bluuebunny/crossref_metadata_2025 huggingface dataset:
Collaboration between the National Institute of Health Somalia and the Public Health Agency of Sweden
Authors: Ahrne M
Published: October 2023

Public Health Agency Sweden (PHAS) has been funded by Sida to provide support and assist in capacity building of the National Institute of Health (NIH) Somalia for six years (2019-2025). The PHAS work closely with the Federal Ministry of Health Somalia, Member States and partners like WHO Somalia, Africa CDC and academic institutions to establish NIHS as an institution that can be sustained and grow over time, and that can contribute to the public health and health system infrastructure of Somalia. Main areas of collaboration 2019-2023 have been technical support to the joint taskforce on Integrated Disease Surveillance and Response (IDSR); supporting basic level field epidemiology training to front line health care workers; organizing workshops in data analyses, visualisation and reporting together with SPIDER/Stockholm University and Statistics Sweden. Building research capacity has included organizing a digital workshop: Reconstructing public health institutions in Somalia at the16th World Congress on Public Health 2020, Rome, Italy and support to the 1st NIH Research Conference 30 January - 1 February 2022 in Garowe, Puntland: “Laying the Foundation for Health Research in Somalia”. The hybrid conference attracted more than 180 participants from different universities. The tentative plan for the remaining project period include recruiting two Somali-speaking public health experts to develop the human resources and institutional capacities in order for NIH to become a centre of excellence for public health in Somalia. The main focus area for the remaining project period is supporting the development of the disease surveillance system including methods for analysis and reporting data. Research capacity workshops will be organized and supported, as well as a 2nd NIH Research Conference in 2024. Another important task is resource mobilization for long-term sustainability and coordination with other stakeholders.

Key messages

• Supporting the development of the disease surveillance system including analytical skills and reporting of data is key.

• Coordination with other stakeholders and resource mobilization for long-term sustainability is essential.
Exploring avoidable, preventable, treatable mortality trends and effect factors by income level
Authors: Yang H S , SY Kim  , JH Park
Published: October 2023

Background

Avoidable mortality (AM) mean death caused by insufficient health policy and health care intervention, and is a rising public health issue. Income polarization in healthcare utilization is a significant concern. The aim of this study was to derive the trend and effect factors of AM, treatable mortality (TM), preventable mortality (PM) according to income levels in South Korea over the period 2008-2017.

Methods

This serial cross-sectional analysis was conducted using national health information data from 2008 to 2017. AM was classified based on criteria presented by the Office for National Statistics in 2011. Age-standardized AM was analyzed annually according to income levels. The odds ratio of AM was examined using multivariable logistic regression after adjusting health behaviors and clinical variables collected in 2016-2017.

Results

There were persistent income inequalities in AM, and the degree of inequality was larger in PM than in TM throughout the period. Medical benefit recipients had an AM of about 8.5 times higher than the highest income quartiles, and men were three times higher than women. In 2016-2017, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher and 1.5 times higher in the first quintile. The risk of AM remained significantly higher in low-income levels even after adjusting for health behaviors and clinical variables.

Conclusions

While AM in South Korea has decreased over time, it remains high in low-income levels. There was a statistically significant difference in AM based on income level. Therefore, inclusion in health policy and services development and in health promotion programs is urgently required to address avoidable deaths and health inequalities for low-income levels.

Key messages

• AM in South Korea have declined over time, but, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher.

• Among health insurance eligible people, the first quintile, the more the proportion of TM and PM, and the highest income quartile, the lower the proportion of non-avoidable deaths.
The use of social media in the self-management of chronic diseases: views of patients and doctors
Authors: Dudina V , Judina D
Published: October 2023

Background

Despite the deep integration of social media into daily self-management practices of people living with chronic conditions, there are still conflicting opinions about the role of social media in disease self-management. Comparing the perspectives of patients and physicians is useful in understanding potential tensions and facilitating more effective collaboration between patients and physicians. The aim of the research was to find out the opinions of patients and doctors about the benefits and risks of using social media for disease self-management.

Methods

We used mixed methods convergent parallel design combined an internet survey and in-depth interviewing. We collected data from online questionnaire posted in online communities for people with chronic diseases on social media platforms Vkontakte and Facebook (N 204). The qualitative phase used in-depth interviews with doctors (N 23). We analyzed quantitative data in SPSS and qualitative data in Nvivo.

Results

From the perspective of patients, the main benefits include access to information about treatment through peer-to-peer expertise (70,8%) and sharing personal experience of disease (60,9 %). Patients indicated risks of unproved information (92,2%) and breach of anonymity (71,5%). All interviewed doctors were skeptical about benefits of the use of social media by patients. They see the main risks in the dissemination of unreliable and unqualified information about treatment and the destruction of the usual patterns of doctor-patient relationship.

