bluuebunny/crossref_metadata_2025_split huggingface dataset:
Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area
Authors: Vivas T , Duarte M , Pitta A , Christovam B 
Published: October 2020

Abstract

Background
The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs.

Methods
This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform.

Results
The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years.

Conclusions
Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges.

Key messages
Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.
Adult mental health centre – A case study report from Slovenia
Authors: Makivić I , Tomšič V , Rešeta M , Mahne N , Selak Š , Švab V 
Published: October 2020

Abstract

Issue
There are two main public mental health problems in Slovenia: suicide and harmful alcohol consumption. The average suicide rate (25 per 100.000 people) is above the European average. There are substantial differences in the accessibility of mental health services and socio-economic and demographic differences within individual geographical areas. To address those challenges the establishment of comprehensive and accessible mental health centres within local environments were planned.

Description of the Problem
First ten adult mental health centres (AMHC) were established last year, one covering population of approximately 80.000 people. The implementation process is well established, while the evaluation process has just begun and assessment of characteristics of the population covered by one of the first AMHC serves as the basis.

Results
There were 74 people in medical treatment in one of the rural AMHC in Slovenia in 2019, mostly women (68.9%) and older people (x ̅=61.9). The income of people included is very low (x ̅=523 EUR). The number of hospitalisations were higher before inclusion (x ̅=1.2 before; x ̅=0.2 after). Beside regular treatment patients receive non-pharmacological therapies such as health education (90.5%) and occupational therapy (47.3%). Within first patients’ assessment mostly the physical health needs, psychological distress, daytime activities and safety to self were not met, which changes after the second assessment (p &lt; 0.05, t &gt; 2.000).

Lessons
Multiple needs of the patients seem to be well addressed through comprehensive, multidisciplinary team work and intersectoral collaboration at local level (e.g. with social work centres, family physicians, non-governmental services).

Key messages
Patients’ needs are well addressed through patient-centred approach at local level. Comprehensive, multidisciplinary team work and intersectoral collaboration at local level can address multiple needs of the patients.
Assessment of the occupational health and safety system in local health centers in Metro Manila
Authors: Uezono D , Medina B , Reario A , Salcedo T , Borromeo L , Camacho V 
Published: October 2020

Abstract
The environment of health care workers (HCWs) is considered as one of the most hazardous settings due to the nature of their work. In the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and effective monitoring and assessment of interventions.
This study assessed the OHS system in 13 barangay health centers in a selected city using the 6 building blocks of a health system framework. Assessment was done through walk-through surveys, documents review, and key informant interview. Qualitative data from the interview were coded using NVivo while quantitative data were summarized using EpiInfo.
Results showed that there remains to be gaps in terms of improving occupational health and safety in local health centers. In terms of leadership and governance, a general policy on OHS for all local health centers was found to be lacking and in effect, an absence of health and safety committees. In terms of financing, the lack of a separate budget specific for OHS programs and services was also found to be a limitation. As a result, there was no OHS personnel identified and only one staff had valid training on OHS among all 13 health centers. There was also no established information system for OHS in place. Only 2 out of 13 health centers have Safety Inspection Reports while only three have Workplace Environment Monitoring Report.
Based on the results of the study, there is a general need for improvement in terms of the occupational health and safety system in the city where the health centers were situated. Among all the elements of the occupational health and safety system, the lack of an overarching policy on OHS resulted in the absence of health and safety committees, inadequate budget and worker specific services for OHS, lack of related trainings and workshops, and poor information and reporting system.

Key messages
Data on conditions of OHS systems in the local health center setting are limited, thus the study provides information on areas of improvement for health systems strengthening. There is a need for policies on OHS in the local health center setting to strengthen the system for improved service delivery, information management and financing for OHS.
Nurse students develop the Intervention Wheel in a Swedish context
Authors: Carlén K 
Published: October 2020

Abstract

Background
Teaching experience, including nine years in Public Health courses given in a nursing program, has shown difficulties in explaining public health issues and their relevance for nursing students. The Intervention Wheel (IW) for Public Health Nurses was a tool developed in Minneapolis 2001, which has been used in educational settings in the US, in Ireland, United Kingdom, and Norway, among others.

