bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing efficiency and outcome in cancer care integrating patient's and survivorship perspectives
Authors: Offermanns O , Schweiger A 
Published: October 2020

Abstract
Although the Austrian health care system generally presents the highest standards and excellence structures of cancer care, patient outcomes continue to lag behind in the global comparison with respect to include the patient's perspective in cancer care. Therefore, potential inefficiencies must be considered in future health system development to achieve more efficient processes and higher outcomes for patients suffering from cancer.
The contribution presents the development of the All.Can initiative in Austria, in line with a cancer care framework and derived health targets for patients suffering from cancer including a special focus on the patient's and survivorship perspectives and enhancing the influence of patient organisations in current Austrian cancer care.
The proceeding is based on a systemic and applied approach to embed All.Can Austria in the national health landscape and ensure a strategic orientation with a concept paper including literature review and stakeholder research. One important point was to include health professionals in the process and experts from different political sectors with a strong relationship to health according to the concept of health in all policies, referring to the real needs of e.g. patients and cancer survivors. The next step consisted of the development of a policy framework for all sectors to empower patient organisations to gain more efficient structures that incorporates multi-stakeholder involvement.
The developed cancer care framework and targets of All.Can Austria aiming at new priorities in Austrian cancer care, creating high-level political commitment to patient outcomes and providing a basis for the empowerment of patient organisations, in consequence changing the system step by step and piloting innovations in cancer care. A special tool will support the allocation of resources for projects in prevention and health promotion linked to the developed health policy framework.

Key messages
Establishing the All.Can initiative in Austria to empower patient organisations by building innovative structures in Austrian cancer care. Enhancing efficiencies and patient outcomes in cancer care according to health in all policies.
Analysis of cervical cancer policy documents in East-African countries
Authors: Njuguna D W , Mahrouseh N M , Varga O V 
Published: October 2020

Abstract

Background
Cervical cancer is largely a preventable disease according to data by Global Burden of Disease. Among the 20 countries with the highest incidence of cervical cancer globally, 16 are African countries. Relevant cancer control interventions in most low-income countries are partially developed attributing to unavailability of statistics limiting understanding and approximation of the magnitude of the burden of cancer. In order to evaluate health policies for prevention and management for cervical cancer among East-African countries a legal mapping was carried out.

Methods
Legal mapping as a qualitative research method is used to determinate existing policies, collect and analyze the information, and ultimately measure the effect of these policies on health outcomes. Legislation was searched from government websites, national cancer institute sites, international and national legal databases in a uniform way. Nvivo 12 software for content analysis of unstructured qualitative data related information was used for analysis. Coding of the data was developed by two researchers. Reliability of policies assessed according to Cohen's Kappa inter-rater reliability.

Results
The sample included 24 policies, plans guidelines, acts and strategic documents from 10 East-African countries. No relevant legislation identified from Somali and Djibouti. Majority of the countries had policy documents related to cervical cancer and touched on the components of cancer control. Majority of the East-African countries have not established screening registries leading to poor or no reliable data for assessing the cancer burden. Prophylactic vaccination against HPV is yet to be included in the national immunization schedules.

Conclusions
Findings show limited coverage of the identified policies, discrepancy to international guides. To reduce the harmful impact of the discordance between scientific evidence and policies, surveillance systems have to be set up/strengthened.

Key messages
Legislation which is brought into force to prevent cervical cancer is a pillar of effective public health efforts. Evidence based policy mapping plays a key role in giving insight on the burden of disease thereby making informed decisions for health.
Maps of Health Needs and their use for policy making
Authors: Olminski J , Koziol M , Bartolik K 
Published: October 2020

Abstract
As the economies transform into data-centered, so does the healthcare system. Responding effectively to the current problems by making right decisions and setting up the adjusted policies, either on national or regional level, requires the evidence-based tool. The one developed in Poland is called 'Maps of Health Needs', which states an unbiased source of information to a broad spectrum of stakeholders.
The project is the answer to the need of evidence based policy making. The process is based on four steps: firstly, the data on demographics, epidemiology, staff, provided services, infrastructure, etc., are gathered,after that, they are analyzed, using the combination of two fields of expertise: advanced programming and statistics with medical knowledge; the qualitative and quantitative indicators are settled, along with its forecast,subsequently, the conclusions for the system are drawn,finally, the recommendations on actions are set up.
First maps were published on 2015. The project is a subject to the constant adjustments, as the maps are upgraded and updated yearly, according to the stakeholders' expectations. Lately the maps for the five most burdening problems have been published in a form of an online app, accompanied by an executive summary.
The spectrum of use of the maps is broad, not only for health priorities and health policy. Project's results are also used to review the legitimacy of financing health investments from public funds. Moreover, the planning and monitoring of the system is enhanced. Recent examples include also geographical distribution of linear accelerators and locations for psychiatric centers.

