bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and factors associated with food insecurity in southern Mozambique
Authors: Militao E , Uthman O , Salvador E , Vinberg S , Macassa G
Published: October 2022

Background

Food insecurity (FI) is one of the major causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how it’s related to negative health outcomes is unknown. This study aimed to investigate the prevalence of FI as well as the factors associated with FI in southern Mozambique.

Methods

Preliminary data from 301 household heads residing in suburb and peri-urban districts of Maputo were analysed in a cross-sectional design. Accordingly, FI was assessed using the 8-items of the United States Department of Agriculture Household Food Security Survey Module, and its association with various factors was determined through multiple regression models.

Results

The prevalence of FI was 62.8% (23.6% of households had mild FI, 16.6% had moderate FI, 22.6% had severe FI). Based on multiple regression models, 10 variables (out of 11) were relevant drivers of FI and reached statistical significance (p-value<0.05) with focus on food diversity, climate change, illnesses, household income, number of meals, type of work, household size.

Conclusions

These preliminary findings suggest the need for decent work and job creation. In addition, food diversity, climate change and some relevant diseases should be taken into account in the development of public health policies designed to alleviate household food insecurity in Mozambique.

Key messages

• Food insecurity in Mozambique calls for joint efforts from government, private sector, international institutions and communities.

• The basic food basket for the most vulnerable groups is encouraged as a short-term solution.
A dietary intervention study to reduce Metabolic Syndrome risks in heart-transplanted patients
Authors: Valdi G , Ferrara V , Marinoni M , Nalli C , Di Nora C , Sponga S , Benedetti G , Parpinel M , Livi U , Moretti V
Published: October 2022

Background

Since heart transplantation (HTx) has become the gold standard therapy in end-staged heart failure, many factors, including metabolic syndrome (MS), represent a burden in HTx patients. Considering key role of immunosuppressive therapy and its side effects on the appearance of MS, we focused on modifiable factors including adherence to Mediterranean Diet (MD) and improvement of dietary habits.

Methods

21 heart-transplanted patients were enrolled and randomized in a control group (CG; N 10) and an intervention group (IG; N 11). During two meetings (baseline, 6-month follow-up) were administered a validated Food Frequency Questionnaire (FFQ), to assess adherence to MD, and collected clinical and anthropometric parameters, IG were additionally requested to fill a food diary. IG received personalized advices, CG received standard recommendations. Comparison between IG and CG were analyzed, differences into the IG were also assessed.

Results

The prevalence of MS at baseline was 46% in IG and 20% in CG. During 6-month follow-up, significant lower blood pressure values were observed (median, 25th-75th: systolic 130, 120-130 IG vs 145, 130-147 CG; p = 0.004). Seven patients of IG underwent a 12-month meeting. In this group MD scores increased significantly (7 + 1.3 vs 4 + 1.5, p = 0.001). Furthermore, significant decrease of fat mass percentage (%) (23.3 + 6.3 vs 14.8 + 10.1, p = 0.014), increase of fat free mass % (76 + 6.3 vs 85.2 + 10.1, p = 0.014) and increase of body cell mass % (50.9 + 3.8 vs 53.4 + 3.4, p = 0.031) were observed. Dietary data in IG showed significant decrease of energy from saturated fatty acids % (13.0±2.1 vs 9.6±1.5, p = 0.001), sodium (mg) (2138±359 vs 1822±417, p = 0.045), and decreasing trend for cholesterol (mg) (219±82 vs 171±59, p = 0.082).

Conclusions

Dietary intervention based on MD perhaps can improve MS risks in heart-transplanted patients. Further investigations may be needed to assess the fundamental role of a structured nutritional follow-up in these patients.

Key messages

• Personalized nutritional advices based on the MD, compared to general recommendation, can significantly improve health and quality of life in heart-transplanted patients.

• A structured nutritional follow-up for heart-transplanted patients may be desirable to prevent risks of Metabolic Syndrome as a public health instrument in selected categories as these patients.
Air purifiers, comparison between real and declared surface for use: fake it or make it?
Authors: Gullotto C , Dragoni L , Amodeo D , Cevenini G , Nante N , Messina G
Published: October 2022

Introduction

Air pollution has been recognized as one of the major risk factors for the global burden of disease. In modern society, most exposure occurs indoors, and air quality may be improved with air purifiers utilizing various cleaning techniques. This analysis aims to evaluate whether recommended room surface in which to use these devices as declared by producers is actually in line with their real effective area of activity.