Objectives
The aim was to adapt the IW into a Swedish context, with learning activities for nurse students. Before the nursing students (n = 250) in Sweden left for a clinical practice period, they got lectures concerning the IW. They were tasked with a written assignment about the model's utility in health care settings. In the middle of the period, there was a seminar to discuss their experiences and how the model helped explain these experiences from child health care, school health care, primary health care, and elderly care. In a final seminar, the students discussed with each other examples of what they had experienced about each part of the model. They were able to reflect on their experience concerning the model, found new Swedish terms and culturally-relevant experiences to describe their learning in relation to the IW.

Results
The IW helps nursing students to connect theory and practice during their clinical studies and clarifies the meaning of public health work in their language and context.

Conclusions
The IW is a useful tool for education about public health work in the nursing program. By reflecting on experiences from clinical practice, the nurse students could adapt and bring in Swedish language terms and culturally-relevant experiences for the different interventions.

Key messages
The IW is a well-developed tool to improve understanding of the practical meaning of public health in the nurse’s profession. Nurse students are able to participate actively in developing the concepts into a Swedish context.
Qualitysaude: assessing the experience of using SUS by translating knowledge from experts and users
Authors: Moita G F , Raposo V M R , Barbosa A C Q , Hartz Z M A 
Published: October 2020

Abstract

Background
Nationally-based opinion polls showed population dissatisfaction ranging from 54 to 93% and increased from 61% in 2011 to 75% in 2018 (1). The user satisfaction is multifaceted and difficult to measure a field of interest for health decision makers. There is no standardization of quality and satisfaction measurement systems in SUS (1). So, what is the value of SERVQUAL questions for the construction of a SUS satisfaction scale?

Methods
The research is observational, transversal, using a mixed method of evaluation, within the PhD from the University of Coimbra. The Likert scale (1 to 5) was used to valuation of 195 professionals and 506 users that were assessed by descriptive and inferential statistics.

Results
Have been validated the 20 questions, 13 sub-dimensions and the five original macro-dimensions (Tangibility, Reliability, Responsiveness, Empathy, and Assurance) by high averages - professionals (&gt;3, IC 3.72-4.69) e users (∼ 4, IC 3.8-4.49). There was mediation (p ≤ 0.005) of the variables level of attention and level of complexity (Users). In the inferential analysis, the reliability and validity of the five Servqual macrodimensions with convergent validation were ensured (AVE &gt; 0,40), adequate reliability (A.C. &gt; 0,60 ou C.C. &gt; 0,60), unidimensionality and discriminant validation (VCM &lt; AVE), but only 15 subdimensions (factor load &gt; 0.50) made up the final model

Conclusions
The collaborative process, which can be expanded to other contexts or countries, validated a SUS quality assessment model with 20 proposed and validated questions, aligned with the five dimensions of the Servqual scale. Moita GF et al - uma adaptação transcultural multicêntrica dos constructos da escala Servqual de satisfação para o SUS... Rev Serv Público. 2019:325-64.

Key messages
An innovative SUS quality and satisfaction assessment scale was validated and applied to a web prototype (QualitySaúde), referring to the user experience and SUS management items. The collaborative process validated a SUS quality assessment model with 20 proposed and validated questions, aligned with the five dimensions of the Servqual scale.
Cost-effectiveness analysis for preventing hepatitis B virus reactivation-related death in Japan
Authors: Fujita M , Kusumoto S , Sugiyama M , Fujisawa T , Mizokami M , Hata A 
Published: October 2020

Abstract

Background
There is no worldwide standard recommendation for preventing hepatitis B virus (HBV) reactivation for patients with resolved infection treated with an anti-CD20 antibody for B-cell non-Hodgkin lymphoma. This study aims to compare the cost-effectiveness between two commonly used strategies to prevent HBV reactivation-related death.

Methods
The two strategies compared were prophylactic antiviral therapy (Pro NAT) and HBV DNA monitoring followed by on-demand antiviral therapy (HBV DNA monitoring) using entecavir (Entecavir, a generic drug for Baraclude). Effectiveness was defined as the prevention of death due to HBV reactivation and costs were calculated under the health insurance system of Japan as of April 2018 using Markov model. A cost-minimization analysis, one of the cost-effectiveness analyses, was applied, since the effectiveness was the same between the two strategies according to a meta-analysis. To consider the effect of uncertainty for each parameter, probabilistic sensitivity analysis (PSA) was performed. In the scenario analysis, costs were calculated using lamivudine (Zefix) or tenofovir alafenamide (Vemlidy) instead of entecavir. All analyses were done using TreeAge Pro 2019 (TreeAge Software, Inc., MA, USA).