Key messages
Data is nowadays a key factor in decision making, also in the health system. The tool developed in Poland, called Maps of Health Needs, resulted in some real changes and might be set as an example or inspiration for others.
Development of Learning and Research Health Districts (LRHD) in the DR Congo: results
Authors: Mwembo -Tambwekoy A , Chenge F , Criel B 
Published: October 2020

Abstract

Issue
There is great need in DRCongo for adequate training sites where national public health managers and workers can discover what is means to manage complex district healthcare delivery systems in a perspective of PHC and UHC. The development of such LRHD is coherent with the national policy in DRC advocating for demonstration districts.

Description of the Problem
The RIPSEC has launched three sites called LRHD, two of which are rural and one urban. A specialist in the organization and management of health services, from each of the three schools of public health, supervised the development and monitoring of those LRHDs. The Provincial Supervisor was also involved. Three approaches to solving priority problems have been defined: strengthening leadership at the HD level; transform health services into a learning and research framework. We analyze the transformation process obtained in these HD.

Results
Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research. The results of those LRHD after 4 years were mixed: the leadership of the management teams has improved. A reflexive attitude developed which contributes to more appropriate decision-making,monitoring and evaluation.At least one hospital service and 2 health centers have been transformed according to specific problems,improving the interaction between health structures, in order to quality of care has improved, the results of action research have made it possible to resolve local health problems. RIPSEC support to Provincial Supervisor to develop their working tools to better address their functions and responsibilities. However, the documentation of these changes induced by RIPSEC was not yet systematized. No residential internship could be carried out due to operational constraints.

Lessons
Mentoring, through its intellectual inputs, has contributed to a dynamic of change in the HD.

Key messages
The basis of the strategy is the improvement of the leadership of the HD management team,reinforced by mentoring and systematic documentation of complex decisions. This program could be continued to perpetuate these fragile achievements. This experience can be used elsewhere in different contexts. But,the residential internship requires other resources.
Participatory systems mapping for localised evidence and decision-making: helminth control, SSA
Authors: Pearson G , Parker M , Storer E , Allen T , Fergus C 
Published: October 2020

Abstract

Background
Evidence-informed decision-making to assist public health practitioners in local-level programme implementation requires adaptive approaches to research, policy and practice. To address these needs there is focus on using participatory methods. Adopting such methods, this research asks: what are the evidence needs of local public health practitioners? How do evidence and decision-making processes interact? We reflect on the process of using Participatory Systems Mapping (PSM) and implications for localising evidence-informed decision-making.

Methods
We conducted workshops with district and national-level MoH personnel in Uganda and Malawi using PSM to elicit insights into local modes of schistosomiasis transmission and control, and group discussions on evidence needs and use in implementing control programmes. PSM maps are analysed, triangulated with thematic analysis of group discussion transcripts.

Results
Analysing PSM outputs alongside discussions on evidence provides critical methodological and policy insights with implications for localised evidence and decision-making. Further insights into the local dynamics of public health decision-making are gained by triangulating PSM with discussions on the meanings and importance of 'factors' identified. Information which is accessible and useful for local practitioner's decision-making in implementing disease control measures does not always align with academic production and dissemination of evidence, nor across levels where policy is produced or implemented.

Conclusions
An array of factors influence local decision-making with implications for global health policies and practices such as for schistosomiasis control. Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.

Key messages
Processes of decision-making and evidence needs of local practitioners need to be better understood within broader context. Evidence and knowledge production on health interventions rarely feedback or respond to local implementation needs, decision-making practices and public health practitioners.
Evidence-based governance: the role of epidemiological indicators in negotiation with stakeholders
Authors: Gattoni M E , Russo A G 
Published: October 2020

