bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding women’s leadership in health sector; findings of a qualitative study in Kerala, India
Authors: Benny G , Sankar H , Nambiar D 
Published: October 2020

Abstract

Background
The lack of women's representation in health and medicine, especially in leadership positions, is a major global challenge. An exception to this is the state of Kerala in India, where female representation is high, defying national trends. We undertook a study to understand the contexts undergirding women's rise to leadership in Kerala and their experiences in leadership.

Methods
We employed a qualitative research methodology like in-depth interviews. We identified 16 women by peer nomination (respondent-driven sampling) or from public records as leaders in health, working in Kerala's health system, in civil society or political leaders dealing with health issues. Following informed consent procedures, interviews were carried out seeking to understand the work-life balance, challenges, gender norms, motivation and leadership styles of participants. Transliterated English transcripts were analyzed by three researchers using a thematic analysis approach and Atlas.Ti8 software.

Results
Participants were aged 42 years and older, with between 19 and 60 years of occupying senior managerial positions in different levels. Most emphasized family members' influence and support for their leadership roles. Their work in communities and in primary care was described as formative. Women leaders reported a combination of leadership styles to accommodate and adapt to varying circumstances, emphasizing motivation and coalition building. Challenges like false allegations, non-recognition of competence and discrimination were overcome through self-determination and perseverance.

Conclusions
Kerala women leaders have faced hardships and challenges and rely on reflexive and variable strategies. They have climbed up the ranks and developed their leadership styles mindful of and benefitting from the maintenance of community and family relationships, suggesting a different kind of leadership model altogether.

Key messages
Women leaders from Kerala’s health sector have faced unique challenges. Women leaders from the health sector have addressed different challenges by developing a hybrid, distinct leadership style.
'Cocooning' the vulnerable - a main pillar of Malta's COVID-19 response
Authors: Calleja N , Gatt M , Azzopardi M , Xuereb E , GrechMercieca E , Micallef R , Buttigieg D , Camilleri L , Galea A , Gauci C 
Published: October 2020

Abstract

Issue
Early epidemiology established higher risk of morbidity & mortality amongst infected older individuals or those having specific chronic diseases, consuming most hospital care. Also where demand exceeding supply of healthcare, mortality was very high. As an island nation with one central main hospital, not overwhelming the healthcare system whilst avoiding total lockdown was key.

Description
On the 27-03-2020, the Superintendent of Public Health enacted the Protection of Vulnerable Persons Order, specifying that these categories (or subcategories thereof) of persons are to be granted vulnerable status: age &gt;65; pregnant; persons suffering from diabetes; immunosuppressed; cancer; end stage renal failure; respiratory disease; cardiac disease; heart failure. Such persons were entitled to stay at home, to be granted special leave from work, entitled to a monthly allowance by social services. One could go out only to attend to essential or urgent personal matters, e.g. groceries, medicines, medical needs, bank etc. with mitigation measures. Exemptions were only granted to special categories such as healthcare workers, farmers, or headship positions. In addition, the carers & staff of most nursing homes voluntarily decided to isolate themselves inside the homes for periods of 2/3 weeks. Thanks to a very active family support network, offspring, relatives or neighbours ran basic errands for them, or else organised deliveries. This legal status has been lifted on the 5th June 2020.

Results
This status was granted to 126 000 persons, including 14000 employed persons. Only 9 deaths occurred in Malta out of 664 cases in a population of 500000 up till 20th June 2020, with a case fatality rate of 1.35% - one of the lowest in Europe.

Lessons
Protection of vulnerable individuals can be a cornerstone of COVID-19 public health response if mobility is effectively restricted in this subpopulation.

Key messages
Protection of the vulnerable reduces healthcare & mortality burden. Effective legal & economic support measures, & extensive societal engagement required.
Feasibility of implementing Integrated Management of Childhood Illnesses through Mobile Technology
Authors: Dharma V K , Abdullah S , Khan A J , Munir M , Siddiqi D A , Shah M T , Habib A , Chandir S 
Published: October 2020

Abstract

Background
The Integrated Management of Childhood Illnesses (IMCI) strategy was launched by WHO and partners in 1995 to reduce child mortality by enhancing frontline health workers' (FHWs) ability to diagnose and manage childhood illnesses, and strengthen overall health systems. However, although IMCI is associated with decreased child mortality, numerous studies have shown its impact has been limited due to persistent barriers to implementation.