Conclusions

There are contradictions between views of patients and doctors on benefits and risks of using social media in disease self-management. Doctors underestimate the role of social media in chronic diseases self-management and doubt in ability of patients to critically evaluate information.

Key messages

• Understanding differences in viewpoints can help improve doctor-patient relationships in an eHealth environment.

• Resalts promotes patient empowerment. Research was supported by RSF (project No 22-18-00261).
Value-based care models for chronic hepatitis B and C among vulnerable populations: a scoping review
Authors: Adduci A , de Mattia E , Paoletti F , D'Agostino M , Salerno P , Farina S , Boccia S , de Belvis A G
Published: October 2023

Background

Chronic viral hepatitis B and C are a significant public health burden worldwide. The prevalence of these infections is much higher among migrants than in the general population, due to factors such as inadequate access to healthcare. The EU VH-COMSAVAC project aims to implement community-based HBV/HCV models of care among migrant populations with documented high HBV/HCV incidence and prevalence, using person-centred referral processes. Our study aims to provide an overview of the scientific evidence on value-based models of care for prevention, treatment and linkage-to-care in high-risk groups.

Methods

This scoping review was performed in the context of the EU VH-COMSAVAC project, following the PRISMA-ScR Checklist, by searching on 5 databases: Medline, EMBASE, GlobalHealth, Scopus and Web of Science. Articles published up to December 2020 investigating models of care targeting migrant populations and related to HBV/HCV prevention, treatment and linkage-to-care, were included.

Results

Out of a total of 2,767 articles screened, 83 were included and preliminarly categorized according to stages of care (prevention, treatment and linkage-to-care) and Bodenheimer’ pillars. Further investigation will be conducted concerning the dimensions of patient experience; utilized resources; population health; care-team well-being.

Conclusions

Implementing patient-centered care models for critical public health issues among specific populations is becoming incresingly relevant. This study will provide the conceptual basis for building a value-based assessment tool capable of evaluating new models of care for prevention, treatment and linkage-to-care for hepatitis B/ C in high-risk groups.

Key messages

• In order to reach viral hepatitis elimination targets, initiatives must pay particular attention to high-risk groups.

• The value (population health, patient experience, care-team wellbeing and costs) of such care strategies should be assessed to contribute to their continuity.
Mapping activities on climate and health to the essential public health operations (EPHO)
Authors: McGurnaghan P , O'Donovan D
Published: October 2023

Issue/problem

Variation exists in the degree to which public health organisations are taking action on climate change and health. However, all countries must effectively and rapidly operationalise climate and health strategy in order to protect national and global population health. Among the challenges, public health systems can have difficulty in conceiving practical ways of taking action.

Description of the problem

Our objective was to develop a resource to support public health organisations in identifying how they can begin to address the issue of climate change and health. It was important for the resource to be balanced in terms of providing tangible examples whilst being sufficiently high level so as to enable translation to different contexts. The method involved using the World Health Organization's essential public health operations (EPHOs) as a framework upon which to describe suggested actions on climate change and health. A collection of expert reports on climate and health were selected and each of the ten EPHOs were cross-referenced against these.

Results

The results are illustrated in a spider diagram in which examples of public health activities are written around the ten standard icons of the EPHOs, and shown connected to these by adjoining and interconnected lines. The visual nature of the diagram is planned to assist the user in more readily appreciating the relevance of climate and health activities in the wider context of the conventional public health agenda.

Lessons

To our knowledge, potential climate change and health activities have not been mapped to the EPHOs before. Users are encouraged to adapt the diagram as a living document in their own organisations and to update it iteratively, as well as in the light of new published expert recommendations on climate and health. Since the model is based on the WHO EPHOs and contains only high level examples, it is hoped it could prove relevant across settings and countries.

Key messages

• Based on published recommendations, we mapped high level activities on climate change and health to the World Health Organization’s essential public health operations (EPHO).

• Since the model is based on the EPHOs, it is hoped it could prove relevant across settings and countries, and help to address barriers to public health action on climate and health.
Healthy ageing in a gentrified city: perspectives of older adults from Porto
Authors: Santos C J , Silva J P , Torres E , Barros H , Ribeiro A I
Published: October 2023

Background

Neighbourhood transformations like gentrification can affect health outcomes. Gentrification is understood as a set of processes of sociospatial change driven by investments in the built environment oriented to the preferences of affluent people. However, little is known about the impact of gentrification on older adults. We aimed to understand how older people perceive gentrification how it relates to healthy ageing.

Methods

This qualitative study, conducted in 2022, was based on nineteen semi-structured interviews of older adults (≥60 years) from the EPIPorto cohort living in Porto, a hotspot of gentrification. Individuals were selected through purposive sampling based on four features: sex, education, homeownership, and area of residence. Inductive thematic analysis was performed using NVivo.

