bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of nurses to improve self-care in heart failure patients: a systematic review and meta-analysis
Authors: Massimi A , De Vito C , Rega M L , Villari P , Damiani G 
Published: November 2019

Abstract

Introduction
Heart Failure (HF) is a pandemic chronic disease with a prevalence up to 3% in the general population, representing the main cause of hospitalization for people over 65. Self-care plays a central role in the management of patients with HF, showing evidence of effectiveness in reducing re-hospitalization rates and mortality.

Methods
We carried out a systematic review and meta-analysis to assess the efficacy of nurse-led educational interventions Vs usual care in improving self-care skills of patients with chronic HF. The main biomedical databases were searched for Randomized Control Trials (RCTs) of nurse-led educational interventions performed on adults with a previous diagnosis of HF. Improvement of HF self-management skills (self-care level) was summarized by calculating the standardized mean difference (SMD) and 95% confidence intervals (CI) stratified for the length of the follow-up.

Results
Globally, 14 RCTs were included involving 2078 participants. Ten studies showed the efficacy of the interventions at 3 months (short term) with a SMD of 0.78 (95% CI 0.38-1.18) in favor of the self-care education interventions. Five studies reported on self-care abilities at 6-9 months (medium term), not showing statistically significant results (SMD 0.35, 95%CI 0.11-0.81). The long-term effect of the educational interventions showed no statistically significant improvement in self-care behaviors (three studies, SMD 0.05, 95CI% 0.12 - 0.22).

Conclusions
These results show that nursing educational interventions improve self-care behaviors in HF, but mainly in the short term. Intensive educational interventions led by nurses, associated with appropriate continuity and transition of care, can determine the best outcomes for patients with HF, strengthening self-care behaviors over time. This approach could have a major impact not only on individual level, but on the general reduction of complications, hospitalization, medical costs and ultimately mortality.

Key messages
Nurse-led educational programs have a short-term efficacy in enhancing self-care behaviors among heart failure patients. Post-discharge repeated educational interventions, along with timely and shared plans ruling the transition between the hospital and the other providers, are strongly needed.
Rural and urban general practice: a comparison in 34 countries
Authors: Groenewegen P , Bosmans M , Boerma W 
Published: November 2019

Abstract

Background
Rural areas have problems in attracting and retaining primary care workforce. Comparable problems but with a different background occur in deprived urban areas. Here we focus on primary care practices that do work in rural areas and not on the shortage or lack of access for the rural population. We answer the question whether these practices have a different organisation, lack resources and have different service profiles, compared to practices in semi-rural and urban areas.

Methods
We used data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries, on the organisation of practices, their human resources and equipment and their service profiles. Data were analysed using multilevel regression analysis, with countries and GPs as levels.

Results
In general the practices in rural areas are more often single-handed and have less other primary care workers available. In most countries they have more equipment and their service profiles are broader, in particular as compared to inner-city urban practices.

Conclusions
The combination of increasing demand for care and undersupply of health care services can lead to a primary care shortage in rural areas. However, the practices that are currently located in rural area in most countries seem to be able to cope with the situation by providing a broader range of services, compared to service-rich urban areas. Against growing health needs of an ageing and often poorer population, there is a risk of lack of facilities and equipment and ageing staff. Until now this is not manifest in the primary care practices in most countries.
eHealth solutions to regional shortages in the health workforce
Authors: Velez-Lapão L , Maia M , Dussault G 
Published: November 2019

Abstract

Background
Healthcare systems are facing significant challenges, from demographics, shortage of health professionals to increasing costs that are associated with increasing demand. New technologies are thought to be a solution to these problems. However, the question is if the digitalization of healthcare will mitigate these problems and the shortage of health professionals in Europe.

Methods
This study provides a scoping review on existing health digital services aiming to cope with health professional shortage in Europe. The main challenges, from workforce performance, services quality, patient-interaction to technology use are addressed. The databases of Pubmed and Ebsco were searched.