Abstract
Following the enactment of Regional Law 23/2015 in Lombardy, Agencies for Health Protection (AHP) were set up with programming, monitoring and control tasks on all areas of public health, including hospital performances. It was therefore necessary to develop a new efficient system of negotiation with stakeholders. A summary document has been created for each hospital that highlight the areas to be improved. This report is based on the use of updated indicators validated nationally and internationally, relating to average hospital stays, volumes and outcomes. Main sources were the National Outcome Program, the Ministerial Decree 70/2015 and the Network of Regions.
As comparison values, the thresholds from international literature or Italian legislation. The report was sent to the stakeholders in advance, initially in paper format then through a dedicated portal, before the discussion of the contractual objectives with Executive Board, Epidemiology Unit and the Department of Planning, Purchase and Control. The achievement of the objectives entails a substantial economic benefit, from year to year more and more conspicuous.
The results accomplished were twofold. On one hand there was the improvement of several indicators: for AHP as a whole, such as the fracture of the femur operated within 48 hours went from 50% in 2015 to 74% in 2019; for individual hospitals, for example, some hospitals that did not perform cholecystectomies in day surgery have started to do them. On the other hand, it was possible to detect system critical issues that made it difficult to achieve the objectives for the stakeholders.
Linking the contractual objectives to epidemiological indicators discussed collectively was productive to both AHP and stakeholders and allows objective and constant monitoring of the progresses and difficulties encountered.

Key messages
Internal cooperation in the AHP and direct dialogue with stakeholders are necessary to achieve ambitious objectives. The use of validated epidemiological indicators as contractual objectives makes the assessment and contracting process of hospitals more transparent and objective.
Epidemiological aspects of human exposure cases to rabies by in the central west region of Tunisia
Authors: Ben Fredj M , Dhouib W , Bennasrallah C , Abroug H , Zemni I , Kacem M , Bannour R , Mhamdi M , Belguith Sriha A 
Published: October 2020

Abstract

Introduction
Rabies is a major public health problem in several countries in the South and East of the Mediterranean and in the Middle East. The objectives of this study were to describe the epidemiological profile of human exposures to rabies by a dog, as well as the profile of aggressive dogs during a period of 15 years in a region in the central west region of Tunisia.

Methods
We have included all cases of human exposure to a dog, reported between 2004 and 2018 in the Kasserine area. The source of the data was the directorate of primary health care in Kasserine.

Results
A total of 41,850 human exposure cases to a dog have been reported over the fifteen year study period with an annual average of 1937.5 cases. Among them, 29,062 cases (69.4%) were attacked by a bite. The crude incidence of dog bite cases was 441 per 100,000 population. The vaccination status of attacking dogs was unknown in 15.4% of the cases (n = 6423). Among all attacking dogs with a known vaccination status (n = 35427), 45.2% were vaccinated (n = 16017) and 54.7% (n = 19392) were unvaccinated. A significant increase in human exposure cases to dogs was noted from 2004 to 2018 (β = 11.7, p = &lt;10-3). The number of exposures by an unknown dog or a known unvaccinated dog increased significantly (β = 28.02; p = &lt;10-3 and b = 69.9, p = &lt;10-3; respectively). However, the number of cases attacked by a known vaccinated dog decreased significantly (β = -86.4, p = &lt;10-3). During the study period, five cases of human rabies were identified in the study area.

Conclusions
In Tunisia, human exposure to rabies by a dog has been on the rise. It could be linked to the period of popular and political movement that the country is going through.

Key messages
In this study, human exposures cases to rabies by unvaccinated dog is significantly increasing. It is crucial to strengthen appropriate preventive measures, such as mass vaccination and dog castration programs.
Response patterns in the Belgian health interview survey: web versus face-to-face mode
Authors: Braekman E , Demarest S , Charafeddine R , Berete F , Drieskens S , Van der Heyden J , Van Hal G 
Published: October 2020

Abstract

Background
Potential is seen in web data collection for population health surveys due to a combination of its cost-effectiveness and ease of implementation and the increased internet penetration rates. Nonetheless, web modes may lead to lower and more selective unit response rates than traditional modes such as face-to-face (F2F) interviewing and hence may increase bias in the measured indicators. This research assesses the response patterns of a web versus F2F study.

Methods
A Belgian health interview survey by web (BHISWEB; net sample=1010) was organized parallel to the traditional F2F BHIS 2018 (BHIS2018; net sample=11611; subsample used in this study=2748). Socio-demographic data on invited individuals were obtained from the national register and census linkages. To address the high item-missingness on education level deriving from the census, multiple imputation (m = 20) was applied. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the impact of mode (web vs. F2F) and interactions between mode and socio-demographic characteristics on unit response.

Results
The unit response rate was significantly lower in the BHISWEB (18.0% (95% CI: 17.0-19.1)) than in the BHIS2018 (43.1% (95% CI: 41.5-44.7)). A lower web versus F2F response rate was found among all socio-demographic groups, however, this lower web response was less pronounced among youngsters, people cohabiting with household members, higher educated people and native Belgians.

