bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating process-mining interoperability: stroke case analysis on Italian health real-world data
Authors: Faragalli A , Bucci A , Gesuita R , Unim B , Spazzafumo L , González-García J , Telleria-Orriols C , Estupiñán-Romero F , Palmieri L , Carle F 
Published: October 2020

Abstract

Background
The Institute for Health Sciences in Aragon developed a process-mining based algorithm deployed using a container solution to describe the Stroke Care Pathway reproducible in different Health Systems. Our aim is to apply the proposed solution to administrative data of an Italian region to explore interoperability in the case of the stroke care; the study is developed in the context of the Joint Action on Health Information 'InfAct' funded by the European Commission.

Methods
The target population included 1538055 residents in Marche Region who received National Health System (NHS) assistance in 2017. The collected information was sex, date of birth and death, residence from NHS Beneficiaries database; admission and discharge date/time, hospital code, admission type, discharge status, up to 6 diagnoses from Hospital Discharge database; admission date/time, urgent care facility code, discharge status, diagnosis from Emergency Care database. Patients without hospital/urgent care events were excluded from NHS Beneficiaries database. Care pathway traces and map with frequency information, timing across the pathway and timeline plots with time information were the outputs obtained.

Results
Data included 17752 patients, 10390 hospital, and 18329 urgent care events. Results were represented graphically, easy to read and spread: 500 episodes of stroke were detected, 66% of patients was hospitalised after emergency room (ER) admissions, 19% directly hospitalised and 10% discharged after ER admission. The most frequent access and exit points of the pathway were ER admission and hospital discharge.

Conclusions
The application of the stroke case to Italian data demonstrates feasibility and usefulness of interoperability in analysing health care administrative data for public health purposes. A European health information system is crucial to build capacity between researchers across Europe and improve health data on Health Monitoring and Health System Performance Assessment.

Key messages
Sharing a process-mining methodology deployed using a container solution is a useful strategy to describe care pathways and ensures results’ reliability across European Health Systems. Developing and testing tools to encourage interoperability between researchers across Europe is essential for public health policymaker in Europe.
Fall prevention in Dutch general practices: A descriptive study
Authors: Meekes W M A , Leemrijse C J , Korevaar J C , van de Goor L A M 
Published: October 2020

Abstract

Background
Falls are an important health threat among frail older people. GPs are often the first to contact for health issues and therefore they can be seen as the designated professional to offer fall prevention. At the moment, it is unknown what GPs in the Netherlands exactly do regarding fall prevention. This study aims to describe what GPs in the Netherlands do during daily practice in regards to fall prevention.

Methods
Thirty-four GP practices located throughout the Netherlands were followed for a period of 12 months. When a GP entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the GP received a pop-up with the question “Is this patient frail?”. If according to the GP the patient was frail, the GP subsequently completed a short questionnaire.

Results
About 65 GPs completed 1396 questionnaires. More than half (n = 726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF). Of 276 patients, GPs did not know if they had experienced a fall and of 408 patients if they had a FOF. Of the patients that had experienced a fall in the previous year and/or had a FOF, 37% received fall preventive care. Reasons for not offering such care were i) GP and patient did not think that the patient had a high fall risk (38%), ii) the patient finds treatment too intensive or too much of a hassle (21%) and iii) the patient was not convinced (s)he had a high fall risk and so treatment was not necessary (12%). The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors.

Conclusions
The results show that GPs are not always aware of a patient's fall history or FOF and that only part of the patients that had experienced a fall and/or had a FOF receives fall preventive care. Hence, it is important to develop and implement strategies for GP practices to systematically screen for fall risk and to offer fall preventive care to reduce falls among frail older people.

Key messages
Thirty-seven percent of the frail older people that experienced a fall in the previous year and/or had a fear of falling, received fall preventive care. The three most treated underlying causes are mobility problems, fear of falling, cardiovascular factors.
Experiences and expectations of women from ethnic minority background on perinatal mental health
Authors: Soltani H , Watson H , Walton E , Harrop D , Young A , Johnson L 
Published: October 2020

Abstract

Introduction
Being from ethnic minority backgrounds is a risk factor for poor perinatal mental health (PMH). To enhance services and prevent the devastating impacts of mental health problems on maternal morbidity and mortality, it is important to understand the experiences and expectations of women and families regarding related service provisions.

