bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health promotion and disease prevention of people aged 60 year or older
Authors: Jackytė J 
Published: October 2020

Abstract
The number of people aged 60 years or older is increasing over the world. According to the World Health Organization, keeping the health and functional independence of older people is one of the major challenges facing the European region. Older people in Lithuania are not linked to take care of their health. As a result, most of the people aged 65 years or older have a poor health. In 2018, 51.6 % of people aged 65 or older had limited knowledge of health literacy in health promotion. In order to change health-related behavior, Kaunas city municipality Public health bureau started to run a healthy ageing project.
The project started in September 2018 and finished in December 2020. The aim of the project was to improve the health literacy level of Kaunas city citizens aged 60 years or older and to form positive changes in their health behaviour by implementing public health promotion program in Kaunas city.
Different evidence-based physical activities were organized during the project: taichi, line dancing, aquatic exercise, functional training, and physiotherapy exercise. 888 residents aged over 60 years participated in 816 project activities. Healthy cooking classes with professional chefs were also organized for older people. As a result, 120 elderly people gained knowledge and skills in property nutrition during 40 healthy cooking classes. To improve older people's mental health, psycho-emotional activities such as mindfulness-awareness and brainstorming sessions were organized. A total of 314 older people participated in the 37 trainings of improving the psycho-emotional state.
Women were more likely to participate in health promotion activities. In order to attract more men, collaboration and involvement of local communities was outgoing.

Key messages
Empowering older people to make healthy choices can help to prolong the autonomy of older people and thus bring significant economic and social benefits. Collaboration and involvement of local communities can bring relevant effect for public health in building complex strategy of healthy aging.
Potential of recruiting high school student volunteers for stroke promotion campaigns
Authors: Maršálková H , Svobodová V 
Published: October 2020

Abstract

Issue
Stroke is the leading cause of death and permanent disability worldwide. Even though an effective treatment exists, the main issue in the Czech Republic and other countries remains low stroke symptoms awareness and correct response. The later a patient arrives to hospital the lower treatment effect is. Thus, continuous education of the population is needed.

Description of the Problem
Holding educational events demands capacities, but there are no health promoters in the Czech Republic and health professionals are overloaded. Therefore, our goal was to establish a voluntary group of young people for conducting stroke awareness campaigns. The question is, if the group of young volunteers is be able to conduct health promotion events. The key recruitment was done in 2015 among high school students, who previously passed our stroke educational program. Once the group was formed the Stroke Awareness Coordinator provided periodical training in health literacy and soft skills so the group is to provide the lay public with accurate information in the most effective way.

Results
The Stroke Ambassadors voluntary group has been formed in 2015 in St. Anne's University Hospital Brno and has 25 members nowadays. Over 5200 people were educated directly through 48 events organized or supported by the group between 2015-2019 (e.g. World Stroke Day, public lectures, children contests, school project days). Thanks to the events, new partnerships with municipalities and public health supporters were initiated.

Lessons
Volunteers are readily available to provide health promotion support. There is only a small additional cost related to education of volunteers. Students have easier access to schools to organize health events for their age group than adult health professionals.

Key messages
High school student volunteers are readily available to provide health promotion support. There is only a small additional cost related to education and motivation of volunteers.
Long-term effect of participation in one-month alcohol abstinence campaign on individual consumption
Authors: Terebessy A , Pongor V , Horváth Z s , Ivers J-H , Pénzes M , Dávid F , Horváth F , Demetrovics Z s , Urbán R , Rácz J 
Published: October 2020

Abstract

Objective
There is limited amount of evidence concerning the effect of population-based interventions. Dry November campaign asks people to go booze-free for a month. The goal of our study was to assess whether success rate of participation in the 2017 Dry November campaign leads to long-term change in alcohol consumption of participants.

Methods
A longitudinal study was conducted in 2017-2018 in the form of an online survey. Alcohol consumption characteristics of respondents (N = 125) were measured by the short-form AUDIT test. Participants filled out the first survey at the end of October 2017 with a one-year follow-up questionnaire. We used the reliable change index to identify participants whose c-AUDIT scores changed significantly over time. We collated participants who exhibited no change or significant decrease in c-AUDIT scores into one group, which was used as reference in our logistic regression analyses. We first conducted a series of univariate regression analyses to identify significant confounders, which were then included in the subsequent multivariate regression analysis.

Results
Based on our results, success rates did not differ significantly between those who exhibited a significant increase in c-AUDIT scores and those whose c-AUDIT scores did not change or decreased significantly over a one-year time period. In our multivariate regression analysis, the occurrence of alcohol consumption in the same household (OR = 3.29, 95% CI: 1.17-10.01) was the only variable significantly associated to an increase in c-AUDIT scores.