Methods

A review of devices for the purification of the air was carried out between January-April 2022. Four different types of air purifiers were considered based on the adopted technologies: I) HEPA filters and UV lamps; II) only with HEPA filters; III) only UV lamps and IV) those using other technologies. For each group, based on the CADR (Clean Air Delivery Rate) provided by the producers, the optimal real surface area of the room to use the device was calculated, referring to the standard EN779:2012. This value was compared with the recommended area of the room declared by the producers. Descriptive statistics and Wilcoxon matched pair test used for comparisons. The significance level was set at p < 0.05.

Results

The analysis was carried out on 252 devices; I) 52 had HEPA filters + UV lamps, with a recommended mean room area of 40 m2 (IQR 49.75), II) 142 devices had only HEPA filters with 52.5 m2 (IQR 46.75), III) 27 devices only UV lamps, 40 m2 (IQR 105), IV) 31 devices with other technologies, 54 m2 (IQR 84.2). As required by EN779:2012, the effective area of activity was calculated using CADR x 0.075: the medians of the 4 groups were I) 12 m2 (IQR 16.5), II) 15.83 m2 (IQR 26.4), III) 4.5 m2 (IQR 22.5), IV) 7.5 m2 (IQR 21.53), respectively. Comparing declared and calculated CADR values, all the groups showed significant differences (p < 0.05).

Conclusions

Results show that recommended surfaces derived from CADR declared by producers largely overestimate the real volume of the room that devices can purify, whatever the technology used.

Key messages

• There’s no correspondence between recommended area of room to be sanitized indicated by producers of air purifiers and area that they are actually able to sanitize, which is significantly lower.

• It is necessary to be aware of the difference between data indicated by producers and real data, in order to purchase a device that actually corresponds to dimensional needs of the environment itself.
Which one to choose? A cost-effectiveness analysis between different technologies of air purifiers
Authors: Gullotto C , Sparacino M , Amodeo A , Cevenini G , Nante N , Messina G
Published: October 2022

Introduction

CoViD19 pandemic highlighted the importance of air purifiers and, in commercialization, their performance and price influence the choice. Since primary focus concerns only performance in terms of CADR (Clean Air Delivery Rate), this study aims to compare: I) levels of declared air purifications according to different types of air purification technologies; II) price of them to evaluate if, with similar group-mean CADR (within +/- 1 SD), there are significant differences in selling prices.

Methods

A review of several devices was carried out, collecting data in January-April 2022. Four different types of air purifiers were considered, divided into as many groups: those equipped with HEPA filters + UV lamps, only with HEPA filters, only with UV lamps and those using other technologies. We applied Kruskal-Wallis test to evaluate statistical differences among prices normalized by CADR, at significant level of 0.05.

Results

Analysis was carried out on 186 devices: I) 37 had HEPA filters + UV lamps, II) 117 only HEPA filters, III) 11 only UV lamps and IV) 21 other technologies. Eight system had HEPA H11 (95% reduction of particle matter 0.5 μm), 8 had HEPA H12 (99.5%), 70 had HEPA H13 (99.95%), 11 had HEPA H14 (99.995%). The mean normalized costs of each group devices, in Euros/CADR were I) 1.22 (SD 2), II) 1.49 (SD 1.4), III) 7.63 (SD 7.38), IV) 1.22 (SD 0.99), respectively. Statistical comparison of four-group selling prices show significant differences (p < 0.05) due to the devices equipped with only UV lamps.

Conclusions

Comparison between technologies analyzed by mean price normalized to CADR showed significant differences between those that used only UV lamps compared to all the others. This is reasonably due to the fact that the use of only UV lamps requires radiant powers considerably greater than all the others, therefore also higher costs (about 5-6 times). In all cases, the level of disinfection reached, as declared, was always > 95%.

Key messages

• With the same mean price normalized to CADR, the selling price is significanly different only for devices equipped with UV lamps compared to all the others.