Methods
This will present the results of a two staged study including: a) a systematic review examining the state of evidence on the experiences of women from ethnic minority backgrounds on PMH. We searched 4 databases and using a convergent approach, synthesised the data thematically. b) an exploratory survey, distributed through a maternity service user and parenting Facebook group. Quantitative data were analysed using descriptive statistics and a thematic analysis was used for the qualitative data.

Results
A total of 15 studies met the inclusion criteria for the systematic review, highlighting the need for an in-depth exploration of these women with issues related to culture stigma and relevance of care provision. The survey questions explored these issues further. There were 51 responses representing 14 different ethnic minority backgrounds, the largest groups being Pakistani and Indian (21.6% and 19.6% respectively). The majority of the respondents reported accessing support for mental health problems very challenging (58.5%). Qualitative data revealed several overarching themes; 'Suffering in silence', 'The need for a safe space to talk' 'What about women like me-community support'?

Conclusions
Women from ethnic minority groups face barriers to seeking help from PMH services due to ongoing stigma, poor attitudes and behaviours of health professionals and inappropriately designed services. Culturally competent care providers with appropriate training are required to ensure women feel safe to access care. The effects of peer supporters as part of PMH services require further investigation.

Key messages
Maternity services should ensure that support for perinatal mental ill health meets the needs of women from ethnic minorities. Research is needed to develop interventions on healthcare professionals' education and cultural competency and services which promote access to culturally appropriate spaces to talk and be listened to.
Rapid scientific update response to public health professions during Phase I of COVID-19 pandemic
Authors: Caminada S , Angelozzi A , Barbaro A , Brambilla G , Carusi D , De Castro P , Gentili D , Mistretta A , Mochi P , Rosi A 
Published: October 2020

Abstract

Issue
Preparedness can be considered the Achilles heel in Western Coutries to adequately fight Sars-CoV-2 pandemy. The Istituto Superiore di Sanità (ISS) has been challenged to give rapid technical and scientific advices to the State and Regions on a huge variety of Sars-CoV-2 aspects related to public health.

Description of the problem
Rapid and timely accumulation of knowledge and empirical evidence is critical for policymakers and emergency managers to maximally inform their decisions through scientific evidence and to better guide and mobilise the expertise of academics and general practitioners towards effective solutions.

Results
An ad hoc “Scientific Literature working group” at ISS in the period 23/03 - 31/05 screened a total of 4,568 pre-prints and 15,590 peer reviewed papers extracted from PubMed, arXiv.org, medRxiv and bioRxiv, which gave rise to the following deliverables: a) a daily pre-prints alert selection delivered to ISS President for the routine national Scientific Technical Committee meetings on Sars-CoV-2 chaired by Italian Civil Protection (still ongoing), and, b) a weekly open access issue of Covid Contents publications (8 volumes, https://www.iss.it/en/covid-contents), as summary of most interesting peer-reviewed papers for public health professions.

Lessons
The needed cross-cutting approach is leading to: interdisciplinarity enhancement within the ISS; coverage of broad expertise areas and interest of health care providers; cross-linkage between the different aspects/disciplines involved in this pandemic and share of experiences.

Key messages
Committed Institutions have the responsibility to support practitioners and decision makers to understand relevant aspects of medical, physical, occupational and public safety, in case of emergency. The Silos culture has to be overcome. There is nothing more powerful in any Institution than having all researchers rowing fiercely in the same direction.
How do diagnostic self-tests change healthcare relationships? A qualitative study
Authors: Roussel S , Rondeaux S , Braeckman T , De Vriese C , Van Den Broucke S 
Published: October 2020

Abstract

Background
Diagnostic self-tests in Belgian pharmacies are a recent phenomenon. While considered a way to empower patients to take informed decisions, self-tests also challenge the relationship between patients and health professionals and between pharmacists and general practitioners. This study explored how the introduction of diagnostic self-tests in pharmacies influences the health care relationships.

