bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing health services accessibility in Colombia: Beyond universal health coverage
Authors: Arrivillaga M 
Published: October 2020

Abstract

Background
Colombia has an insurance-based, private and public health care system, with the intermediation of health insurance agencies that control the resources. At present, the Universal Health Coverage (UHC) is around 97%. However, there is wide scientific evidence that criticizes the structure and operation of the system due to the persistent differences between the UHC indicator and real accessibility to health services. This study aimed to analyze the concept of accessibility of health services in order to design and validate alternatives instruments for its assessment beyond UHC.

Methods
A mixed methods approach with concurrent design in three phases was conducted between 2014 and 2017: 1) systematic review of literature and documentary research; 2) design, content validation with experts and pilot test of instruments to assess health care accessibility and 3) definition of a route to assess accessibility.

Results
The reviewed literature revealed five conceptual logics to define accessibility: decent minimum of health care, health care market, factors and multicausality, needs and, social justice and human right to health. A Household Survey on Accessibility to Health Care Services and a Health Care Services Availability Questionnaire was designed and validated with experts and pilot test in representative samples of households and care centers in three cities in Colombia was conducted. Those instruments were designed under the conceptual logic of human right to health. Finally, an alternative route to assess accessibility in Colombia was proposed.

Conclusions
The route for assessing accessibility with primary data, territorial approach and without intermediation of health insurance agencies allow obtaining an overview of the real situation beyond the UHC indicator. The instruments included in this assessing process can be useful to monitor progress in guaranteeing the human right to health, declared in Colombia and other countries.

Key messages
The UHC indicator is not enough to assess real accessibility to health services. This study presents an alternative route and two validated instruments for its assessment with primary data and territory-based approach, applicable to countries with public-private health systems.
How accessible is the Serbian health system? Main barriers and challenges ahead
Authors: Hernandez-Quevedo C , Bjegovic-Mikanovic V , Vasic M , Vukovic D , Jankovic J , Jovic-Vranes A , Santric-Milicevic M , Terzic-Supic Z 
Published: October 2020

Abstract

Background
Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes.

Methods
We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country.

Results
We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia.

Conclusions
Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations.

Key messages
Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.
Accessibility to health services in Italy and in the world
Authors: Marchetti G , Simonelli M , Dente M G , Marceca M , Declich S 
Published: October 2020

Abstract

Background
The Universal Health Coverage (UHC) proposes that an ideal health system must be able to extend the health coverage to the whole population (universality), to guarantee all the necessary services (globality) and to do it without additional direct costs for the people (free of charge). The achievement of the UHC represents the target 3.8 of the Sustainable Developed Goals. The World Health Organization and the World Bank have developed an index to monitor the UHC (an algorithm that contains 16 indicators of essential health services), while for financial protection they rely on the incidence of catastrophic expenditure on health (percentage of families in which the living expenses for health without reimbursement exceed the10% of consumption).

Objectives
To strengthen the Italian operators' knowledge about the accessibility to health services in Italy and in countries around the world utilizing the UHC index and the incidence of catastrophic expenditure.

Results
The National Center for Global Health of the Italian National Institute of Health (ISS) collected the documents and the data already produced and validated by the international scientific community. ISS in collaboration with the Department of Public Health and Infectious Disease of Sapienza University of Rome developed a workshop training program to bring the UHC concepts at national level in a simplified manner. This was developed in order to encourage a reflection and to strengthen the understanding of the complexity of the UHC. The framework and the program of the workshop will be presented during the conference.

Conclusions
Studying the UHC means focusing on the inequalities in health care. To increase the sensibility of professionals may be a resource to promote the health coverage for all in the national territory.

Key messages
Encouraging the discussion between professionals is possible to understand the complexity of the UHC. The achievement of the UHC may happen only through the improving of the knowledge about it.
Searching for Elysium: teaching universal health care as a human right
Authors: Souza I , Garcia T C , Sayão M N 
Published: October 2020

Abstract

Background
Brazil have a huge free health care system. Inspired on UK National Health System (NHS), the Sistema Único de Saúde (SUS, that means Unified Health System) was consolidate as a right for all citizens after 1988's Brazilian Federal Constitution. Despite your spread, part of Brazilian citizens have an opposite opinions about SUS. So, the main question is: How to teach the relevance of a universal free health care system as a human right.