Results
38 papers were selected and analysed addressing eHealth with impact on the workforce performance. It highlights the challenges associated with the digitalization of healthcare, the implementation of digital services, considering the design online service, and the impact of digitalization on healthcare workforce performance. An overview of the major effects of transformative technologies (e.g. eHealth services, Internet of Things solutions, Artificial Intelligence) on the healthcare workforce are addressed. Moreover, what are the major implications of technological change for future skill needs and competences of the public health workforce? Are there any reliable projections on how technologies will change the structure of the labour market for health professionals? And to what extent is the workforce equipped to adapt to the changes?

Conclusions
Proper digitalization of healthcare will enable changes in the paradigm of healthcare delivery as well as in the mechanism for patients’ participation and engagement. Sustainable implementation of eHealth is an important opportunity to address health workforce shortage but it is not enough.
Egg consumption and risk of total and cause-specific mortality in a Mediterranean population
Authors: Ruggiero E , Castelnuovo A Di , Costanzo S , Persichillo M , Curtis A De , Cerletti C , Donati M B , de Gaetano G , Iacoviello L , Bonaccio M 
Published: November 2019

Abstract

Background
The relation between egg intake and health outcomes is controversial. We aimed to evaluate the association of egg consumption and risk of mortality in a large sample of an adult Mediterranean population.

Methods
We prospectively analyzed 22,849 men and women aged ≥35 y, recruited within the Moli-sani Study (2005-2010). Dietary data were collected by the EPIC food frequency questionnaire, egg intake was expressed as g/d and used as ordered quintiles. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression and competing risk models.

Results
Over a median follow up of 8.2 y, a total of 1,237 deaths were ascertained. Mean weekly intake was 1.8 eggs (13 g/d) and regular consumers (27 g/d corresponding to more than 2 eggs per week) were more likely to report less risk factors (e.g. history of cardiovascular disease, diabetes, smoking habit). After adjustment for possible confounders, eating eggs &gt;2 times/week) was associated with increased risk of all-cause mortality (HR = 1.21; 95%CI 1.02-1.44 for Q4 vs Q1) and coronary heart disease/cerebrovascular mortality (HR = 1.51;1.04-2.18, for Q4 vs Q1) in a non-stepwise manner; eating more than three eggs per week increased risk of cardiovascular mortality by 33% (HR = 1.33;95%CI 1.00-1.76 for Q5 vs Q1), while no association was found with cancer death or mortality for other causes. Dietary cholesterol explained up to 37% of the excess of CVD mortality risk associated with the highest egg intake (&gt;3 eggs/week).

Conclusions
Regular egg intake (&gt;2 times/week) was associated with increased risk of CVD mortality in a general Mediterranean population, and part of this association was likely due to its cholesterol content.

Key messages
Eating egg regularly is not associated with health benefits, rather it appears to increase CVD mortality risk. High dietary cholesterol content is likely to be on the pathway between egg intake and increased CVD mortality.
Identifying and describing a model region to evaluate the impact of telemedicine
Authors: Harst L , Oswald S , Timpel P 
Published: November 2019

Abstract

Background
Telemedicine solutions providing patient-centered care over distance need to be integrated into the regional setting. The acceptance by both providers and patients hat to be continuously evaluated using methods of participatory implementation research. In controlled trials, often taking place in laboratory settings, these methods cannot be applied. In the following, research in progress is presented.

Methods
Based on socio-demographic data, epidemiology prevalence of age-related chronic diseases and data on the value of health care provision in Saxony, Germany a model region was chosen. Then, a focus group (n = 6) was conducted to differentiate the results and analyze the health networks of patients. For this, network maps putting the individual in the middle and his/her sources of information and support in case of illness in concentric circles around it, were used. The focus group was audiotaped, transcribed and analyzed by two researchers using MaxQDA.