Results

Most respondents identified changes in the physical environment and how it is used due to gentrification, namely concerning green and leisure spaces, food and beverages outlets, housing and commerce. It was also mentioned that gentrification leads to a shortage of affordable housing and weakens social cohesion. Participants described that changes in the physical environment due to gentrification can contribute positively to their well-being, while others admitted a higher cost of living and increased vulnerability to worse mental health. Yet, some interviewees revealed little or no influence of gentrification on healthy ageing.

Conclusions

Gentrification has dual and disparate effects on older adult's health and well-being. Policies should maximize the health benefits of gentrification, while protecting citizens from the negative effects.

Key messages

• Considering people’s perspectives on gentrification and healthy ageing is essential to plan age-friendly cities and achieving better health outcomes.
The obesogenic environment and incident cardiovascular disease in The Maastricht Study
Authors: Chan J A , Bosma H , Schram M T , Stehouwer CDA , Lakerveld J , Koster A
Published: October 2023

Background

The built environment has been identified as an upstream determinant of cardiovascular disease (CVD) in which neighborhood walkability and healthy food environments may promote increased physical activity and healthier dietary intake. Our aim is to determine if these neighborhood environments are associated with decreased incidence.

Methods

Data from 6,563 participants of The Maastricht Study and Geoscience and Health Cohort Consortium between the ages of 40-75 without history of CVD were analyzed. Objective walkability was measured by the 7-component Dutch Walkability Index while the food environment was an aggregate score of available food outlets, within 1000m Euclidian buffers around residential addresses of participants. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Incident CVD was obtained from a follow-up questionnaire. A Cox regression analysis was performed with CVD morbidity time to event outcomes adjusting for demographic and socioeconomic covariates.

Results

Over a median follow-up of 7.2 years (1.0-12.0 years), 975 cases were reported. The most walkable neighborhoods were not associated with incident CVD for both perceived (HR: .80; 95% CI = .64, 1.00) and objective (HR: 1.14; 95% CI = .91, 1.43) neighborhood environment measures compared to those living in the least walkable neighborhoods. When considering individual CVD conditions, participants had statistically significant lower incidence of peripheral vascular disease in the highest perceived walkable neighborhoods (HR: .57; 95% CI = .41, .78). The healthiest food environments (HR: .84; 95% CI = .66, 1.06) were not related to incident CVD.

Conclusions

Objectively measured walkability and neighborhood food environment were not associated with overall incident CVD with participants in our study. We found perceived neighborhood walkability to be associated with lower incident peripheral vascular disease.

Key messages

• Research on the obesogenic environment should additionally be carried out in other regions to gain additional understanding of its effect on cardiovascular disease.

• Further study on the impact of walkable environments on individuals with peripheral vascular disease should be considered to understand its effect with this population.
Risk exposures in early life and incidence of early-onset colorectal cancer across countries
Authors: Wang Z Y , Yao W Y , Wu W M , Huang J J , Ma Y L , Yang C , Shi J F , Fu J X , Wong MCS , Xu W H
Published: October 2023

Introduction

Globally, the incidence of early-onset colorectal cancer (EoCRC) is increasing, indicating substantial changes in risk exposures. However, little is known about the environmental risk factors for EoCRC in young populations.

Methods

CRC incidence and risk factors data (1990-2019) were extracted from the GBD 2019. Age-standardised incidence of EoCRC and summary exposure value (SEV) of risk factors were estimated with the GBD world population standard using direct method. Early-life exposures were estimated as the gross domestic product (GDP) per capita, the socio-demographic Index (SDI) and the SEV of risk factors in previous decades and at age of 0-4, 5-9, 10-14 and 15-19 years. Average annual percent changes (AAPC) and their 95% confidence interval (CI) were calculated by Joinpoint regression. Associations between risk exposures and incidence were examined at national level by weighted linear or non-linearity regression.

Results

The global age-standardized incidence of EoCRC increased from 3.05 (95%CI, 3.03-3.07) per 100 000 in 1990 to 3.85 (95%CI, 3.83-3.86) per 100 000 in 2019. The incidence was higher in countries with high socioeconomic level, but increased drastically in countries in East Asia and Caribbean, particularly in Jamaica [AAPC: 5.1% (95%CI: 3.2, 7.0)]. The GDP per capita, SDI, and SEV of iron deficiency, alcohol use, high body mass index and child growth failure in earlier years were more likely to be associated with the incidence in 2019. Exposures in four age windows in early-life were significantly associated with the incidence, particularly for the exposures at age of 15-19 years. Similar association patterns were found in both gender.

Conclusions

The global, rapidly rising incidence of EoCRC highlights the importance to screen and control the cancer in young populations. The associated risk factors at country level in early life suggest the contribution of the early-life exposures.