Objectives
The main aim of this work is teaching the recognize of SUS as a human right and ratified by Brazilian Federal Constitution in a High School class. In this sense, we used the cinema and debate for stimulate an effective comprehension of Universal Declaration of Human Rights (UDHR) and health promotion as a human right in a high school class. We used the movie Elysium (Neill Blomkamp, 2013) that show a dystopian world with two social class: citizen and non-citizen of Elysium (an artificial satellite of the Earth with high technology of cure for your citizens).

Results
The class has three Lessons: in first lesson we teaching about different notions about rights and the UDHR. In the second lesson we teaching about free health care systems in the world and a historical perspective about SUS. The third lesson we show the movie Elysium and proceed a debate. In debate we discuss about citizenship and rights, how the movie show two societies with different rights about work, transport and health, and how this aspects impact the quality of life of human being.

Conclusions
What options we have? The notion of free health care as a human right isn't an easy concept. So, efforts are needed for this comprehension and cinema can be used, followed by discussion, as a significant teaching tool for achieving humanistic educational objectives about free health care system as a human right in the high school curriculum.

Key messages
Health care is a human right and free health care system is a concretization of this right. Cinema can be used for stimulate a critical evaluation and effective understanding of rights in a high school classroom.
Incuding behavioral determinants of vaccine demand and acceptance in the EU policy-making process
Authors: Baggio M , Proestakis A 
Published: October 2020

Abstract
Vaccination is one of the most powerful and cost-effective public health measures developed in the 20th century, and remains the main tool for primary prevention of communicable diseases. Yet, in spite of the overall benefits of vaccination, a number of key challenges still remain to ensure sustainable, equitable and effective vaccination programmes in all EU Member States, and to secure that the added benefits of vaccinations are not lost.
The overall purpose of the research programme presented is to facilitate and execute research on vaccine confidence, identifying behavioural determinants of vaccine hesitancy across different subgroups of the population (including disadvantaged and socially excluded groups) and healthcare workers, for specific categories of vaccines in a number of Member States of the European Union (MS of EU).
The research group has facilitated and executed a preliminary research (consisting of a set of focus groups and an experimental survey) on vaccine confidence, for specific categories of vaccines in a number of MS of EU (Spain, Portugal, Romania, Italy, Poland, French). The outcome of the preliminary study will support the identification of the most promising areas of implementation of behavioural insights to improve vaccine confidence. At the time of writing of this abstract, the results are under collection, and will be ready by the end of June 2020.
During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. This is crucial for policy making at the EU level, especially since the principle of subsidiary limits the possibilities for direct EU action over choice architecture. This requires further coordination with national health authorities

Key messages
During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. In the policymaking at EU level, including behavioural insight at the design and preparation stage is crucial for effective delivery of policy objectives.
Determinants of influenza vaccination intention among Tunisian elderly
Authors: Kharroubi G , Cherif I , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J 
Published: October 2020

Abstract

Background
Influenza vaccination coverage among elderly remains unsatisfactory even in developed countries. Since attitudes are predictors of behavior, understanding factors influencing the intention to receive influenza vaccine (IV) among elderly may orientate interventions to increase vaccination rate. The aim of the current study was to identify factors associated to willingness to receive IV next season among Tunisian elderly.

Methods
During 2018 -2019 flu season a cross-sectional study was conducted among older persons aged 60 years and over with chronic disease attending primary and secondary health care facilities. The intention to get vaccinated against influenza was measured by means of a face to face questionnaire. Factors that affect willingness to receive IV were identified using a multiple logistic regression analysis.

