bluuebunny/crossref_metadata_2025 huggingface dataset:
Concordance between child’s and parents’- reported Health-related quality of life and overweight
Authors: Esposito F , Scrimaglia S , Masini S , Marini A , Gori D , Bragonzoni L , Barone G , Messina R , Gibertoni D , Dallolio L
Published: October 2020

Background

Health-related quality of life (HRQoL) of children is an important health outcome which has frequently been investigated regarding children's chronicle illnesses using parents proxy-reported HRQoL. Obesity is an increasingly frequent condition in children, for which the evidence about perceived quality of life is lacking. The aim of our study is to examine the concordance between child's and parents'- reported HRQoL according to children's weight status.

Methods

A cross-sectional study was conducted in 2019 among 128 children, aged 6-10, recruited in a primary school of Imola (Italy). Children were divided in Group1 (G1: normal-underweight) and Group2 (G2: overweight-obese) using the International Obesity Task Force cut points. HRQoL was assessed using the Italian version 4.0 of Paediatric Quality of Life (PedsQL) questionnaire. We obtained self-reported children's HRQoL total score and the parents' perceived children's HRQoL total score. Each score had two subscales: one for physical health and one for emotional, social and school functioning.

Results

In G1 there were 86 children and in G2 42. The correlation between the children's and parents' HRQoL scores is low in G1 (physical health: 0.24; emotional, social and school functioning: 0.15). Children in G2 and their and parents' perception of physical health are poorly correlated (r=-0.09) and those of emotional, social and school functioning are well correlated (r = 0.43).We observed that in case of discordant HRQoL results, parents usually overestimate their children's HRQoL.

Conclusions

Correlation between the children's and parents' HRQoL scores is low in G1. In G2 children's and parents' perception are concordant for emotional, social and school functioning and unrelated for physical health. It would be useful to investigate whether these results depend from lack of communication between parents and children or lack of parents' awareness of health-related problems with obesity.

Key messages

Parents and children have a discordant perception of physical health quality of life. Further studies should investigate the reasons why these results are discordant.
Aerobic capacity as a protective factor for hypertension in Bogota’s soccer players
Authors: Ramírez J , Gálvez A , Arguello Y , Castro L
Published: October 2020

Background

In Colombia between 1998-2011 the 23.5% of deaths that were reported were from CardioVascular Disease (CVD), 12.4% were caused by hypertensive disease; well now physical activity has been reported as a protective factor for CVD and Hypertension (HT), those people who perform high levels of physical activity have a relative decrease in developing HT by 19%, however what happens when this physical activity takes place with a duration greater than 4 hours a day, with moderate and high intensities, becoming a sports practice, the same benefits or opposite effects would be had, so the objective of the study was to determine the relationship between aerobic capacity and blood pressure in soccer players in the city of Bogotá.

Methods

Quantitative cross-sectional research; blood pressure of 64 players and the aerobic capacity was assessed using the Legger test (VO2 Max).

Results

It was evidenced that 4.6% of the players have hypotension, 50.8% normotension, 30.8% prehypertension and 12.3% stage I hypertension; As regards for VO2 max, 7.7% had an excellent capacity, 73.8% good and 12.3% favorable, there was no relationship between the variables.

Conclusions

Soccer players, although they have good levels of VO2 max, they do not present a decrease in blood pressure data, being mostly within a normal range.

Key messages

Although physical activity is a protective factor for HT. Soccer training does not show a decrease in blood pressure, possibly could be a risk factor for HT and CVD.
Integrative and Complementary Health Practices Building a New Health Paradigm
Authors: Gemeli T , Silva H , Kato M
Published: October 2020

This work arose from the need to broaden the therapeutic approach and offer a differentiated health intervention proposal based on the understanding that the illness process has repercussions on all integrated systems of Being. Since 2019, the Health Center for the Elderly in Blumenau (SC-Brasil), specialized multi-professional service, offering support for biopsychoenergetic transformation with the practice of Yoga and Meditation, through a holistic and comprehensive view of health. It begins with the Multidimensional Assessment of the Elderly, with a guideline in welcoming and qualified listening, which considers the subject and all subjectivity. From there, the expanded diagnosis and the Singular Therapeutic Project are built and the consultations with the team and the 'Re-Conhecer group' begin. The activity is weekly, aimed at the elderly and their family, takes place in an appropriate place and lasts two hours. Welcoming, pranayama, mantras, kriyas and meditation are made, as well as reflections on free themes. The professionals who conduct the practice are the dentist, trained in yoga, and the social worker, the welcoming process continues individually after the activity. Due to subjectivity, results are routinely collected in a qualitative way from the participants' report. There is a perception on the part of the participants, therapists and members of the multidisciplinary team that this work provides improvement in cognitive abilities, self-care, well-being, self-confidence, creativity, improved sleep, autonomy, balance, strengthening bonds, joy, vitality.

