bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Sense make sense? Mixed methods study of a Dutch sexual health program
Authors: Joosten R , Jochems L , Wijsen C , Heijman T , Timen A 
Published: November 2019

Abstract

In the Netherlands, the Sense program addresses several key elements of sexual health for young people &lt;25 year. This program offers free consultations at the PHS concerning STI, contraceptives, pregnancy or sexuality. The performance of this program has not been studied yet. This mixed methods study investigates facilitators and barriers of a Sense consultation from the perspective of clients and health care professionals (HCP) and investigates the outcome of the consultation at three points in time. Semi-structured interviews were conducted after consultation among 16 clients and 6 HCP. Questionnaires were collected directly after consultation and at 3, 6 and 12 months after consultation. Two cohorts were recruited; clients with STI consultation only and clients with questions related to sexuality, contraception and pregnancy (Sense consultation, SC). Satisfaction of the consultation and applicability of the given advice was measured. In the follow up presence of STI, pregnancy, sexual problem and contraceptive use was measured. A minority of the interviewed clients were familiar with Sense, highly valued the expertise of the HCP and the open atmosphere during the consultation. Reasons for visiting Sense included expertise, more anonymity and feeling more comfortable than at the GP. The questionnaire after consultation was returned by 144 STI clients and 32 SC clients. Both type of consultation were highly valued and advice was easily applicable. The follow up cohort included 97 STI clients and 23 SC clients. Response rate of the 3- and 6 month-questionnaires was 61%. Results of the full one year follow-up are expected in September 2019. Study results provide evidence for a highly valued Sense program, by both clients and HCP. Sense is a platform to discuss STI, contraception and sexuality in an open atmosphere, though familiarity with Sense is low. A major conclusion is that an STI consultation provides the opportunity to address questions related to sexuality.

Key messages
The Sense program is highly valued by young people, and yet the program is not widely known among young people. There is need for more publicity to the program to enable more young people to use this program and to improve the sexual health care of young Dutch people.
Gender-specific health literacy of individuals with a migrant background: A mixed-method approach
Authors: Aldin A , Chakraverty D , Baumeister A , Monsef I , Jakob T , Seven ÜS , Anapa G , Kalbe E , Woopen C , Skoetz N 
Published: November 2019

Abstract

Background
The project “Gender-specific health literacy in individuals with a migrant background (GLIM)” (German Federal Ministry of Education and Research; 01GL1723) aims to provide a comprehensive overview of international research and evidence on aspects of gender and migration related to health literacy. It encompasses primary and secondary research using a mixed-methods approach.

Methods
In a first step, we systematically review the available quantitative and qualitative evidence: in the first quantitative review, we meta-analyse the evidence on gender differences in health literacy of migrants. The second quantitative review assesses the effectiveness of interventions for improving health literacy in female and male migrants. The third review summarises qualitative evidence to assess factors associated with gender and migration that may play a role in the design, delivery, and effectiveness of such interventions. In a second step, we conduct primary research by performing focus group discussions (FGDs) with health care providers who regularly work with different migrant groups in order to explore their perspectives on the challenges and needs of migrants in the German health care system.

Results
To date, we identified 163 relevant references after screening of 17,932 references, for all reviews combined. Various health literacy interventions and measurement tools exist and require critical evaluation. The FGDs yielded hints to factors that a) influence gender differences in the health literacy of migrants (e.g. masculinity norms preventing Mediterranean men from consulting psychotherapists) or b) limit systemic health literacy (e.g. lack of translators).

Conclusions
Results from the FGDs can provide insights into the processes underlying the results of the reviews. However, despite increasing research, summarising the available evidence is highly challenging, as there are no universal definitions of the key concepts health literacy and migrant background.

Key messages
This is an interdisciplinary project, combining quantitative and qualitative evidence to provide maximum value to health policy and decision-making for the health care and health literacy of migrants. Research on gender-, and migration-specific aspects of health literacy is of great importance for the development and delivery of effective interventions for improving migrants’ health literacy.
Cardiovascular hospitalisation before and during the financial crisis among occupations in Taiwan
Authors: Chang Y 
Published: November 2019

Abstract

Background
Cardiovascular diseases (CVD) were related to financial stress. Little was known about the effects of financial crisis on cardiovascular health by occupations. This study examined CVD hospitalisations before and during the 2008 financial crisis among five occupational groups in Taiwan.