Key messages

• Incidence of EoCRC is increasing globally, which was most notable in countries or regions that are undergoing rapid demographic and epidemiological transitions.

• This study demonstrates significant associations of economical and life-style factors in early-life with the incidence of EoCRC at country level.
Recurrence of wheeze in preschool aged children: a retrospective cohort study in primary care
Authors: Creese H , Hargreaves D , Foley K , Saxena S
Published: October 2023

Background

Approximately 1 in 7 children with wheeze will be admitted to hospital for treatment, often leading to repeat visits to emergency departments and hospital admissions. The UK lags other wealthy countries in the management of preschool wheeze and has amongst the highest rates of asthma deaths in Europe. There were reports that wheeze and asthma admissions to hospitals fell during the Covid-19 pandemic lockdowns, but the changing community incidence is unknown. We aimed to report the changing incidence of recurrent wheeze across the Covid-19 pandemic.

Methods

Using data from the UK Clinical Practice Datalink, a nationally representative sample of the UK population, we followed a cohort of 57,603 children aged 1-5 years who consulted their general practitioner with their first wheeze attack between January 2009 and July 2020. We calculated the incidence of wheezing recurrence by calendar year. We will calculate the incidence rate ratios for recurrent wheeze by level of area-based deprivation whilst accounting for potential confounders including child age, sex, birth weight, gestation age, ethnicity, comorbidities, bronchiolitis, maternal smoking, maternal asthma, and maternal age at birth.

Results

The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic (e.g., 2019: 27% vs 2020: 23%) even though total wheeze events in general practice fell from 3,135 in 2019 to 1,280 in 2020.

Conclusions

Around a quarter of children with wheeze have repeat visits to the GP. Our next steps are to identify preventive actions to reduce the risks of recurrent wheeze for children presenting with their first wheeze attack in primary care.

Key messages

• Around a quarter of children will have a repeat visit to the GP for wheeze within the first year after their initial wheeze attack.

• The incidence of recurrent preschool wheeze remained stable across the Covid-19 pandemic.
Age trajectories of disability in middle and older age: a machine learning approach
Authors: Chang Y-H , Chung R-H , Lu X-H , Chiou H-Y
Published: October 2023

Background

The study employed machine learning methods to explore age trajectories of Instrumental Activities of Daily Living (IADL) disability in a representative cohort of middle- and older-aged individuals. This is crucial for understanding the impact of disability onset on healthy life expectancy (HLE) across sub-populations.

Methods

We utilized data from the Taiwan Longitudinal Study on Aging, which included 5,334 individuals aged 50 and over from 1996 to 2011. To investigate the change in physical functions, we focused on the 6 IADL items assessed over five waves of surveys. Each IADL item was dichotomised and summed to calculate a disability score ranging from 0 to 6 based on its difficulty level. We used K-means clustering to identify IADL disability trajectories and applied 10-fold cross-validation, repeated ten times, to select the optimal classification. We transformed the identified groups into age trajectories based on the mean IADL score at each age within each group. The age trajectories were then smoothed using locally estimated scatterplot smoothing and generalized additive models.

Results

We identified four trajectory groups based on changes in IADL scores over 15 years: (1) individuals who remained consistently able, (2) individuals with persistent and slower decline, (3) individuals with persistent and faster decline, and (4) individuals with persistent disability. The proportions of the four groups were 56.1%, 20.0%, 16.1% and 7.8%, respectively. The average posterior probabilities for all groups were above 83.3%. The results of this study were comparable to those of traditional regression-based models. We also analyzed the associations between trajectory group membership and participants’ characteristics at baseline.

Conclusions

This machine learning approach based on K-means clustering is valuable for investigating diverse disability trajectories within the population and can inform future research to explore factors that may enhance HLE.

Key messages

• Machine learning enables investigating disability trajectories across sub-populations.

• The study identified four distinct disability trajectory groups using K-means clustering, providing insights into factors for enhancing healthy life expectancy.
Night shift work and sickness absence – many for the few or few for the many?
Authors: Larsen A D , Nielsen H B , Nabe-Nielsen K , Kolstad H A , Hansen ÅM , Hansen J , Garde A H
Published: October 2023

Background

Night shift work is related to adverse health outcomes. Yet, some choose working permanent night and it is speculated that they tolerate night work better. However, research on permanent night work is sparse. The aim was to study the association between organisation of night work and sickness absence. Should we allow many night shifts for the few or should we enforce few night shifts for the many?

Methods

Information on working hours, age (19-70 years), gender (women, men) and sickness absence (annual number of days) was obtained from 94 815 nurses and nurse assistants (88% women) from the Danish Working Hour Database (DAD). DAD contains daily information on working hours based on payroll data for all employees in Danish public hospitals (2017-2020). For each year with >50% work participation, individual schedules were classified into “no night shifts”, “1-50 night shifts”, “51-100 night shifts”, “101-150 night shifts” and “more than 150 night shifts”. We applied linear regression (with individual as random intercept) for risk of sickness absence the following year adjusted for age, gender and calendar year.