Conclusions
The F2F unit response rate was generally higher, yet for certain groups the difference between web versus F2F was smaller. It is therefore worthwhile to experiment with adaptive mixed-mode designs to optimize resources without increasing selection bias; e.g. only inviting socio-demographic groups more eager to participate online for web surveys (e.g. youngsters) while remaining to focus on increasing the F2F response rates for other groups.

Key messages
The advantages of web versus F2F interviewing come against its considerable lower unit response rate. Differences in unit non-response between web and F2F vary between socio-demographic groups.
Resident co-created urban redesign to improve health in post-war neighbourhoods: an exploration
Authors: Koene M , Reijneveld S A , Tuinstra J , Broekhuis H , Wagenaar C , van der Spek S C 
Published: October 2020

Abstract
Urban interventions in the built environment can improve the health of residents by impacting daily living patterns and lifestyles. Co-creation of these interventions with residents enhances their effectiveness. This pilot study investigates how the co-creation process can be developed, with elderly as a target group. The setting of the pilot is the area around a shopping centre in a post-war neighbourhood.
Residents were recruited via the neighbourhood council and existing networks, via student-recruiters and via door-to-door flyers. They were asked to participate in the evaluation of proposed interventions, which aimed to increase physical activity. Virtual reality (VR) techniques were used as a tool to communicate current and redesigned environments. We organised three meetings for residents, where VR was used to: 1) collect data on current urban issues, 2) evaluate the different redesigns of the project location, and 3) present a final redesign. During meeting 1 and 2, VR was supported by questionnaires to collect data.
We recruited 31 residents with an average age of 65, mostly through the neighbourhood council and existing networks. Recruitment with flyers resulted in only 1 participant (&lt;1% response). The data collected from the combination of VR and questionnaires showed that participants were likely to walk more often in the redesigned interventions. Moreover, participants indicated that the differences between current and redesigned environments were very clear (score 4.8 out of 5) and that they could imagine very well what the designs would look like in real-life (score 4.6/5). The VR-experience was scored an 8/10 and 28 participants were willing to participate in future activities.
Recruiting residents through existing networks, including the neighbourhood council, was most effective. VR technology is a very useful tool to communicate urban interventions and the residents were very capable of evaluating them while providing valuable input for the redesigns.

Key messages
Co-creating urban redesigns with residents to improve health is feasible, and virtual reality is of great added value as a co-creation supporting and communication tool. Urban interventions impact daily living patterns and lifestyles of residents and thereby public health.
Comparability of questionnaire and interview responses on health among people with foreign origin
Authors: Lilja E , Seppänen A , Kuusio H 
Published: October 2020

Abstract

Background
In health surveys, self-administered questionnaires are a good way to collect data most cost-effectively. For some population groups, a mixture of methods might be necessary in order to reach the desired response rate. If the collection methods vary, the comparability of data might become an issue when evaluating differences between two population groups or changes over time. This study examines the comparability between questionnaire and phone interview responses in a survey on migrants in Finland.

Methods
This study uses the data collected in Survey on Well-Being Among Foreign Born Population (FinMonik), conducted in 2018-19. There were 6 836 respondents, out of which 6 505 filled the questionnaire and 331 were interviewed by phone. The survey included questions 'Do you ever feel lonely?' and 'Do you find that your current state of health is:'. Both were answered using a five-point Likert scale ranging from 'never'/'good' to 'all the time'/'bad'. Logistic regression was used to assess statistical differences.

Results
Among those interviewed by phone, the distributions were more skewed than among those who had filled the questionnaire. In the phone interviews, the emphasis was on the socially more desirable options: regarding loneliness, 'never' was selected 1.7 times more often in the phone interview compared to the questionnaire while 'good' was used to describe the state of health 1.3 times more often. On the common binary indicator 'fairly often or all the time', those who had filled the questionnaire appeared lonelier than those interviewed by phone (14.5% vs 10.4%, p = 0.032), and the difference remained significant when adjusted with a range of sociodemographic variables. However, there was no significant difference on the binary indicator of perceived health ('good or fairly good').

Conclusions
The distributions differed considerably between questionnaire and interview responses, but the level of impact varied between indicators.

Key messages
The data collection methods should be examined carefully when comparing results from different surveys. Instruments designed for questionnaires may yield different results when asked by an interviewer.