Methods
A qualitative study, part of the Care-test research program, was conducted using semi-structured interviews with 18 patients, 25 doctors, and 16 pharmacists from Brussels. Data collection ended after data saturation. Reflexive thematic analysis was performed.

Results
Mutual partnership approaches were not mainstreamed and mainly intuitive when existing, with patients being often more in demand for a partnership with their doctors than what their doctors offered. This perceived lack of dialogue led some patients to autonomous behaviours, qualified as “non-adherence” by professionals (self-medication with medicinal herbs, unilateral adaptation of therapies including those for HIV-infection and for orphan disease, etc.). Not all the patients, however, were in demand for a more active role. Some deferred to the doctor's choice, but they did not experience another kind of relationship. The doctor-pharmacist collaboration mainly entailed factual information exchange, although more collaborative relationships exist. Current collaborations related to self-tests were limited due to their novelty and controversial nature. While patients were generally in favour of diagnostic self-tests, professionals had divided opinions about them.

Conclusions
The study reveals divergent views between patients and health professionals and amongst professionals, about self-tests and the need for a partnership between patients and professionals. This suggests a need for health professionals to be better skilled in dealing with participative approaches.

Key messages
Mutual partnership and Interprofessional collaboration are not mainstreamed in health care. Patients, doctors and pharmacists had divergent views about diagnostic self-tests and about the need for partnership.
What makes digital health intrusive? Qualitative findings from an international study on diabetes
Authors: Oikonomidi T , Ravaud P , James A , Cosson E , Montori V , Tran V T 
Published: October 2020

Abstract

Background
Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why.

Methods
We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]).

Results
We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests.

Conclusions
Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden.

Key messages
Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.
Smoking during pregnancy. Results of the cross-sectional KiGGS Wave 2 study and trends
Authors: Garnica Rosas L , Kuntz B , Zeiher J , Starker A 
Published: October 2020

Abstract

Background
Maternal smoking during pregnancy represents a significant risk, increasing the adverse consequences for mothers and newborns. Different national targets have been developed in Germany to reduce smoking rates during pregnancy. To monitor the achievement of these goals, this study aims to assess social differences and temporal trends of smoking behaviour during pregnancy in mothers living in Germany.

Methods
Data of children aged 0 to 6 with valid information on maternal smoking habits during pregnancy were subtracted from German Health Interview and Examination Survey for Children and Adolescents (KiGGS)(KiGGS baseline 2003-2006, n = 6,525 and KiGGS wave 2 2014-2017, n = 4,838). The information on maternal smoking during pregnancy was recorded retrospectively as part of a self-administered written questionnaire. We estimated the prevalence of smoking in pregnancy and multivariable logistic regression models to assess the association with the age of the mother at the time the child was born, the socioeconomic status of the family and the migration background. In addition, to analyse trends over time, we compare the current data with the KiGGS baseline study.

Results
The prevalence of mothers who smoked during pregnancy decreased statistically significant from 19.9% (KiGGS baseline) to 10.9% (KiGGS wave 2). Younger mothers aged up to 24 years were more likely to smoke during pregnancy (OR 1.74; 95%CI 1.04-2.89), similar to those with intermediate (OR 5.52; 95%CI 2.90-10.48) or low socioeconomic status (OR 22.43; 95%CI 10.84-46.39), and those without (OR 4.18; 95%CI 2.27-7.70) or with one-sided migration background (OR 2.47; 95%CI 1.26-4.84), in comparison to the groups of reference.

Conclusions
Our findings, present the reduction of smoking prevalence during pregnancy, recognising the effectiveness of the tobacco control programs in Germany. However, more emphasis on the prevention strategies for young and socially disadvantaged women are still required.