Key messages

This initiative builds new models of health care, transcending the traditional biomedical model, according to the operational guideline for comprehensiveness, universal access and equity. Provokes reflections and builds a new perspective of life with quality and participation of the elderly as subjects of their health.
Knowledge, attitudes and beliefs on organ donation among students and lecturers in Quito, Ecuador
Authors: Lima dos Santos S P , Rueda Gómez C A , Fernández M J , Vallejo J
Published: October 2020

Countries have reported that people's attitudes towards organ donation are influenced by knowledge, education and religion. In Ecuador, more than 800 patients are on the waiting list for an organ; likewise, the population does not recognize the importance of the donation. Although, since 2011, the Organic Law of Donation and Transplantation of Organs, Tissues and Cells states that all Ecuadorians are donors, but still, the high number of people on the waiting list is not well understood. The purpose of this study is to determine the factors towards organ donation of students and lecturers of the Pontifical Catholic University of Ecuador. This is a cross-sectional study, and the universe was the entire population; however, only 469 (students) and 321 (lecturers) answered, despite our efforts. We applied an anonymously validated questionnaire, and we sent it for five months by email. 89.8% of students and lecturers agreed with the donation; however, 10.2% of the students refused, and 14.6% of lecturers were undecided (p < 0.001). The highest hesitation was found in the age group between 36-64 years (14.2%), while the most refusal was found in the young adult, 9.4%. 40.1% of them alluded to have regular knowledge, while 27.9% claimed to have low knowledge about organ donation (p = 0.016). Based on their opinion, 65.9% said that a person with brain death could not recover, although 26.9% did not know (p = 0.023). 38.9% affirmed they did not know if their religions agreed with the donation. 78.5% claimed the best methods could increase the number of donors is education. Public health in Ecuador does not have sufficient regulations through its state policies that should favour recipients. If each citizen knows that their organs save lives, the waiting list will decrease, and state expenditures will reduce. However, the populations' beliefs are still related to an abuse of authority to donate organs without the consent of relatives.

Key messages

With better strategies to increase awareness of the importance of organ donation, great results. It will increase survival rates, improve quality of life and decrease health expenses.
Barriers to exercise among participants of a bariatric surgery program from a Brazilian capital
Authors: Aguiar J , Pinto M F , Rodrigues I R C , Freitas L R N , Brito L L , CO Mota  , Santos A L B , Gurgel L A , Machado S P
Published: October 2020

The aim of this study was to analyze the perceived barriers to exercise and its associated factors among participants of a bariatric surgery program, in a reference hospital, from a Brazilian northeastern capital. Therefore, the Scale of Benefits and Barriers to Exercise (EBBS), which used only the domains related to the dimension of the barriers that evaluate them in four subdimensions (physical effort, environmental, time and family) was applied with 289 patients (49 men and 240 women) with a mean age of 43 years (SD 8.6), who were in the pre (n = 81) or post (n = 208) operative period. It was collected information about their sex, age, weight and height (for BMI calculation), exercise (WHO recommendations were used), and if they had already undergone bariatric surgery. To analyze the associations and estimate the prevalence ratios of the variables in relation to the barriers, Poisson Regression was used. The level of significance was set at 5%. In the general assessment of barriers, it was found that physically active patients (PR = 0.78 95% CI = 0.72-0.83 p < 0.001) have less perception of barriers than inactive ones. In the physical effort and environmental subdimensions, the assets (PR = 0.82 CI95% = 0.76-0.88 p < 0.001 and PR = 0.78 CI95% = 0.73-0.84 p < 0.001, respectively) and those who have already undergone bariatric surgery (PR = 0.88 CI 95% 0.80-0.97 p = 0.014 and PR = 0.88 CI 95% = 0.80-0.96 p = 0.006, respectively) have lower perception of barriers. Those over 42 years of age (PR = 0.88 CI95% 0.81-0.95 p < 0.001) and the active ones (PR = 0.79 CI95% = 0.73-0.85 p < 0.001) have lower perception of barriers of the time sub-dimension. In the family sub-dimension, there was no association between the variables studied and the perception of barriers. It was concluded that being physically inactive, not having undergone bariatric surgery and being under 42 years old is associated with a greater perception of barriers to exercise.

Key messages

The health service can use the findings to track those most likely to use barriers to exercise. The health service can propose personalized physical activities to reduce barriers to exercise.
Young multiple sclerosis in Italy: attitude towards present life and expectations for the future
Authors: Bezzini D , Vaccaro M C , Bandiera P , Messmer Uccelli M , Battaglia M A
Published: October 2020

Background

Multiple sclerosis (MS) is usually diagnosed between 20 and 40 years, affecting the most productive and active period of life.

Aim

To analyse the health perception of young people with MS and to compare the present results with a previous one.