Methods
Data were collected from the Taiwan Survey on Hypertension, Hyperglycemia and Hyperlipidaemia 2007, including 4,673 participants aged 20 and above, categorized into five types of occupations, i.e., professional & manager (PM), office clerk & administrative staff (OA), skilled work (SW), unskilled worker (UW) and non-worker (NW). We abstracted their CVD hospitalisation records in the three years before (September 2005 to August 2008) and during the 2008 financial crisis (September 2008 to August 2011) from the National Health Insurance Research Database. Using incidence rate ratios (IRRs), we compared CVD hospitalisation of the first, second, third year from September 2008 to the three-year average before September 2008 for five occupational groups. Random effect negative binomial models were performed to estimate IRRs.

Results
After adjusting for covariates including age, sex, education, smoking, alcohol drinking, exercise and body mass index, there was an increase of CVD hospitalisation incidence for NW in the first year of the financial crisis (IRR=1.46, 95% Confidence Interval [95% CI]=1.19-1.77); in the second year, SW had a raised risk of CVD hospitalisation (IRR= 2.71, 95% CI = 1.59-4.60). For all occupational groups, the incidence rates of CVD hospitalisation reached the peak in the third year (PM: IRR=2.68, 95% CI = 1.05-6.83; OA: IRR=2.70, 95% CI = 1.18-6.19; SW: IRR=5.13, 95% CI = 2.89-9.09; UW: IRR=2.12, 95% CI = 1.02-4.41; NW: IRR=1.85, 95% CI = 1.18-2.67).

Conclusions
CVD hospitalisation of all occupations were affected by the financial crisis; when non-workers were the early victims, skilled workers may be the most vulnerable in the 2008 financial crisis.

Key messages
This study investigated the effects of the 2008 financial crisis on cardiovascular disease hospitalization by five occupational types in Taiwan. All occupations, particularly skilled workers, were affected by the financial crisis.
Socioeconomic Inequalities in Cardiovascular Risk Factors in Turkey, 2008-2016
Authors: Erkoyun E , Mackenbach J P 
Published: November 2019

Abstract

Background
This study aims to investigate the magnitude of occupational class (OC) and educational inequalities in cardiovascular risk factors in Turkey from 2008 to 2016.

Methods
We used the Turkey Health Survey, a bi-annual health interview survey among a representative sample of the Turkish population. We calculated the age-standardized prevalence of four cardiovascular risk factors (obesity, overweight, hypertension, diabetes and smoking) by OC and education, and summarized inequalities with the Relative Index of Inequality (RII) and Slope Index of Inequality (SII). To determine whether the RII/SII changed over time we estimated a regression model with an interaction term between survey year and OC/education.

Results
We found different patterns for men and women. Among men, smoking was the only risk factor with a higher prevalence in both lower OC and education groups (RII = 1.18 (95% CI: 1.08-1.28) and 1.40 (1.26-1.55), respectively). Obesity, overweight and diabetes was higher among higher OC (e.g., for overweight RII = 0.83, 95% CI 0.76-0.90) whereas obesity was higher among lower educated (RII = 1.32, (95% CI: 1.08-1.61)) and no inequalities were found for hypertension by socioeconomic status. However, among women, all risk factors except smoking had a higher prevalence in lower OC and education groups (e.g., for overweight RII = 1.14 (1.06-1.24) and 2.98 (2.71-3.29), respectively), whereas for smoking we found a higher prevalence in higher socioeconomic groups (RII for OC = 0.77 (95% CI: 0.65-0.90 and for education = 0.36 (0.29-0.44)). Significant interactions with survey year were only found in a few cases, mainly pointing to emergence or widening of inequalities to the disadvantage of lower socioeconomic groups.

Conclusions
Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but if current trends continue similar inequalities will emerge in the near future.

Key messages
In Turkey, in men obesity, overweight and diabetes are concentrated among higher occupational classes, obesity is concentrated among lower education groups and lower socioeconomic groups smoke more. In Turkey, in women obesity, overweight, hypertension and diabetes are concentrated among lower socioeconomic groups however higher socioeconomic groups smoke more.
The achievements of the ToREACH project and next steps
Authors: Montante S 
Published: November 2019

Abstract
Putting in practice the Strategic Research Agenda of TO REACH within a European platform for learning and collaboration requires the engagement with a wide range of stakeholders both at national and European level. The TO-REACH project is itself a first step towards establishing such a partnership and cooperation approach, involving policymakers, funders, researchers and other stakeholders from across the European Union. A shared European approach to health services and policy research will contribute to addressing the challenges described in the previous presentations by putting in place the governance and framework conditions needed to support the necessary research across the region and beyond.
Coriine Alberti
Contact: corinne.alberti@urc-eco.fr
Matthias Wismar
Contact: wismarm@obs.who.int
Clinical and policy contexts for cancer care: Evidence from Denmark, Ireland and Ontario (Canada)
Authors: Morris M , Landon S , McKee M , Nolte E 
Published: November 2019

Abstract

Background
We know there are large differences in cancer survival between countries. We know much less about why they exist and persist. In the International Cancer Benchmarking Partnership, we are seeking to understand the influences on patient journey in different countries. In this study we explore how health system factors impact on cancer care in Denmark, Ireland, and Ontario (Canada) to identify common themes, national specificities, and messages for other health care providers.

