bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outflow management of health professionals in Serbia: survey results from a tertiary-level hospital
Authors: Šantrić Milićević M , Vasilijevic N , Vasic V 
Published: October 2020

Abstract

Background
Some rich countries are actively recruiting labour from abroad for lack of health workforce. A high-level tendency for emigration among health care personnel in Serbia has attracted the attention of policymakers. In the search for evidence that can support the interventions to manage the outflow of the health workforce, the objective of the study was to obtain the opinion of medical doctors and nurses about retention factors.

Methods
A 65-item questionnaire was distributed to 384 hospital physicians and nurses to explore their views on fourteen aspects for labour outflow management (recruitment, training, job, salary, benefits, managers' behaviour, career development, relationships, work conditions, institutional image, organizational support, and three types of organizational commitment). Any difference between physicians and nurses and their responses' scores was assessed with Pearson Chi-Square (p &lt; 0.05) and Independent Samples t-test (p &lt; 0.05).

Results
Few nurses (17.8%) and physicians (13.6%) are familiar with measures taken in the country to manage the migration of healthcare workers, but most would work abroad if given such opportunities (56.8% and 63.0%, respectively). The responses of physicians and nurses differ for many aspects of management; the best scored were managers' behaviour (11.9 v 10.4, respectively, p &lt; 0.001) and organizational support (15.3 v 13.4, respectively, p &lt; 0.001), while the least scored were job benefits (4.1 v 4.0, respectively p = 0.531), salary (5.9 v 5.8, respectively p = 0.459), relationships (5.3 v 5.3, respectively p = 0.911) and performance assessment (5.3 v 4.9, respectively p = 0.008).

Conclusions
The study has identified success and failure factors for the outflow management of health workers in Serbia. Hospital doctors scored higher than nurses almost all retention factors. There is a space to strengthen the policy and practice to retain hospital doctors and nurses in the country.

Key messages
Hospital nurses are in a worse position than hospital doctors in regard to almost all aspects of outflow management. Stakeholders should invest in retaining medical doctors and nurses in the hospital.
Nurse migration in Germany, the UK, and Australia: a comparative situation analysis
Authors: Ewers M , Smith J , Tomkins Z , Woodward-Kron R 
Published: October 2020

Abstract

Background
Nurse migration is increasingly seen as an appropriate response to address nursing shortages in overburdened health systems. This paper aims to analyse the situation in Germany, the UK and Australia and identify similarities and differences in the dimensions, perceptions and processing of nurse migration in different health systems.

Methods
A rapid evidence assessment and comparative situation analysis of routine data obtained from public health, education and labour market reporting systems, and academic and grey literature were carried out in Jan-Feb 2020. Primary outcome measures were key data of nurse population and migration, barriers and opportunities, and educational initiatives to support migrating nurses to meet the requirements to work in the destination country.

Results
Germany, the UK and Australia are confronted with an ageing and increasingly chronically ill population and severe nursing shortages. Skilled migration is seen as an opportunity to address these problems, but each country is faced with different contextual conditions and requirements. Data on the nurse workforce obtained from public health, educational and labour market reporting systems are more differentiated and extensive in the UK and Australia than in Germany. Furthermore, there is a substantial amount of published literature in the UK (n = 65) and Australia (n = 87) on nurse migration and on how the countries address challenges in this area; in comparison to the German context, where such research is limited (n = 7). Available research focuses on the economic, epidemiological and geographical impact and distribution of nurse migration. Qualitative dimensions and educational requirements are less well discussed.

Conclusions
Evidence on nursing migration is strongly based on quantitative factors and may not reflect current needs. More information about qualitative aspects of nurse migration is required to develop recommendations that support enhanced nursing workforce migration.

Key messages
Nurse Migration presents many challenges that have not yet been fully researched. Results of a comparative analysis of three countries offer the opportunity to highlight missed opportunities.
Why is syphilis rising in Europe? Multi-level modelling of alternative hypotheses in 31 countries
Authors: Mendez-Lopez A , Stuckler D , Noori T , Semenza J C 
Published: October 2020

Abstract

Background
Syphilis transmission has increased markedly over the past two decades in Europe, concentrated in men who have sex with men. We test alternative potential social and behavioral individual- and population-level determinants of this resurgence.

Methods
Two rounds of the cross-sectional European Men who have sex with men Internet Survey (EMIS 2010 and 2017, n = 272,902) were used to fit multi-level linear probability models to evaluate determinants of the incidence of self-reported syphilis, capturing risky sexual behaviours and pre-exposure prophylaxis use, among others, adjusting for potential sociodemographic confounders.