Methods
We developed a digitized version of IMCI (eIMCI) using Android technology to overcome implementation problems, including poor protocol compliance, lengthy trainings, paper-based data collection, and gaps in the referral system. The feasibility and efficacy of eIMCI was assessed through a mixed-methods pilot study encompassing baseline and end-line surveys, interviews, and Focus Group Discussions, in a low-resource rural district of Punjab, Pakistan. During the 8 weeks of deployment, a total of 1,978 children were enrolled in the eIMCI application by 10 participating FHWs, and 47 electronic referrals were generated.

Results
Preliminary outcomes showed reduced disease occurrence (for example, diarrhea decreased from 48% at baseline to 29% at endline), increased adherence to IMCI protocol, and strengthened health system linkages (facility referrals increased from 5% at baseline to 45% at endline). FHWs reported enhanced performance, as well as an improved community response to their services.

Discussion
Indicating the feasibility and efficacy of eIMCI deployment in a low-resource setting, evidence from the pilot demonstrates the benefit of digitizing the IMCI protocol. eIMCI is a digital health solution with the potential to significantly reduce child mortality and improve service delivery and performance of FHWs.

Key messages
eIMCI is a feasible solution for the implementation of IMCI strategy in developing countries and demonstrates increased compliance and enhanced performance by the frontline health workers. Implementation of eIMCI can result in a significant reduction in child morbidity and mortality via timely referrals of patients and reduced disease occurrence.
Health and finance in the post-austerity context: the Portuguese experience
Authors: Perelman J , Avila A , Matias M A , Coelho M 
Published: October 2020

Abstract
In March 2018, a Mission Structure (EMSPOS) was created in Portugal, under supervision of both Ministries of Health and Finance, to analyze the economic situation of the National Health Service (NHS), and propose recommendations to ensure its financial sustainability. The main concern was the recurrent cycles of overdue debt of NHS hospitals, which reached, in September 2018, more than 1.3 billion euros. These debts cycles, mainly to the pharmaceutical industry, were viewed as a combination of (i) under-budgeting during and following the Great Recession; (ii) expenditure growth related to population aging and new technologies; and (iii) a hospital financing and governance model that provided few incentives towards adequate management.
Hospitals' overdue debts limit their autonomy to assume investment compromises, while they deteriorate the NHS negotiation power vis-à-vis suppliers/creditors. Also, these debts were paid through financial bailouts, which shifted from punctual to predictable and regular, constituting an “indebtment reward” that destroyed any incentive towards efficiency and cost containment.
The challenge faced by EMSPOS was to ensure better budgets and autonomy to hospitals, both indispensable to face growing needs (the health sector claim), while providing the right monitoring and incentives to avoid new cycles of debt, inefficiencies, and unsustainable expenditure growth (the Ministry of Finance claim). This last request was reinforced by the Post-Program Surveillance (PPS), by the European Commission and Central Bank, that “measure Portugal's capacity to repay its outstanding loans”.
The EMSPOS proposed a new governance model that included better budgets with an efficiency-related performance component, a new management contract for hospitals' executive boards, and a path towards more investment autonomy, through the approval of “Activity and Budget Plans”. We will discuss the details of this new models and the challenges of its implementation.

Key messages
Portuguese NHS hospitals have been facing regular cycles of overdue debt, related to under-budgeting and inadequate governance models. Better budgets and hospital autonomy are needed to face growing needs (MoH claim), and right incentives are needed, to avoid inefficiencies and unsustainable expenditure growth (MoF claim).
Health financing reform in the primary health care in Montenegro
Authors: Scepanovic L 
Published: October 2020

Abstract

Background
Primary health care financing reform should be undertaken with aim to support universal health coverage, make the health care accessible and to provide a financial risk sharing in a way that prevents suffering of financial hardship.

Objectives
To describe challenges, development and introduction of primary health care financing reform in Montenegro. The specific objective was to assess the effectiveness of the implementation of the capitation formula.

Methods
This retrospective study has been undertaken to describe implementation of a capitation formula in Montenegro.