Conclusions
Even though success rate of participation in the 2017 Dry November campaign did not influence c-AUDIT scores significantly at follow-up, we were able to identify the occurrence of alcohol consumption in household as a significant risk factor for those who exhibited a significant increase in c-AUDIT score.

Key messages
A one-month alcohol-free challenge might be an effective tool for reducing alcohol consumption but further analysis is needed. The inclusion of individuals in the same household in interventions aiming to decrease alcohol intake may lead to higher success rate.
Fighting childhood obesity in Brazil: a grassroots perspective
Authors: Nasser G 
Published: October 2020

Abstract

Issue
Brazil is facing one the main growing public health concerns of this century, with obesity and overweight affecting approximately 20% of children. Alongside this epidemic, there is a an increase in concomitant non-communicable diseases such as diabetes and cardiovascular disease. Interventions that promote health and integrate the civil society with the public and private sectors are essential to tackle changes in the long term.

Description of the Problem
The nutrition education project presented here was developed by a Brazilian non-profit from 2016 to 2018. With a focus on health and nutrition, the project included interventions such as BMI monitoring, assessment of iron-deficiency anemia among children, school gardens and education. This strategy has been developed in several areas of the country, with success in all scenarios, demonstrating that a bottom-up approach, with the involvement of the community is needed to promote change.

Results
The program has been successful in integrating the major activities into the daily curriculum of the schools, with the adoption of healthier lunches for children. 76% of parents attested that a school garden made their children eat more fruits and vegetables and 33% of the children affirmed changing their eating habits after the program. Buy in from the local governments and communities demonstrate the effectiveness of interventions.

Lessons
Investments from the private sector on social programs needs to ensure a more sustainable approach, so that behaviour change, which is key to reduce the risk factors associated with NCDs can be fostered. This needs to be done with an integral approach, with the support from local, as well as national and international stakeholders.

Key messages
Long-term change is possible with a grassroots approach that engages communities towards a healthier lifestyle. A school or a home garden can bring about better nutritional choices.
Difficulties in implementation of the National Health Map in Bulgaria
Authors: Georgieva S , Kamburova M , Tsanova D 
Published: October 2020

Abstract

Background
National Health Map (NHM) of Bulgaria determines the required minimum of healthcare facilities, hospital beds and specialists at different levels of Health System to meet population's needs of healthcare. Its main objective is to adapt structure of the healthcare network to the population health needs ensuring for every Bulgarian citizen an equal access to health services. Through it healthcare resources have been planned on a territorial basis and the national health policy has been implemented. The aim of this report is to analyze the actual availability of healthcare facilities and staff, and compare with the minimum necessary according to the NHM.

Methods
Content and critical analysis of statistical data of the Bulgarian Ministry of Health.

Results
Bulgaria is among countries with relatively low number of general practitioners (GPs) among countries of EU where the range is between 42 and 253 per 100 000 inhabitants. According to the NHM, taking into account administrative division, infrastructure and morbidity, optimum GPs/population ratio is about 67/100 000 while an actual availability is 55.9/100 000. The most serious deficiency is in remote areas where the ratio is between 26 and 32 per 100 000. Quality of primary health care is affected by the fact that 23.89% of GPs are without acquired specialty. Number of practicing nurses in Bulgarian health system is 30% lower than the recommended minimum. Nurses/population ratio is unsatisfactory. Physicians/nurses ratio is not consistent with European standards. Hospital beds are 6.3/1000 which range Bulgaria among five European countries with the highest availability of hospital beds but they are unevenly distributed both on a territorial basis and on specialties.

Conclusions
There is a lack of human resources in Bulgarian Health System and unequal availability and accessibility of health facilities in different regions of the country. Distribution of hospital beds on specialties also must be optimized.

Key messages
National Health Map of Bulgaria determines population needs of accessible outpatient and hospital care, distributes health institutions on territorial bases and implements National Health Policy. Difficulties in implementation of National Health Map are insufficient number general practitioners (GPs), a large proportion of GPs without acquired specialty, inadequate ratio physicians/nurses etc.
The role of leadership in driving change in cancer survival outcomes in seven high income countries
Authors: Morris M , Seguin M , McKee M , Nolte E 
Published: October 2020

Abstract

Background
There is well-established variation in cancer survival across high-income countries with seemingly-similar health systems. There is much research on reasons for these differences, but the role of leadership has been under-researched despite being one of the WHO 'building blocks' that underpin a functioning health system. Leadership is variously defined as including governance, stewardship, responsibility and accountability. As part of the International Cancer Benchmarking Partnership, this study looked at these diverse aspects of leadership to identify drivers of change and improvement across a range of high-income countries.