• Choice of devices with a certain level of declared air purifications can be directed towards those with HEPA+UV/HEPA/other without the mean price normalized to CADR undergoing significant differences.
Health and morbidity among those in paid work after age 64: a systematic review
Authors: Farrants K , Alexanderson K , Dervish J , Marklund S
Published: October 2022

Background

Despite the increase of labour market participation at older ages, very little is known about health and morbidity among those who remain in a paid work after age 64. The aim was to systematically review the scientific knowledge on health and morbidity among people aged above 64 years who are in paid work.

Methods

A systematic literature review of studies published in English in scientific journals in 2014-2020. We identified 18,972 unique publications, of which 66 were deemed relevant by at least two independent researchers. Quality judgements and data extraction were done by at least two independent researchers according to pre-specified templates.

Results

There was a great heterogeneity in the included studies regarding study design, included populations (both size and type), exposures, outcomes, covariates, measures, and analytical methods. Few were assessed as having high quality. Most studies (95%) were from OECD countries and results were about men to a greater extent than women. 42 of the 66 studies had results indicating that being in paid work after age 64 was associated with good health and less morbidity. Six studies presented at least one result showing the opposite; those in paid work had worse health than those not, while 21 studies presented at least one result showing that there were no health/morbidity differences between those in paid work and who were not. Only one study presented results regarding mortality. Many aspects had not been studied at all, or only in one or two studies.

Conclusions

Many studies had results indicating that those who were in paid work >64 had better health/less morbidity than those who were not, however, there was a great variety in the results. There are surprisingly few studies about health/morbidity among people in paid work after age 64, and those published are heterogeneous: it is thus not possible to draw conclusions regarding scientific evidence based on the currently existing studies.

Key messages

• Both study designs and results were very heterogenous in the 66 studies that presented results on health or morbidity among people in paid work after age 64.

• More and better studies are needed as well as greater clarity regarding study designs, populations, measures, analytical methods and definitions of central concepts such as work, health and morbidity.
Managers’ prevention and self-confidence in supporting employees with common mental disorders
Authors: Hultqvist J , Zhang P , Staland-Nyman C , Bertilsson M
Published: October 2022

Background

Despite managers’ responsibility for work environment and employee health few studies have investigated managers’ actions to prevent common mental disorders (CMD). Concerning prevention of CMD, qualitative studies report managers feeling unconfident. We investigated managers’ self-confidence in supporting employees with CMD and two managerial preventive actions (MPA): ‘reviewing assignments and the work situation’ (MPA-review) and ‘taking initiative to talk about depression and anxiety at the workplace’ (MPA-talk). We hypothesized that managers’ self-confidence in supporting employees with CMD would be positively associated with both MPAs.

Methods

An on-line survey was sent in 2017 to 4737 managers, answer rate 71% (n = 3358), of which 2 899 were included in this study. Both independent and dependent variables were measured through single questions. Self-confidence in supporting employees with CMD was analyzed in relation to MPA-review and MPA-talk using binary logistic regression analysis adjusted for sex, education, managerial experience and training, lived experiences of CMD, work organizational context and general preventive actions in the organization towards CMD.

Results

The proportion of managers with higher self-confidence in supporting employees with CMD was 48.9%, performing MPA-review and MPA-talk was 50% and 57% respectively. Adjusted for all co-variates, managers with higher self-confidence in supporting employees with CMDs were more likely to do both MPA-review (OR 1.57; 95% CI, 1.31-1.87) and MPA-talk (OR 2.06; 95% CI, 1.71-2.25).

Conclusions

The study hypotheses were confirmed. Managers with more self-confidence in supporting employees with CMD were more likely to take actions to prevent CMD, particularly regarding initiating talks about CMD with subordinates. The study suggests it is important to strengthen managers self-confidence in supporting employees with CMD to increase their preventive actions towards CMD.

Key messages

• Managers’ self-confidence in supporting employees with CMD is vital for workplace prevention.

• To strengthen managers’ self-confidence in supporting employees with CMD is essential.
Violence against healthcare workers during COVID-19 vaccination campaign
Authors: Lo Presti T , Scarpis E , Arnoldo L , Fiorillo F , Zuliani P , Farneti F , Croci E , Pellizzari B , Cocconi R , Brunelli L
Published: October 2022

Background

Violence against healthcare workers (HCWs) has gained increasing attention in recent years, both because it is on the rise and because there is growing concern about these incidents, which are classified as sentinel events by the Italian Ministry of Health. Since little is known about the actual burden of this phenomenon, especially during the stressful COVID-19 vaccination campaign, we decided to explore the problem in our region.

