bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of telemedicine project in Bhutanese refugee camp in Nepal
Authors: Khatoon S 
Published: October 2020

Abstract
While working with UNHCR (UN Refugee Agency) in Nepal, I faced the challenge of managing Bhutanese refugee health care programme with limited resources. Since 1993, UNHCR was providing health services to Bhutanese refugees living in seven camps. UNHCR Nepal had received limited budget due to emerging refugee crisis in other parts of the world in 2016. As a health focal person, I was assigned to look for new approaches to provide health services to refugees. After exploring several possibilities, telemedicine project was introduced in the camp in 2016 with the collaboration of tertiary hospital, B. P. Koirala Institute of Health Sciences.
The main objective of the project was to reduce medical referral, which consumed most of the resources. From testing and prototyping, videoconference was considered as the most appropriate method to perform telemedicine in the camp. Telemedicine helped camp clinical staff to directly communicate with consultants in the tertiary hospital at distant and address the refugee health issue at camp level.
After implementation of telemedicine, medical referral from camp clinic to hospitals in 2016 was reduced by 54.8 % in comparison to previous year 2015. Telemedicine project also enhanced the coordination and linkage of refugee and UNHCR with tertiary referral hospital.
Regular monitoring visit from the expert helped to improve the telemedicine project significantly. The most important lesson learnt was that beneficiaries and camp health staff should be involved from beginning. Camp health workers must be trained on using telecommunications equipment.
Telemedicine is cost-effective in refugee setting where internet access is strong. Regular monitoring and technical support from the expert, learning attitude of camp health workers and acceptance from refugee are vital for the success of the project. Telemedicine increased access of essential healthcare to the most disadvantaged communities and ultimately facilitated universal health coverage.

Key messages
Telemedicine is cost-effective way of providing health services to refugee at remote area where access to hospitals is challenging due to certain limitation such as distance, budget, transportation. Telemedicine not only save the cost of medical referral but also save opportunity cost, time and energy of refugees, which are invested while visiting hospital.
Urban green infrastructure size, quality and proximity and health outcomes in older populations
Authors: Cook P A , Dennis M , Wheater C P , James P , Lindley S 
Published: October 2020

Abstract

Background
A city's multi-functional network of green and blue spaces has an important role underpinning the health and wellbeing of its residents. Although evidence of positive links between nature and health is plentiful, little is known about which particular aspects of green and blue spaces are most influential, and how benefits might vary between social groups and age.

Methods
We used a green infrastructure (GI) approach combining a high-resolution spatial dataset of land-cover and function with area-level demographic and socio-economic data. A comprehensive characterisation of the Greater Manchester UK city region was generated. The GI attributes were used in step-wise multi-level regression analyses to test for associations between population chronic morbidity and the functional, physical and spatial components of GI across an urban socio-demographic gradient.

Results
Individual GI attributes were significantly associated with health in all socio-demographic contexts; even when associations between health and overall green cover were non-significant. For areas with having higher proportions of older people ('older neighbourhoods'), associations were found between health and land-cover diversity, informal greenery and patch size in high income areas. In lower income areas, health was predicted by proximity to public parks and recreation land.

Conclusions
A nuanced description of greenspace in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace. This has implications for strategies to decrease health inequalities and inform international initiatives, such as the World Health Organisation's Age-Friendly Cities programme.

Key messages
A nuanced description of green and blue space in terms of quality, cover type, diversity explains more variation in population health than a single metric such as percentage green cover. People in urban neighbourhoods that have older age populations and lower income are disproportionately healthy if their neighbourhoods contain accessible, good quality public greenspace.
Crowdfunding for medical expenses in the United Kingdom
Authors: Pifarré Coutrot I , Cornelsen L , Smith R 
Published: October 2020

Abstract

Background
Medical crowdfunding is a rapidly growing phenomenon worldwide and a new means for patients to finance health related expenses. It raises many ethical concerns such as increasing inequities. In the UK, which operates a state-funded universal health care system, the phenomenon is unexpected and hasn't yet been studied. Our study aims at answering basic questions as who is using crowdfunding to fund health-related expenses, for what and why.

Methods
We have drawn the first 400 medical campaigns amongst 1,000 available on GoFundMe UK website. We used a content analysis method to extract data from narratives on age, sex, health condition and funds' purposes.

Results
Among the 400 campaigns, 1/2 requested funds for cancer care for both common and rare cancers, from which 1/3 disclosed a stage 4. A third of the sample sought funds to get treatment abroad, mostly in Germany and the US, for most part cancer therapies such as immunotherapy but also alternative therapies. A quarter of the sample sought support to alleviate financial burden associated with ill-health. Other purposes included getting private care in the UK (19%) and getting medical equipment (18%).

