions with PDS, professionals and relatives/informal caregivers from Spain, Portugal, Slovenia, Rumania and Greece were carried out to determine contents, methodology and materials of the TP. This methodology allows meeting their real needs but also it promotes inclusion. The resulting TP is formed by the next topics (and its subtopics): active ageing, cognitive functioning (attention, memory, executive functions, praxis, gnosis, etc.), facing transition events, physical health (healthy habits & postural control). Training will be performed by 3 types of activities: face-to-face, practical and e-training. Co-validation sessions with end-users were conducted to validate the TP. Also, an e-training platform to support the TP implementation will be designed.

Conclusions

An easy, practical and flexible TP was co-created to be adjusted to each PDS and to be used by any person with/without experience in training. In such way, this study has a holistic perspective as cover all end-users needs: PDS will be able to train in the affected areas and professionals and relatives will have tools to assist them in the training.

Key messages

This co-created TP will be a tool for professionals and relatives/caregivers to foster AA and increase QoL of PDS. This study will promote an early detection of deterioration symptoms and the preservation of abilities in PDS.
Impact of overweight on the burden of non-communicable diseases in Belgium: the WaIST project
Authors: Gorasso V , De Smedt D , Vandevijvere S , De Clercq E , Van der Heyden J , Doggen K , Pelgrims I , Devleesschauwer B
Published: October 2020

Issue

Excess weight status is one of the main metabolic risk factors for non-communicable diseases. According to the Belgian health interview survey of 2018, 49.3% of the adult population suffered from overweight. Despite the great national burden, and apart from isolated actions, there is not anymore a comprehensive nutritional and physical activity health plan in Belgium. Consequentially, Belgium requires action-oriented research to support the implementation of evidence-based policies for the prevention of excessive weight gain.

Description of the Problem

The WaIST project aims to assess the contribution of excess weight status to the societal impact of non-communicable diseases, disability and multi-morbidity, and to model and compare the potential impact of internationally recommended health policies. The project also aims to support knowledge translation and policy transfer through a close interaction with national decision makers and stakeholders.

Results

The disease burden of diabetes, cardiovascular diseases, cancer and musculoskeletal disorders will be estimated in terms of disability-adjusted life years (DALYs) and healthcare expenses from a societal perspective. For this purpose, survey, registry, health insurance, and hospital discharge data will be used. Subsequently, health interventions tackling overweight will be selected considering scientific evidence and stakeholder priorities. Health impact assessments will then be conducted projecting the future impact of the interventions on health outcomes and costs related to excess weight status.

Lessons

The use of national data for the computation of the burden of disease provides better estimates for DALYs and costs compared to European or global study results. Moreover, the results of the project will allow to explore the impact of health intervention specific for the Belgian case.

Key messages

Considering the burden associated with overweight-related diseases, preventing obesity is important from a public health and financial perspective. Integrating these results into evidence-based policies could provide governments and partners with a key tool for effective health interventions.
Valuing experiential knowledge in health promotion: a new method to build up knowledge in France
Authors: Laurent A , Ferron C ,   National committee to promote EKHP, Berry P , Soudier B , Georgelin B , Gaspard S , Berdougo F , Rush E , Lombrail P
Published: October 2020

Issue

Effectiveness analyses of health promotion (HP) interventions (HPI) abound nowadays in France, but few research details how HPI work, nor explains how practitioners can translate conclusive evidence from the literature into action. Furthermore, large amounts of experiential knowledge remain untapped and undervalued. To close these gaps, a national multidisciplinary committee, comprising public officials, academics and practitioners, has worked since 2016 at designing a new method to build up knowledge in HP.

CEKHP

The method aims at Capitalizing, collecting and circulating Experiential Knowledge in HP (CEKHP).

Committee members first investigated methods used in other countries to synthesize and share practical evidence, then drafted and experimented CEKHP in 11 different settings to test its relevance and applicability.

