bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization, satisfaction and barriers of medical care among adults of Turkish descent in Germany
Authors: Dornquast C , Solak S , Durak M , Krist L , Jöckel K H , Schramm S , Schmidt B , Keil T , Reinhold T 
Published: November 2019

Abstract

Background
The growing proportion of people with a migration background poses major challenges for public health and the health care system in Germany. People of Turkish descent represent the largest group within this specific population. The aim of this study was therefore to examine the use and satisfaction of medical services and barriers to health care access among adults of Turkish descent in Germany.

Methods
A cohort study of a group of nearly 1200 Turkish adults in Berlin and Essen constitutes the basis of this analysis. The baseline examination was carried out as part of the pretests of the German National Cohort study. This follow-up survey assessed utilization, satisfaction and subjectively perceived barriers in the German health care system, as well as socio-demography, lifestyle, health status and quality of life via self-report (paper based or online) in Turkish or German. Descriptive preliminary results are presented in this abstract.

Results
The first 287 participants interviewed until December 31, 2018 were on average 49 years old, with 64% being female. 90% of the participants had a family doctor and in the last 12 months, 17% were in a hospital for in-patient treatment and 23% in an emergency room. The use of screening programs varied from 15% (skin cancer screening) to 87% (mammography). The most frequently visited physician was the general practitioner (86%). The participants were satisfied regarding many aspects, with the best values for the communication with their doctor. However, 22% reported problems or barriers in the context of medical care in the last five years.

Conclusions
These preliminary results provide a first insight into the utilization behaviour among adults of Turkish descent, their satisfaction as well as barriers with the German health care system. However, possible consequences of our study should only be discussed after all analyses have been completed.

Key messages
This is one of the few cohort studies in a migrant population in Germany. Knowledge of barriers could provide indications of problems of adults of Turkish descent in the German health care system.
Transnational medication management by elderly migrants – a mixed-methods approach
Authors: Tezcan-Güntekin H , Akbulut N , Stern A , Özer-Erdogdu I , Razum O 
Published: November 2019

Abstract

Background
Many elderly people of Turkish origin choose a transnational lifestyle and commute between Germany and Turkey every few months. These circular migrants often suffer from chronic diseases. The transnational lifestyle can lead to discontinuities in long-term medication and irregular check-ups. If continuity of care is not ensured transnationally, health risks arise.

Methods
In a mixed-methods study 8 expert-interviews with general practitioners and 25 guideline interviews were conducted with circular migrants to analyze their medication adherence. Additional quantitative analyses were conducted based on data from a German statutory health insurance popular with migrants to investigate discontinuities of prescribed medication.

Results
Cross-border care involves different health risks with regard to medication adherence. For example, patients in Germany rarely receive the amount of medication they need for their stay in Turkey and there are discontinuities in medication delivery. The multi-perspective insight into the patients’ experiences of medical care and the view of general practitioners shows strong variations of preferred strategies to handle the challenges of transnational medication management. Single strategies, such as leaving the health insurance card in one state for prescription and sending of medication through family members or asking for higher amounts of medication to store before travel, lead to frustration both at GPs’ and patients’ sides. GPs experience high pressure by the health system’s structure in providing good care for the patients, especially in providing enough time for information transfer between GPs and patients.

Conclusions
Transnational solutions for health care, and in particular medication care, such as an interprofessional collaborative care across borders or transnational e-health records need to be developed.

Key messages
A transnational lifestyle can lead to discontinuities in the provision of medication. Transnational, inter-professional cooperation is needed to ensure continuity of health care for circular migrants.
A mixed-method evaluation study of a comprehensive cross-cultural training program in Stockholm
Authors: Tewelde J , Dahlin M , Bäärnhielm S 
Published: November 2019

Abstract

Background
Global migration and increasingly diverse populations poses new challenges to mental health services. Cultural differences between refugees and mental health professionals and lack of cultural competency is described as challenging. Cross-cultural training has been proposed as one way to reduce these problems. There are few evaluations on cross-cultural mental health training outcomes. Between 2016-2018, 13 one-day cross-cultural training interventions was implemented in Stockholm to equip mental health professionals to respond to mental health needs in a time of high influx of refugees.

Objectives
To evaluate a comprehensive cross-cultural training program regarding participant’s knowledge development, their experiences and views of the training - and their perceptions about their capacity to deliver mental care to refugee patients. An embedded mixed-method design was applied. We used before and after training questionnaires (n = 248) and conducted six focus group discussions (FGD) with mental health professionals. Quantitative data were analyzed by paired t-test and factor analysis, qualitative data were analyzed by thematic content analysis.