Conclusions
Our findings may put forward some gaps within the National Health Service (NHS) and social care such as issues to access therapies or equipment, lack of holistic care and inadequate welfare patient support. However, it does not explain fully the rise of crowdfunding that may also be a counterpart of patients' empowerment. For instance, patients can shift to the private sector, in the UK or abroad, when a treatment is not available within the NHS, such as high cost last-resort treatments for those with poor prognosis. We recommend policy makers to: use medical crowdfunding to inform policy,support patients to make empowered decisions,protect patients from commercial traps.

Key messages
Studying medical crowdfunding allows better understanding of patients’ perceived or actual unmet need for health and social care to inform policy development. This threat to equity should be addressed globally by providing patients with support to be empowered, with universal health coverage and by regulating better private facilities and health tourism.
Left behind: the state of universal health coverage in Europe
Authors: Burns R , Graversen P , Miller A , Bader C , Offe J , Fille F , Aldridge R W 
Published: October 2020

Abstract

Background
Barriers to access healthcare and lack of data undermine Universal Health Coverage (UHC) in Europe, despite the region's clear commitment to the Sustainable Development Goals and UHC. Current indicators measuring unmet healthcare needs in the European Union (EU) often exclude more marginalised groups, further rendering their health needs invisible and the data to inform policy flawed. For effective evaluation of UHC, comprehensive data on the health of these groups is needed.

Methods
We conducted an evaluation of humanitarian healthcare provision of people attending Médecins du Monde (MdM) programmes in seven countries in Europe (Belgium, France, Germany, Luxembourg, Sweden, Switzerland, and the United Kingdom). MdM is a humanitarian organisation, providing care to those excluded from mainstream healthcare services. We describe the characteristics of MdM service users, their determinants of health and healthcare access.

Results
A total of 29,359 people were seen between January 2017 and December 2018. Nearly all were migrants (97.2%, 21,591/22,136), with 66.3% (11,690/17,629) of people reported not having a right or permission to reside in the country they presented in. A majority were living below the poverty line (92.6%, 7,660/8,268), residing in insecure housing (44.3%, 8,895/20,097) or living as street homeless or in emergency shelters (20.4%, 4,107/20,097). Most people reported having no healthcare coverage (81.7%, 14,848/18,164). When asked about barriers to accessing healthcare, 20.8% of responses reported economic barriers (3,960/19,020) and 14.3% reported a lack of knowledge of health system/entitlements (2,718/19,020).

Conclusions
This humanitarian service evaluation highlights the intersecting vulnerabilities and barriers to access healthcare for people excluded from mainstream healthcare systems across Europe. Our findings provide a unique insight into the extent of unmet healthcare needs of migrants and other marginalised populations.

Key messages
UHC requires comprehensive data on the population groups who are many times left without access to health services and who are often excluded from national data collection and research. A majority of MdM service users do not have healthcare coverage and experience multiple and intersecting barriers to access healthcare across Europe.
5.I. Skills building seminar: National burden of disease studies: inspirational experiences from across the globe
Authors:   Organised by: COST Action CA18218,   Chair persons: Brecht Devleesschauwer - Belgium, Henk Hilderink - Netherlands
Published: October 2020

Abstract
What are the most relevant diseases in a country? Which risk factors are the strongest contributors to disease and death? How is the impact of different diseases evolving over time, and how does it compare to other countries or across sub-national units? With a constantly growing need to rationalize the allocation of available resources, a timely, sound and comprehensive answer to these fundamental questions is more than ever needed to inform public health decision making.
Driven by the impact of the Global Burden of Disease study, several countries have decided to establish a national burden of disease study to address these questions. Central to any national burden of disease study is the establishment of a coherent framework for routinely quantifying the impact of diseases and risk factors in terms of Disability-Adjusted Life Years (DALYs). National burden of disease studies further allow to valorise existing health information, foster collaborations with national stakeholders, and support capacity building. Implementing a national burden of disease study is however highly resource demanding, and many researchers struggle to effectively translate their findings to decision makers.
This skills building seminar gathers five inspirational examples of national burden of disease studies from across the globe. They reflect the diversity in approaches that currently exist. Indeed, while some countries have implemented their national burden of disease framework themselves, an increasing number of countries is collaborating with the Institute for Health Metrics and Evaluation (IHME) to conduct national and sub-national burden of disease studies. Both approaches have their own specific advantages, which will be outlined during the seminar. The selected examples further document the iterative, step-wise processes behind the implementation of a national burden of disease study, as well as the challenges, but also success stories, in translating data to policies. Overall, the aim is to demonstrate the added value of national burden of disease studies, and to share realistic, hands-on experiences on the steps needed to initiate, implement and maintain a national burden of disease study.