Methods
Cancer strategy documents were analysed from 22 jurisdictions: Australia (3 states), Canada (10 provinces), Denmark, Ireland, New Zealand, Norway, and UK (4 countries). Key informants in 15 of these jurisdictions, representing a range of stakeholders, were recruited through a combination of purposive and 'snowball' strategies, and invited to participate in semi-structured interviews. Documents and interview transcripts were analysed using a thematic approach.

Results
Different facets of leadership emerged: diffused vs centralised (including the central role of a cancer agency in some places); national, regional and local leadership structures; links between primary and secondary care. This study, however, demonstrated a central role for sustained leadership and political commitment, crucial for initiating and maintaining progress, as was a coherent vision that supported the implementation of national policies locally. Clinical leadership emerged as vital for translating policy into action.

Conclusions
Improving cancer outcomes is challenging and complex but is unlikely to be achieved without effective leadership and sustained political commitment that can create effective co-ordination of care.

Key messages
Different facets of leadership of the cancer care system emerged as important when exploring the reasons for variations in cancer outcomes in high-income countries. The persistence of these variations is unacceptable. Change will require political commitment and effective leadership, especially by clinicians.
Increasing efficiency for reducing elective surgery waiting times: a multi-interventions approach
Authors: Quercioli C , Carta G A , Cevenini G , Messina G , Nante N , Becattini G , Sancasciani S 
Published: October 2020

Abstract

Background
Elective surgery long waiting times are a common problem in publicly funded health systems. They have been tackled allocating additional resources or using existing resources more efficiently but results are patchy. We studied the effectiveness of a multi-interventions project based on the reorganization of existing capacity.

Methods
In a district general hospital (Siena's Province, Italy) with 150 beds, 4 elective surgery operating rooms (ORs) opened 6 hours/day 5 days/week (surgery specialties: general surgery, orthopedics, gynecology and urology) in October 2018 a project for reducing surgery waiting times was implemented based on 3 key points: i) separation of the Day Surgery (DS) flow from that of the ordinary activity; ii) increase of available operating time through reorganization of personnel: 30 additional hours/week were made available; iii) allocation of operating sessions flexibly in proportion to the waiting list: the made-available hours were redistributed through an algorithm able to estimate the optimal allocation of surgical time blocks to minimize the length of waiting lists, taking account of the interventions priority class. The waiting time of the out from 1/10/2019 to 31/12/2019 (N = 635) was compared with that of the interventions carried out from 1/10/2018 to 31/12/2018 (N = 634) using t-test.

Results
Waiting times for non-urgent cases (that can be operated beyond 30 days) were significantly reduced for all specialties (p &lt; 0.01) except urology. For general surgery, orthopedics and gynecology, DS interventions' mean waiting time decreases from 198 to 100 days (-50%) that one of ordinary interventions from 213 to 134 days (-37%). Waiting time for urgent cases (to be operated within 30 days) was also reduced.

Conclusions
A multi-interventions project based on using existing capacity (personnel and structures) more efficiently and improving planning methodologies resulted to be strongly effective in reducing waiting times for elective surgery.

Key messages
To effectively reduce surgical waiting times, a strategy is needed that involve the entire process: from surgical planning, to staff and structures organization. The flexible OR time allocation on the base of the waiting list is a key point to improve surgery planning and reduce waiting list.
Adaptive work in the health care response to domestic violence in Palestine
Authors: Bacchus L , Alkaiyat A , Shaheen A , Alkhayyat A , Od H , Halaseh R , Feder G , Sandouka R , Colombini M 
Published: October 2020

Abstract

Background
A health system response to domestic violence against women is a global priority. However, little is known about whether or how they work in LMICs where there are greater structural barriers. HERA (HEalthcare Responding to violence and Abuse) aimed to strengthen the primary healthcare response to domestic violence in the West Bank of Palestine.

Methods
The sample for the qualitative study was 18 participants at two primary health care clinics and included five women, nine primary health care providers, two gender-based violence focal points and two domestic violence trainers. Data were analysed using thematic analysis drawing an Extended Normalisation Process Theory (ENPT) and feminist scholarship. We collected data on identification and referral of domestic violence cases.

Results
HERA interacted with political, sociocultural and economic aspects of the context, creating a degree of unpredictability and uncertainty in working of the intervention. The political occupation restricted women's movement and access to support services, whilst the concomitant lack of police protection left providers and women feeling exposed to acts of family retaliation. This was interwoven with cultural values that influenced participants' choices as they negotiated normative structures that reinforce violence against women. Participants engaged in adaptive work to negotiate these challenges and ensure that implementation was safe and workable within a context of constraints. Participant narratives highlight the use of subterfuge, hidden forms of agency and governing behaviours (of self and others) to ensure the safety of all involved during implementation.