Methods

Between January and March 2022, in the 1.2 million-inhabitant Friuli Venezia Giulia region (Italy), we conducted an anonymous online survey to collected data on episodes of violence and their consequences for HCWs. Data from validated tools assessing characteristics of violent episodes and post-trauma impact were analyzed in conjunction with socio-demographic data of respondents.

Results

200 HCWs participated in the survey, most of whom were women (72%), worked as nurses (107) or doctors (71), and had a mean age of 47 years. More than half of them (59%) reported at least one episode of violence, mainly in the form of a verbal assault (64%); there were no differences between victims. In 72 cases, these incidents affected the HCW’s private life, mainly disturbing sleep or concentration (68%). Most HCWs stated that inadequate communication was a trigger for the violence (97%). Although 80% of HCWs would readily report any violent incident, to improve the situation they called for certainty of action against the perpetrator (87%), more organizational support (85%), standard procedures (75%) and self-defense courses (75%).

Conclusions

Violence in COVID-19 vaccination campaign appears to be common and to affect both the personal and professional lives of HCWs. Improvements at the institutional and personal level could help to address this problem that affects the health workforce.

Key messages

• Given the growing public debate, violence in healthcare settings is an important issue that needs to be addressed in the coming years.

• Assessing workplace violence and its associated risk factors will help focus on the strategies that can be usefully employed to prevent it in the future.
Organizational cultures in the Swedish restaurant business and the risk for sexual harassment
Authors: Gillander Gådin K , Zampoukos K
Published: October 2022

Background

The hospitality sector has the highest level of sexual harassment incidents compared to any other sector. The negative consequences of sexual harassment at the restaurant workplace are not limited to the health of the victim alone as it also affects the organization as well as the health of a society. The organizational context is a fundamental determinant of sexual harassment and we need to increase our understanding of organizational cultures that affect such behaviors in order to develop and implement effective interventions in the restaurant business. The aim of this study was to give a comprehensive picture of organizational cultures that increase the risk for sexual harassment in the restaurant business.

Methods

Individual interviews with twenty-nine employees in the restaurant business (e.g. waiting staff, chefs, bartenders, managers) were conducted during 2019-2021. Thematic analysis was used to analyze organizational cultures that increase the risk for sexual harassment in the restaurant business. Preliminary results show a complex web of intersecting cultures such as a toxic macho culture, a weak leadership culture and a close relational culture that cooperate at different hierarchical levels and increase the risk for sexual harassment. The results also show how organizational factors such as workforce demography, unsocial working hours, staff turnover and understaffing are interacting with the organizational cultures in the creation of a hostile environment that increases the risk for sexual harassment.

Conclusions

The results elucidate why traditional interventions such as training or bystander interventions are inefficient in the restaurant business. The results can be used to develop interventions that focus on macho-cultures in restaurants, the leadership culture and the specific relationship culture that develop due to the specific organizational structures in the restaurant business.

Key messages

• There is a need to focus on organizational factors in order to work against sexual harassment in the restaurant business and is a prerequisite for developing efficient interventions.

• Sexual harassment affects many people in working life and is a serious public health problem. Also, sexual harassment at work maintains gender-based inequalities that exist at a structural level.
A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul
Authors: Yu S , Moon D , Sohn M , Kim J , Chung H
Published: October 2022

South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea.

Key messages

• Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed.

• By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.
Effort-reward imbalance and the mental health of middle managers in Europe
Authors: Vos M , De Moortel D , Vanroelen C
Published: October 2022

Background

According to the Neo-Marxist Class Theory, supervisors’ health is at risk due to their position of authority without strategic power. We investigate how the interaction between the class location and an Effort-Reward Imbalance (ERI) is related to mental health risk, including gender differences and mediation by work-life balance.

Methods

From the 6th wave of the European Working Conditions Survey, we selected workers aged 15 to 64 of the 28 European Member States (pre-Brexit). ERI was measured with 18 proxies for the ERI Questionnaire items. For mental health, the WHO-5 well-being index was used. Relationships were analyzed using linear regression models.