Key messages
Smoking prevalence during pregnancy has decreased in Germany over time, though still represents a challenge for public health and tobacco control. The prevention strategies should reduce the social breach, to extend the benefit among women and their offspring.
India’s national health insurance scheme: Analysis using the Growth Diagnostics Framework
Authors: Wundavalli L , Topno N 
Published: October 2020

Abstract
The world's largest health assurance scheme, Ayushman Bharat-Pradhan Mantri Jan Suraksha Yojana (AB-PMJAY) was launched in India in 2018 to achieve universal health coverage aspired in the National Health Policy 2017.
Our objective was to critically analyse AB-PMJAY through the lens of Growth Diagnostics Framework developed by Hausmann, Rodnik et al using secondary data. The framework analysed the scheme on five aspects: physical investment, knowledge/application/productivity, productive livelihood, skill set and cooperative federalism in terms of demand and supply side problems. The analysis was conducted for six months.
The results highlighted issues relating to supply side such as availability of beds, equipment, manpower, information systems, deficient rural public health facilities, health insurance governance, scaling technological capabilities, improving procurement of drugs, equipment, technical training of staff in IT; highly skewered ratio of public and private sector hospital beds and manpower. Demand side issues include high demand of services, requirement of research and development related to premium rates, maturity of the scheme, pay outs, increased demand of specialists/technicians/health administrators in government sector and willingness of federal states to enroll in the scheme.
Our recommendations highlight the importance of gaining the trust and confidence of citizens in public sector, reducing asymmetric information, mandating a formulary policy in hospitals, measures to prevent private hospitals from indulging in cream skimming and dumping patients, increasing package amounts for chronic conditions like dialysis, more health technology assessments, strengthening referral levels of care, focusing on outcome based standards for facilities, creating demand for preventive and promotive care using innovative ICT tools and coordination with different systems of medicine, addressing social determinants of health through inter-sectoral convergence.

Key messages
Growth Diagnostics Framework is a novel way to study a national health insurance scheme. India's national health insurance scheme is dynamic and aspirational that requires multi sectoral co-ordination.
Value-driven workforce, systems and leadership
Authors: Tahzib F 
Published: October 2020

Abstract

Background
Our norms and values are key to decision making, policy and practice. Some commentators have highlighted need for greater courage and purpose in public health leaders and systems. There is need for greater appreciation of moral mandate of public health and implications for public health system leadership and capacity building activities and practice

Objectives
Demonstrate the case for value-driven workforce, systems and leadership Share key findings and learning from research by the Faculty of public health around the public health values, and activities to build capacity and competency around the issue.

Body of the session
Surveys of the public health workforce and schools of public health have consistently highlighted need for education and training in public health ethics and law for some time and their key role for effective public health policy and practice. In this presentation there will be demonstration of the key findings of the surveys and their consequences, including moral distress for the workforce and potential failings of public health systems Some key activities and initiatives in building competency and capacity in public health ethics and law will be described. This will include activities to develop organisational values and professional values and the important distinctions between them, and development of public health code of ethics and professional conduct as part of efforts for professionalisation of the public health workforce.

Conclusions
Value-driven workforce, systems and leadership are key in meeting complex public health challenges. Building competency and capacity of the workforce and public health institutions are important part of the agenda.
The USA
Authors: Willison C E , Singer P M 
Published: October 2020

Abstract

Background
In the United States, political regimes directly influence health policy agenda setting, adoption and reform. The priorities of health policy shift across administrations and over time as political parties evolve, polarization occurs, and key political actors change. What is less clear is the degree to which other ideologies - such as nationalism and populism - shape the types of policies that are pursued and adopted in health care. We hypothesize that trends in nationalism and populism in the US across presidential administrations influence the scope of access across different populations in health policies. Additionally, we argue that the rise of populism and nationalism in the United States under the Trump administration has led to restrictions on accessing health programs through targeted limitations placed on certain populations.

Methods
We apply a comparative historical analysis framework to track changes in healthcare policy over time that reflect populist or nationalist agendas. We analyze health policies enacted and pursued by presidential administrations as well as trends in populism and nationalism across presidential administrations in the U.S.

Results
Results demonstrate that as populist sentiments rise, a parallel trend of increased othering in health policies takes place. This othering appears to reflect policies targeting supporters through both policy spoils and values while constraining opposing groups (e.g. increased restrictions on out-group members such racial/ethnic minorities).

Conclusions
Our results highlight the tension that exists in populist and nationalist health policy. Populist and nationalist leaders need to strike a balance between ensuring that their “people” continue to have access to health programs, requiring targeted limits placed within programs. Much of the limitations placed on populations are accomplished through submerged mechanisms and by devolving administration and governance to state and local governments.