Results
Of the 1191 older persons included, 19.4% [17.1-21.9] participants received IV in 2018-2019 flu season, 64.7% [61.9-67.3] expressed willingness to be vaccinated next season. Willingness to receive IV was more likely among persons with chronic pulmonary disease (ORa=2.6), those suffering from diabetes (ORa=1.6), those who received IV in 2018-2019 flu season (ORa=16.5), those who feel that they get enough information about vaccines and their safety (ORa=2.9) and persons who trust the advice of their health care providers (ORa=4.5).

Conclusions
Vaccination status was the most determinant factor associated to willingness to receive the vaccine. Therefore, sustainable efforts to promote IV may lead to cumulative increase of influenza vaccination coverage year by year. Doctors should be involved more in advocating IV and providing elderly with the necessary information about IV, but that could not be effective without a climate of trust between patients and health care providers.

Key messages
Positive self-experience of older persons with IV may change their perception about it and encourage them to adhere to the vaccine in the future. Elderly should be provided with the necessary information about IV in terms of effectiveness and safety.
Vaccine misinformation - topic-based content analysis on Facebook
Authors: Klimiuk K , Biernacka K , Balwicki Ł 
Published: October 2020

Abstract

Background
Even though vaccinations are referred to as one of the greatest achievements of modern medicine, they are constantly associated with the mood present in part of society denying their sense and effectiveness. The development of technology has moved discussions about vaccinations to the space of the internet. The study aims to analyze the arguments of vaccine-deniers of children use in social media.

Methods
All public comments from the leading Facebook page of opponents of vaccination on Facebook were collected, which were available there between 01/05/2019 and 31/07/2019. Then the comments were stored on a Google spreadsheet and analyzed quantitatively in terms of the content according to the modified method developed by Kata (Kata, 2010).

Results
18685 comments were analyzed, of which 4042 contained content within the adopted criteria: 28.2% concerned conspiracy theories, 19.9% covered misinformation and based on unreliable premises, 14.0% related to the safety and effectiveness of vaccinations, 13.2% to non-compliance with civil rights, 10.9% own experience, 8.5% of morality, religion, and belief, and 5.4% of alternative medicine. There were also 1223 pro-vaccine comments, of which 15.2% were offensive, mocking or non-substantive.

Conclusions
A relatively large amount of content concentrated in terms of conspiracy theories and disinformation may indicate that this is a community characterized by a lack of trust in the scientific achievements of medicine. Surprisingly many comments related to one's own negative experiences with vaccinations, which contrasts with official statistics about side-effects. Vaccination promotion should refer to the arguments of vaccination opponents.

Key messages
The tendency of vaccine-hesitancy is strengthened by 'anti-vaccine' content in social media. To understand the individuals we need to understand what information he daily learns from the internet. It can be hard to maintain herd immunity, due to the prevailing misinformation on vaccination. To overcome this phenomenon, information campaigns must be dependent on the content in social media.
Knowledge and Behavior of Nurses on Childhood Vaccine Refusal in a Hospital of Eastern Turkey
Authors: Boz G , Yigit E , Gokce A , Aslan M , Ozer A 
Published: October 2020

Abstract

Background
Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working in Malatya Turgut Özal Hospital on childhood vaccine refusal.

Methods
This study, conducted between June-July 2019, is a descriptive cross-sectional study and its universe is composed of 850 nurses working in Turgut Özal hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. In the questionnaire, sociodemographic questions on nurses and children as well as questions determining nurses' knowledge and behavior on childhood vaccine refusal were asked. Chi-square test and Fisher's Exact Test were used in statistical analyses. p &lt; 0.05 was determined to be significant.

Results
31.7% of nurses participating in the study stated that they had concerns on childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines were from their education, one-thirds of them knew that childhood vaccines were mandatory by law while three out of four stated they knew the vaccination schedule recommended by the Ministry of Health. The level of concern in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p &lt; 0.05).

Conclusions
One-thirds of nurses was proven to have concerns on childhood vaccines and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary trainings and practices in order to ease their concerns on vaccination.