Preliminary results
Before the training, significant differences of mean knowledge was found (p = 0.004) among participants. Principle axis Factoring resulted in 3 factors before and 4 factors after the training, explaining 78% of the covariance. Findings from the after training FGDs, revealed that refugee patients were described as different and challenging, and little was known about the reality they live in. The training contributed to a better understanding of migration, integration and refugee health- as well as the role of culture. Further, it promoted empathy and professional self-reflections.

Conclusions
Cross-cultural training can contribute to knowledge development, attitude changes and also be valuable for care provider’s professional role.

Key messages
Training mental health professional in cross-cultural issues may facilitate improved quality of care to refugee groups. The training can also strengthen participants in their professional role.
The importance of ensuring artificial intelligence and machine learning can be understood at the human level
Authors: Ram S 
Published: November 2019

Abstract
With rapid developments in big data technology and the prevalence of large-scale datasets from diverse sources, the healthcare predictive analytics (HPA) field is witnessing a dramatic surge in interest. In healthcare, it is not only important to provide accurate predictions, but also critical to provide reliable explanations to the underlying black-box models making the predictions. Such explanations can play a crucial role in not only supporting clinical decision-making but also facilitating user engagement and patient safety. If users and decision makers do not have faith in the HPA model, it is highly likely that they will reject its use. Furthermore, it is extremely risky to blindly accept and apply the results derived from black-box models, which might lead to undesirable consequences or life-threatening outcomes in domains with high stakes such as healthcare. As machine learning and artificial intelligence systems are becoming more capable and ubiquitous, explainable artificial intelligence and machine learning interpretability are garnering significant attention among practitioners and researchers. The introduction of policies such as the General Data Protection Regulation (GDPR), has amplified the need for ensuring human interpretability of prediction models. In this talk I will discuss methods and applications for developing local as well as global explanations from machine learning and the value they can provide for healthcare prediction.
Analysis of needs, expectations and capacities of health and social care professionals in order to provide culturally adapted care
Authors: Lebano A , Hamed S , Bradby H , Gil-Salmerón A , Garcés-Ferrer J , Karnaki P , Zota D , Riza E , Tsiampalis T , Linos A 
Published: November 2019

Abstract
The Mig-HealthCare consortium conducted a qualitative study of the health care needs of vulnerable migrants/refugees in Europe. The research was conducted between Fall 2017 and Spring 2018. In total, 20 focus group discussions or, where necessary individual interviews (19), were organised with health care professionals and service providers; policymakers; and representatives from Non-Governmental Organisations - NGOs. Thematic qualitative analysis was employed. The main results of the analysis show that:
Health care provision for migrants is uneven throughout the EU and variations exist even within the same country. Health care providers and NGOs agree that health care for migrants is inadequate and biased in favour of particular conditions and cases (minors, pregnant women and acute conditions). Challenges faced by different countries vary; while in some countries the main issue is legal access, in other basic needs such as sanitation and basic infrastructure were emphasised. Austerity measures following the 2008 financial crisis have negatively affected the health care system in general, which in turn has negatively affected the provision of health care for migrants/refugees. Discrimination linked to socio-economic and ethnic conditions is reported as a barrier to equal health care access. Knowledge, language and communication on both the demand and the supply side of health care provision emerge as crucial to ensure equal access for migrants/refugees. Gender may act as a barrier with women tending to be more marginalised in the host country, in terms of language proficiency and health literacy, lowering health care access. One of the main challenges for providing equal health care access for migrants has to do with the ability to balance a universal right to health with the particular means of achieving it. The evidence collected here shows how this tension between end and means is at work in different moments of the provision of health care for migrants/refugees.
Best practices addressing healthcare care access of migrants and refugees in European countries
Authors: Riza E , Kalkman S , Karnaki P , Zota D , Gil-Salmerón A , Durá-Ferrandis E , Garcés-Ferrer J , Linos A 
Published: November 2019