Results
Estimated costs per patient during the 30 months after initiation of chemotherapy for lymphoma were 1,513 USD with Pro NAT and 1,265 USD with HBV DNA monitoring. A PSA revealed that HBV DNA monitoring was more consistently cost-effective compared with Pro NAT when some parameters were set randomly according to probability distributions. In our scenario analysis, costs of Pro NAT and HBV DNA monitoring were calculated as 2,762 and 1,401 USD using lamivudine, 4,857 and 1,629 USD using tenofovir alafenamide.

Conclusions
Our cost-effectiveness analysis shows that an HBV DNA monitoring strategy using entecavir should be recommended for preventing HBV reactivation-related death in Japan.

Key messages
Cost-effectiveness analysis demonstrated that HBV DNA monitoring was more cost-effective compared to Pro NAT; this result was consistent with PSA. HBV DNA monitoring strategy should be recommended to prevent HBV reactivation-related death for the patients with resolved HBV infection in Japan.
Socioeconomic impact of informal care provided to patients with remote monitoring of pacemakers
Authors: Lopez-Villegas A , Leal-Costa C , Catalan-Matamoros D , Robles-Musso E , Lappegard K T , Bautista-Mesa R , Peiro S , Lopez-Liria R 
Published: October 2020

Abstract

Background
The aging of the population leading patients with pacemakers to exhibit more comorbidities and, consequently, a greater need for both formal and informal care. The objective of this study was to assess personal characteristics, associated problems, workloads, time, and costs related to informal care provided to patients with pacemakers under remote monitoring (RM) vs. conventional monitoring (CM) at hospital, five years after implantation.

Methods
This is a controlled, non-randomised nor masked trial conducted with information obtained from the perspective of informal caregivers. The “Disability, personal autonomy, and dependency situations survey” was administered to collect information on sociodemographic characteristics, time, care difficulties, health status, professional aspects, and impact on economic, family, or leisure aspects of main caregivers providing care to patients with pacemakers.

Results
of the 50 patients who reported having informal caregivers, 42% belonged to the RM group. The average age was 63.14 years, 96% were women, and 72% was married. Informal caregivers lived in the homes of the patients in 70% of cases, and 88% indicated that they had to provide care six to seven days a week. The average cost per patient during the monitoring period studied was 13.17% lower in the RM group than in the CM group, and these differences were not statistically significant (p = 0.35).

Conclusions
This study found similar results in both groups of follow-up with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and relatives. The costs associated with care were higher in the CM group.

Key messages
There are not significant differences between both groups of follow-up with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and relatives. The average cost per patient during the monitoring period studied was 13.17% lower in the Remote Monitoring group than in the Conventional Monitoring group.
Developing a roadmap for Health Technology Assessment implementation in public health decisions
Authors: Di Macio F , Caricato M , Primieri C , Favaretti C , De Waure C 
Published: October 2020

Abstract

Issue
Although the recognized importance of Health Technology Assessment (HTA) in fostering health policy and management, little is known and differences emerge in the state of the art of HTA development and use in public health decisions.

Description of the Problem
HTA applied to public health interventions could lead to improved population's health, risk factor reduction and high quality services. All these factors represent the basis of health care system sustainability. Nevertheless, there is a lack of evidence about the application of HTA to public health. In this light, the Section on HTA of the European Public Health Association (EUPHA) is conducting a Delphi process in order to define a shared roadmap for the implementation of HTA in public health.

Results
A literature search was first performed on PubMed to identify useful documentation for drafting the roadmap. Taking clues from Kalò et al., who drafted an HTA roadmap scorecard to support HTA implementation in Central and Eastern Europe, a preliminary core set of actions and pillars to pave the way for the implementation of HTA in public health, was identified. Then, a group of HTA experts was invited to participate to the Delphi process with the aim to build consensus on the final set of actions and pillars to include in the roadmap.

Lessons
Evidence on the ways to strengthen the role of HTA in public health decisions is scant and the development of a shared roadmap could be useful to identify milestones to do it.