Methods

A descriptive cross-sectional study was conducted in 2017. A validate and anonymous questionnaire was administered to 613 Italian young, aged 18-40, affected by MS (women 78.5%).

Results

Analyzing the declared health status, most of young MS defined good health status (76% good or excellent health) with differences between age class (82% at 25-29 years vs 71% at 35-40) and with a reverse trend with the increasing of disability (92% in subject with no disability vs 34% in ones with a medium or severe disability). The comparison against 2004 data highlights an improvement in the health conditions perceived, also for ones with a serious disability. Regarding the time elapsed from diagnosis, the trend was not linear, since respondents with a diagnosis <1 year indicated a worst health condition than those with a diagnosis from 5 to 10 years. Significant percentage of them paid attention to positive attitudes in health promotion: 71% practiced physical activity, 70% controlled smoke and alcohol consumption, 38% was on a special diet.

Conclusions

Diagnosis and disability constitute a decisive factor in the assessment of the state of health, but the perception goes to stabilize with time, even if the conditions tend to worsen. In this regard, the worst declared conditions in patients with a recent diagnosis seem to be influenced by psychological factors. So, the moment of diagnosis need a better management. Only 30% got adult vaccination (vs 61% in young Italians) due to lack of information on vaccine safety in MS patients. The improvement of perceived health in young with MS is another proof of the progress of MS treatments, which appears transversal to all the conditions of disability.

Key messages

The perception of health is strongly related to disability and to time elapsed from diagnosis. In the last 15 years the progress of MS management improved well-being of all MS young patients.
Multisector prevention of childhood obesity in a Finnish municipality - factors perceived as crucial
Authors: Koivusilta L , Alanne S , Mustila T , Kamila M , Ståhl T
Published: October 2020

Background

Obesity among children threatens health and life expectancy. Risk factors interact in complex ways on individual, household, and community levels. Interventions on lifestyle factors have been targeted at children. Although some have impacted weight gain positively, environment and policy approaches by multiple actors across the society, especially when integrated in everyday life could have longer lasting effects. In Finland, multisector collaboration is enabled by several institutional structures, such as child welfare clinics and student welfare services. We studied in a municipality how administrative sectors and some key NGOs contributed to the prevention of childhood obesity, and particularly, which were the factors seen as potentially crucial.

Methods

The informants were purposely selected, being those, who had operated in the process of health promotion in the City of Seinäjoki (Finland) in 2009-2016. They represented several administrative sectors, either as office holders at the managerial level or as working at the operational level or in NGOs. In total, 37 participated (1 refusal) the semi-structured interviews, which were recorded, transcribed verbatim (355 pages), anonymized, and analyzed with deductive content analysis.

Results

There emerged six entities of factors crucial for obesity prevention: strong and long-term commitment to health promotion both at the administrative and executive levels; activity aiming at well-being of all inhabitants; a shared view of the importance of preventive work and multiprofessional collaboration; competent and development minded personnel, appropriate administrative structure and the strong leadership role of the health promotion coordinator; the light administrative structure of the Finnish municipality; convenient size of the municipality.

Conclusions

There was a shared opinion among the interviewees about the crucial elements of multisectoral collaboration for obesity prevention.

Key messages

Multisectoral collaboration and strong commitment to long-term activity both at the administrative and executive levels form key elements in the prevention of childhood obesity. A supportive administrative structure in a municipality together with strong coordination of health promotion are important prerequisites for the prevention of childhood obesity.
Mediterranean nutrition and physical activity education program at deaf and hard of hearing community
Authors: Bizirgianni V , Bakola M , Kitsou K S , Sakaretsanou A K , Jelastopulu E
Published: October 2020

Background

Today's eating reality includes a more westernized dietary pattern which seems to erode sensitive groups of our populations, such as people with disabilities. Deaf and hard of hearing people(DAHOHP) are a marginalized community in our country, whose access to the health system, health education, nutrition and exercise is limited. Our aim was to promote health education, focusing on Mediterranean diet and physical activity, through an alternative approach, that of the Greek sign language.

Methods

A three-day training program was created for the members of the Association of deaf and hard of hearing persons in Central Greece. Analysis of the nutritional profile of everyone was performed and an in-depth presentation of all aspects of the Mediterranean nutrition was showed. Furthermore, an experiential training on the size of food portions of all categories was performed and information and recommendations on physical activity were given. Adherence to the Mediterranean diet was assessed by the MedDietScore (range 0-55), Body Mass Index (BMI) and frequency of food consumption were evaluated.

Results

A total of 25 individuals (25-70 years old, 62% men) participated in the program. The average BMI was 26.2 kg/m2 in women and 25.9 k/m2 in men. Increased body weight was observed in women, whereas in men it was normal. The average questionnaire score was 31/55 for women and 29.6/55 for men, which indicates a good compliance with the Mediterranean-Diet in both. Women consumed smaller portions and fewer meals in all food groups/day, whereas men showed a high intake of alcohol/day.