Results
Eight years after the implementation (2017 data) indicate that some monitoring indicators reflect output increase in the primary health care, such as number of prevention services provided to the patients (adult population of age 18 years and more). However, other indicators. e.g., number of referrals to other levels of healthcare is rising, indicating that primary care might not be meeting the adequate level of health care needs of the population.

Conclusions
Montenegrin experience shows that financing reform in short term resulted in establishment of a system based on output models of health care financing and increased capacities for performing main financing functions.

Key messages
Introduction of a capitation formula represented a fundamental shift in the way primary health care was financed in Montenegro. Further research needs to be done on how primary care responds to the needs of the population.
The bio-psycho-social frailty: a key to the integrate territorial and hospital care in Europe
Authors: Roller-Winsberger R 
Published: October 2020

Abstract
Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards Active and Healthy Ageing (AHA). The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. The European Innovation Partnership on Active and Healthy Ageing (EIPonAHA), a private public partnerships (PPP) launched by the European Commission (EC) is aimed at developing new solutions to facilitate AHA. The partnership combined the view on frailty coming from public health as well as the clinical management, and managed to overcome barriers between these two worlds. Bio-Psycho-Social frailty represents a synthetic indicator providing an effective basis to overcome a silos approach that is often performed by health and social professionals working in the field. The A3-Action Group on ' Lifespan Health Promotion & Prevention of Age-Related Frailty and Diseases” proposes good practice models to achieve and support the healthy ageing of European citizens using a bottom-up approach targeting the prevention of frailty and subsequent functional decline. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Integrated health and social care is a key factors to affect ageing positively either in the field of prevention of functional decline and in the field of care. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. A crucial role is played by training of health personnel and education at population level in order to achieve a new awareness about AHA trajectory.
Obstetric referrals to the regional maternity of Kasserine (Tunisia)
Authors: Limam M , Sahli J , Alouani D , Gassoumi M , Mellouli M , Mtiraoui A , Ajmi T , Ghardallou M 
Published: October 2020

Abstract

Background
A large proportion of maternal deaths are related to the health care system, including the failure of the referral system between maternity wards. The objectives of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian regional care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme guidelines.

Methods
A descriptive study was carried out at the regional maternity facility of the regional Hospital of Kasserine in 2018, among parturients referred during a period of three months. Data collection was carried out prospectively from medical records, transfer documents, interviews with parturients and with the nursing staff of the reference maternity hospital. The ICD-10 was used to code recorded indications and diagnoses for referrals.

Results
A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity in this facility. There were 26 reasons for referrals and the most common was Maternal care for pelvic organ abnormalities (19.7%) and premature rupture of membranes (12.8%). 34.4% of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (71.4%) did not conform to the list of referral indications of the NPP. Twenty-eight diagnoses were retained after referrals: the most common was Maternal care for pelvic organ abnormalities (15.8%). In 42% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital.

Conclusions
The referral system must be analyzed in order to ensure a maximum level of safety for the mother-child couple through the formalization of the protocols and the promotion of the role of peripheral maternity facilities, which are the structures of first recourse.

Key messages
The current referral system in the region of Kasserine still faces several challenges that need to be addressed in order to make it more effective. Maternal referral systems are an effective measure to help to reduce preventable maternal deaths, they should be continuously assessed and revised.
16.A. Round table: Responding to COVID19 in Europe: politics and policies
Authors:   Organised by: University of Michigan (USA),   Chair persons: Gemma Williams - UK, Scott Greer - USA
Published: October 2020

Abstract
The COVID-19 virus presented challenges in virtually every area of public heath, from surveillance to research to action. Governments and whole societies faced hard questions: how should they balance containment measures, economic activity, and human rights? How should they communicate effectively and manage disinformation? How should they slow spread of the disease without triggering xenophobia? How should they manage pressures on health care facilities? How should they manage the consequences of social distancing for society as a whole?
This panel addresses the fast-moving events surrounding the virus from the perspective of public health policies and politics. Its goal is to identify and explain the different responses of European countries and the European Union- in other words, why do public health systems act as they do in response to a novel threat? It will contribute to our understanding of how the politics and governance of public health in different countries produce different outcomes, with lessons for the overall organization of European public health and also for immediate responses in what is likely to be an ongoing challenge associated with COVID-19.
Each panellist will discuss a country that had a distinctive experience of the virus and response. The countries were selected for the diversity of their situations as well as the significant differences in the organization of public health and health care systems as well broader political differences. Yves Charpak will discuss France, Michelle Falkenbach will discuss Italy; Thomas Czyprionka will discuss the German speaking countries, Anniek de Ruijter will discuss the European Union's collective responses and coordination, and Elizabeth King will discuss Russia. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened. Gemma Williams will chair.
After the panelist's contributions the debate will open up to draw on the experience of everybody in the room. It will be highly interactive, given that many in the audience will have direct experience of managing the responses to the virus in different countries. The chairs will ensure timekeeping and facilitate discussion.