Results

We found evidence for the relationship between ERI and mental health of European employees (ß = -0.641, p < .001), partially mediated by work-life balance. Contrary to previous NMSC studies, we did not find worse mental health for supervisors. The vulnerability for ERI increases with class position (supervisors ß = -0.703; topmanagers ß = -1.099), with supervisors showing a higher mean ERI (subordinates M = 0.445; supervisors M = 0.459; topmanagers M = 0.437, p < .001). The mental health of female supervisors appears more vulnerable to ERI than men’s.

Conclusions

Our findings show that mental health risks of supervisors become apparent especially in situations where esteem, job security and promotion opportunities do not match the status expectations of the position. A labor market policy that encourages organizations to have those tasks performed by their own permanent employees (as opposed to outsourcing them), with a focus on a healthy work-life balance and fair remuneration, can benefit the mental health of this group of employees.

Key messages

• The mental health of employees in higher positions of authority is more vulnerable to situations of effort-reward imbalance.

• European labor market policies focused on security for employees, rather than flexibility for employers, can reduce mental illness among the European middle managers and subordinates.
Evaluation of the prescription amount of narcotic analgesics based on cancer pain relief management
Authors: Park J
Published: October 2022

Background

A basic plan for promoting pain relief management for cancer patients was formulated in Japan, and proper use of narcotic analgesics is being promoted to relieve cancer pain. We aimed to explore the relationship between age and opioid narcotic dose in cancer patients and examine the effects of healthcare systems and social policies to prevent opioid abuse and addiction in a national cohort in Japan.

Methods

Data were collected from April 2014 to March 2019 from the nationwide health insurance claims open database in Japan. Prescription data were collected for opium alkaloids and synthetic narcotics. A multivariate logistic regression analysis was performed based on the age groups and in- or out-of-hospital prescription quantities (mg), taking into account equivalences in quantities of opioids prescribed yearly on the hypothesized relationships between variables.

Results

The average annual quantities of opium alkaloid prescribed gradually decreased by 2.8% (mg = 10,249,115) over six years, especially in in-hospital prescriptions. On the other hand, in-hospital annual prescriptions of synthetic narcotics increased by 24.1% (mg = 2,135,568), out-of-hospital opium alkaloid by 1.3% (mg = 37,565,229), and synthetic narcotics by 25.9% (mg = 1,404,641). Among the demographic variables, cancer patients aged 65 years or older were significantly associated with the types of opioid variables (p < .001) and annual reductions in prescribed amounts (p < .001).

Conclusions

Treatment with opium alkaloids and synthetic narcotics increased among outpatients in the years examined; however, the trend varied across age groups. Our findings suggest that improvements in early detection and treatment have resulted in a rise in the number of cancer patient survivors, thereby leading to an increase in narcotic analgesic dose. The palliative care for cancer patients will contribute as an epidemiological indicator to review the evidence-based health-related impact on public health.

Key messages

• Treatments other than medical intervention should also be considered, taking into account the increase in the number of outpatient opioid prescription recipients due to increased cancer survival.

• Social interventions to prevent opioid abuse during cancer pain relief will contribute to preventing substance abuse by promoting collaboration between clinicians and local communities.
The humanization of care after the COVID-19 pandemic in Italian historical hospitals
Authors: Giusti M , Cosma C , Stefania S , Persiani N
Published: October 2022

Globally, the reforms of healthcare systems aim to bring back the patient at the centre of these organisations after the issues related to the COVID-19 outbreak. The patient returns to be fully considered, as an individual whose must be protected physical and psychological health as well as social well-being. Humanization of care is returning to the foreground. For centuries, art has been used throughout Europe in the health context for its power to support patients in their disease. Today, this approach can be rediscovered in historical hospitals, where tradition, art and assistance coexist. This study aims to investigate the interest for the development of projects for the humanization of care exploiting the artistic heritage of the historical hospitals owned by Health Authorities. The cross-case analysis was chosen as study design. The case studies are the historical hospitals in the city centre of Venice, Florence, and Rome. The evaluation of the proposal was carried out through semi-structured interviews with the general managers of the Health Authorities, the medical directors of the selected hospitals and the delegates for the protection and promotion of cultural heritage. The results were analysed using a qualitative model (coding). All respondents welcomed the proposal to launch projects for the humanization of care that foresee the use of the artistic heritage of the historical hospitals to involve patients in the field of health care. Interviewees expressed the desire to invest human and structural resources in the development of these projects. Moreover, directors suggest choosing a specific target with which to start the experimentation and to dispense a specific training to future engaged social and health personnel. The implementation of projects for the humanization of care using the artistic heritage of historical hospitals can be replicated worldwide where healthcare institutions have a cultural wealth to be handed down, shared and valued.