Abstract
Mig-healthCare has identified sources in the countries and languages of the consortium providing guidance for community-based healthcare for migrants and refugees. A total of 54 sources that refer to best practices in seven European countries were identified. Results were categorized along with the themes: organization, communication, training, education and facilities & services. Successful organizational measures were a close collaboration with different governmental authorities, NGOs, community organizations and various local service providers. Moreover, engagement with members from both the host community and the migrant/refugee community in the design and implementation phases is essential. The need to track all activities through data collection and periodic evaluations is important in order to evaluate the effectiveness of systems. Funding was mentioned as important to secure continuity of projects and systems. Bridging communication barriers is a major facilitator to reduce health disparities. Differences in the types of practices and challenges per country were noted. Translators and cultural mediators are a key element in successful implementation, but across EU there is a need for more specialized staff to face the cultural barriers of the large variation in refugee/migrant backgrounds. The empowerment of migrants/refugees in promoting well-being through the engagement of the host community to help reduce stigma and discrimination is a successful strategy facilitating the access to care due to the increase of their health literacy skills. Finally, tailored services to give an answer to the specific needs of migrants and refugees are important, for example at first reception centres, standard medical screening and psychosocial risk assessment was recommended. Through this analysis, we can distinguish community-based care models elements facilitating the access of migrants and refugees to healthcare.
A comparison of the effects of maternal anxiety and depression on child development
Authors: Gete S , Calderon-Margalit R , Grotto I , Ornoy A 
Published: November 2019

Abstract

Background
Most studies on the association between the mental health of mothers and the development of their offspring have focused on maternal depression, but only a few have investigated the association between maternal anxiety and child development. We aimed to compare the associations between maternal depression and anxiety symptoms 6-8 weeks postpartum and infant development at 1 year.

Methods
We conducted a longitudinal study of 396 mother-child dyads. The mothers were recruited after birth in 3 different hospitals in Israel in 2017 and were followed for one year. Mothers were assessed by completing the General Anxiety Disorder-7 (GAD-7) questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) 6-8 weeks postpartum. Child development was assessed by the Ages & Stages Questionnaires (ASQ-3) at 12 months. Multivariate linear regressions were used to explore the relationship between the EPDS and GAD-7 scores and child development, all as continuous variables, adjusting for maternal education, parity, and gender.

Results
Depressive symptoms postpartum were only associated with poor personal-social skills (β=-0.5, 95% CI: -0.91, -0.08). Increasing maternal anxiety was associated with poorer development in communication skills (β =-0.48, 95% CI: -0.93, -0.04), personal-social skills (β =-1.02, 95% CI: -1.58, -0.46), solving problems skills (β =-0.7, 95% CI: -1.27, -0.14) and fine motor skills (β =-0.46, 95% CI: -0.9, -0.02). Neither anxiety nor depressive symptoms were associated with gross motor skills. Controlling for quality of attachment, the associations of depression and anxiety with development were no longer significant, suggesting mediation.

Conclusions
Postpartum anxiety was a stronger predictor of low developmental scores than depression, and associations were probably mediated by impaired attachment. Identifying and supporting mothers experiencing anxiety after birth may mitigate the risk of developmental delays in children.

Key messages
Maternal anxiety was found to be a significant risk factor for developmental delay at 1 year of age. The association between maternal anxiety and child development was probably mediated by attachment.
The use of quality indicators (QIs) to evaluate the oncologic care in CCCN: a systematic review
Authors: Cocchiara R A , Mannocci A , Cianfanelli S , Sestili C , D’Egidio V , Lia L , Backhaus I , Dorelli B , Federici A , La Torre G 
Published: November 2019

Abstract

Due to the increase of life expectancy for cancer patients, it has become necessary to implement complete and economically sustainable clinical care pathways that integrate different professional competences. The Comprehensive Cancer Care Network (CCCN) model consists of multiple specialized structures that cooperate for cancer patients care. Quality Indicators (QIs) represent valid and reliable tools of evaluation that allow a standardized comparison among different structures. The aim of this systematic review was to highlight a wide and complete description of the implemented QIs within the CCCNs and to identify and analyze methodologies used for the development of QIs. The literature was performed investigating two databases (PubMed and Scopus) and the search identified 7342 studies. After duplicate removal, title and abstract screening, and full text evaluation, 46 studies were included in the study. Most QIs were implemented in USA, Germany and Italy where the CCCN approach seems to be well defined. Eighty -two QIs concerned diagnosis, 260 concerned treatment, 7 concerned prevention, 29 about follow up, 71 about palliative care, 12 concerned rehabilitation and 7 research. The majority of the identified QIs belonged to the process domain, followed by the structure ones. Excluding QIs related to the management of cancer in general, the most represented organs resulted breast, colorectum and lung. Overall, it can be stated that the most represented categories of QIs concerned diagnosis and treatment. Furthermore, also the palliative care domain appeared very represented. Regarding the methodology of the QIs development, a consensus approach among experts and the Delphi method were the most frequently used methodologies. Only a few studies included the participation of patients for the implementation of the QIs. This systematic review provides a synthesis of existing QIs related to the setting of integrated oncological care