Key messages
HTA applied to public health could promote an efficient, sustainable, equitable and high-quality health system. Nevertheless, the role of HTA in taking public health decisions should be strengthened. As evidence on the application of HTA in public health is scant, the development of a shared roadmap could enhance fostering its use in taking decisions on public health interventions.
Parental and offspring psychopathological disorders after the 2012 Italian earthquake
Authors: Panciroli G , Forresi B , Soncini F , Botosso E , Di Pietro E , Scarpini G , Scaini S , Aggazzotti G , Caffo E , Righi E 
Published: October 2020

Abstract

Background
Parental mental health can affect offspring Post-Traumatic Stress Disorder (PTSD), but up to now few data focused on families exposed to natural disasters. Thus, this study aimed at investigating the association between parental and youth psychopathology after the Italian earthquake of 2012.

Methods
In this cross-sectional study, 1162 parents and 682 children and adolescents (9-14 years) living in two districts, earthquake area (EA) and control area (CA), were assessed for psychopathological distress two years after the earthquake. Children filled in the UCLA PTSD-Index for DSM-IV, an exposure questionnaire, and the Strengths and Difficulties Questionnaire (SDQ); parents the Symptom Checklist-90 (SCL-90).

Results
Parents in EA showed a higher frequency of psychopathological difficulties than those in CA (28% vs 17.5% had a SCL-90 global score over the cutoff, p &lt; 0.001). Sleep disturbances were the most prevalent disorder, followed by obsessive-compulsive disorder, depression, somatization and anxiety. Compared to fathers, mothers had significantly higher scores, especially in the EA sample.
Both SCL90 total and symptom domain scores correlated with PTSD total and clusters scores, especially for hyperarousal and re-experiencing. Parental anxiety, depression and somatization showed the highest correlations. Considering SDQ, mothers' psychopathology resulted to be associated mainly with offspring's emotional and peer problems, while fathers' disorders affected mainly children's hyperactivity.

Conclusions
This study showed a significant association between parental mental health and both PTSD and emotional/behavioral problems among offspring after earthquake. These results should be carefully considered when planning mental health support interventions in areas affected by earthquakes.

Key messages
Parental psychopathology and PTSD and other emotional/behavioral difficulties in children tend to cluster in families exposed to natural disasters, especially earthquakes. Parental and offspring psychopathological disorders should be considered when planning mental health support interventions in areas affected by earthquakes.
Preparedness for transplantation during COVID-19 outbreak: how to manage?
Authors: Valdi G , Varadi G , Panzera A , Parpinel M , Peressutti R 
Published: October 2020

Abstract

Problem
When WHO declared COVID-19 “international”, it was important not to damage some critical patients who need emergency procedures like organ transplantation, due to end stage organ disease. In 2003 SARS outbreak demonstrated the vulnerability of organ transplantation services o network.

Descritption
If transplantation is required as a life-saving procedure, it can be conducted with appropriate risk infection assessment. It is crucial during these emergencies to assess donor pool, as it is expected to decrease. A crucial point is to organize and evaluate the surge capacity, in terms of understaffing and lack of supplies, especially in ICU. The research methods were literature review using Pub Med, CDC, ECDC, WHO, TTS, searching as key words “SARS-CoV-2”, “COVID-19”, “transplantation”, “preparedness”. The analysis has been conducted between Feb 26th 2020 and March 5th 2020.

Results
As happened during SARS breakout in 2003, it is essential to establish a task force for crisis, currently updated and skilled for this particular management. Preparedness should regard especially the adoption of donor safety assessment procedures, ICU capability, the availability of covid-19 test for all the donors, and the adoption of specific post-transplant care. It is essential in this case establish preparedness in several points: education and training of the staff, practice drills, inspection of supplies, evaluation of surge capacity, relocation of patients.

Lessons
SARS-CoV-2 imposed in public health to establish new protocols and guidelines, which should be regularly updated to be useful in other epidemics outbreaks or other emergency situation. These protocols should focus on donor pool and ICU capability in order to carry on transplantation activities.

Key messages
This outbreak has tested the resilience of the whole system by day-by-day updating for transplantation teams and preparedness of the staff involved in transplantation management. During outbreak, seems to be useful a task force for crisis in order to support organ transplantation services.