Results
Self-reported syphilis incidence rates rose by about 1.8 percentage points (within the last 12 months) and 3.9 (within the last 5 years) between the 2010 and 2017 waves, after adjusting for sociodemographic factors. HIV status was a major risk factor for syphilis infection (27.6 ppt higher incident rate, 95%CI: 24.7 to 30.5). A dose-response relationship was observed between greater numbers of condomless non-steady partners and syphilis infection, with more than 10 partners estimating increases in the probability of diagnosis of over 25 ppt (11-20 partners vs none: 24.5 ppt, 95%CI: 20.5 to 28.5); further, we observed evidence of mediation for number of condomless non-steady partners, which attenuated the estimated rise in 2017 vs 2010 by about 35%. STI testing uptake also accounted for a substantial increase in syphilis incidence signaling higher detection rates over time. While country-level PrEP use was linked to greater number of condomless partners, there was no substantial impact of population-wide factors, including GDP and PrEP use, on overall syphilis trends.

Conclusions
Risky sexual behavior changes, particularly condomless sex with non-steady partners, appears to be a major contributing factor to rising syphilis incidence. Further research is needed to understand what accounts for this substantial behavior change.

Key messages
Increased number of condomless non-steady partners accounts for a substantial rise in syphilis trends. Population-level PrEP use was linked to increasing numbers of condomless non-steady partners but had no substantial impact on overall syphilis trends.
Characterization of emerging predominant HFMD pathogen, coxsackievirus A6 in mainland China
Authors: Song Y , Zhang Y , Xu W B 
Published: October 2020

Abstract
Hand, foot, and mouth disease (HFMD) had the highest yearly incidence, with over 10 million cases of HFMD annually reported in China. Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) have been regarded as the leading pathogens of HFMD outbreaks worldwide and in China; however, in recent years, the leading pathogens have been changing, as large outbreaks of CV-A6-associated HFMD have been reported worldwide. Since 2013, repeated large-scale HFMD outbreaks caused by CV-A6 happened in mainland China, where, as a result, CV-A6 has surpassed EV-A71 and CV-A16 as the leading HFMD pathogen in most Chinese provinces.
We sequenced the whole genomes of 158 CV-A6 clinical samples that were isolated between 2010 and 2018 from the HFMD Surveillance Network established in our laboratory. Our results showed that: seven recombination forms (RFs) of Chinese CV-A6 were detected; different CV-A6 RFs showed distinct virulence and transmissibility; VP1283T may play an important role in the virulence of Chinese CV-A6.
HFMD epidemics in China have become a serious public health problem over the past decade. In this research, we have attempted to explore the causes of the high transmissibility of the emerging CV-A6 in mainland China on the basis of CV-A6 evolution based on 336 whole-genome sequences, and we have yielded some fruitful results for the future research and surveillance of HFMD in China.

Key messages
HFMD epidemics in China have become a serious public health problem over the past decade. CV-A6 has surpassed EV-A71 and CV-A16 as the leading HFMD pathogen in most Chinese provinces.
A policy analysis of the chronic care policies in Belgium
Authors: Danhieux K , Martens M , Colman E , Remmen R , Van Olmen J , Anthierens S 
Published: October 2020

Abstract

Introduction
Chronic diseases form the largest burden of disease in European countries. Redesign of health systems towards chronic integrated care is needed, with more collaboration between first and second line, between medical and social services and support to prevention and self-management. What are the levers for change in such health systems? This study addresses this knowledge gap, through a policy analysis of barriers and facilitators for change towards chronic integrated care.

Methods
26 central level stakeholders were selected, based upon their influence in regulation and policy, financing, health care provision and community representation. Semi-structured face-to-face interviews were held covering assessment of past and current policies and implementation, barriers and opportunities for change.

Results
Reforms have taken place, such as the stimulation of local initiatives for chronic integrated care projects and the set-up of local care councils. Most stakeholders assessed the current Belgium's implementation of integrated care as low, despite a growing awareness for the need for change. A context factor often mentioned to constrain implementation was a state reform which led to a partial decentralization, fragmentation of decision power and a division of healthcare competences between federal and federated levels. Other barriers were the current financing system, the lack of investments in new models of care and the vested interests of providers.

Discussion
This analysis shows that chronic care reform in Belgium is constrained by partial decentralization of primary health care, and by the financing system and vested interests. It points to the need for coordination of health policy making and implementation. Disentangling the levels of decision-making and the financial leverage at these levels gives insights for change and change management, for the Belgium health system and other countries with a strong decentralized system.