Results

Key components of CEKHP are: 1/CEKHP consists in in-depth semi-structured interviews and offers a guideline template adjustable for various contexts and multiple public health issues (behaviors, environments, etc.); 2/a trained outsider, mastering 7 core competencies, must conduct CEKHP; 3/CEKHP includes a framework for reporting key mechanisms that influence HPI outcomes. Detailed mechanisms include: context, partnerships, key steps, barriers and levers, ethics, theoretical foundations (intervention models, evidence-based literature, etc.), transferability. A guidebook and a toolkit are published in 2020. CEKHP successfully disseminates within the French HP community. It is currently used as the main data collection tool in a research project investigating health promoting sports clubs (PROCeSS) and in a practice-focused project documenting tobacco prevention (DCAP).

Lessons

Practitioners benefit from access to knowledge on how HPI work. CEKHP offers new tools to value and disseminate experiential knowledge. Given that policymakers increasingly prioritize funding in France on documented HPI, providing such tools and training is crucial.

Key messages

CEKHP offers a new method in the French context that has proven fruitful in various settings, for various public health issues, and can be useful to practitioners and researchers alike. Building up experiential knowledge with and for practitioners can be effective at both documenting practices and helping them gain new skills and better understanding of their interventions.
Articulation between hospital and primary healthcare: The experience of Brazilian pregnant women
Authors: Gouveia L M R , Pereira C G S , Gomes A V N S , Nascimento A B
Published: October 2020

Introduction

Primary healthcare was considered by the World Health Organization as one of the ten health priorities for 2019 in the fulfillment of the specific commitments undertaken in the Declaration of Astana in 2018. The integration of the healthcare network in primary healthcare through visits to a maternity of a Brazilian Public teaching Hospital is one of the resourced for the protection and bonding of the pregnant woman.

Objective

To describe the experience and assessment of pregnant women in relation to visits to the maternity through a participative action between the Teaching Hospital and Primary Healthcare.

Methods

Qualitative study through a Community Based Participatory Research. Phases: Reduction in the number of visits was identified by the multidisciplinary team associated to actions of the Brazilian Ministry of Health; meetings with primary and hospital healthcare leaders; eight interviews with nurses from the hospital; seven workshops with 34 primary healthcare nurses and interviews with 32 pregnant women after the visit. For the purpose of this study, the interviews with the pregnant women, recorded and transcribed, were stored and organized using the webQDA ® software and thematic analysis performed.

Results

The pregnant women were of ages between 25 and 32, 63% were primipara and with gestational periods of between 13 and 39. Seven descriptive categories were identified: Care, bonding and health promotion of pregnant women; Challenges of communication with the pregnant women in primary healthcare; Challenges of communication with the pregnant women in hospital care; Clarification of the pregnant women's needs; Strategies for encouraging visits; Reassurance and safety in relation to the hospital; Public healthcare system image.

Conclusions

Countless challenges are identified by the pregnant women for the rapprochement of primary healthcare and hospital care in the attention to childbirth promoting quality healthcare, bonding and protection.

Key messages

Integration of healthcare network in primary healthcare through visits to a maternity is one of the resources for the protection and bonding of pregnant woman. Enhance the challenges of pregnant women as the path for rapprochement of primary healthcare and hospital care in the attention to childbirth quality healthcare, bonding and protection.
E-learning and an action model for promoting psychosocial health: knowledge transfer in a university
Authors: Helfer T , Fäh D , Berg A , Frey S , Luijckx E
Published: October 2020

Background

Promotion of the psychosocial health of individuals, groups and society, is becoming an increasingly important task for healthcare professions. In the Department of Health Professions at the Bern University of Applied Sciences, an interdisciplinary team of professors and researchers developed an e-learning programme, which highlights a new action model. This innovative model guides health professionals in systematically utilizing health promotion and prevention, to promote psychosocial health among their target groups. Internationally, such a model does not exist. Therefore, it offers an new and systematic approach to promoting psychosocial health among various population health levels.