Key messages
In-service trainings should be given importance in order to reduce nurses’ concern. Due to the fact that the information source for nurses on vaccination was their education, subjects that would eliminate their concerns should be highlighted.
Evaluation of Vaccination Knowledge, Attitudes and Practices and Health Literacy Levels of Adults
Authors: Çam C , Kılınç A , Ünsal A , Arslantaş D , Öztürk Emiral G 
Published: October 2020

Abstract

Background
This study aims to evaluate the vaccination and immunization knowledge, attitudes and practices and health literacy levels of adults living in rural area of Eskisehir City in Turkey.

Methods
The study is a cross-sectional study conducted on individuals aged 18 years and over who live in the rural area of Eskisehir City between November 16 and December 30, 2018. The study group consisted of 955 participants. The survey includes the questions about the evaluation of vaccination and immunization knowledge, attitudes and practices and the questions from the European Health Literacy Scale Short Form (HLS-EU-Q16). The statistical significance value was accepted as p ≤ 0.05.

Results
493 participants (51.6%) of the study group was female. Their ages ranged between 18 and 85 years with a mean (SD) 42.6 (15.6) years. In the study, it was found that 325 people (34.0%) had insufficient knowledge of vaccine and immunization. A positive weak correlation was found between the scores obtained from the information questions about vaccination and immunization and the scores obtained from HLS-EU-Q16 (r = 0.252; p = 0.001). It was found that there was a weak positive correlation between the scores obtained from information questions about vaccination and immunization and the scores obtained from questions about their attitudes and practices towards vaccination and immunization services(r = 0.333; p = 0.001). Being 65 years and older, living in the village having not been vaccinated in the last 10 years and lack of previous information about vaccines, were found to be important risk factors for lack of knowledge level on vaccine and immunization.

Conclusions
In the study, it was observed that one third of the group's vaccine and immunization knowledge levels were insufficient. Determining the factors that affect the level of knowledge about vaccination and immunization may be important in terms of sustaining the effectiveness of vaccination applications and campaigns.

Key messages
Lack of information about vaccines and insufficient knowledge about vaccine-preventable diseases can feed individuals' indecisiveness to vaccination. Health education and information services can be provided to increase the level of vaccination and immunization knowledge.
Impact of a community empowerment programme in disadvantaged UK neighbourhoods: results of a survey
Authors: Bagnall A M , Trigwell J , Heisse C , Quick A , Southby K , Woodward J , South J , Button D 
Published: October 2020

Abstract

Background
A community empowerment programme in the UK aims to enable people to have greater collective control over area-based decision making, improved health and wellbeing and reduce health inequalities, by providing small grants to support residents of deprived neighbourhoods and communities of interest to come together to take action on issues of importance to them.

Methods
A survey was conducted at 4 6-month intervals as part of a mixed methods evaluation, to collect data about participant demographics, level of involvement, opinions of the project, and impacts. The survey was self-completed online or on paper, and distributed by local project leads. Outcome questions were adapted from the UK Government Community Life Survey to facilitate comparison with national statistics. Data were analysed using SPSS to produce descriptive statistics, supported by inferential statistical tests where appropriate. Regression analysis using multi-level modelling was used to estimate the conditional correlation between health outcome and Local People project participation.

Results
1053 people from 29 local areas responded to the survey over the 4 time points; only 93 responded more than once. 43% took part in project activities, 36% were local project committee members and 19% were volunteers. The analysis found positive impacts on confidence, control, friendships, skills, happiness, life satisfaction, feelings of worth (p &lt; 0.05), and that greater length and degree of involvement in the projects were associated with greater positive impacts on all of these outcomes.

Conclusions
The survey provides tentative evidence that participation in a community empowerment initiative may result in improved wellbeing, feelings of power and control, sense of belonging and trust. People who are involved for longer or more deeply involved are more likely to see these impacts. More community-based survey research is needed to gather people's views on neighbourhood initiatives.

Key messages
An evaluation of a community empowerment programme found positive impacts on control, wellbeing, belonging and trust. Greater length or degree of involvement were associated with greater impact.