Key messages
The current Belgium’s implementation of integrated care was assessed as low, due to different contexts factors such as division of health care competencies between different governmental levels. In a country as Belgium with a strong decentralized health care system coordination of health policy making and implementation is key in order to scale up integrated care for chronic diseases.
Association of long-term care utilization and functional ability in older adults
Authors: Kyaw K 
Published: October 2020

Abstract

Background
Healthy Ageing is the process of developing and maintaining the functional ability that enables wellbeing in older age as per the World Health Organization (WHO). Establishing foundations necessary for improvements in long-term care (LTC) systems for increasing the world's older adults is one of the public health priorities. LTC provides assisted daily living (ADLs), instrumental assisted daily living (IDALs), healthcare, and social services. This study aims to assess the association of LTC utilization and functional ability in the two industrialized countries with a globalized aging perspective. This study would guide to identify the approaches for establishing fundamentals, developing and sustaining a trained workforce to achieve high-quality, healthy aging.

Methods
This retrospective longitudinal population-based study, individuals age 65 and above from the national data of the United Kingdom, UK, (English Longitudinal Study of Aging) and the United States, U.S, (Health and Retirement Study). The outcome is LTC: nursing home and home care. Predictors: functional status: scores of ADLs and IADLs, and declining ADLs and IADLs. Covariates are age, gender, marital status, income, chronic diseases. Multiple logistic regression analysis was carried out in SAS software version 9.4, p-vale (p) &lt;0.05.

Results
LTC utilization (UK) is associated with declining IADLs (OR: 15.01, 95%CI: 1.62,139.23), p- 0.02 with adjustments for covariates. LTC utilization (U.S) is associated with declining ADLs (OR: 2.66, 95%CI:1.82,3.87) and IADLs (OR: 2.42, 95%CI:1.73,3.40), both at p-&lt;0.001. With adjustment for covariates, LTC utilization (U.S) is associated with declining ADLs (OR: 2.20,95%CI:1.51,3.22), p-0.001 and declining IADLs (OR: 2.12, 95%CI:1.49,3.02), p-&lt;0.001.

Conclusions
Declining functional ability is associated with LTC utilization. This study guide to improve LTC systems to develop personalized social and healthcare foundations, increase the trained workforce.

Key messages
To demonstrate the long-term care (LTC) utilization by declining functional capacity in the UK and the US older adults to a better understanding of the distribution of LTC utilization between them. To guide developing approaches in the improving long-term care system to achieve high-quality, healthy aging through evidence findings of this national study.
Maternal mental health and partner delivered massage: a pilot study
Authors: Hall H , Munk N , Carr B , Fogarty S , Holton S , Weller C , Lauche R 
Published: October 2020

Abstract

Background
Mental health problems place a significant burden on the health system and are an important public health issue. Many pregnant women experience anxiety and depression, which can negatively impact health outcomes for both mother and baby. Partner-delivered massage may provide a cost effective and accessible approach to support the mental wellbeing of pregnant women.

Methods
A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with a self-directed stress management program (control), for pregnant women with mild anxiety. Women attended an initial workshop at 28-32 weeks gestation, followed by the completion of either the self-directed massage or stress management program. Qualitative feasibility and acceptability data (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21).

Results
14 women/partner dyads attended the partner- delivered massage group and 13 women attended the self-directed stress management group. Participants from both groups reported the programs were feasible and acceptable. Mean scores on all DASS-21 subscales significantly decreased over time in both the intervention and the control group.

Conclusions
The partner-delivered massage program was feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress, with no significant between-group differences identified. An adequately powered, experimental study is needed to determine the effectiveness of partner-delivered relaxation massage.

Key messages
Many women experience anxiety and depression during pregnancy and this can have a negative impact on both mother and baby. Partner-delivered relaxation massage, at least once a week in the third trimester, may help reduce women’s symptoms of anxiety, depression and stress.
Mental health interventions in healthcare workers in infectious disease outbreak-A systematic review
Authors: Zace D , Hoxhaj I , Orfino A , Viteritti A M , Silvetti L , Di Pietro M L 
Published: October 2020

Abstract

Background
Extended evidence has established that healthcare workers face several mental health problems during a disease outbreak, which could have a long-term impact. To address these issues, elaboration and implementation of psychological/psychiatric interventions or strategies is of utmost importance. In this context, this systematic review aimed at identifying strategies to manage mental health issues in healthcare workers during infectious disease outbreaks.

Methods
PubMed, Cochrane, Scopus and Web of Science were searched to retrieve pertinent articles published in English until May 2020. Articles reporting measures, interventions, strategies, or recommendations to manage mental health problems in healthcare workers during an infectious disease outbreak, of any study design were included. The quality assessment was performed according to the study design of the included articles.

Results
Our search strategy produced a total of 2358 articles. After the screening process 33 articles met the inclusion criteria, addressing COVID-19 (40%), followed by SARS (21%) and Ebola Virus (15%). The findings emphasized that organisations should follow an evidence-based approach and establish comprehensive programs to assist hospital staff during disease outbreaks. The preliminary results show that the creation of a psychological response team, training, e-learning, courses, psychosocial counselling, screening instruments and telemedicine activities could improve the capacity of response and coping, and reduce mental health issues in healthcare workers.