Objectives

2019-2023: utilization of programme by department professors and researchers, and transfer of this knowledge to students, or to research projects (via internal marketing and incentives); integration of programme into interdisciplinary bachelor curriculum (via learning packages designed for use with students); national and international dissemination of the new model. How is the programme and model perceived among the professors and researchers? What is the models' relevance for public health?

Results

Preliminary results according to various professors, suggest that the programme is user-friendly and very useful. It has been integrated into the interdisciplinary bachelor curriculum. Researchers provided less feedback; however, ongoing incentives should result in its increased integration into research projects. Additional feedback is that the model is an innovative tool, and is relevant for health professionals at the international level. Its dissemination will begin in spring 2020, through its submission for publishing.

Conclusions

This e-learning programme and model are considered to be valuable and innovative. Upon publication, this systematic approach to improving the psychosocial health of target group(s) will be widely available for health professionals.

Key messages

An innovative action-model has been developed for the promotion of psychosocial health. A new understanding of how health promotion and prevention can applied to promote psychosocial health is offered.
Conceptualizing health literacy promotion in second language courses based on a realistic review
Authors: Harsch S , Bittlingmayer U
Published: October 2020

Background

Second language courses (SLC) and adult basic education courses are considered appropriate settings for promoting health literacy (HL) of vulnerable and hard-to-reach migrants and refugees. Yet, these courses and the process of HL promotion in SCL are not yet empirically well-understood. In the project SCURA, funded by the German Federal Ministry of Education and Research, we explored the role of SLC in HL promotion and developed interventions to improve the HL of newcomers. This study's aim was to analyze projects on HL promotion in SCL and to develop an empirically based theory of change.

Methods

We conducted a systematic literature search on HL and SCL on four databases (PubMed, PsycInfo, ERIC, google scholar) and a free online research. Two researchers screened titles, abstracts and full-text and identified 20 articles of 13 interventions eligible for a realistic review (Pawson 2005). We extracted the context and characteristics of the programs, methods, results, influences and triangulated the data to create a model.

Results

Despite the heterogeneous contexts, HL can be successfully promoted in SLC. The theory of change unfolds key program activities, outputs and outcomes, supporting factors and their relationships, and specifies the roles of teachers, health professionals, schools and students. The study reveals factors ensuring sustainability e.g. integrating health topics in the standard SLC, capacity building of teachers and institution, partnerships with local health services and focusing on language for health.

Conclusions

HL can be improved in SLC, but interventions need to adapt flexibly to the context and situation. Further relevant factors and process are depicted in the empirical-informed model facilitating the development of interventions and to advance the discussion on HL in SLC.

Key messages

Empirical data proves second language courses are adequate settings for promoting health literacy. The empirically-informed theory of change helps to guide the development of promising interventions to develop health literacy in second language courses.
“CicloExpresso das Barrocas”: a Portuguese example of promoting physical activity
Authors: Matos J
Published: October 2020

Issue

Active travel to school is one of the main forms of physical activity for children, contributing to attainment of several of the United Nations Sustainable Development Goals. Young people who travel to school in an active way increase the overall amount of time they spend being physically active each day.

Description of the Problem

In 2017 the association Ciclaveiro created the 'CicloExpresso das Barrocas” in Aveiro. The 'CicloExpresso das Barrocas” is a “bike train” comprising a group of children cycling to their school - Escola Básica das Barrocas - accompanied by parents. It is organized by a group of parents, with the support of the local parish council and school parents associations. The main objective was to promote sustainable mobility and get children to go to school in sustainable and healthy means of transport.

Results

Since 2017 more “train lines” were created to different schools, involving more children and parents. In the near future, the aim is to increase the numbers of “train lines”, schools involved,”trains” per week and children and parents who use them regularly. Physical activity has not only health benefits and contributes to a child's physical, mental and emotional development but also has potentially broad social and academic gains. Additionally it contributes to social cohesion, which in turn can boost confidence and self-esteem.

