bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors contributing to physicians’ use and satisfaction with Electronic Health Records in Kuwait
Authors: Alotaibi J , Tolma E , Alali W , Alhuwail D , Aljunid S 
Published: October 2020

Abstract

Introduction
Electronic Health Records (EHR) help physicians make effective decisions in patient care. With limited research in this area in Kuwait, we sought to identify the factors that contribute to the current use and satisfaction of EHR in Kuwait.

Methods
This cross-sectional study took place in a public hospital in 2019. Three-hundred ten physicians were recruited through convenience sampling (response rate: 95%). The survey which was translated into Arabic, was self-administered and it contained 48 statements. The Technology Acceptance Model was used as the theoretical framework. The dependent variables were satisfaction with EHR and current use of EHR. The main independent variables were barriers of using the EHR, perceived level of ease for using EHR, and effect of EHR on the physicians' work. Descriptive analysis, followed by bivariate, multivariate linear regression adjusted for demographics were conducted.

Results
The study sample consisted of predominantly males (82%), non-Kuwaiti (84%), and of young age (42% were 30-39 years old). The majority of the participants (76%) were currently using the EHR system. The physicians' satisfaction with use of EHR system was moderate (Mean: 3.47, SD: 0.81, range 1.33-5). The EHR effect on the physicians' work was the most significant predictor of satisfaction (β = 0.491, p = 0.000), followed by the level of ease (β = 0.274, p = 0.000), and length of use of EHR (β = 0.100, p = 0.006). Perceptions of barriers was the strongest predictor of current use of EHR (β=-0. 417, p = 0.000), followed by level of ease (β = 0.227, p = 0.000) and quality of a related training (β = 0.195, p = 0.000).

Conclusions
In the promotion of EHR use and related satisfaction, making the use of EHR functions (e.g. registration of clinical notes) as easy as possible seems to be a key factor. Other factors to consider are removing the barriers physicians face, making the benefits of use of EHR visible, and ensuring a high quality related training.

Key messages
Most physicians in a Kuwaiti public hospital use the EHR system. Perceived barriers, effect of EHR on the physicians’ work, and user-friendly application of EHR are associated with satisfaction and EHR use.
Prevalence of amputations amongst people with type 2 diabetes enrolled in primary care in England
Authors: Meza-Torres B , Heiss C , Cunningham S , Carinci F , de Lusignan S 
Published: October 2020

Abstract

Background
Different patterns of co-morbidities observed among people with type 2 diabetes (T2D) and lower extremity amputations (LEA) compared with those without may provide insights into the quality of care provided by general practitioners in England. We analysed routinely recorded clinical data to build predictive models for benchmarking and continuous improvement.

Methods
A cross-sectional computerized data extraction of clinical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database of people with T2D in England. Key target cases were defined as adults with T2D and a record of major/minor LEA between 2008-2019 vs all subjects with T2D without amputation. Quality of care was assessed in terms of percentage of patients treated with optimal medical therapy and diagnostic procedures and referred to specialized care according to their clinical profile. The association between quality of care and outcomes was explored using a logistic regression model, adjusting for case-mix.

Results
During the last decade, in a sample covering approximately 7.4% of all general practitioners in England, a total of 1,052 subjects out of 127,100 adults with T2D had a LEA (832 per 100,000). The median time since amputation was 3.4 years. Only 410 (38%) patients had a recorded DFU diagnosis prior to the amputation, with a median of 2 years from diagnosis to amputation. Major LEA was recorded in 280 (27%) cases. People with a record of retinopathy, peripheral arterial disease, renal disease, neuropathy and DFU had a higher risk of amputations. Quality of care was heterogeneous between patients with and without LEA.

Conclusions
People with T2D and LEA have a distinct pattern of co-morbidities some of which may be sensitive to improved primary care management, and differential quality of care. Models built using this national database can routinely monitor amputations in England. Variation in treatment should be properly investigated.

Key messages
The automated extraction of clinical cases from a national database may help shed light on clinical patterns among people with diabetes at high risk of amputations, based on evidence-based criteria. Variation in treatment and quality of care among amputated vs non-amputated subjects can be rapidly explored using a cross-sectional analysis of current records.
The implementation of a mobile application to support community-based health workers
Authors: Martins A C F , Pereira P L , Mafra A C C N , Miraglia J L , Monteiro C N , Silva J R , Almeida E S , Oliveira J S , Santos V S , Borges L M 
Published: October 2020

Abstract

Issue
Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information.

