bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geographical accessibility to permanent care centers of family doctors from Bihor County, Romania
Authors: Tirt D P , Rahota D 
Published: November 2019

Abstract

Accessibility (geographic or spatial) to health services is a component of health care services access that through measurement can assess inequities in health. Geographical accessibility can be measured using a geographic information system (GIS) where travel time is calculated from the patient’s home to the place where a service is delivered. Permanent care centers of family doctors (PCCs) are units providing family medicine services (consultations, injections, solving minor emergencies) outside the work schedule of family doctors (night and holiday), for overloading prevention of emergency hospitals services by direct addressing or by calling to the unique emergency number 112. Bihor County has 617118 inhabitants in the 101 administrative-territorial units (458 localities), 334 family medicine practices, and there were 34 PCCs.
We intended to identify the number of localities in more than 10, 20 or 30 minutes of travel by car from the PCC (based on end-2018 data). A GIS was created using the QGIS application, which includes layers: the county border, the 454 localities and the georeferenced addresses of PCC. Using the ORS Tools plug-in, the appropriate isochrones were created. Then overlapping isochrones and localities (points), the number of localities for which the travel time to the nearest PCC is greater than 10, 20 and 30 minutes, respectively, was obtained.
The time needed for the inhabitants to reach the PCC is: more than 10 minutes for 247 localities; more than 20 minutes for 81 localities and over 30 minutes for 10 localities. The results are presented in the form of maps and in tabular form (localities).
Using GIS, accessibility to medical services in a territory (city, county, country) can be measured. The application of free GIS software, QGIS, requires hardware, staff training, procedures (for work and decision-making) to research and improve population access to health services.

Key messages
Access to health services can be assessed using geographic information systems. The use of appropriate maps facilitates decision making to optimize health services.
Research Management Committee as strategic device for Implementation Research
Authors: Treichel C A S , Silva M C , Presotto R F , Onocko-Campos R T 
Published: November 2019

Abstract

Issue/problem
Implementation Research (IR) are particularly useful in identifying whether when an intervention does not succeed, this is because the intervention was ineffective in the new scenario or if a good intervention was poorly implemented. In order to do this, it is important to establish evaluation strategies capable of provide feedback and encourage learning and incorporation of changes. However, the best strategies for this are not clear yet.

Description of the problem
Despite the existence of references with clear definitions of the outcomes for IR, it is still unclear what are the best strategies for the stakeholders’ participation in these outcomes evaluation. By identifying that, the framework of participatory research could contribute to the choice of these strategies. We sought to retrieve some of the devices already used in other research to test whether they would be able to respond to the assumptions of IR. The chosen device was the Research Management Committee (RMC) which has its use evaluated by a qualitative study with focus group and the data review of the minutes of meetings held by the RMC.

Results
The RMC functioned as a space where members of the research team, managers and workers from the services where the intervention occurred could meet systematically to plan, monitor and make adaptations in the IR. Besides its success as a tool for accessing outcomes, the RMC has also proved to be an important strategy to promote the increasing of acceptability, adoption, penetration and sustainability.

Lessons
The RMC was an important promoter of the participation for the stakeholders in several aspects of the research; made possible the evaluation and monitoring of the meaning and feasibility of the research in the field of study from the point of view of those who live the experience of daily work and care; and favored access to the outcomes of IR in a transversal and organic way.

Key messages
The RMC is a strategic device for Implementation Research and configures a possibility to make the research a more dialogic and potentially transformative process. Besides its success as a tool for accessing outcomes, the RMC has also proved to be an important strategy to promote the increasing of acceptability, adoption, penetration and sustainability.
Two-year supervised tooth brushing program evaluation in preschools in Southern Israel
Authors: Dekel D , Zusman S P , Pikovsky V , Natapov L 
Published: November 2019

Abstract

Background
Dental care for children was included into National Health Insurance Law in 2010 and eligibility age went up gradually to 18 in 2019, providing universal dental care. As a part of dental care reform, community based preventive School Dental Services were extended to preschool children. School dental service (SDS), funded entirely by the State, was extended to younger ages providing supervised tooth brushing module. The national supervised teeth brushing program (STBP) was first implemented in 2015-2016 amongst 3-4 year old children attending 600 nurseries in Israel. Due to the program’s success, it was gradually extended to more nurseries in low socio economic regions across the country, reaching 2200 settings in 2019.
The objective of this study was to assess dental health among preschool children participating in the program during the last two years, comparing to those who did not.