Lessons

The promotion of active travel to school can be challenging and may require support from sectors other than education. This example shows it can be implemented successfully through collaboration among relevant sectors. CicloExpresso have been getting public recognition. In Aveiro it received a “family-community involvement award for his work with CicloExpresso”.This example of good practice can provide inspiration for policy-makers, schools and researchers. They provide an overview of actions taken to increase physical activity among children and adolescents.

Key messages

Children who travel to school in an active way increase the time they spend being physically active each day. Active travel to school can be challenging and may require support from many sectors.
Public and private hospitals – different opportunities for nurses (Bulgaria, Pleven, 2016-2018)
Authors: Grancharova G , Dulgerova S t , Aleksandrova-Yankulovska S
Published: October 2020

Background

The freedom of private initiative is one of the basic principles of Bulgarian health reform. Since 2000 to 2018 the private hospitals increased over 6 times and hospital beds - over 40 times. The total number of nurses decreased by 3%. Nurses/physicians ratio dropped to 1.03:1. Private hospitals with better facilities and higher payment attract great proportion of nursing graduates. Public hospitals cannot compete and often fall in financial crisis and lack of human resources. We aimed to analyse the opportunities, motivating and demotivating factors for nurses in public and private hospital settings for lifelong learning (LLL).

Methods

The study included a sample of 573 nurses (448 in public and 125 in private hospitals). By anonymous self-administered questionnaire we collected and compared information about opportunities, motivation and obstacles for LLL in different hospital settings using parametric and non-parametric tests (t-test, chi-square) and correlation coefficients (Phi, Kramer, contingency coefficient). The accepted level of statistical significance was p < 0.05. Data processing was performed by IBM SPSS v.24.

Results

Great discrepancy was found in age distribution: in private hospitals 52,8% were below 40 years while in public hospitals 69,2% - over 40 years (p < 0.001). Significant differences were observed in motivation for LLL: in public hospitals 46.4% ranked “better payment” compared to 36.8% in private hospitals; “career development” took 31.2% in private hospitals and 24.1% in public hospitals (p < 0.05). Financial problems were the biggest obstacle in public hospitals (49,8%) and substantially lower (33.6%) in private hospitals (p < 0.01). Prevailing form of LLL in public hospitals was on-site training.

Conclusions

Our results underlined the significant differences in nursing profile, opportunities and motivation for LLL in public and private hospitals. Public hospitals do not provide equal prerequisites for nurses' professional development.

Key messages

Lifelong learning is irreversible prerequisite for provision of high quality and safety health care. Nurses in public and private hospitals should have equal opportunities to participate in LLL. Public hospitals need substantial investments to provide better opportunities and to attract younger nursing generations able to respond to increasing requirements for high quality health care.
Empty shelves: selected essential medicines stockouts in South Africa
Authors: Wolvaardt L , Nemuntandani R , Kamungoma-Dada I
Published: October 2020

Background

Access to essential medicines in South Africa has been compromised by stockouts in health facilities. This study describes the occurrence of stockouts for a selection of essential medicines.

Methods

This cross-sectional study used secondary data retrieved from the Stop Stock Outs Project (SSP). A descriptive analysis was conducted on data from the 2013-2015 SSP case management database of routinely reported stockouts. Chi square tests of independence was conducted on data from the SSP 2015 annual telephonic survey to investigate associations between the occurrence of stockouts, the level of health facility and the type of health professional.

Results

231 facilities reported 609 stockouts. Antiretroviral medication had the most stockout reports (78%; n = 475/609), followed by anti-infectives (17.1%; n = 104/609) and tuberculosis medication (4.9%; n = 30/609). The highest number of stockout reports were received from Gauteng province and the majority (71.09%; n = 150/211) of facilities reporting stockouts were in urban areas. There were more stockouts at ambulatory, rather than inpatient care, facilities however, this was not statistically significant.

Conclusions

This study confirms that South Africa experiences medicine stockouts for many of the essential medicines, with antiretroviral medication being the category most affected. The stockouts vary between provinces and the urban-rural divide but are an equal threat to both ambulatory and inpatient facilities.