Results

Preliminary results showed night shift workers with more than 150 night shifts per year had 5.0 more sick days (95% CI: 3.5-6.4, p = <0.001) than employees with no night shifts. No statistically significant differences were observed between the four night shift groups.

Conclusions

Employees had more sickness absence the year after working during the night compared to employees without night shift work. However, no differences were seen when yearly comparing employees with many night shifts to those with few night shifts.

The study adds to scientific support to guidelines on scheduling of shift work in governmental policies with the aim of securing healthy and safe workplaces.

Key messages

• Night shift workers have higher number of sick days compared to daytime workers; however, number of night shifts during a year did not affect the results.

• The study adds value for the use of the scientific recommendations for minimizing health risk for night shift workers in governmental policies with the aim of securing healthy and safe workplaces.
Novel ways to drive catch-up vaccination of adult migrants in UK primary care: a pilot study
Authors: Crawshaw A F , Goldsmith L P , Deal A , Carter J , Knights F , Seedat F , Iwami M , Wurie F , Majeed A , Hargreaves S
Published: October 2023

Adult and adolescent migrants to Europe may have missed routine vaccinations and must be aligned with European schedules, but awareness and implementation of catch-up guidelines in UK primary care is poor. We conducted a pilot study of novel primary care mechanisms (May ‘21-Sept ‘22) to explore under-immunisation and increase catch-up vaccination of migrants ( > =16 years, born outside W. Europe, N. America, Australia, or New Zealand) in 2 London boroughs. We recorded vaccination history, past vaccine-preventable diseases (VPD), and prompted staff to offer MMR, Td/IPV, HPV, MenACWY vaccines according to UK guidelines on uncertain or incomplete immunisation status. Data were analysed in STATA12. We included 57 participants (mean age 41 [SD 7.2] years; 62% female; mean 11.3 [SD 9.1] years in UK) from 18 countries. Demographic distributions were not significantly different between boroughs (sites) for age, sex, or years in UK, but differed by birth region (p < 0.0001). Nearly all participants required vaccination for MMR (86%) and Td/IPV (88%), suggesting migrants would benefit from catch-up vaccination on arrival.12/22 participants reported a past VPD (15 cases including measles, rubella, pertussis, active TB, HPV, hepatitis A, HPV, meningitis). 93% of participants were referred for catch-up vaccination and 81% had at least one dose (at study end). Start of vaccination was higher in Site 2 (100%) than Site 1 (44%). Half (30, 59%) of those referred for MMR completed the course (2 doses) by study end. Less than half (17, 41%) referred for Td/IPV had received at least 1 dose at study end. Direct and indirect barriers exist to delivering catch-up vaccines to migrants, including staff knowledge/training; incomplete vaccination records; lack of incentives, time and care pathways. Designated staff champions, financial incentives and awareness are needed to drive catch-up vaccination in primary care, alongside novel ways to deliver vaccinations at scale and in the community.

Key messages

• Designated staff champions, incentives and other mechanisms to raise staff awareness and willingness to engage with guidelines are needed to drive catch-up vaccination in primary care.

• Novel ways to deliver vaccinations at scale and use of community-based or community-led interventions are needed to advance vaccine equity and ensure inclusion of marginalised migrant groups.
Integrated maternity care in Finland: mothers’ experiences and professionalś perceptions
Authors: Paavilainen M , Kalliolehto J , Vuorenmaa M , Gissler M , Heino A , Hujala A , Jouhki M R , Kaarakainen M , Raussi-Lehto E , Klemetti R
Published: October 2023

Background

Divided responsibility to organise primary and specialised maternity care is common. In Finland, this has caused increasing number of visits and poor information flow between the care sectors. Some counties have had vertically integrated care sectors for a few years. Thus, we aim to study mothers’ experiences on care in counties with integrated care (IC) and non-integrated care (NIC), as well as perceptions of maternity care managers about the integration.

Methods

FinChildren Survey data 2020 on mothers with small babies (N = 8,923) and qualitative thematic interviews for maternity care managers (N = 8) were used. IC-counties were compared to NIC-counties adjusting for confounders in logistic regression. Over 30 indicators on motherś experience were used as outcome measures. The qualitative data were analysed with content analysis.