Conclusions

Concerning DAHOHP's knowledge and adherence at the Mediterranean nutrition pattern, a good compliance was observed. However, hearing loss tends to disrupt interpersonal communications. Consequently, it severely restricts/isolates such individuals to their own closed groups with possibly experiencing diminished self-esteem and becoming more vulnerable to abuse.

Key messages

A need to promote health and dietary-behavior modification in people with disabilities such as DAHOHP, is obvious and immediate, by exploring incentives to improve their quality-of-life.
Importance of health education actions to improve quality of life of vulnerable populations
Authors: Jara Baraybar Alvarenga de Oliveira A , Albertini Reis B , Fedrigo B , souza vasconcellos G , Bertaglia L , Espinosa M V , Benevides M H , Nagano Nishida N , Succi G , Moreira A
Published: October 2020

Introduction

Health Education (HE), which is an integral part of Brazilian basic health care policy, reflects on the actions of a specific service or area. In regions where access to health care is precarious and poor socioeconomic conditions predominates, HE is fundamental for the comprehension of the health-illness process which aims at promoting a better quality of life. This study aims to assess through experiment the viability and adhesion of HE actions conducted in indigenous and Riverside communities in the Brazilian Amazon region.

Methodology

This study aims at reporting field trips during health expeditions between July and August 2019 in communities of the state of Pará, Brazil. The HE was composed by seven students and professors. Throughout patient's medical care, the team selected individuals to participate in different group dynamics at common spaces in the community area. The topics covered had been pre-screened based on epidemiological surveys conducted in previous expeditions. Visual and ludic resources were adapted to match local reality.

Results

2860 medical and dental care consultations were given. The adherence to the dynamics in was significant and covered the majority of them. The topics approached by the HE team were breast-feeding, family-planning, non-transmissible chronic diseases, healthy eating habits, hygiene, and awareness for natural resources. It has been observed that culture was a determinant factor for small a number of individuals in the comprehension of actions taken by the HE team.

Conclusions

Despite the strong cultural influence, HE proves to be a fertile ground and it must be encouraged in indigenous and riverside communities. The actions taken by the HE team should consider the local reality in every step of the process of implementation. In spite of the context in which locals of indigenous and riverside communities are inserted, HE promotes an autonomous development of their quality of life.

Key messages

Health education is one of the pillars of the national policy of basic health care in Brazil and is fundamental to promote better quality of life in vulnerable populations. Encouraging interventions in vulnerable communities contributes directly to the autonomous development of quality of life.
Health Literacy regarding people with intellectual disability 'Our right to a healthier future'
Authors: Skes M , Lukavečki V , Radašević H , Živec M , Polić-Vižintin M , Šostar Z
Published: October 2020

Background

People with disabilities make 10,1% of the City of Zagreb society in 2019. Intellectual disability makes 4,8% of total disability population. One of the main goals of Zagreb Strategy of Equal Opportunities for People with Disabilities from 2017 to 2020 is the accessibility to health care and services. Andrija Stampar Teaching Institute of Public Health undertaken public health initiative “Our right to a healthier future” in the City Zagreb in 2019.

Objectives

The aim was to recognize the need for early risk factors prevention, to increase health literacy and to improve access to health-care for adults with intellectual disability in Social-humanitarian organization and Daily Center Ozana.

Results

In order to assess the health status and health-related lifestyle attributes a multidisciplinary approach was carried out including a total od 53 adults with intellectual disability in Center Ozana. Activities included preventive exams, conducted workshops with individual counseling about healthy and unhealthy lifestyles. Hypertension was found in 14,9% adults with intellectual disability using standard diagnostic criteria (i.e. BP ≥ 140/90 mm Hg). High blood sugar was found in 15,7% adults. Body mask index (BMI) was calculated. The awerage was slightly higher in woman (28.8) then in man (27.6).

Conclusions

Healthcare service have predominantly focused on the primary disability. The multidisciplinary approach and collaboration could help to achieve better health for people with intellectual disability. Obesity is a significant health problem for people with intellectual disability. Causes are multifactorial and obesity leads to a higher risk of developing chronic conditions, such as diabetes and heart disease. It is important to understand where and how they need help and support in health terms and what resources and assets they already have or can access if needed.

Key messages

The health literacy concept for people with intellectual disabilities should not be dominated by specific perspectives, such as functional health literacy. Caregivers, family and supporters are a very important factor for health-related decision-making and health literacy for people with intellectual disabilities.
The burden of low back pain in Malta at a population level
Authors: Cuschieri S , Calleja N , Gorasso V , Devleesschauwer B
Published: October 2020

Background

Low back pain (LBP) is a leading global cause of all-age years lived with disability (YLD). Studies conducted in Malta reported that musculoskeletal complaints were the commonest in primary care. The aim was to estimate for the first time the burden of LBP at population level in Malta in terms of disability-adjusted life years (DALYs) and compare to estimates obtained by the Global Burden of Disease (GBD) study.