Results
With a mean age of 47.8 years (n = 17,431), high prevalence of diabetes (&gt;15.85 %) and hypertension (&gt;39.1%) and an expected shortage of primary physicians in 2030, the town of Kamenz is a mirror image of the current health care challenges in rural areas of Saxony. Participants of the focus groups also stated problems in finding a primary physician or a dentist. Compensatory behavior, such as traveling large distances, relying on self-researched online diagnoses and immediately going to the emergency room for medical support was described. According to the network maps, primary sources of support in case of illness are partners and relatives, yet there is little connection between those and health care providers, as well as between different medical specialists.

Conclusions
The results will lead to potential use cases of telemedicine to be included into a standardized questionnaire for the assessment of telemedicine readiness in the model region.

Key messages
Telemedicine implementation in a rural area can be studied using a participatory approach. Focus groups and network maps are useful qualitative methods for participatory research and can inform the design of quantitative measurements.
Well Being of Older Gay and Bisexual Men and Women in England: Results of a Cross-Sectional Population Based Study
Authors: Grabovac I , Smith L , McDermott D T , Stefanac S , Yang L , Veronese N , Jackson S 
Published: November 2019

Abstract

Background
Lesbian, gay, and bisexual (LGB) older people are an under-represented population in research, with limited research noting more depression, loneliness, rejection, overall poorer health and well-being outcomes. Our study compared well-being, defined as quality of life (QOL), life satisfaction, sexual satisfaction, and depression, among LGB people with their heterosexual peers’.

Methods
Cross-sectional data from the English Longitudinal Study of Aging, collected 2012-2013. A total of 5691 participants were included in the analysis, with 326 (5.7%) self-identifying as LGB. We used CASP-19 questionnaire for well-being; the Satisfaction with Life Scale for life satisfaction; and the Center for Epidemiologic Studies Depression Scale for depressive symptoms. The question “During the past three months, how satisfied have you been with your overall sex life?” was used for sexual satisfaction. T-test and chi-square tests were used for differences in sociodemographic characteristics between LGB and heterosexual participants. Regression models were used to test associations between sexual orientation and well-being outcomes.

Results
LGB participants reported significantly lower mean quality of life and life satisfaction, and had significantly lower odds of reporting satisfaction with their overall sex life and higher odds of reporting depressive symptoms in unadjusted models. After adjustment for sociodemographic and health-related covariates, there remained significant differences between groups in mean QOL scores (B= -0.96, 95% [CI] -1.87 to -0.06) and odds of sexual satisfaction (OR = 0.56, 95% CI 0.38-0.82).

Conclusions
LGB older people report lower quality of life and lower sexual satisfaction than their heterosexual counterparts, possibly associated with experiencing lifelong social discrimination.
Main message: Older lesbian, gay and bisexual people in England report significantly lower QOL and sexual satisfaction in comparison to heterosexual counterparts.
From health care hospitals to health literate organizations: the case of health literacy of health workers in Brazil
Authors: Martins R , Saboga-Nunes L , Regina Farinelli M , Gabriela Carascosa M , Ribeiro P 
Published: November 2019

Abstract

Background
Health literacy (HL) presents itself as a strategy to rethink lifestyles and enhance health promotion strategies (with the inclusion of social determinants of health) in the workplace. The aim of this research was to evaluate HL levels of health workers from the urgency and emergency sector of a public hospital in Brazil (Uberaba, Minas Gerais, HC/UFTM-SUS).

Methods
An exploratory, quantitative and qualitative research based in the European Health Literacy survey (validated to Brasil HLS-EU-BR) collected data from 216 participants, by the means of a CAWI methodology.

Results
A total of 141 participants were retained for data analysis. HL level of participants from the administrative sector reached a score of 40.0% for insufficient and problematic HL; 33.3% had sufficient HL levels and 26.7% showed excellent HL levels. For the category of Healthcare medium / technical level, 48.2% had inadequate and problematic HL; 37.5% had sufficient and 14.3% showed excellent HL levels. In the third category - Healthcare participants with higher education levels - 31.6% had problematic, 34.2% sufficient and 34.2% showed excellent HL levels.