Description of the Problem
During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry.

Results
Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application.

Lessons
A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced.

Key messages
A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.
Validation of the CASUS score in Tunisian patients: a quality management tool in intensive care units
Authors: Besbes T , Mleyhi S , Sahli J , Messai M , Ziadi J , Ghedira F , Ajmi N , Denguir R 
Published: October 2020

Abstract

Background
Early prediction of patients at highest risk of a poor outcome after cardiovascular surgery, including death can aid medical decision making, and adapt health care management in order to improve prognosis. In this context, we conducted this study to validate the CASUS severity score after cardiac surgery in the Tunisian population.

Methods
This is a retrospective cohort study conducted among patients who underwent cardiac surgery under extracorporeal circulation during the year 2018 at the Cardiovascular Surgery Department of La Rabta University Hospital in Tunisia. Data were collected from the patients hospitalization records. The discrimination of the score was assessed using the ROC curve and the calibration using the Hosmer-Lemeshow goodness of fit test and then by constructing the calibration curve. Overall correct classification was also obtained.

Results
In our study, the observed mortality rate was 10.52% among the 95 included patients. The discriminating power of the CASUS score was estimated by the area under the ROC curve (AUC), this scoring system had a good discrimination with AUC greater than 0.9 from postoperative Day 0 to Day 5.From postoperative day 0 to day 5, the Hosmer-Lemeshow's test gave a value of chi square test statistic ranging from 1.474 to 8.42 and a value of level of significance ranging from 0.39 to 0.99 indicating a good calibration. The overall correct classification rate from postoperative day 0 to day 5 ranged from 84.4% to 92.4%.

Conclusions
Despite the differences in the profile of the risk factors between the Tunisian population and the population constituting the database used to develop the CASUS score, we can say that this risk model presents acceptable performances in our population, attested by adequate discrimination and calibration. Prospective and especially multicentre studies on larger samples are needed before definitively conclude on the performance of this model in our country.

Key messages
The casus score seems to be valid to predict mortality among patients undergoing cardiac surgery. Multicenter study on larger sample is needed to derive and validate models able to predict in-hospitals mortality.
The Situation Room as a management tool: the case of the Municipal Health Secretariat of Salvador
Authors: Pereira M , Santos dos , Alves H , Lima Vieira , Carvalho Cerqueira S , Almeida A , Jure F , Rosemberg R , de Fernandes Oliveira 
Published: October 2020

Abstract

Problem
The Salvador Municipal Health Secretariat (MHS) utilizes health data to elaborate technical documents to manage and respond to instances requiring internal or external control. In answer to demands for the modernization and transparency of municipal management, the constitution of a Health Situation Room (HSR) was included in the political agenda of the Secretary, thereby guaranteeing political, technical and operational support for its implementation.

Description of the Problem
To describe the process of construction of the HSR in the Salvador MHS in 2020. The HSR is a physical, virtual and collective space for the analysis of information, which begins with a data search which allows to understand the information flow, identifying the solicitor and the constructor of the information, the data source and the informational object itself.

Results
130 technicians and managers were interviewed, and their responses then categorized into 161 indicators across different themes. The results point out the need to define a spatial analysis unit to be adopted, and to communicate with external actors who demand information, as well as to develop a communication plan for the HSR.

Lessons
To develop an informational culture oriented by local and central protagonism, generating evidence for decision-making and information transparency for the whole of society.

Key messages
The Health Situation Room reduces the time between information-decision-action. The Health Situation Room prioritizes interdisciplinary collaboration and increases the efficiency of the health system.
A GDPR-compliant information system to improve community primary care in a middle income country
Authors: Oliveira V A , David R B , Mota L G , Barral-Netto M , Carreiro R P , Botelho D F 
Published: October 2020

Abstract

Background
A strong primary health care (PHC) is associated to better overall health system results. Brazil has good results in PHC in the last decades, integrating 260,000 community health workers (CHW) in 43,000 family health teams (FHT), assisting 90 million people and delivering 500 million health activities yearly, such as home visits, consultations, colposcopy, etc. We address the challenges of incorporating CHA-produced data to official electronic health records, automate its analysis and promote information use by FHT to plan activities & prioritize individuals considering social determinants of health, clinical data and treatment plans. Our study developed a general data protection regulation (GDPR) compliant information system to improve community health agents and family health teams coordination of care in order to address this challenge.