Methods

LBP prevalence data were obtained from the Maltese European Health Interview Survey dataset for 2015 through representative self-reported history of chronic LBP for 12 months in combination to the extent of daily activities limitation. Proportions of LBP severity (with and without leg pain -mild, moderate, severe and most severe) and their corresponding disability weights followed values reported in GBD study. YLDs for LBP were estimated for the whole population by sex. Since LBP does not carry any mortality, YLDs reflected DALYs. The estimated local DALYs per100,000 were compared to the GBD study for Malta for the same year.

Results

Point prevalence of LBP causing a limitation was of 6.3% (5.6% males; 7.0% females), contributing to a total of 27,006 Maltese suffering from LBP. Global LBP DALYs were of 783 per100,000. Females experienced higher LBP burden per100,000 (876 DALYs) than males (689 DALYs). On comparing these DALYs to those reported by GBD study, a discrepancy was observed per 100,000 (Global LBP 1,828 DALYs; Males 1,657 DALYs; Females 1,999 DALYs).

Conclusions

LBP imposes substantial burden in Malta, which is expected to increase with the ageing population. Since etiology of LBP is multifactorial, it is suggested that a multi-disciplinary targeted preventive and management approach is considered. Differences observed between local estimates and those of the GBD study suggest the integration of locally sourced data into the model in order to improve the DALYs estimates of each country.

Key messages

Low back pain is a public health burden. Locally sourced data is suggested to be integrated with the GBD study to improve the DALYs estimation for each country.
Person-centred care in complementary medicine for individuals with chronic conditions in Australia
Authors: Foley H , Steel A , Adams J
Published: October 2020

Background

Increasing chronic condition diagnoses burden public health systems, individuals and communities. The duration and complexity of chronic conditions require ongoing, multifaceted care - such as person-centred care (PCC) - to address the individual needs and quality of life for patients. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines the extent of PCC being experienced by patients with chronic conditions who consult CM practitioners.

Methods

Cross-sectional survey (n = 191), conducted nationally, November 2018 to March 2019, in clinics of the five CM professions most commonly consulted by individuals with chronic conditions in Australia (massage, chiropractic, osteopathy, acupuncture, naturopathy). Participants with chronic conditions (n = 153) were surveyed about experiences of PCC during CM consultation, and regarding consultation with medical doctors, using four validated measures.

Results

During consultation with CM practitioners, patient perceptions of PCC were consistently high. Ratings of PCC were consistently higher for consultations with any CM practitioners (summary mean 3.33) than consultations with medical doctors (summary mean 2.95). The highest mean scores for PCC were reported by patients of naturopaths (summary mean 4.04). Variations in perceived PCC for different items between professions indicate nuance in the experience of consultation across different CM professions.

Conclusions

This study indicates PCC is characteristic of CM consultation, which may reflect CM philosophies such as holism. CM practitioners may present an existing resource of PCC. Further attention should be given to CM professions regarding the potential to address unmet needs of individuals with chronic conditions, and subsequently to better manage the public health burden associated with chronic conditions.

Key messages

Person-centred care appears to be a consistent characteristic of complementary medicine clinical care for individuals with chronic conditions. Due to rising rates of chronic conditions and the associated burden on public health systems, complementary medicine professions should be considered as a resource to optimise chronic illness care.
Towards a positive health approach – a professional perspective
Authors: Overmars-Marx T
Published: October 2020

Background

The current view on health and disease is changing in the Netherlands. When the idea 'from illness and care to health and behaviour' was adopted by one municipality in the Netherlands, a movement to bring positive health into practice was initiated. Accordingly, health professionals, social workers and policy officers were trained to help residents adapt and self-manage in order to improve their health. Two years after the onset of the project, an evaluation study was conducted to evaluate the following research question: “to what extent has the view on health and disease changed from 'illness and care' to a more positive approach focusing on 'health and behaviour'?”

Methods

Both quantitative and qualitative methods were applied to gain more in depth information on how the positive health approach was adopted in practice and which barriers and facilitators professionals experienced. Structural questionnaires were filled in by 24 professionals, a focus group interview was conducted with 7 professionals, and one of the researchers attended two peer coaching sessions.

Results

The following four themes were obtained from the qualitative analysis: perception of the training, residents and their self-management, positive health approach facilitates collaboration, and integrating a positive health approach in the (financial) structure of health care.