Key messages
National burden of disease studies are increasingly established across the world to support public health decision making. Different international initiatives are emerging to support countries initiate, implement and maintain a national burden of disease study.
The French national Global Burden of Disease (GBD) evaluation project
Authors: Gallay A , Rachas A , Gastaldi-Ménager C , Desenclos J C , Constantinou P , Tajahmady A , Le Strat Y 
Published: October 2020

Abstract
As in many countries, there is an urgent need to prioritize the issues in public health care and prevention in France. The French GBD project aims to offer a unique set of combined morbidity and mortality estimates to inform health policy makers in France, at the national level. However, because of the variability in health status and risk factors across geographical areas, policy makers need comparable estimates at the regional and local levels to target specific populations and to implement actions to improve health. Besides, although the accuracy of the indicators provided by the GBD has not been evaluated in the French context, it would be likely improved by enhancing and enriching the French data used as input.
The French national health data system is one of the largest healthcare claims database in Europe. Based on these data, the French National Health Insurance (Cnam) and Santé publique France (SpFrance), in collaboration with clinicians and researchers, have developed a set of algorithms to identify diseases based on health care reimbursements, which could improve GBD estimates.
Cnam and SpFrance both contribute to the definition, prioritization and evaluation of health policies in France and have therefore decided to pool their strengths and mutualize their resources to build a common rationale and provide consistent French Burden of Diseases estimates. A collaboration with the Institute of Health Metrics and Evaluation (IHME) has also been initiated, to allow Cnam and SpFrance benefiting from IHME's infrastructure and expertise and together seek to improve the estimates of the indicators using comparable methods at local and national levels, and consistent with the overall Global Burden of Disease project.
Finally, beyond the ongoing production of the GBD metrics, another objective is the knowledge transfer to Cnam and SpFrance as learning organizations.
The project has started with a framework between the three parties and the expression of interest.
Hospital admissions/mortality ratio: a composite health indicator for monitoring NCD
Authors: Ortiz-Pinto M , Pérez-Gómez B , Galán I , Sarmiento-Suárez R , Gómez-García T , Fernández-Navarro P , Padrón-Monedero A , Noguer I 
Published: October 2020

Abstract

Background
Our aim was to test the usefulness of a new tool to monitor NCD. We evaluated a composite indicator, the ratio of hospitalizations vs mortality rates (HMR), by assessing its capacity of identifying additional variability among regions. In this communication, we present the analysis corresponding to ischemic heart disease as an example.

Methods
We used the Hospital Morbidity Survey and the Death Statistics for Spain in 2016, both provided by the National Institute of Statistics, to calculate age-adjusted hospitalisation and mortality rates for ischemic heart disease for men and women in all 52 provinces of Spain. Subsequently, we computed HMR, the ratio of the age-adjusted of hospital morbidity and mortality rates. The correlation and linear adjustment between provincial mortality and morbidity rates, as well as mortality and HMR, were also estimated by sex.

Results
The rate of hospital admissions for ischemic heart disease in Spain was 407 per 100,000 in men and 129.4 in women. The mortality rate was 93.1 per 100,000 in men and 40.3 in women. In both sexes, the highest morbidity and mortality rates were observed in the south of Spain. Pearson correlation between morbidity and mortality rates were 0.53 (p &lt; 0.01) in men and 0.75 (p &lt; 0.05) in women. HMR showed a different spatial pattern with important variability. In men the average ratio was 4.3, with a range of 2.8 (Tenerife) to 7.1 (Melilla); in women the average was 3.2 with a range between1.7 (Zamora and Tenerife) and 4.7 (Barcelona), and in both sexes very high ratios were found in Catalonia's provinces. Association between mortality rate and HMR showed a negative correlation in both men (-0.39; p &lt; 0.01) and women (-0.24; p &lt; 0.05).

Conclusions
HMR is a composite indicator that provides complementary information regarding the individual analysis of hospital morbidity and mortality rates. HMR of ischemic heart disease shows an important geographical variability and an inverse association with mortality.
Assessing and piloting interoperability for population health research
Authors: Estupiñán-Romero F , Gonzalez-García J , Bernal-Delgado E 
Published: October 2020

Abstract

Issue/problem
Interoperability is paramount when reusing health data from multiple data sources and becomes vital when the scope is cross-national. We aimed at piloting interoperability solutions building on three case studies relevant to population health research.
Interoperability lies on four pillars; so: a) Legal frame (i.e., compliance with the GDPR, privacy- and security-by-design, and ethical standards); b) Organizational structure (e.g., availability and access to digital health data and governance of health information systems); c) Semantic developments (e.g., existence of metadata, availability of standards, data quality issues, coherence between data models and research purposes); and, d) Technical environment (e.g., how well documented are data processes, which are the dependencies linked to software components or alignment to standards).