Methods
Participant and non-participant kindergartens were randomly selected in Jewish and Bedouin Arab towns in the Southern district matched according to SES level. DMFT index measuring mean number of decayed, missing and filled teeth was recorded among preschool 5 years-old children.

Results
283 children were examined, 157of them Jewish (86 participants in STBP, 71 non-participants) and 126 Bedouins (59 vs 67 respectively). Mean untreated carious teeth (d) was 1.15 vs 1.8 for Jews and 3.22 vs 3.9 for Bedouins. Percent of treated teeth within total caries experience index (f/dmf) was higher in tooth brushing group: 37% vs. 29% for Jews and 23% vs. 8% for Bedouins.

Key messages
Supervised tooth brushing shows favorable effect. Less carious teeth and more treated caries were recorded in STBP group.
Are general practitioners willing to deprescribe in oldest-old patients with polypharmacy?
Authors: Jungo K T , Mantelli S , Rozsnyai Z , Reeve E , Poortvliet R K E , Gussekloo J , Rodondi N , Streit S 
Published: November 2019

Abstract

Managing the growing number of oldest-old patients with multimorbidity and polypharmacy in primary health care poses an increasing public health challenge. Since inappropriate polypharmacy can harm patients’ health, general practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe. This case vignette study evaluates the deprescribing decisions of GPs from 31 countries and compares the factors influencing GPs’ deprescribing decisions.
We invited GPs to participate in an online survey, containing a) three cases of increasingly dependent oldest-old multimorbid patients with potentially inappropriate polypharmacy and b) Likert-scale questions assessing the importance of factors influencing deprescribing. We presented each case with and without history of cardiovascular disease (CVD). For each case, we asked whether GPs would deprescribe any medication and, if so, which one(s). We calculated percentages of GPs deprescribing at least one medication in each case, compared cases with/without CVD history and different levels of dependency in activities of daily living, and calculated the percentage of factors rated as important or very important.
Of 3175 invited GPs from 31 countries, 53% responded (N = 1’706) with a mean age of 50 years and 60% females. Results are preliminary, but despite some differences across GP characteristics (male/female, age) and across countries, GPs generally showed a high willingness to deprescribe in oldest-old patients (&gt;80 years) with polypharmacy. GPs were more likely to deprescribe in patients with a higher level of dependency, in the absence of history of CVD, and when patients are on statins, proton-pump inhibitors or potentially inappropriate pain medication. Factors GPs rated as important or very important for the deprescribing decision were patients’ quality of life, risks and benefits of medications, patients’ life expectancy, and potential negative health outcomes resulting from deprescribing.

Key messages
Despite international differences, most GPs report they would deprescribe in older multimorbid patients with polypharmacy. The results will facilitate the development of interventions supporting general practitioners to deprescribe.
Intervention on knowledge and perception of hand hygiene among healthcare workers
Authors: Ben Cheikh A , Ben Fredj S , Bhiri S , Ghali H , Khefacha S , Dhidah L , Ben Rejeb M , Said Latiri H 
Published: November 2019

Abstract

Background
Many studies conducted in healthcare settings with limited resources reported healthcare associated infections (HAIs) rates higher than in developed countries. Hand hygiene is considered as the most effective procedure for reducing infection in a wide variety of settings. The aim of this study was to assess the effectiveness of an intervention program to improve knowledge and perception of hand hygiene among healthcare workers (HCWs).

Methods
We conducted a prospective before-and-after study design in university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The same questionnaire, constructed by the WHO was distributed and collected at HCWs’ workplace.

Results
A total of 149 and 146 HCWs were enrolled, respectively at pre and post intervention. The majority was nursed women aged between 20 and 35 in pre intervention, whereas in post intervention the majority where physicians. Globally, our results showed tendencies toward improvement, but only two items were significant: the HW is the appropriate technique after injury (73.5% vs 86.8%; p = 0.006) and the hands of HCWs are the lead vehicle of HAIs (65.1% vs 83.6%; p = 0.01). On the other hand, judging by the HCWs’ responses, the probably most effective intervention to enhance hand hygiene compliance was that an alcohol-based hand-rub is available at each point of patient care. In contrast, empowering patients to remind HCWs to perform hand hygiene was mostly rated to be the least effective intervention both in pre and post intervention.

Conclusions
Our intervention to positively influence hand hygiene knowledge was unfortunately less effective than we had hoped it would be, which suggests a HCWs’ reluctance to attend the training program.