Key messages

• In the post COVID-19 era, it is strategic to exploit artistic heritage owned by the Health Authority for the positive impact in the patient’s experience.

• Artistic heritage claims its role as a health service for supporting patients, caregivers and also health workforce.
Hospitalist System under the Covid-19 Pandemic: The Perspective of Value Co-creation
Authors: Yan Y
Published: October 2022

Background

The core spirit of the Hospitalist system aims to set up dedicated wards, integrate physician manpower, focus on whole-person care, in order to cope with the aging population and Covid-19 pandemic, and to ensure that both parties, the medical personnel and patients, can provide or receive complete medical care. As the Taiwan medical system is facing a paradigm shift, the Taiwan hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients.

Methods

Hospitalists from 12 hospitals across Taiwan completed a cross-sectional survey. The target population was identified through Taiwan Doctors and Nurses. Survey questionnaire was accessed by 342, incomplete response (18) were excluded and 324 completed responses were analysed.

Results

That the higher the cognition of medical staff on whole-person care, the higher the motivation to participate in cross-team cooperation (F = 35.914, p < 0.001); when the motivation to participate in cross-team cooperation was higher, the behavior of participating in whole-person care also increased. Will be higher (F = 36.483, p < 0.001); whole-person care behavior participation behavior has a significant impact on value creation (F = 21.068, p < 0.001)

Conclusions

As the Taiwan medical system is facing a paradigm shift, the Taiwan hospitalist system will play an essential role in the transition as moving forward to provide professional care for inpatients. This change will make possible the improvement of patient safety and quality medical care. The research results can be provided for reference in European and American countries.

Key messages

• A hospitalist support system is essential for establishing an efficient medical environment and reducing administrative work, which can help hospitals introduce a hospitalist system.

• To build a more stable and sustainable system, it is necessary to create a systemic operational foundation for proceeding with this new hospitalist system.
Continuity of care in Danish peer-led patient online communities on social media. A survey study
Authors: Ledderer L , Karlsson A , Stage C
Published: October 2022

Background

Patients in the Danish healthcare system and other Western countries experience a lack of ‘continuity of care’ due to inadequate communication and sharing of clinical information. ‘Continuity of care’ is often defined as informational, managerial and relational failures. A lack of continuity is particularly problematic for patients with chronic conditions as they are often highly dependent on longitudinal and complex treatment processes. Some of these patients have formed self-organised groups on social media in order to share their personal experiences with the health care system and discuss health related problem with peers. The aim of this paper is to understand the role peer-led online communities (PLOC) play for patients with chronic conditions experiences of continuity of care.

Methods

The material consists of survey data from patients with chronic conditions participating in peer-led online communities on the experience of continuity of care in the Danish healthcare system. A link to the survey was posted in the public online community “Chronic Influencers” (Instagram 10,000 followers), and in the closed Facebook group “Chronic pain patients” (Facebook, 2,200 members). The questionnaire was posted three times between 10 and 30 March 2022.

Results

207 respondents answered all questions in the survey of which 95% were women. Most of them (62 %) were between 36 and 55 years. 37 % live with chronic conditions for more that 20 years. 72 % of the respondent experience lack of continuity with the healthcare system, often with regard to information or communication with health professionals and they look for peers’ advices or experiences in the online groups. 68 % felt recognized by the peers in the online community in another way than in the meeting with the healthcare system.

Conclusions

Patients use PLOC to find and exchange experiences from other patients with chronic conditions about their treatment and especially daily life with chronic conditions.

Key messages

• Patients participating in peer-led online communities provide online support and recognition to each other than that provided by the healthcare system.