Results

Mothers were often more satisfied with care in IC- than in NIC-counties. 72% of first-time mothers in IC-counties compared to 66% in NIC-counties considered visits in antenatal clinics customer-oriented (adjusted OR 1.30 (1.05-1.63)). 87% of mothers in IC- and 81% in NIC-counties received adequate professional support for personal coping during pregnancy (OR 1.57 (1.08-2.27)). 64% of mothers in IC- and 56% in NIC-counties found prenatal classes beneficial for fear of childbirth (OR 1.44 (1.04-1.98)). However, part of the indicators did not show difference in motherś experience on care between IC- and NIC-counties. Maternity care managers felt that the fragmented structures within maternity care together with organisational boundaries pose a challenge to integrated care. Shared structure, management and information systems were seen as promotors for integration.

Conclusions

Integration of maternity care is to some extent associated with positive experience. However, maternity care should be better integrated in terms of structures, resources and management, to guarantee continued care and support for mothers and families.

Key messages

• Integrated maternity services are essential from the perspective of pregnant mothers.

• Shared organisational systems are needed to ensure sustainable care for mothers and families.
Monitoring the outpatient process: the Teaching Hospital of Siena experience
Authors: Guarducci G , Vannini P , Cuccaro C , Messina G , Golinelli D , Nante N , De Marco M , Barretta A D
Published: October 2023

Background

Nowadays, the outpatient process is assuming an increasingly central role health authorities’ strategic planning, which is why it is necessary to develop new approaches and specific skills to ensure its more effective organizational management. The aim of this paper is to illustrate how the Teaching Hospital of Siena (THS) has responded to the demand for outpatient services and its fluctuation after the COVID-19 pandemic.

Methods

A retrospective study was conducted on outpatient services’ prescriptions and provisions of the catchment area of THS during years 2021 and 2022. The prescription data was extracted from the regional computer system “Business Object”, while the provisions data from information flow of outpatient service. Monthly data were divided into two fortnightly periods; the prescription fortnight was associated with the dispensing fortnight of the following period. The statistical analysis (T-test and linear regression) was carried out with STATA. Significance level was set at 95%.

Results

During studied period, the demands increased from 2.728±407 twice-weekly prescriptions in 2021 to 3.054±502 twice-weekly prescriptions in 2022 (p < 0.05). At the same time, the provisions increased from 1.152±162 in 2021 to 1.470±196 in 2022 (p < 0.05). The relationship between fortnight of prescription and subsequent provision shows a R2 of 0.6921 with an angular coefficient of 0.4025[95%CI: 0.3755-0.4295] (p < 0.05) in 2021 and an R2 of 0.7396 with an angular coefficient of 0.4729[95%CI: 0.4463-0.5011] (p < 0.05) in 2022.

Conclusions

The results show the resilient response of THS to the increase in services’ demand after the COVID-19 pandemic, avoiding system distress and recovering the backload of patients in the waiting lists. This result is due to a refinement of the outpatient process, through the creation of an Operational Management Team, the implementation of process monitoring, the reorganization of slots and the extension of outpatient activity hours.

Key messages

• It is essential to consolidate more appropriate and organizationally efficient forms of healthcare services.

• Monitoring hospital processes is important to respond to the increasing population health needs.
Is violence a gender issue among community health agents in Northeast Brazil?
Authors: Vieira-Meyer A , Ferreira RGLA , Albuquerque G A , Aguiar A S , Guimarães JMX , Morais APP , Meyer CHC , Castro M C , Yousafzai A K , Guedes F
Published: October 2023

A biopsychosocial phenomenon, violence may be defined as the hurtful outcome of conflicting social forces. Violence affects individual and collective health, creating a demand for targeted public policies and the implementation of services for the prevention and treatment of injury. Community Health Agents (CHAs) are the link between the Brazilian primary health care system and the community. As they live and work in the same neighborhoods, they are involved in what happens in the community, including observants and or potential targets of violence. We aimed to investigate the violence to which CHAs are exposed and if female CHAs experience and or perceive violence the same way as male CHAs. A structured questionnaire applied to CHAs was used to collect information. Two periods (2019 [n = 1402] and 2021 [n = 364]) were compared. The sampled CHAs were found to be highly exposed to violence (>80%), whether as victims in the workplace and at home or as witnesses within the community served. In general, while the occurrence of violence towards CHAs decreased, their perception of community violence increased. Moreover, between 2019 (before the Covid-19 pandemic) and 2021 (a year into the pandemic) the prevalence of perceived urban/community violence (physical aggression, assault, stabbing, lethal and non-lethal gunshots, and gang violence) increased among female CHAs, but remained practically unchanged (with the exception of ‘assault') among male CHAs, indicating a gender-related difference for this variable. In addition to impacting the health and work routines of CHAs, violence is also injurious to the health of the community (directly or indirectly - inability of CHA to deliver care). Given the complexity of violence and its repercussions on the daily routines of CHAs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

Key messages

• CHA are highly exposed to violence (> 80%), whether as victims in the workplace and at home or as witnesses within the community served.