Key messages

The pattern of stockouts experienced over a three-year period suggest that stockouts are ‘normal’ despite the substantive effects of treatment interruption – especially patients with HIV and/or TB. Antiretroviral therapy is at risk as a result of stockouts.
The effect of the employment of consultants in the Emergency Department on quality of care and equity
Authors: Lindstroem M B , Andersen O , Kallemose T , Rasmussen L J H , Rosthoej S , Jervelund S S
Published: October 2020

Background

Hospitals struggle with increasing acute admissions and crowding in Emergency Departments (EDs) negatively affect length of hospitalisation, in-hospital mortality, patient safety and flow. In response to this, the Danish Health Authorities have recommended the presence of consultants in the ED to expedite the clinical decision-making process. In 2016, consultant-led triage and continuous presence of consultants was introduced at the ED at Hvidovre Hospital, Denmark. However, little is known on the effect of consultants in the ED, and how it affects care for patients of varying socioeconomic status. This study investigated whether the employment of consultants in a Danish ED affected the quality of care for acutely admitted medical patients in terms of length of admission, readmission, and mortality, and how this effect was distributed across socioeconomic status in patients.

Methods

Admission data was collected during two 7-month periods, one prior to and one after the organisational intervention, with 9,869 adult medical patients admitted for up to 48 hours in the ED. Linear regression and Cox proportional hazards regression analyses adjusted for age, sex, comorbidities, level of education and employment status were applied.

Results

Following the employment of consultants, an overall 11% increase in index-admissions was observed, and 90% of patients were discharged by a consultant with a reduced mean length of admission by 1.4 hours (95% CI: 1.0 - 1.9). No significant change was found in in-hospital mortality, readmission, or mortality within 90 days after discharge. No difference was found in quality of care across socioeconomic status.

Conclusions

Consultants in the ED was found to reduce length of admission without a negative effect on the quality of care for ED admitted medical patients in general, or for patients with lower socioeconomic status. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.

Key messages

Consultants in the ED may reduce length of admission without a negative effect on the quality of care. To reduce readmission and mortality among acutely admitted patients, other means must be initiated.
Factors influencing participatory intervention implementation to improve care coordination
Authors: Mendes M F M , Cazarin G , Hemetério M M , Samico I C , Vargas I , Vázquez M L
Published: October 2020

Background

Problems related to care coordination are identified as challenges to the organization of health systems. In order to improve coordination, it is necessary to invest in interventions that promote collaboration between levels of care. The study analyzes factors influencing the implementation of the intervention joint meetings between levels of care, guided by participatory action research to improve clinical coordination from the perspective of actors involved in a public health care network in Brazil.

Methods

Qualitative descriptive-interpretative study carried out in the health network of a municipality in the northeast of Brazil. Ten interviews were conducted to managers and health professionals, members of local steering committee and focus group with primary care physicians and specialists participating in the intervention. Thematic content analysis was used; it generated categories from theoretical and emerging frameworks.

Results

The willingness of professionals and management support to participate of the intervention process emerge as fundamental factors. However, they are influenced by factors of the system, such as electoral period and management change and these reflected on the slowdown and instability in implementation process. In the health network, turnover of professionals and low trust between primary and specialized care were evidenced as challenges. However, the proactive role of local steering committee, driven by participatory strategy for development of the intervention, promoted reflections and decisions agreed between professionals and managers. This rebounded on adjustments to strengthen the intervention and improvements on knowledge and collaboration between levels.

Conclusions

analysis of factors contributes to reflection on changes in the context, adaptation of intervention over time and importance of the role of professionals. Such understanding becomes essential for sustainability and improvement of care coordination.

Key messages

Knowledge about factors that influence implementation of an intervention guided by participatory action research contributes to the development of strategies aimed at its sustainability. Contextual factors that hamper improvements implementation to coordination of care can be overcome through participatory strategies mobilizing health professionals and managers.