Conclusions

The training encouraged the positive health approach, in which professionals are enthusiastic about helping residents adopt self-managing skills to improve health. Nonetheless, specific tools for adopting the positive health approach in specific professional settings are still lacking. Furthermore, the participants emphasized the importance of facilitating a partnership between local government and health insurers for further development of the positive health approach.

Key messages

The training sessions encouraged professionals to support the positive health approach. Facilitating a partnership between the local government and health insurers is needed for further development of the positive health approach.
New cervical screening program in Albania. Access and barriers in all levels of health system
Authors: Ylli A , Filipi K , Shundi L , Fico A , Risto M , Xhani A
Published: October 2020

Background

In 2019 Albania started a national screening program which uses as primary screening examination the high risk Human Papilloma Virus (hrHPV) testing. It targets women 40-50 years old providing systematic screening tests, as part of the routine examinations at primary health care centers. The evaluation study aimed to identify the performance of the program in its first year, barriers and satisfaction of women.

Methodology

A representative sample of 200 women, positive in screening test, was retrieved from the database of program information system. They were interviewed during the period October-November 2019, using a standardized questionnaire.

Results

Although the risk of being hrHPV-positive was higher in cities (OR = 1.52; 95%CI=1.29-1.81), the program was used more by women living in rural areas compared to those living in urban areas (OR = 1.81; 95%CI =1.74-1.89). 60.2% of women found the vaginal sampling procedure very simple and 72.4% not at all painful. 95.8% of women received the test results within two months. At the time of the survey, 90.4% of HPV-positive women had gone for follow up visit (71.7%) or were planning to go as soon as possible (18.7%). 35.2% of women who have performed colposcopy, have chosen private healthcare, with 7.8% going abroad. Higher education increased the odds to use a private facility or go abroad for the follow up visit. 87.2% of women reported substantial worries about the positive result. 89.8% of the sample rated the overall service as 'good' or 'very good'.

Conclusions

While results from the first evaluation show good acceptance from users, the program should address the proportion of women who chose private clinics for follow up examination.

Key messages

Results from the first evaluation of the cervical screening program in Albania show good acceptance from users. Program should address the proportion of women who chose private clinics for follow up examination.
Continuing and online education for health professionals in Brazil: Results from UNA-SUS
Authors: Gasque K C S , Lemos A F , Rodrigues M M S , Vilaça J P V , Araujo D G , Campos F , Passos M F D
Published: October 2020

UNA-SUS System was established to enforce the National Policy of Continuing Education in Health, and it is composed of a Network of 34 public institutions (mostly Universities), responsible for online educational offerings, in response to the demands generated by the Ministry of Health. The system produces courses that are committed to the 2030 Agenda for Sustainable Development (specially Goals 3, 4, 5, 10, and 16).

Objectives

to verify the profile of users and the penetrance of UNA-SUS online courses and their contribution to the democratization of Continuing Education of health workers.

Methods

Data were collected from Arouca Platform and statistical analysis was performed by the Open Free Software R 3.6.

Results

There were more than 2.8 million enrollments, counting more than 1 million students, from every SUS health regions, Brazilian municipalities and states. Courses with the greatest demands were related to important clinical situations faced by the Primary Care professionals in Brazil. There was a predominance of women (80%), whites (36%), followed by browns (33%), singles (57%) and in the age group of 21 to 40 years (70%). Nurses, doctors and dentists were the professionals who most sought courses at UNA-SUS. No relationship was found between enrollment in population-weighted self-instructional courses and the Brazilian State HDI, but a negative relationship was established between the Gini coefficient and enrollment in courses, showing that the more unequal the region, the fewer enrolled students it had.

Conclusions

The UNA-SUS is effective in providing continuing education through free, online course offerings, reaching users from different Brazilian geographic regions, including those leaving in areas with few presential or free educational opportunities, contributing to improve the service offered by the Brazilian Public Health System.

Key messages

Continuing education for Health Professionals in Brazil using online education courses is democratic. UNA-SUS is an effective system to consolidate the National Policy of Continuing Education.
How professions make intersectoral governance happen in the context of Denmark
Authors: Burau V , Ledderer L , Kuhlmann E
Published: October 2020

Background

Intersectoral governance is recognised as key to achieving better healthcare, but our understanding of how to make this happen is limited. Earlier studies on individual professionals fail to acknowledge the resources of health professions as collective actors and pay very little attention to professional agency to support intersectoral governance. The aim is to add new knowledge on how professions contribute to intersectoral governance in healthcare.

Methods

The study develops a novel conceptual framework, distinguishing between the what, the how and the why of professional agency. The study is based on a secondary analysis of five qualitative case studies of coordination in Denmark, conducted 2011-8 and with a total of 89 hours observations, 18 focus groups, 36 interviews. The case selection identified studies from different organisational settings. Coordination was the key indicator of intersectoral governance and used for coding and for drawing up a data display for more systematic analysis.