• There is a gender-related difference for the perception of violence among CHA, which may be due to social inequalities or women's vulnerability to violence.
Care pathways for older multimorbid patients: lessons learned from 16 clinical sites in 3 Countries
Authors: Ferrara L , Ardito V , Tozzi V , O'Sullivan B , Staines A , Davies P , Tarricone R
Published: October 2023

Background

The fact that multimorbid and vulnerable patients need improved care coordination is well known. However, current healthcare system is still mainly single-disease oriented and as a result, coexisting morbidities are often under-evaluated and under managed leading to inappropriate care, inefficiencies, duplication and poor quality of care. We also know that different strategies have been developed to manage older multimorbid patients and varies from one country to the other. We therefore aimed to describe the care pathway for older, multimorbid cancer patients to understand current practices and shed light on the care pathways currently followed by the 16 clinical sites in 3 Countries that are participating to a EU funded research project.

Methods

Semi-structured interviews were conducted in each site with key, relevant stakeholders (e.g., oncologists, geriatrician, nurses). An interview outline was drafted and followed systematically, to collect coherent responses across centres. Overall, 39 interviews were conducted. Evidence of the interviews were processed under several dimensions, including but not limited to organizational context, health care professionals involved, multidisciplinarity, spaces and organization of the activities.

Results

The analyses highlighted high variability in the process of care of older multimorbid patients across countries and centres. In particular, the organizational context in which each site is embedded affects its operating conditions and there are at least three dimensions that affect the delivery of patient care: a) the scope of the services offered by each clinical site within the care pathway; b) the relationships between health care professionals, including access to specialist knowledge; c) the tools available to ensure integration between the different professionals in the different stages of the care pathway.

GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218.

Key messages

• Multimorbid patients need improved care coordination but current healthcare system is still mainly single-disese oriented.

• Delivery of patient care is affected by the scope of the services offered by each hospital, the relationship between professionals and the operational tools available.
University students’ predictors of vaccine intention toward routine vaccination: a systematic review
Authors: Mussetto I , Bernucci M C , Isonne C , Kaminska A E , Iera J , Migliara G , Marzuillo C , Villari P , Baccolini V
Published: October 2023

Introduction

Vaccine hesitancy is a major challenge for national immunization programs, especially after the COVID-19 pandemic, which disrupted routine coverage for many vaccinations. Therefore, we systematically examined the determinants of vaccination intention among university students, an age group undergoing training, and for this reason particularly receptive to educational campaigns.

Methods

We searched PubMed, Scopus, and Web of Science. Studies were considered eligible if they analyzed vaccination intention(s) (i.e., sure/willing vs. unsure/unwilling) through multivariable logistic regression analyses in university students. All routine vaccines were considered. Study quality was assessed using the Newcastle-Ottawa scale. Determinants were grouped into three categories: contextual, individual and group, and vaccine/vaccination-specific influences. A narrative synthesis of the results was performed.

Results

A total of 14.940 articles were retrieved. Of these, 40 were included, 34 regarded the Human Papillomavirus (HPV) vaccine, and 6 on influenza (flu) vaccine. Out of the 282 factors found, 231 regarded the HPV vaccine. Among the contextual influences, age, gender, and sexual behavior were the most studied, whereas “HPV knowledge” (N = 44) and “awareness” (N = 16) were the most investigated among individual and group influences, showing also higher rates of statistical significance with the outcome. Lastly, among vaccine-specific influences, “healthcare professionals’ recommendation” was the most studied. As for the flu vaccine, 51 factors were found, with ‘Previous flu vaccination’ (N = 5) being the most investigated and always positively associated with vaccine intention.

Conclusions

Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively. These results should be used in planning educational campaigns to increase vaccine uptake in this subgroup.

Key messages

• Vaccine Hesitancy (VH) is a major public health issue and a challenge for national immunization programs.

• Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively.
Negotiating healthy food retail initiatives: An ethnographic study of a partnership with supermarkets
Authors: Duus K S , Tjørnhøj-Thomsen T , Krølner R F
Published: October 2023

Background

The health promotion literature advocates for partnerships with private actors, but scholars have called for detailed knowledge on the development of interventions in studies using such co-approaches. This study aims to increase our understanding of how such partnerships influence intervention development and content. In 2019, researchers at the National Institute of Public Health, Denmark, established a partnership with the food retailer Salling Group and the Danish Cancer Society, which will be the case used in this study. The vision of the partnership was to develop and test healthy food retail initiatives to make the healthy choice the easy choice for customers.

Methods

We performed a focused ethnographic study from the initiation of the partnership (2019) until the feasibility test of the initiatives (2021). We used participant observation of meetings and intervention development activities, interviews with partners, and document analysis of e-mail correspondences and project materials. We analysed data abductively with inspiration from a chronological narrative analytical approach and concepts of partnerships, negotiation, and institutional logics.