Methods
We systematically analysed (i) cancer policy and strategy documents from the three jurisdictions, published between 1995-2014 (n = 20) and (ii) interviews with key informants representing government, health services providers, professional bodies and patient organisations (n = 25). We thematically analysed both datasets using NVivo.

Results
Five themes emerged from the document review and were confirmed by interview: governance, quality assurance, service delivery, infrastructure and workforce. All three jurisdictions introduced a designated organisation to lead, monitor and, in Ontario, fund cancer services. Reducing wait times was prioritized, with the expansion of diagnostic capacity from the 2000s, for example. Concentrating services into fewer specialist centres was widely viewed as crucial for improving survival for some cancers. Yet policy intent was not always successfully realised on the ground, with lack of sustained investment, organisational barriers or logistical challenges impeding implementation. Jurisdictions face particular challenges maintaining and upgrading infrastructure and equipment, and recruiting and retaining critical staff, specifically in radiology and primary care.

Conclusions
Cancer care is complex and understanding the interrelationships between factors acting at different levels of the health system is important to improve outcomes. Continued investment in infrastructure and people will be essential.

Key messages
Countries face common challenges in creating health systems that optimise cancer outcomes. Sustained investment in equipment and human resources will be critical to optimise cancer care and survival.
Workshop: Health workforce meets HSR: Tackling regional inequalities in health service provision
Authors:   Organised by: EUPHA (HSR), EUPHA (HWR) Chair persons: Judith de Jong - EUPHA (HSR), Ellen Kuhlmann - EUPHA (HWR)
Published: November 2019

Abstract

Background
Many countries across Europe are facing considerable challenges in providing accessible and high quality care regardless of where people live. A major element is the difficulty that countries face to attract and retain health care professionals to work in remote and rural areas. This applies to primary care services as well as to hospital care, and to the care provided by physicians and other health professionals, including nurses. A widely shared question is therefore how to safeguard access to health care in rural areas and to solve recruitment and retention problems in such regions, both of medical and nursing staff. The workshop will build on last year’s joint workshop of the Sections on HSR and HWR that ended with questions related to how to organize accessible and equitable health services including the workforces required to do so.

Objectives
This workshop will provide a snapshot of studies from across the European region, with a particular focus on differences between rural and urban health care practices and the types of solutions being used to reduce regional disparities in provision of care. This often refers to retention and recruitment strategies, but the session will also address other types of solutions in the organization of care that can help ensure accessible care, including in vulnerable regions and settings. Tackling this challenge will therefore require a joint approach, tapping into experience from health workforce research as well as wider health services research, bringing together research into the organization and management of healthcare and into the health human resources providing this care, operated from different angles and being informed by different research traditions and data sources. Based on statements, we will discuss the topic of how to organize accessible and equitable health services including the workforces required to do so after the presentations.

Key messages
Workforce policies should focus on retaining primary care workforce in rural areas and integrated policies should attract new primary care practices. Both in primary care and hospital care new solutions are being sought which should help resolve regional differences in access to care and attractiveness for the health workforce.
Regional shortages in a small country: how to provide the right care in the right place?
Authors: Hansen J , Batenburg R , Vis E , Van der Velden L 
Published: November 2019

Abstract

Background
The Netherlands, though being a relatively small and densely populated country, is faced with a similar challenge as other countries in terms of regional differences in access to care and attractiveness for care workers to build their careers. Both in primary care and hospital care new solutions are being sought which should help resolve these growing difficulties.

Methods
We conducted a literature review, survey and registry analysis, and held interviews with key stakeholders.

Results
Substantial differences exist between regions in the supply of both primary care and hospital care doctors. Particular and less populated regions appear to be hit in multiple ways, both with an extra ageing population requiring more care as well as by limited attractiveness for both primary care and hospital care workers. Solutions being used so far are mostly initiated by individual health care settings, such as strategic personnel management, redistribution of tasks and campaigns to increase the inflow of staff. Increasingly, solutions are also being explored at regional level, including a growing emphasis on regional collaboration, both in providing the right care in the right place as well as in terms of joint recruitment strategies. Still, such approaches only have a limited effect as a result of which new approaches are needed.