Key messages
Hand hygiene is considered as the most effective procedure for reducing nosocomial infection. the intervention to positively influence hand hygiene knowledge was effective.
Assessment of unmet needs and barriers to end-of-life care provision in Kazakhstan
Authors: Toleubekova L , Crape B , Dauyey K , Argandykov D , Bekenova A , Madikenova M , Kaukenova B , Noskov A 
Published: November 2019

Abstract

Introduction
Palliative care, a holistic multidisciplinary approach for those persons with terminal diseases, providing relief for physical, emotional, psychosocial and spiritual suffering of both the patients and their families and to support the dignity of all involved in the process of dying. The purpose of this qualitative research project is to identify the barriers for end-of-life care provision in Kazakhstan and to provide recommendations on how to integrate and assure high quality palliative care for patients within the cultural context of Kazakhstan.

Methods
Our proposed research project employed qualitative research methods, including semi-structured in-depth interviews using grounded theory. We conducted purposive recruiting with content analysis and semi-structured interviews until saturation was achieved. The interviews have been conducted at the University Medical Center (UMC) teaching hospitals, including National Research Center for Maternal and Child Health and the National Children’s Rehabilitation Center. The total number of participants were 65 individuals, of whom 26 were medical doctors, 20 nurses, 7 speech therapists, 6 psychologists, 4 educators and 2 social workers. All participants had experience working with terminally ill patients, family members, and caregivers. The data was then translated into English. Analysis of the interview data have been performed by using the computer assisted software analysis package - NVivo. Institutional review board (IRB) approval of the Nazarbayev University has been received, assuring informed consent and confidentiality safeguards in the research.

Results
The study findings indicate the evidence of growing demand in training of healthcare professionals, inadequate provision of pain relief and lack of public awareness about palliation as primary obstacles for palliative care development in Kazakhstan.

Key messages
The findings of the study are very important to help stakeholders to focus on the development of training opportunities for palliative care specialists. The results of the study help to develop milestones and concrete strategy for integration of palliative care services into the national healthcare system of Kazakhstan.
Keeping up with the codes; accounting for quality in cancer patient pathways (CPPs) in Norway
Authors: Håland E , Melby L 
Published: November 2019

Abstract

Background
Standardised cancer patient pathways (CPPs) were introduced in Norway in 2015. CPPs are national standardised patient pathways which are discipline- and target-based (28 cancer diagnoses), aiming to minimize waiting times and make cancer care more predictable and secure for patients. One important part of the CPPs are different codes aimed at measuring time in the different phases of the pathway. These codes are reported to the Norwegian directorate for health and are made public on a national web site. On the basis of these reports hospitals across the country can be compared regarding compliance to timescales. From a political and bureaucratic level, the codes are seen as signs of quality, and hence very important.

Methods
In this paper, we present preliminary results from a project which is evaluating the introduction of CPPs. Based on interviews with administrative staff responsible for coding and with other health personnel (physicians, nurses, clerical workers and managers) in different hospitals, we present experiences with and perceptions of coding practices.

Results
We find that even though the coding manual is presented as a universal tool implying standardised coding practices, there is a multitude of coding practices (which makes comparison between hospitals challenging). The coding represents a massive bureaucratic workload for the dedicated staff, raising concerns if their time is spent on the most important issues.

Conclusions
The codes are seen as timescales set according to logistics and not according to what is medically safe - and some of the health personnel argue that these timescales have nothing to do with quality. However, they still recognize that keeping the timescales might be important for the patient experience.

Key messages
Standardised coding are often not standardised, but contains a multitude of practices. These practices need to be explored in order to understand if and how codes can be seen as signs of quality.
Reasons for cervical cancer screening participation among Turkish- and Moroccan-Dutch: focus groups
Authors: Marchena E , Hamdiui N , Stein M L , van Steenbergen J E , van den Muijsenbergh M , Timen A 
Published: November 2019

Abstract

Background
Cervical cancer (CC) is ranked fourth most frequently diagnosed cancer in women worldwide. Compared to the 79% CC screening participation rate of native Dutch women, the rate of 64% among Turkish- and 53% among Moroccan-Dutch women is considerably lower. Our aim was to explore reasons for CC screening (non)participation of Turkish- and Moroccan-Dutch women, and their attitude towards self-sampling.

Methods
Six focus groups were conducted in March and April 2019 with Turkish (n = 25) and Moroccan (n = 20) women in the Netherlands, aged 30-60 years. Questions were based on an extended Health Belief Model. Discussions were transcribed verbatim and thematically analysed.