Results

Health professions engage in a wide range of coordination activities; this includes documenting, monitoring, meeting, giving practical support and teaching. Health professions employ diverse mechanisms to adapt coordination activities to local contexts; this is about flexibility and combining mechanisms in a highly tailored way. When they engage in coordination activities, health professions draw on two different rationales: one relates to better healthcare services for patients, the other to professional interests, including work conditions.

Conclusions

Health professions engage in coordination that spans sectors, organisations and/or professional groups; thus professions are key to making intersectoral governance happen.

Key messages

Health professions have many resources highly relevant for coordination. Policy and administrative decision makers need to better support health professions to strengthen intersectoral governance.
Integrated transitional care for older patients discharged from hospital and ED
Authors: Jensen N , Pulkki J , Liljas A E M , Burström B , Andersen I , Schön P , Tynkkynen L-K , Keskimäki I , Jämsen E
Published: October 2020

Background

Care integration through high level care continuation for older patients discharged from the hospital may secure positive health outcomes and reduce subsequent emergency visits. Integrated transitional care is, however, challenged by fragmented care delivery systems. We explored integrated transitional care from the delivery system perspective in three Nordic cities (Copenhagen, Stockholm and Tampere) to compare levels of integration of social and health service delivery systems and care paths for older patients discharged from hospital.

Methods

Information on organizational structure and care integration was obtained from administrative documents, legislation and statistics, webpages of the cities, and empirical studies. Based on the material we outlined the degree of integration at different levels and mapped the possible care paths for older patients discharged from the hospital for each city.

Results

All three cities are characterized by fragmented care systems for older patients based on financially and organizationally independent institutions. Sweden and Denmark, however, have introduced legislation to steer the integration of services between the local and regional level actors. However, older patients still have complex care paths after discharge from hospital care.

Conclusions

The fragmented care systems for older patients consisting of independent institutions across local and regional levels may impede integrated transitional care. Alternative care settings for older people with different needs could be an asset, but they can also form a hurdle for care continuation if the responsibilities and liaison between these sites are not clear.

Key messages

The fragmented organisation of care systems for older patients may impede integrated transitional care. The care facilities for older patients after discharge is targeted to accommodate the complex and varying needs, but pose challenges for continuity of care.
Is the EU ready for a generic set of indicators for health system performance? A qualitative study
Authors: Perić N , Ullmann T , Hofmarcher M M , Or Z , Simon J
Published: October 2020

Background

As part of the EU funded BRIDGE Health project, 23 headline indicators for assessing and comparing the performance of public health systems were proposed. They were shortlisted out of the currently existing and often overlapping pool of over 2000 health system performance assessment (HSPA) indicators. In this qualitative study, we explored their validity and perceived national-level utility for policy making and factors affecting the potential uptake of an indicator hierarchy (headline, operational & explanatory levels) at Member States' and EU levels.

Methods

Semi-structured interviews with a purposive sample of 24 policy makers and senior policy advisors from 15 EU Member States and one candidate country were performed between July and November 2018. All interviews were transcribed and coded using summative and directed content analysis to generate thematic categories in MAXQDA.

Results

Preliminary results suggest that experts positively perceived the overall balance of the shortlist across performance domains reflecting most of the important policy areas. However, some further amendments to the generic set of indicators were recommended to increase their policy relevance and measurement validity while keeping the size manageable. The concept and usage of headline HSPA indicators is mostly viewed as a communication tool whereas more granular information at explanatory levels is perceived to be more appropriate for data driven policymaking and cross-country learning.

Conclusions

Interviews showed a considerable heterogeneity in the feasibility of applying a generic HSPA framework in an EU-wide health strategy as a compass for improvement through comparisons of health systems. Factors such as flexibility in adaptation to the national context, improvement in building knowledge capacity, potential misinterpretation in the 'European Semester' context, as well as lack of appropriately defined benchmarks were recurrent themes in hindering its uptake.

Key messages

Policy makers assess explanatory level indicators to be more actionable than headline level indicators. To facilitate the use of headline indicators at EU-level as a navigation tool for health systems, the list has to be stable to create trends and sufficiently flexible in adapting to new priorities.
Responsibilities for patients? A comparison between US-based VA and the Danish healthcare system
Authors: Jervelund S , Miake-Lye I , Shekelle P , Goldzweig C , Froelich A , Krasnik A
Published: October 2020

Background

The European healthcare systems aim to leave no one behind. Responsibility for the patients may nevertheless be less clearly placed, even in a welfare context such as the Danish healthcare system (DHS). Contrastingly, the Veterans Affairs (VA) in the US is known for their high quality of care and strong care coordination. To understand how responsibility for patients is understood in VA and DHS, we investigated how health providers in the two healthcare systems view their responsibilities to the patients and which tools are used to support responsibility for patients.