Results
We have developed a federated research network architecture with 10 hubs each from a different country. This architecture has implied: a) the design of the data model that address the research questions; b) developing, distributing and deploying scripts for data extraction, transformation and analysis; and, c) retrieving the shared results for comparison or pooled meta-analysis.

Lessons
The development of a federated architecture for population health research is a technical solution that allows full compliance with interoperability pillars.
The deployment of this type of solution where data remain in house under the governance and legal requirements of the data owners, and scripts for data extraction and analysis are shared across hubs, requires the implementation of capacity building measures.

Key messages
Population health research will benefit from the development of federated architectures that provide solutions to interoperability challenges. Case studies conducted within InfAct are providing valuable lessons to advance the design of a future pan-European research infrastructure.
Research on High School Students’ and Teachers’ Mental Health Literacy Levels in Istanbul, Turkey
Authors: Karabey S , Arslan S 
Published: October 2020

Abstract

Background
Mental health literacy (MHL) is critical to reduce health inequality and for raising awareness and early recognition of mental illnesses. This study among students and teachers in Istanbul, Turkey, aimed to (1) determine the knowledge levels towards mental illnesses, (2) identify barriers to help-seeking behaviors and (3) assess stigmatizing attitudes towards mental illnesses.

Methodology
A cross-sectional, descriptive study design was used, and 810 high school students and 241 teachers were included in our study between Mar-Jul 2019. Data was collected through the Mental Health Literacy Questionnaire and the Beliefs towards Mental Illness Scale.

Results
Students' recognition percentages of depression, schizophrenia and social phobia vignettes were found to be 27.5%, 47.7% and 6.2%, respectively. Teachers' were found to be 46.5%, 42.7% and 26.1%, respectively. A statistically significant relationship was found between students' correct recognition of vignettes and gender, age group, mother education levels, and father education levels (p &lt; 0,005). Female sex, older age, and having a parent with higher level of education were more likely to correct identify the vignettes. Among teachers, a significant relationship was found between correct recognition of vignettes and gender (p &lt; 0,005). Females were more likely to correct identify the vignettes. Regarding the BMI subscales, students' average score was 21,6±9,8 for “poor social and interpersonal skills and incurability”, 19,9±6,9 for “dangerousness”, 1,5±2,3 for “shame” and 42,9±16,2 for total scale and the teachers' average scores were 23,6±10,1, 21,3±6,6, 1,2±1,7 and 46,2±16,6 in the same order.

Conclusions
The findings show that efforts are needed among both pupils and teachers in order to encourage help seeking behavior and to increase the belief that the solution of mental health problems is possible. Strengthening accessible mental health services and reducing stigma towards mental illnesses are also crucial.
Ten recommendations to foster mental health in children - Systematic development of information materials for parents and pediatricians
Authors: Zysset A , Winogradow D , Passalacqua S , Crameri A , von Wyl A , Wieber F 
Published: October 2020

Abstract

Introduction
Many mental disorders develop during childhood, with an estimated 10-20% of children affected, and they often persist into adulthood. As mental disorders are often recognized delayed or not at all, mental health promotion and the early detection of mental illness in childhood are relevant public health tasks. Pediatric practices are a particularly suitable setting for such efforts are as they do have regular and direct contact with most children. This project therefore aimed to develop materials to raise parents' awareness of children's mental health and provide specific suggestions for mental health promotion and screening for mental health problems.

Methods
A systematic literature review in the field of mental health promotion, clinical psychology and positive psychology on life skills and resilience revealed several effective concepts. In a participatory process with psychiatrists and pediatricians, ten concepts were selected: self-esteem, self-efficacy, problem solving skills, optimism, emotion regulation, recreation, family climate, nature, offline-activities, and peer support. In a preliminary evaluation of parents' perspective on a parent-brochure, 74 parents of 6-12-year-old kids filled in two online-questionnaires on the perceived relevance and usefulness of the ten concepts and the respective behavioral suggestions; one right after learning about the recommendations and one four weeks later.

Results
First analysis show that parents perceive the recommendations as highly relevant and useful at both measurement time points and that they integrated many of them in their everyday family life.

Conclusions
Resource-oriented suggestions on the promotion of mental health in children seem to offer a non-stigmatizing way to address mental health topics in the pediatric practice. In a next step, we plan to field-test the evaluation and uptake of the accompanying information brochure by pediatricians.