Key messages
COVID19 tested every element of European public health systems. The different responses carry lessons about the policy and politics of public health. We can draw lessons to improve the governance and politics of public health as well responses to COVID19.
The vaccination registry of the local health company (ASL) Roma 4
Authors: Sinopoli M T , Fusillo C , Belfiore G , Galliano E , Quagliariello F , Matera C , Quintavalle G 
Published: October 2020

Abstract

Issue
The regional vaccination of Lazio (AVR) and the ASL vaccination registries(AVA) that feed it, have had to adapt to the directions of national vaccination registry. The ASL Roma 4 added other implementations.

Description of the Problem
L'AVA must, first of all, allow easy search of subjects, defaulters and vaccination coverage for various filters but it can also facilitate the recording and analysis activity.

Results
The provision of barcodes allows the prompt search of subjects, the check of tax code and AIC codes of vaccines. The digital signature of the privacy and consent forms and anamnesis, taken from the “Guide to contraindications to vaccinations” directly available, allows the elimination of the paper. The possibility to go directly to AVR allows the registration of vaccinations made in other ASL. In addition, the AVA allows the compilation of the adverse event reporting form and vaccine management. The link with the portal on the ASL website allows users to download the vaccination certificate. Important is the possibility to send SMS before vaccination deadlines or appointments. The SMART-SMS allows sending videos or photos and manage a short link (http://tiny.cc/XXX) to an information page on ASL website, as well as user response SMS, that can also directly change appointments.

Lessons
The dematerialization of the forms leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session, the SMS bring greater compliance of users and an increase in vaccination coverage. The use of mobile analytics tools allows monitoring of vaccination campaigns.

Key messages
The dematerialization of the forms in the vaccination registry leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session. The ability to send SMS through the vaccination registry brings greater compliance of users and an increase in vaccination coverage.
Environmental Effects of the Livestock Industry: Knowledge, Attitudes, and Behavior among Students
Authors: Dopelt K , Radon P 
Published: October 2020

Abstract

Background
The livestock industry has numerous impacts on the environment. The aim of this study is to examine the level of knowledge, awareness and behavior on topics related to environmental pollution caused by industrial animal food production and to determine whether there is a relationship among them.

Methods
Cross-sectional study using an online questionnaire. 361 students were asked about their knowledge, attitudes, and behavior related to the environmental impact caused by livestock industry. The data were analyzed using correlations, t-tests for independent samples, and linear regression models.

Results
Students have almost no knowledge about the environmental impact of livestock industry, their attitudes are moderately pro-environmental, yet they are not strict about them. Students with higher levels of environmental knowledge demonstrated more pro-environmental attitudes and behavior (r = 0.33, p &lt; 0.001; r = 0.36, p &lt; 0.001 respectively); attitudes mediate the relationship between level of knowledge and behavior with respect to environmental pollution caused by the livestock industry (Adj. R2 =0.28, p &lt; 0.001). Significant differences were found between participants who rear animals and participants who don't, in the level of knowledge (t = 3.78, p &lt; 0.001), attitudes (t = 3.04, p &lt; 0.01), and behavior (t = 2.33, p &lt; 0.05).

Conclusions
These findings are in line with other studies, which showed that some consumers are concerned about production of animal foods but their knowledge on this topic is very limited, and most continue to consume animal products without any intention of reducing consumption. There is a need to raise awareness of the environmental and health impacts caused by livestock industry. An introductory course on environmental science should be integrated into different academic study programs. Further research should be conducted among additional population sectors.

Key messages
Students have almost no knowledge about the environmental impacts of the food they consume. There is a need to develop campaigns to raise awareness of environmental impacts of food.