Key messages
The CCCN has been recognized as an ideal model for structuring the process of care that guarantees a complete and integrated approach for the management of oncological patients. Quality Indicators represent valid and reliable tools that should be used to perform a standardized comparison among different healthcare systems and to guarantee a homogeneous quality of care.
Perceived health and quality of life in chronic and end-stage kidney disease
Authors: Legrand K , Speyer E , Stengel B , Frimat L , NGUEYON SIME W , Briançon S , Ayav C 
Published: November 2019

Abstract

Background and objectives
Health-related quality of life (HRQoL) is increasingly considered a major outcome in patients with chronic kidney disease (CKD), but the size of its effect on physical and mental health at different disease stages, compared with the general population, is unclear.

Design, setting, participants, and measurements
We compared HRQoL measures in four groups: 2,687 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR] 30-60 mL/min/1.73 m2) or advanced (stage 4-5, eGFR &lt; 30 mL/min/1.73 m2) CKD under nephrology care from 40 nationally representative facilities, 1,658 patients with a functioning graft, 1,251 dialysis patients randomly selected from the national REIN registry, and 20,574 participants in the French Decennial Health Survey, representative of the general population.

Results
Mean age (years) was 67, 69, and 55 in patients with non-end-stage CKD, on dialysis, or with transplants, respectively; 60% were men. Age- and gender-standardized health status was perceived as fair or poor in 27% of those with moderate CKD and more than 40% of those with advanced CKD and those on dialysis, compared with 12% in transplant patients and 3% in the general population. Compared with the general population, HRQoL physical scores adjusted for age, gender, education, obesity, and diabetes, were significantly lower, by a factor of 2.2 among patients with moderate CKD, 4.1 among those with advanced CKD, 10.2 among those on dialysis, and 4.1 among those with transplants. The effect was stronger for those younger than 65 years. The mental score was lower only for dialysis patients.

Conclusions
This study highlights the importance of the physical health effects beginning at the moderate stage of CKD. More attention to patients’ CKD-related perceived health is needed.

Key messages
Physical health declined significantly from moderate through end-stage CKD, with impact greatest among the youngest patients. More attention to CKD’s impact on quality of life is needed.
FC Prostate - Football for men with prostate cancer in local football clubs
Authors: Soerensen C D 
Published: November 2019

Abstract

Prostate cancer is the most frequent cancer found in men. Physical activity has shown to counteract some unwanted psychological and physiological side-effects, however sustainable exercise concepts have been hard to achieve.
Since 2011 Danish researchers from The University Hospitals’ Center for Health Research have tested, evaluated, and developed football training for men with prostate cancer. In the period 2011-2017 FC Prostate was conducted in three phases (I-III). Pilot study (I), a small scale randomized controlled trial (II), and the FC Prostate Community (III) conducted in a real-world setting in six Danish football clubs.
Researchers found that participants who played football once a week or more improved their mental health and reduced fat mass. For some men with prostate cancer, football proved to be a sustained, and viable alternative to other types of physical rehabilitation.
Based on these research results the ambition in phase IV is to offer FC Prostate nationally. This task was undertaken by The Danish Health Committee (DCHE) and The Danish Football Association (DBU). During the period 2018-2019 DCHE and DBU have collaborated to initiate and implement local partnerships around each of the currently 20 active FC Prostate-teams in Denmark (spring 2019). DCHE have developed a simple model of collaboration. The model contains a clear division of relevant tasks and outlines a meaningful collaboration between municipal rehabilitation centers, hospitals, and local football club to run locally based FC Prostate-teams; covering such tasks as recruitment, training, and retention of men with prostate cancer in an active life style.
The main focus of the presentation will be the national implementation of FC Prostate, including experiences and identified barriers during the project, and expected outcomes based on the project development so far.

Key messages
Local club-based football is a viable alternative to other types of physical rehabilitation. Rehabilitation centers and hospitals are currently collaborating with local club to host and run FC Prostate-teams in Denmark.