Methods

Semi-structured face-to-face interviews with 23 managers and healthcare providers in VA and DHS were conducted in 2013 and 2014. The interviews were of 42-82 minutes of duration and transcribed verbatim. Data were analysed using thematic analysis.

Results

The responsibility for the individual patient was clearly placed on the general practitioner in VA, and VA providers felt responsible for their enrolled patients and not just the patients who seek care. In DHS, the responsibility of the treatment was often divided between several providers and this often created dissonance on who is responsible for the care. VA providers made a systematic and active effort to reach out to the individual patients who do not turn up for an appointment as well as for clinical outliers who had pronounced medical needs. In DHS, the responsibility of seeking and attending healthcare laid upon the individual patient. DHS providers seldom played an active part in contacting no-show patients resulting that vulnerable patients may not get the care they need.

Conclusions

Learning from VA suggests that a clear placement of responsibility will help patients, especially vulnerable patients, to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools or who need the care the most supporting high quality of care.

Key messages

Clear placement of responsibility for patients will help vulnerable patients to get timely and well-coordinated care. Patient outreach is an important tool to grasp vulnerable patients who are likely to fall between two stools.
Effectiveness of interventions related to continuity of health care in five Latin America countries
Authors: Espinel-Flores V , Vargas I , Samico I , Eguiguren P , Mogollón-Pérez A , López J , Bertolotto F , Vázquez Navarrete M L
Published: October 2020

Background

Evaluation of interventions to improve continuity of care across care levels is scarce in Latin America. The

Aim

to analyse the impact of implemented interventions on the perception of continuity of care of chronic patients in public health care networks of five LA countries (Brazil, Chile, Colombia, Mexico, and Uruguay).

Methods

Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN) were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying CCAENA questionnaire® to a sample of patients with chronic conditions (392/network; 784/country/year). Result variables: information continuity (exchange of clinical information) and clinical management continuity (repetition of exams, accessibility of primary care (PC) and secondary care (SC), perception of agreement between PC and SC doctors and of collaboration between PC and SC doctors. Descriptive analysis were conducted, and chi-square test was calculated to determine significant changes.

Results

An increase in the perception of continuity of information between care levels was observed in the IN of all countries, but Colombia. Clinical management continuity: decrease in the repetition of exams and increase in accessibility of consultation with the specialist in all countries but Mexico. The accessibility of PC doctor decreased in the IN in all countries. No differences in the perception of agreement between PC and SC doctors regarding diagnosis, treatment and recommendations were found. The perception of collaboration between PC and SC doctors increased in the five countries.

Conclusions

Consistent with expected results, the level of perceived information continuity and clinical management continuity increased in the IN, with differences between countries. Further multivariate analyses will be conducted to explore the differences between the IN and CN.

Key messages

Provides a cross-country comparison of the perception of continuity of care in patients with chronic conditions. Contributes to fill the knowledge gap on the effectiveness of participatory interventions improving continuity of care.
Pain assessment of elderly with neurocognitive disorders in long-term care: an occupational lens
Authors: Ruest M , Léonard G , Lagueux E , Boissy P , Milot M H , Bourbonnais A , Guay M
Published: October 2020

Background

Occupational performance of older adults living in long-term care facilities is influenced by environmental possibilities and service provision. Pain among older adults with neurocognitive disorders might be a factor mitigating functional status. However, pain evaluation during daily routine through advanced stages of the disorder is scarce.

Objective

Identify pain-related behaviors of older adults with neurocognitive disorders during their morning routine in long-term care facilities.

Methods

A multiple-case study based on an embedded concurrent mixed methods design (quan-QUAL) was conducted in Quebec (Canada) in three long-term care units. Older adults with a neurocognitive disorder were observed (from 7:00 to 12:00 AM) and evaluated through the accomplishment of their morning routine. Through inter- and intra-case analyses, pain assessment scales (PACSLAC-II, Algoplus and DS-DAT) and morning routine assessment (occupational therapist's observations of the person, occupations and environment, functional autonomy measure, field notes) were integrated in mixed methods matrixes.

Results

Sixteen (n = 16) participants (average age: 76 years old [59, 93]) with various but advanced functional declines and pain symptoms were included. Participants' significant occupations all related to basic activities of daily living. Hygiene care and getting dressed were occupations for which an alteration of occupational performance was identified.

Conclusions

During their morning routine, older adults with a neurocognitive disorder living in long-term care facilities are facing pain symptoms and occupational deprivation, limiting the fulfilment of their needs and their engagement in occupations. Accordingly, older adults' occupations in relation to their environment should also be considered in future studies investigating pain.

Key messages

Occupational performance of older adults with a neurocognitive disorder living in long term care facilities is limited to basic activities of daily living. Assessment of pain of patients with a neurocognitive disorder in long-term care units should include the identification of environmental and occupational factors contributing to this pain.