Conclusions
Strategies to improve the attractiveness of particular regions are now often fragmented, both between types of professions and sectors and different regions. In addition, innovative and new solutions appear to be hampered by vested interests of stakeholders. If new solutions are to be developed it is key that stakeholders are willing to compromise, be it when it comes to the autonomy of health care professionals and their associations and to the financial commitments required from government and insurer side.
Relationship between sleep patterns and multimorbidity in the Canadian Longitudinal Study on Aging
Authors: Nicholson K , Rodrigues R , Anderson K , Wilk P , Guaiana G , Stranges S 
Published: November 2019

Abstract

Background
Sleep difficulties are an unmet public health problem, affecting large segments of the population around the world. Poor sleep quality and reduced sleep duration impact over half of older adults and are associated with adverse health outcomes like multiple chronic diseases (multimorbidity) and reduced longevity.

Methods
A cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA), a national health survey of community-dwelling adults and older adults. A total of 30,011 participants had physiological and psychosocial data collected at baseline. Sleep measures included self-reported sleep duration (short: &lt;6 hours, normal: 6-8 hours, long: &gt;8 hours) and sleep quality (dissatisfied/very dissatisfied, neutral, satisfied/very satisfied). To capture multimorbidity, a primary definition was operationalized with 17 chronic conditions, whereas a secondary definition was operationalized with 9 chronic conditions to capture both the primary care and public health perspective.

Results
In our sample, 50.9% were female (average age: 62.7 years) and 49.1% were male (average age: 63.2 years). The majority reported a normal sleep duration and approximately half reported being either satisfied or very satisfied with sleep quality. About 70% were living with multimorbidity using the primary care definition (females: 71.7%; males 64.3%), while about 30% were living with multimorbidity using the public health definition (females: 34.8%; males: 28.9%). The adjusted analyses indicated the odds of multimorbidity increased for those who reported short or long sleep duration, as well as dissatisfaction with sleep quality, across age groups and both females and males.

Conclusions
Disrupted sleep may be an additional behavioural risk factor for a number of chronic diseases, in the context of aging populations. It is necessary to understand the potential impact of sleep on the risk of multimorbidity, and this research will build knowledge in this important area.

Key messages
This research will utilize a national health survey to examine and report the characteristics of sleep quality and sleep duration among approximately 30,000 community-dwelling adults in Canada. This research will explore relationships between sleep duration, sleep quality and multimorbidity (controlling for confounding factors) among community-dwelling adults in Canada.
Difference in access to health care for newly arrived refugees in Germany: a natural quasi-experiment
Authors: Wenner J , Rolke K , Razum O 
Published: November 2019

Abstract

Background
Providing quantitative evidence on structural access barriers to health care for newly arrived refugees constitutes a challenge due to a lack of suitable data. The coexistence of two different local access models in Germany allows for a comparative analysis of the association between access policies and realized access. Our study compares these two models to establish whether they lead to differences in access to care among refugees.

Methods
Municipalities in Germany’s largest federal state of North Rhine-Westphalia (NRW) have implemented different access models to which refugees are quasi-randomly assigned. We recruited 6 municipalities of which 3 decided to implement the health care voucher (HcV) model and 3 the electronic health card model (eHC) in a natural quasi-experimental study design. Analyses were based on claims data collected from the welfare offices or the statutory health insurance. We compared standardized incidence rates (SIR) based on 3 indicators: emergency service, ambulatory sensitive hospitalization and use of specialized care.

Results
We included data on health care use of all recently assigned refugees in the 6 municipalities over a period of 7 quarters (2016/17). The average quarterly sample size is n = 9,077 which corresponds to 6.5% of the population of recently assigned refugees in NRW at that time. We find differences in realized access between the models. For emergency care, the SIR differ significantly between municipalities using the HcV model (SIR:1.88; 95%-CI: 1.62-2.18) and eHC model (SIR:1.33; 95%-CI: 1.14-1.55).

Conclusions
Local decisions regarding the organization of access to health care are associated with differences in realized access to health care of refugees in NRW. The implementation of the eHC model may contribute to a decrease of emergency service. Further analyses should attempt to reduce a possible (self-)selection bias of municipalities which might have led to an underestimation of the difference between models.

Key messages
The organization of health care for newly arrived refugees on the local level is decisive for their access to care. Local policy makers may use their scope for action to remove access barriers for newly arrived refugees.