bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health needs, community and network in primary care: an action research program
Authors: Milani C , Occhini G , Francini C , Orsini G , Baggiani L , Maciocco G , Bonaccorsi G 
Published: October 2020

Abstract

Issue
According to the Alma Ata Declaration, Comprehensive Primary Health Care (C-PHC) addresses the main health problems in the community, promotes participation and involves all health related sectors. In Italy the so called Case della Salute model aims at realizing these principles. The purpose of the project is to understand how this model should be implemented in order to better answer the community needs. In the outskirts of Florence there is an area mostly made of public housing, devoted to people with housing and economic problems. There it is Casa della Salute (a health center where a PHC multidisciplinary team works), which could represent the key to cope with health inequalities and to create a network with the multiple associations rooted in the community. The implementation of an experimental model of C-PHC needs to involve local population, community actors, health professionals and researchers in a process of action-research.

Results
• An epidemiological study described a heavily deprived population compared with the rest of the city, with a burden of mortality especially affecting those most deprived and women. Mental health and addictions showed a deep need of care. A map of the neighbourhood was created in order to analyse formal and informal resources.The health needs of the community were deepened using social and ethnographic methodologies (semi-structured interviews, participant observation and focus groups with health workers, associations' representatives and individuals).Standing multi professional briefings were launched in order to facilitate the process of taking care of complex situations as a team.

Lessons
Preliminary results show the need for stronger collaborations with the actors in the community; further exploration of health related topics; community participation in the process of informing and transforming health practices; involvement of health workers in interprofessional practices to create a shared knowledge.

Key messages
Local health networks need a methodology to expand knowledge of peoples’ needs. Complexity in health and inequalities require a paradigm based on social determinants of health such as PHC.
A simulation model of microbe overlapping for the correct estimation of UV-C device log-reduction
Authors: Cevenini G , Amodeo D , Nante N , Messina S , Messina G 
Published: October 2020

Abstract

Background
Candida auris is an emerging pathogen responsible for several outbreaks within healthcare facilities. It can be found on hospital surfaces and patient care devices. UV- C sanitisation may constitute an effective adjunct to routine room cleaning to prevent the spreading of this yeast. Previous findings with this technology suggest to investigate different sources of variability in the study of the biocidal effect of UV devices on C. auris. In this study we develop a computer simulation of surface distribution of microorganisms on a stainless steel carrier, to optimize UV-device experiments.

Methods
Based on the literature about C. auris studies and its estimated average size (about 5 μm diameter), several Matlab simulations have been performed to include as many microorganisms as possible to be ideally placed on a 20 cm2 stainless steel support, avoiding cell overlapping. This was done in order to maximize the effectiveness of UV exposure.

Results
Two initial simulations were performed to evaluate a random arrangement of a very large number of microorganisms (8x107 CFU) on the steel support, widely overlapped. In this case, due to the poor UV-C penetrability, we would not exceed two log10 reduction. By randomly distributing 1x106 CFU, the probability of overlapping was about 1.3%, but even a partial overlap limits the log10 reduction. By randomly distributing 1x105 CFU, the overlaps were at least 10 times less likely.

Conclusions
The simulation results allowed us to evaluate the most appropriate microorganism distribution model able to optimize the biocidal effects of UV-C devices. The overlapping of microorganisms reduces UV-C penetrability. Our simulated study is consistent with literature results where we observed a lower log-reduction by increasing the concentration of microorganisms and therefore the probability of overlapping. The resulting model would simulate any log-reduction scenario, at any distance and any concentration, with and without overlapping.

Key messages
The complete or partial microorganism overlapping plays a relevant role in the outcome of UV-C biocidal experiments. To identify the exponential CFU reduction curve and estimate accurately the inactivation rate constant, simulated experiments should be performed to assess the real effectiveness of UV devices.
Six ultraviolet minutes for cleaner operating theatres
Authors: Bosco R , Gambelli S , Urbano V , Cevenini G , Messina G 
Published: October 2020

Abstract

Background
Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D).

Methods
Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively.

Results
In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p &lt; 0.001). Without UVC-D we had a significant CFU drop (p &lt; 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p &lt; 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p &lt; 0.05).

Conclusions
UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered.