Findings

We identified six phases of the development process, characterized by randomness, compromises, fear, conflicting logics, and unforeseen events. We show how 1) a random meeting and initial verbal agreements between a few persons affect the mindset and decision-making of the partners, 2) conflicting logics can both hinder and facilitate the development of initiatives, and 3) the process is shaped by unforeseen events i.e., Covid-19 restrictions, and organisational changes.

Conclusions

This study highlights how fragile public-private partnerships are and the significance of each step taken. To succeed with effective health promotion in the retail setting partnerships may benefit from being flexible and investing time in forming a shared understanding based on discussions of different perspectives.

Key messages

• Partnerships between academics and non-academics are fragile and unpredictable.

• Negotiation of healthy food retail initiatives is facilitated and hindered by differences in institutional logics.
Is the education of the parents differently associated with their children health literacy?
Authors: Rosário R , Silva M J , Duarte A , Martins J , Martins S , Lopes C , Augusto C
Published: October 2023

Background

Parents with higher levels of education tend to have better abilities in searching and integrating health information, which can ultimately benefit their childreńs health literacy. We aim to analyse the associations between childreńs health literacy and parents’ education in families with school-age children.

Methods

A total of 735 children (51.7% boys) with a mean of age (SD) of 7.7 (1.2) years old, participated in this study. Childreńs health literacy was measured with the HLS-Child-Q15, which contained 15 items assessing the child's perceived ease or difficulty in finding, understanding, appraising, and applying health information (α = 0.7). A mean of all items was conducted along with a median split (limited and sufficient health literacy). Parents self-reported their education (e.g., primary school, secondary schools and higher education) and family income. Binary regression models were used, adjusting for age and income.

Results

Boys whose mothers had a higher education degree had lower odds of achieving sufficient health literacy (adjusted odds ratio (aOR)= 0.4, 95% confidence interval (CI)=0.1; 0.9). In contrast, boys whose fathers had a secondary or higher education degree had a significantly higher odds of achieving sufficient health literacy (aOR=2.3 (1.1; 4.7) and 2.9 (1.2; 6.9, respectively), irrespective of their age and income.

Conclusions

The indirect association between mothers’ education levels and their sons’ health literacy, and the direct association of fathers’ education levels on their sons’ health literacy, could be explained by previous research that has linked a motheŕs education level to the quality of everyday childcare and a fatheŕs education level to the access of higher social positions and resources, that ultimately can be invested in the child's health literacy. Future intervention studies should take into account the important role of fathers in improving childreńs health literacy, mainly in boys.

Key messages

• Parents with higher levels of education tend to have children with better health literacy.

• There are significant associations between parentśeducation and childreńs health literacy, mainly in boys.
Health literacy, quality of life and burden of informal caregivers in Portugal
Authors: Pedro A R , Avelar F G , Raposo B , Brandão D , Amaral O , Escoval A
Published: October 2023

Background

The process of informal caregiving may have significant impacts on physical, psychological, social and economic conditions of informal caregivers. Worldwide lower levels of health literacy are associated with worse informal care, reduced quality of life and higher burden of informal caregivers. The aim of this study is to assess the correlation between health literacy score (HL), quality of life (QoL) and informal caregiver burden in Portugal.

Methods

A cross-sectional study was conducted through an online survey directed to informal caregivers. Three validated scales were applied in Portuguese versions: a) European Health Literacy Survey (HLS-EU-PT-Q16); b) European Quality of Life Questionnaire (EQ-5D-5L), c) Modified Caregiver Strain Index (M-CSI). Overall statistical analysis and the Pearsońs correlation test at 5% significance level were performed in SPSS®.

Results

In total, 760 informal caregivers were surveyed, mean age 57 years (±9.9), 92.5% female, 62.6% married or living with a partner, 41,5% at least university level, 44.4% works full or part-time. Regarding the process of care, 78.9% takes care of one person, 85.2% have been caring for more than 1 year, 54.3% feel that are not supported at all, and 20.3% do not feel competent to care. The mean HL score of informal caregiver (n = 673) was 31.9 (+7.8), QoL (n = 733) was 0.8 (+0.2), and burden (n = 760) was 14.8 (+5.3). HL Score is directly correlated with QoL (r = 0.215; p < 0.001) and inversely correlated with informal caregiver burden (r=-0.150; p < 0.001).

Conclusions

A higher health literacy score is associated with better quality of life and lower informal caregiver burden. Improving health literacy may be strategic to promote health conditions and quality of life and care for both the informal caregiver and the person being cared for.

Key messages

• A higher health literacy score is associated with better quality of life and lower informal caregiver burden.

• It is crucial to invest on the definition of an integrated strategy, between Health and Social Security, to provide better health conditions to informal caregivers.