Methods
The intervention was developed using UX techniques and combines Apps and Web dashboards, issuing digital alerts to the FHT and municipal health manager, regarding individual health status and pending care for each covered individual. The research used the “Monitoring and Evaluating Digital Health Interventions” toolbox by World Health Organization (WHO), and GDPR compliance was attained by terms of use acceptance, pseudonymisation and anonymization procedures.

Results
Stage 1 and Stage 2 Maturity tests with doctors, nurses and CHA showed good feasibility, usability and user satisfaction of the solution. UX and Qualitative Assessment are reported separately.

Conclusions
Results so far point that the solution is viable and acknowledged as useful by health professionals. Stage 3 (Pilot) will run in September 2020 in two different cities to test efficacy and health system adherence in real world setting. Digital health interventions are powerful tool to improve health care system performance, particularly in Primary Health Care.

Key messages
Digital Health Intervention are viable in Primary Care as long as they reduce health profesisonal burden and increase service quality. Brazil is a promising environment for Digital Health. Careful planning, development and deployment are essential in the process.
UX Research applied to digital transformation of primary care in Brazil
Authors: Mota L G , David R B , Botelho D F , Oliveira V A 
Published: October 2020

Abstract

Background
Digital are powerful tools to improve the work and quality of information of primary care teams (PHC) in Brazil has been encouraged through the institution of the e-SUS Primary Care strategy (e-SUS AB). Digital tools were developed to optimize the PHC work process in collecting data on the health of the Brazilian population. The e-SUS AB application was one of those tools developed by the Ministry of Health. This simplified collection of population data. Despite technological updates, since 2015 there were updates regarding the usability of the application.

Objective
Aim to report on the use of UX research tools to identify changes needed in the e-SUS AB application and to propose solutions aligned with the concepts of usability.

Methods
For the UX Research, we used focus groups and field monitoring. As a result, we produced personas, empathy map, user journey, and user history documents. The Heuristic User Interface Design, proposed by Nielsen, was used for the application analysis. The World Health Organization's MEDHI (Monitoring and Evaluating Digital Health Interventions) protocol was used for designing solution proposals for UX Design.

Results
In the design process, we produced navigation sketching's flow and high-fidelity prototypes for improvement proposals. It was necessary to correlate Nielsen's 10 heuristic principles with the needs inherent to public health applications. Problems related to the freedom of control and use by the health professional and the flexibility and efficiency of use were the most significant finds. We also identified underutilization of data collected.

Conclusions
Based on the results found, an aesthetic reformulation was proposed to solve the heuristic problems. It was also proposed to include a new functionality: a checklist for specific conditions, thus optimizing the use of data collected for primary health care. The proposals are currently undergoing usability testing in a municipality in northeastern Brazil.

Key messages
We need to plan health digital tools with UX knowledge to improve analysis and decision making capabilities to pointing out strategies to face health issues in the territories. Digital tools are powerful tools to improve health care system performance.
Reviewing Effective Contents for a Gamification Approach to Foster Wellbeing among Adolescents
Authors: Thiele A , Tolks D , Sailer M , Dadaczynski K , Lampert C , Paulus P 
Published: October 2020

Abstract

Background
Ample evidence exists that wellbeing is critical during teenage years. Therefore, options for implementing wellbeing among adolescents are needed. To fulfill this need, gamification promises to be a suitable method. Gamification uses game design elements from a game context (points, leaderboards) and game elements (randomness, tension) in a real life context to reach life goals such as behavioral changes. Recent studies indicate that gamification only produces long-term effects when filled with stimulating content. To categorize the content of the adventures and other game design elements within the gamification concept, the “5 ways to wellbeing” have been a suitable evidence-based approach among adult interventions: connect, give, take notice, keep learning and be active. This research aims at filling the framework of gamification with the most opportune content to foster wellbeing among adolescents.

Methods
71 interventions of fostering wellbeing among adolescents could be identified in a scoping review from Pubmed. Eligible interventions had to focus on adolescents and had to have outcomes on wellbeing. Interventions that covered a more specific target group, such as cancer survivors, were excluded from this research.