• Patients use peer-led online communities to read about other patients’ experiences with chronic conditions and learn about their treatment and daily life.
Evaluation of fall risk factors for among hospitalized patients: systematic review and meta-analysis
Authors: Govoni E , La Porta F , Negro A , Valpiani G , Caselli S , Bassi E , Pecoraro V , Lullini G , Tedesco D , Rolli M
Published: October 2022

Background

Hospitals falls are an important challenge for healthcare systems. An early identification of patients at risk is critical, but no assessing tool has proven to be sufficiently predictive. This review aims at identifying factors associated with an increased risk of falls in hospitalized adults and at mapping them according to main international classification systems.

Methods

We carried out a systematic literature review and metanalysis to detect risk factors positively associated with the increase of falls in hospitals, searching litterature from January 2015 to March 2022. We included studies investigating falling risk factors in patients older than 16 years. Researchers independently assessed records’ eligibility and the methodological quality of included studies was assessed. When possible, data was processed using a random effects model and odds ratio (OR) with 95% confidence interval to quantify the effect. Risk factors were than classified according to ICF, ICD, and ATC classifications.

Results

We included 40 observational studies, enrolling 3,495,552 patients. Considering ICF-factors, mental and sensory functions-pain have a strong association with falls (OR = 3.311 and 2.149, respectively). ICD-factors associated with falls were mental and behavioural disorders (OR = 2.219), diseases of the nervous system (OR = 2.974), and symptoms, signs, and abnormal clinical and laboratory findings (OR = 2.665). Considering ATC-related factors, medications for alimentary tract and metabolism (OR = 1.978), and nervous system (OR = 1.779), showed a strong association with falls. Other factors were also associated with a moderately increased risk.

Conclusions

The comprehensive evidence-based assessment achieved with this meta-analysis alongside with the classification according to ICF, ICD and ATC systems provides a new standardized identification of the risk factors associated with an increase of falls in hospital.

Key messages

• Falls occurring in hospital are an important challenge for health care systems. Therefore the identification of risk factors associated to patients increased risk of fall is fundamental.

• The comprehensive evidence-based assessment achieved with this meta-analysis provides a new standardized identification of the risk factors associated with an increase of falls for hospital.
Age ranges in breast cancer screening: simulated scenarios and analysis of benefits and harms
Authors: Pinto-Carbó M , Vanaclocha-Espi M , Martín-Pozuelo J , Romeo-Cervera P , Hernández-García M , Ibañez J , Castán-Cameo S , Van Ravesteyn NT , Zurriaga O , Molina-Barceló A
Published: October 2022

Background

The Valencia Region Breast Cancer Screening Programme (VR-BCSP) (Spain) invites women aged 45-69 for mammography every 2 years (y). The aim is to evaluate benefits and harms of 3 age range scenarios of the VR-BCSP according to different adherence rates.

Methods

Long-term impact simulation study (2020-2050) of 3 age range screening scenarios (S) for women ≥40y of the VR in 2020 (n = 1487000): S1, 45-69y (current VR-BCSP scenario); S2, 50-69y (excluding 45-49y) and S3, 45-74y (including 70-74y). A biennial screening interval was considered. The simulations were performed for 4 participation rates: A=current adherence (72.7%), B = +5%, C = +10% and D = +20%. Benefit indicators were: nº of BC in situ and invasive (screened vs. clinically detected), nº of BC deaths and % of BC mortality reduction. Harms indicators were: nº of false positives (FP) and % of overdiagnosis. Screening scenarios were simulated using the EUTOPIA evaluation tool.

Results

Considering the current adherence, a reduction of BC mortality was observed in all scenarios (S1A=30.6%, S2A=27.9%, S3A=32.2%). In S2A the harms decreased vs. S1A: nº of FP (236vs423 x1000) and overdiagnosis (4.9%vs5.0%), but also the benefits: BC mortality reduction (27.9%vs30.6%) and nº of invasive BC screen detected (15/28vs18/25). In S3A vs S1A, an increase of benefits was observed: BC mortality reduction (32.2%vs30.6%) and nº of in situ BC screen detected (5/2vs4/3). On the other hand the nº of FP increased (460vs423 x1000), but overdiagnosis decreased (4.8%vs5.0%). All the results with an increased adherence had similar trend as the previous scenarios, showing a gradual increment in BC mortality reduction. Nevertheless overdiagnosis increase significantly in S3 (5.8% in all adherence increments), being higher than S1 (S1B=5.0%, S1C=4.9%, S1D=5.0%) and S2 (S2B=4.9%, S2C=4.9%, S2D=4.9%).