Conclusions
The findings have implications for how HERA can be sustained in the long-term, particularly with regards to the provision of support for women. Support at all levels within the health system is needed to enable change and strengthen the response to violence against women.

Key messages
Health care providers and women worked with and around contextual constraints. The transformation of the clinic case manager role is an emergent feature of HERA. Extended Normalisation Process Theory helped to articulate nuances about intervention-context interactions.
Pediatric ambulatory care sensitive admission and deprivation index, ten years retrospective analysis
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Masciarelli M , Meo F , Scampoli P , Staniscia T 
Published: October 2020

Abstract

Background
Ambulatory Care Sensitive Conditions (ACSCs) are conditions where effective community care and case management can help prevent the need for hospital admission. Even if the ACSC episode itself is managed well, an emergency admission for an ACSC is often symptom of overall poor quality of primary and community care. Lower socioeconomic status individuals show higher rates of hospitalization due to ACSCs. The purposes of this study is to examine the association between socioeconomic status and the risk of hospitalization due to an ACSC in pediatric population through a retrospective analysis of administrative data of the Abruzzo region.

Methods
We identified hospital discharge records from 2008 to 2018 of subjects under 18 years of age to take into consideration for the study. Hospitalizations due to ACSCs were selected by ICD9-CM coding developed by Billings et al. and implemented by Lu et al. For establishing the socioeconomic status, we used the Italian Deprivation Index (IDI) developed by Caranci et al. as a categorical variable expressed in quintiles. A multilevel logistic regression model was implemented using ACSC vs non ACSC hospitalization as dependent variables.

Results
In the study period, a total of 317,586 hospital discharge records were selected, 18059 (5.69%) of which related to ambulatory care sensitive hospitalization. After correcting for age, gender, and citizenship, ACSCs hospitalization was associated with lower IDI (aOR1.21;CI95%1.09-1.34) and a slight gradient as the deprivation increased. Moreover, it was also associated with emergency department admission (aOR6.53;CI95%6.19-6.89).

Conclusions
Avoidable hospitalization in pediatric settings is associated with lower socioeconomic status computed by IDI. This study confirms inequity in primary care or community care after adjusting for age, gender and citizenship. Italian deprivation index represents a useful tool to identify population and areas where improving prevention is necessary.

Key messages
The Italian deprivation index could be used to implement primary and community care strategies in pediatric settings. Socio-economic factors are associated with the performance of the health services.
Assessment of immunization service delivery in Pakistan: A cross-sectional survey of health facilities
Authors: Abdullah S , Taighoon M T , Siddiqi D A , Dharma V K , Khamisani T , Khan A J , Chandir S 
Published: October 2020

Abstract

Background
Routine childhood immunization coverage in Pakistan remains sub-par, in part, due to the poor quality of service delivery. This study aims to summarize the quality of immunization centers throughout the Sindh province, Pakistan, by assessing all Government vaccination facilities and their associated health workers.

Methods
A health facility and worker assessment survey adapted from tools developed by BASICS and EPI-Sindh was used to record facility infrastructure, processes, and human resources. Using expert panel ranking, we developed critical criteria to indicate items immunization centers need to be operational (vaccinator, a cold box or refrigerator, and vaccine supplies) as well as high, low, and moderate function requirements and their respective scores.

Results
Out of 1396 centers assessed, 1236 (88.5%) were operational, while 1209 (86.6%) offered immunization services. Only 793 (66.0%) of the functional immunization facilities met the critical criteria. The average scores for high, moderate, and low function requirements were significantly lower for centers that did not meet the critical criteria. Of 2,153 healthcare workers interviewed, 1874 (87.1%) were vaccinators. 1805 (96.3%), 1655 (88.3%), and 1387 (74.0%) were trained in vaccination, cold chain, and inventory, respectively.

Discussion
One out of three immunization centers in Sindh lack the critical components essential for quality vaccination services. Health workers have adequate training and experience, suggesting that sub-optimal vaccination center quality is due to inadequate infrastructure and inefficient processes. Our study presents innovative and critical research findings with high-impact policy implications for identifying and addressing gaps to improve vaccination uptake within an LMIC setting.

Key messages
Every 2 out of 5 facilities in Sindh Province lacked essential equipment for immunizations such as vaccines, vaccinator and cold box for vaccination. In all health facilities, the health workers appear sufficiently trained, indicating that poor quality may be due to missing infrastructure and inefficient processes in resource-constrained settings.