Results
Adolescent interventions' contents, which had a positive outcome on wellbeing, mostly dealt with physical activity (13) and health promotion (11), followed by psychological training interventions (9). 11 interventions did not have a positive outcome on wellbeing.

Discussion
The many positive outcomes in above categories result from the amount of interventions. To further investigate the effect of the five ways to wellbeing within a gamification framework for adolescents, we develop an intervention application (ONYA) which will be applied among adolescents in German middle schools.
ONYA is funded by the German Federal Ministry of Health Education.

Key messages
Research on suitable content for gamification frameworks on wellbeing is rare. Wellbeing interventions are underrepresented in the categories of the 5 ways to wellbeing.
Promoting education on the health effects of climate change for nurses in Finland
Authors: Tiitta I , McDermott-Levy R , Jaakkola J J K , Turunen H , Kuosmanen L 
Published: October 2020

Abstract

Background
Climate change has a direct and indirect impact on human health that include health impacts from rising temperatures and poor air quality. Without changes in our greenhouse gas emissions, it is estimated that by the end of this century average temperatures will rise from two to four degrees Celsius worldwide. In Finland, this rise in temperature is estimated to be 1.5-2 times higher than other regions of the world. During the heatwaves in Finland in the 2000s, the mortality rate among the elderly increased by 21%. Nurses should be aware of these health effects and the patients who are particularly vulnerable to the health impacts caused by climate change.

Purpose
The purpose of the study was to identify the health issues that Finnish nurses associate with climate change. The purpose was also to find out how prepared nurses are to deal with the health effects of climate change.

Methods
A qualitative descriptive study was conducted in November 2018 using focus group interviews to collect data.

Results
Interviews revealed that nurses have seen much of the health damage caused by climate change in their patients. However, they had not linked their observed changes in patients' health to climate change. Nurses interviewed felt unaware of the health effects of climate change. In addition, nurses felt that climate change was not adequately addressed in basic and in-service training.

Conclusions
Education could strengthen the competence of nurses in helping their patients prevent and reduce the health impacts caused by climate change. It is therefore important to include climate change and its impact on human health in the nursing curriculum.

Key messages
Nursing organizations can influence nurses’ understanding of climate change in their practice. Nurses' understanding can be used leverage their role in reaching nurses for new and emerging health conditions that influence public health.
Urbanization and greenness in HBSC survey: association with life satisfaction and health complaints
Authors: Gintoli I , Bellisario V , Squillacioti G , Caputo M , Borraccino A , Dalmasso P , Bono R , Lemma P 
Published: October 2020

Abstract

Background
Several studies have shown that neighborhood greenness is associated with lower problematic behaviors in children and better perceived well being. While urbanization showed opposite results. The aim of the study was to assess the relationship between urbanization and greenness levels with perceived health, life satisfaction and health complaints on adolescents.

Methods
The study is based on data from 2018 Health Behavior in School-aged Children in the region of Piedmont(Italy), which involved 3022 11-,13-,15-year olds, sampled in 122 schools across the region. Every school was georeferenced. Greenneess was measured by Normalised Difference Vegetation Index (NDVI-satellite images) and urbanization by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations). Health complaints were evaluated with a set of 8 psychosomatic symptoms(reported more than once a week). Life Satisfaction (LS) was measured by using the Cantril scale (low LS &lt; 5, high LS &gt; =6). Self-Rated Health was measured by means of a four points scale (fair or poor, good or excellent).

Results
More than 66% of adolescents reported frequent health complaints; 11% declared low life-satisfaction and 9% of adolescents scored poor or fair self-rated health. The proportion of the three variables increased with age in both genders, and was higher among girls. Gender differences increased from 11- to 15-years of age. Preliminary results showed a positive association between greenness and life satisfaction, urbanization and health complaints.

Conclusions
In times of increasing urbanization and reduced availability of green areas, characterizing the association between urbanization, greenness and perceived health is revealed to be the challenge for Public Health. Redefine the urban spaces accordingly requires collaboration between different disciplines. Coherently with the recent studies, communities can be actively involved through qualitative approaches.

Key messages
The topic of urban nature is becoming central for healthy and sustainable urban planning, not the least for population groups like adolescents and children. The relation between urbanization, with decreasing access to green spaces, and the impact on physical as well as mental health presents an important issue and a big challenge for Public Health.