Conclusions

The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis.

Key messages

• The wider age range, the greater reduction in BC mortality but also the probability of FP and overdiagnosis.

• This study provides a balance between benefits and harms of different screening scenarios allowing evidence-based decision making.
Clinical practice variability: a systematic review of shock wave therapy for spasticity
Authors: Faubel R , Martínez IM , Navarro O , Sempere-Rubio N
Published: October 2022

Background

The purpose of this study was to collect and analyse the available scientific evidence on the clinical practice variability and effectiveness of shock wave therapy as a treatment for spasticity.

Methods

the systematic search was performed in the following databases: PubMed, PEDro, Cochrane, Embase, and the Virtual Health Library. All publications from November 2009 to November 2019 were selected that included a sample of patients with spasticity and prior suspension of botulinum toxin, to whom shock wave therapy was applied. The methodological quality of the articles was evaluated using the Jadad scale and the pyramid of quality of scientific evidence.

Results

25 studies involving 866 participants with spasticity were selected. The results obtained suggest that shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect.

Conclusions

shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin. However, due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies.

Key messages

• Shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin.

• Due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies.
Introduction of medical assistants in France: an innovative approach to healthcare access?
Authors: Guyonvarch O , Bourgueil Y , Dugué F
Published: October 2022

Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care. Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas. Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices. How does French model of MAs impact quality and productivity in GPs’ practices and articulate with other policies? We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs’ work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews). MA was defined as a function centered on physicians’ needs, accessible both to administrative staff and nursing professions. MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management. Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise. In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity. However, for most GPs, it primarily helped them to maintain high workload without burning out. Although MAs with clinical background seem better suited for patients’ needs, recent figures have shown that more than half of MAs employed are former secretaries. If in-person secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals. Other aspects than productivity must be taken into account in a support policy.

Key messages

• Regardless of productivity objectives to attain, hiring MAs can relieve physicians’ workload and stress, preventing them from burning out and guarantee access to care in deprived areas.

• MA’s clinical profile could have a stronger impact on public health issues such as chronic disease care management.
Measuring the performance of health systems in Latin America
Authors: Flores S , San Sebastian M , De Alva P
Published: October 2022

Background

Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years.

Methods

Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs.

Results

Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen.

Conclusions

The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making.

Key messages

• Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years.

• Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.
The development of a regional network for health care research in Hamburg, Germany
Authors: Lindemann C , Busch S , Bott T , Meusch A , Loewe B , Scherer M , von dem Knesebeck O , Haerter M
Published: October 2022

Background

At the University Medical Center Hamburg-Eppendorf (UKE), health care research has been established as one of five research priorities recommended by the Research Council with the founding of the Center for Health Care Research (CHCR) in 2006. The CHCR was involved in numerous research projects with the focus on strengthening regional networking. Despite the numerous initiatives, there is still potential for improvement with regard to a systematic and sustainable exchange in the region of Hamburg, Germany.

Methods

These requirements led to the initiation of the ‘Hamburg Network Health Services Research (HAM-NET)'. The mission of HAM-NET is to build an open forum for all relevant institutions, to concentrate their interests and needs in health services research and to promote and conduct innovative, efficient, needs-based and patient-centred health services research projects in the metropolitan area of Hamburg. Three main tasks were appointed: 1) linking health care research to relevant regional institutions, 2) promoting research activities and new fields of research and 3) using methodological expertise to promote young scientists.

Results

By today 40 institutions from all sectors of health care joined HAM-NET. The regularly general meetings offer exchange and advice. Internal communication is promoted by mailing lists and newsletters. Also, HAM-NET presents itself with a website, logo and by organizing recurring events and participating in international and national congresses and networks. Within two funding phases a total of four overarching research projects were developed and implemented. Furthermore, a person with lived experience committee was established.

Conclusions

For the further development of health care research as one the core disciplines of public health a regional network with an efficient infrastructure is needed. HAM-NET promotes this with the implementation of an innovative, efficient and patient-oriented network.

Key messages

• Regional networks help to integrate multiple public health initiatives and community stakeholders.

• Public health networks can be established on multidisciplinary cooperations in different out- and inpatient sector levels.