Results
We found that women lack knowledge and awareness about CC. Barriers for screening were lack of a good command of the Dutch language, having a male as general practitioner, fatalism, shame and taboo related to the intimate procedure, and the association of CC with lack of femininity and infertility. Other barriers were fears of the test result, cancer, suffering, death, and leaving their children behind after death. Facilitators were perceived severity of disease, social support, and short procedure time. Additional religious facilitators included the responsibility to take care of one’s own health using medical facilities that God provided. Differences were found between Turkish and Moroccan women, such as lack of a good command of the Dutch language. Conflicting attitudes were found regarding self-sampling. Although perceived easy and accessible, women were hesitant whether they could sample correctly. Overall, women preferred a physician-taken smear to a self-sample.

Conclusions
Several barriers and facilitators for CC screening participation were identified that can be used to design tailored information materials. Women’s doubts about incorrect self-sampling should be taken into account to encourage self-sampling among nonparticipating Turkish and Moroccan women.

Key messages
Important barriers and facilitators were identified that can be used to well-inform Turkish and Moroccan women. To promote self-sampling, women’s attitudes on their self-efficacy should be explored.
Obstetrical complications treated in the maternities of the region of Sousse (Tunisia)
Authors: Limam M , Sahli J , Hachani F , Ghardallou M El , Mellouli M , Bachraoui M , Zedini C , Khairi H , Mtiraoui A , Ajmi T 
Published: November 2019

Abstract

Background
About 800 women die each day worldwide due to complications related to pregnancy, childbirth or in the postpartum period. The objective of this study was to describe the activity of the public maternities in the Governorate of Sousse (Tunisia) and to identify obstetrical complications treated in these facilities.

Methods
A cross sectional study of all public health facilities, which performed deliveries in Sousse was conducted in 2017 (Five maternities: one University maternity and four peripheral ones). Data were collected by reviewing clinical records and registers of these maternities for the year 2016.

Results
In total, in the health visited structures, there were 13427 deliveries in 2016, the majority of them (78.8%) took place at the university maternity of Farhat Hached hospital. Of these deliveries, 3397 were performed by caesareans (25.3%). In 2016, there were three maternal deaths and 69 very early neonatal deaths. There were 2036 direct obstetric complications treated in the five maternities visited. The most frequently encountered direct complications were: ’obstructed/prolonged labor’ (41.21%), ’severe pre-eclampsia/eclampsia’ (19.5%) and ’ante and postpartum haemorrhage’ (15.18%). The most encountered indirect obstetrical complications were: gestational diabetes and anaemia.

Conclusions
The reduction of maternal and neonatal mortality requires the existence of a functioning basic health care system that provides all pregnant women and their newborns with timely access to skilled care, particularly when a complication occurs. The provision of this qualified care requires also the presence of qualified personnel working in a suitable professional environment.

Key messages
The majority of obstetrical complications occur in university maternity and this is due to excessive references from peripheral maternities. Peripheral maternities need to be strengthened with material and human resources.
Availability and drug lag of new medicines in South Korea
Authors: Son K 
Published: November 2019

Abstract

Introduction
This study aims to capture the availability of new medicines, to measure drug lags for new medicines, and to demonstrate various factors affecting timely availability of new medicines in Korean market.

Methods
We construct two models for the analysis; logistic and Cox model. First, we provide the logistic regression to analyze the availability of new medicines in Korean market. Second, we are interested in the timely availability of new medicines in Korea. Therefore, we calculated the drug lag between the United States and South Korea, and applied an event history model for a statistical estimation.

Results
There have been 160 NDAs approved by the FDA in the United States between 2007 and 2015. Among 160 new drugs approved in the United States during the study period, 112 NDAs (70%) were also approved by the MFDS in Korea, while 48 new drugs (30%) are not currently available in the Korean market. In addition, we are interested in the order of timing for market approval for 112 NDAs that approved in both countries. Not surprisingly, 95 NDAs (85%) were approved in the United States, and then approved in Korea, while 17 NDAs (15%) were approved in Korea, and then approved in the United States.

Conclusions
Compared to the United States, a striking drug lag was observed in Korea. For the new drugs approved between 2007 and 2015, the median approval lag ranged from 1.72 years in 2013 to 5.84 years in 2007. Presence of the manufacturers in Korea and medicines belonging to the antineoplastic agents were not only positively associated with the availability in Korea, but also accelerated the time to approval in Korea compared to the reference.

Key messages
Compared to the United States, a striking drug lag was observed in Korea. Presence of the manufacturers in Korea were not only positively associated with the availability in Korea, but also accelerated the time to approval in Korea.