Conclusions
To minimize the psychological impact of future infectious disease outbreaks, evidence-based intervention strategies should be implemented to retain mental health among healthcare workers. Our results may provide the necessary insights that could be applied during the COVID-19 pandemic.

Key messages
During infectious disease outbreaks healthcare workers are faced with mental health issues, that need to be addressed through tailored interventions offering coping strategies and increase resilience. Mental health related interventions or strategies include the implementation of professional training, psychosocial counselling, courses, and the creation of a psychological response team.
Youth-led efforts against infodemic
Authors: Uakkas S , El Omrani O 
Published: October 2020

Abstract

Problem
The IFMSA, voicing the opinion of 1.3 million medical students from 129 countries, acknowledges the importance of health literacy in driving social change. Today, there is a global epidemic of misinformation, spreading rapidly through social media platforms and other outlets, posing a critical threat for public health due to the COVID-19 outbreak. Also, it threatens the possibility of slowing down the progression of the virus. The fight against such misinformation requires continuous provision of the most reliable and recent information.

Description
A global study was conducted by IFMSA, in collaboration with the WHO, composed of a survey to get data about all the organizations, institutions, NGOs, and other entities that focus on fact-checking and correcting misinformation about COVID-19. The survey was filled by medical students from end of April to end of May who reported name, type, scope of work, languages, primary funding source, type and source of information shared by the organization.

Results
We discovered 182 initiatives from 62 countries worldwide that verified information in 48 languages. Social media, internet, radio, SMS, printed media and hearsay were identified as the main sources of misinformation. Video podcasts with experts, regular social media updates and newsletters, were described as best practices, in addition to debunking myths on a regular basis and verifying statements by public figures. Also quality of fact-checking differed between initiatives.

Lessons
Data showed that myths and false information are spreading through different means from public figures to daily social media outlets. Fighting misinformation should use innovative and accessible approaches. There is urgent need for national initiatives and political engagement for myth-busting. IFMSA and WHO are following up by designing a platform to share fact-checking initiatives and recommendations openly, and by creating an AI system with Amazon to analyze articles in social media.

Key messages
Fact-checking and myth-busting are essential to limit the COVID-19 related infodemic spreading through different media and social media platforms, famous figures and others. Initiatives worldwide are doing fact-checking. Yet, the quality and quantity of available fact-checking differ between countries and there is a need for more universal good quality fact-checking.
Sugary drinks, artificially sweetened beverages and cardiovascular disease in NutriNet-Santé cohort
Authors: Chazelas E , Debras C , Fezeu L , Julia C , Hercberg S , Deschasaux M , Touvier M 
Published: October 2020

Abstract

Introduction
Sugary drinks consumption has increased worldwide in recent years and evidence demonstrating their detrimental impact on cardio-metabolic health is accumulating. Artificially sweetened beverages (ASB) are marketed as a healthier alternative, but their cardio-metabolic impact is being debated in the scientific community. This study aimed to investigate the relationships between the consumption of ASB, sugary drinks and the risk of first incident cardiovascular disease (CVD) in a large prospective cohort.

Methods
The French NutriNet-Santé cohort was launched in 2009. Every 6 months participants are asked to fill 3 validated web-based 24-hour dietary records. All major health events reported by participants were validated based on their medical records by a committee of physicians. Data were also linked to national health insurance system and to the French national cause of specific mortality registry. For each type of beverage, 3 categories were defined as follows: non-consumers, low consumers and high consumers (separated by sex-specific median among consumers). Multi-adjusted Cox proportional hazard models with age as the primary time scale were performed.

Results
A total of 104,761 participants were included. During follow-up (2009-2019), 1,379 first incident cases of CVD occurred. Compared to non-consumers, higher consumers of sugary drinks had a higher risk of overall CVD (HR = 1.21, 95% CI 1.04 to 1.40, Ptrend=0.009). Higher consumers of ASB had also a significantly higher risk of CVD (HR = 1.30, 95% CI 1.00 to 1.71, Ptrend =0.04).

Conclusions
Both sugary drinks and ASB were similarly associated with CVD risk. The health effects of non-nutritive sweeteners is currently being debated based on contrasted epidemiological results. Mechanistic data suggests metabolic effects through gut microbiota perturbation and body weight gain. To imply a causal link, they need replication in other large-scale prospective cohort as well as further mechanistic investigations.

Key messages
Higher consumption of sugary drinks and ASB was associated with higher risk of CVD, suggesting that ASB might not be a healthy substitute for sugary drinks when considering cardiovascular health. These data provide additional arguments to feed the current debate on taxes, labeling and regulation of sugary and artificially sweetened beverages.