Conclusions
This is the first time the instrument (HLS-EU-BR) to evaluate HL is used in a health professional setting in Brazil. This research demonstrated that HL is sensitive to socioeconomic differences and highlights the need to promote HL of health workers. Targeting lower socioeconomic groups that have a routine of dealing with the general public in a public hospital to increment HL levels, seems to be an option worth investigating. Such a proposition could not only benefit the specific worker, but target a social change in quality of care, health promotion and social support that can be centered in hospitals. This would trigger the needed change proposed by WHO in Nairobi and Shangai: shifting health care organizations to health literate organizations.
Migration and integration: the case of health literacy (HLS-EU-PT) as a foundation to promote cultural sensitiveness
Authors: Saboga-Nunes L , Silva A , Mendes S , Almeida B , André M R , Reis A 
Published: November 2019

Abstract

Background
Portugal has experienced trough-out his recent history successive migration patterns. Lately, with instability in Syria and the Mediterranean routes of migration between Africa and Europe, new challenges have emerged. One of them is related to migrants’ health and their navigation of health care system. In order to better understand cultural patterns of migrants, this research aims to explore their health literacy (HL) in the context of the European Health Literacy Survey framework (HLS-EU).

Methods
A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores &lt;30). In order to access the migrant condition, a proxy variable considered the participant’s parents origin: at least one of the parents was born in a foreign country.

Results
Out of the 748 participants, 4.1% (n = 31) were considered migrants. Of the migrant participants, 6.9% have inadequate, 51.7% problematic, 24.1% sufficient and 17.2% excellent HL (HLS-EU-PT). Migrants have lower levels of HL when compared with nationals in this sample (respectively 58.6% and 45.8% for insufficient HL) but this difference is not statistically significant.

Conclusions
Although results didn’t show an association between being migrant and lower levels of HL (when compared with nationals), it is nevertheless relevant to consider that more than 1 in every two migrants (58.6%) have insufficient HL levels. Special consideration should be given to this group to promote HL levels and further research is needed to better understand how HL and cultural sensitiveness may work for a better integration of migrants.
Round table: The new EUPHA strategy 2020-2025: what are the new skills public health professionals need
Authors:   Organised by: EUPHA Chair persons: Dineke Zeegers Paget - EUPHA, Marieke Verschuuren - Netherlands
Published: November 2019

Abstract

2019 is the last full year of the EUPHA strategy 2014-2020: Voicing knowledge. Enhancing capacity. The 2014-2020 strategy has allowed EUPHA to strengthen capacity building throughout Europe and has given our EUPHA sections and EUPHAnxt the visibility they deserve. Voicing knowledge has made big steps forwards with the help of our two presidents: Martin McKee and Natasha Azzopardi Muscat. But society has changed, new threats (fake news) are surfacing, old threats (measles) are coming back and EUPHA and its members need to adapt. In 2018, a working group was installed with representatives from our members, our sections, our Executives and EUPHAnxt to discuss what EUPHA should focus on in the next 5 years. The new strategy has (hopefully) been adopted by all our members in November 2019 (the day before the conference) and is presented here.
Next to the new strategy, EUPHA will have to develop a 5-year work plan to describe what needs to be done to achieve this strategy. More importantly, what is expected of the public health network. What skills do they need? How should the training, life-long education be shaped?
In this workshop, we will first present the changing environment (McKee), followed by a presentation on our new strategy (Azzopardi Muscat and Nagyova). We will than have a Round Table with representatives of our members and of our partners. Questions to be discussed/answered are: do they have these skills already, how can we move forward, what is missing.
Round Table members: Danijela Stimac, Croatian Public Health AssociationYves Charpak, French Society of Public HealthJorid Grimeland, Norwegian Public Health AssociationPasquale Cacciatore, EUPHAnxtWalter Ricciardi, Italian Society of Hygiene, Preventive Medicine and Public Health, president-elect of the World Federation of Public Health AssociationsKasia Czabanowska, ASPHER immediate past president

Key messages
Public health will be stronger when we plan collaborative actions. Evidence to policy should focus on actionable recommendations.
European network staff eXchange for integrAting precision health in the health Care sysTems” project
Authors: Mariani M , Pastorino R , Ricciardi W , Boccia S 
Published: November 2019

Abstract

Background
Precision health aims to prevent and predict illness, maintaining health and quality of life for as long as possible, by drawing on the new technological and data science tools to translate volumes of research and clinical data into information that citizens, patients and doctors can use.

Objective
The ExACT consortium, funded by the Marie Curie Research and Innovation Staff Exchange (RISE) 2017 - Horizon 2020, is aimed at building a community of academic and non-academic institutions that generates high quality, multidisciplinary collaboration by exchanging knowledge in research and training activities on precision health.

Results
From 2019 to 2023, 74 secondments are foreseen; staff involved will be trained on precision health research topics unavailable at their home institutions. The research topics include 5 domains: Integration of Big Data and digital solutions into healthcare systems; design and promotion of innovative citizen engagement models; education of healthcare professionals and leadership; HTA in precision health; Ethical-legal, social, organisational and policy issues surrounding precision health.

Conclusions
Secondees will produce key reports, policy recommendations, scientific papers, and informative materials for citizens, fostering public-private interplay and fostering integration of precision health in the EU health systems, contributing to better health for EU citizens.

Key messages
Once the secondees are back in their home institution, they will use competences acquired during the secondment to advance the research, and transfer the knowledge to the home organization. Sharing knowledge,building synergies and expertise and encouraging best practices,among top-level institutions,will stimulate translational effort for implementing precision health in EU health system.
Asymptomatic malaria: building bridges with communities through patients in Côte d’Ivoire
Authors: Hounsa A , Yao D , Attia A R , Gokpéya M , Sackou K J , Kouadio L 
Published: November 2019

Abstract

Background
In malaria-endemic areas, asymptomatic carriers are a reservoir of parasites that contribue to the persistence of malaria transmission. In Côte d’Ivoire, this situation is poorly documented. The objective of our study was to assess the frequency and socio-environmental factors associated with asymptomatic malaria in the town of Assuefry, located in the northeast of Côte d’Ivoire, a region where malaria prevalence remains high.

Methods
A cross-sectional study in two stages was conducted from October to December 2018, first at the Urban Health Center (UHC) in Assuefry and then in the households. The sample size calculated for patients was 162 extrapolated to 201 people. All persons received at the CSU who had clinical symptoms of malaria and a positive Rapid Diagnostic Test (RDT) were included. In the households of these index subjects, a follow-up survey allowed active RDT screening for malaria among all household members with no clinical signs of malaria. The socio-environmental factors taken into account were: the area of residence (urban or peri-urban), domestic animals husbandry, water storage at home, nearby garbage dump, wastewater collection and disposal system, type of housing and number of people in the household.

Results
The frequency of asymptomatic malaria was 341 (38.8%) out of 879 household members visited. Both female and male gender was concerned (51% vs. 49%). The 5 to 25 years old group concentrated nearly 82% of all cases. Only domestic animals husbandry was associated with asymptomatic malaria at the household level (p = 0.021).

Conclusions
The high frequency of asymptomatic malaria found in this study is a challenge for the National Malaria Control Program in Côte d’Ivoire. This should be taken into account while organizing control strategies.

Key messages
The frequency of asymptomatic malaria in Côte d’Ivoire is high. Control strategies must take into account in the guidelines the challenges of detecting and treating asymptomatic malaria. For the judicious use of antimalarial drugs, any subject with a positive RDT without clinical signs of malaria should receive a ‘Drop - Thick’ before treatment.