Key messages
UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.
Discount Rate Determination for Economic Evaluations in HTA in the Philippines
Authors: Zuniga Y , Kraft A , Uezono D , Fajardo M , Obmana S , Genuino A , Guerrero A 
Published: October 2020

Abstract
To inform the development of a reference case for economic evaluation, we explored various approaches to determine a base case discount rate and rate options for discounting benefits and costs.
We conducted literature review and expert consultations to list approaches to determine base case discount rates, noting the advantages and disadvantages of each approach. The same methods were used to identify whether different discount rates would be applied to costs and benefits. We computed a social rate of time preference using the Ramsey formula: rc = ρ+μg, where ρ = pure rate of time preference μ= elasticity of the marginal utility of consumption and g= growth rate in per capita income. We assumed ρ = 1%, μ = 1.4% consistent with international practice, but used actual g of the Philippines of 4.5%. We compared this with the official social discount rate and with rate most commonly used internationally. These options were presented to the Philippine Health Technology Assessment Council for decisionmaking.
Based on reviewed literature, 10 out of 22 countries used a 3.0% to 3.5% discount rate while 18 countries from the same pool applied equal discount rates for both costs and outcomes. The official social discount rate (SDR) prescribed by the Philippine National Economic Development Authority is 10% for all social investments. Upon input of the values, rc was calculated at 7%, which is above the international norm but below the official rate. Four discount rate options were identified: 3%, 3.5%, 7% and 10%.
Evidence suggested using a discount rate higher than 3% to 3.5% for low-to-middle income countries. A more conservative rate based on the Ramsey formula of 7% base case discount rate was selected in performing economic evaluations. Sensitivity analysis was set between 3% and 10% to allow benchmarking with international practice and with the official SDR, respectively. Given Philippines' early HTA implementation phase, it was agreed to subject these rates to regular review.

Key messages
Setting a discount rate in economic evaluations is a crucial process for HTA institutionalization. Discount rate determination heavily relies on decision context a country considers most relevant.
The introduction of new medical devices in the public health service of a small region of Spain
Authors: Arana Aragón B , Gavrila D , Fernández Gomez V , Ferrandez Cámara M J , Floris Martín J A , García Córdoba F , Quesada Torres J A , Sabuco Tebar E , Soria Aledo V , Parra P 
Published: October 2020

Abstract

Issue
The introduction of health technologies could have a positive impact on the population's health. However, it also plays a significant role on the evolution of the sanitary budget. These circumstances have promoted the development of specific groups of experts in health technologies assessment under the criteria of effectiveness, safety and efficiency.

Description of the Problem
The main goal of Murcia Health Service is to guarantee the health of its population through an optimal use of resources. New medical devices(MD)need to be evaluated prior to their use in medical practice. HTA reports published by international and national agencies are not covering the growing and accelerated offer and demand of new MD

Results
A technical group in charge of the evaluation of new MD requests (GTESIDS)was created in 2014. The group consists of 12 part-time collaborators of different health professions. During 2019, GTESIDS received 69 requests of evaluation, two thirds of which from surgical specialties, mainly general(11),orthopedic(10)and ophthalmic(7)surgery. GTESIDS advised to incorporate 23 and not to incorporate 26 MD, while 20 were still being evaluated as of February 29, 2020. The mean time GTESIDS needed to reach a conclusion and emit a recommendation was 151 days. We have found a published HTA report for only one of the MD evaluated.

Lessons
HTA reports published by international and national agencies are rarely available and need to be adapted to the local framework. The GTESIDS scope would improve with a better resource allocation that will allow a more thorough and rapid evaluation.

Key messages
HTA reports are not covering the growing offer of new medical device. The experience in Murcia has taught us the need to strengthen an actual collaboration between agencies.
Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey
Authors: Karadag Caman O , Uner S , Arica Yegin B , Ozcebe H 
Published: October 2020

Abstract

Background
Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption.

Methods
This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393).

Results
Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education.

Conclusions
Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care.

Key messages
Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.
Community health workers & medical students: a strategic partnership for Brazilian public health
Authors: Faria de Moura Villela E , Morato de Oliveira F 
Published: October 2020

Abstract

Introduction
Family Health Strategy represents a successful initiative for reorganization of primary care in Brazil. A differential is the Community Health Workers (CHW), who act facilitating community access to effective professional care in the form of health-promoting actions. However, the way CHW receive training to manage epidemics, as dengue, is almost unknown. In this context, this project addresses the importance of bringing together medical students and CHW in order to strengthening not only continuing education of CHW, but also the experienced learning of future physicians.

Methods
An exploratory study of qualitative approach was done. Two focus groups were conducted with ten CHW in a primary health care unit (PHCU) in Brazilian Midwest. The focus groups were conducted by the tutor and students previously trained on dengue prevention and management.

Results
Students identified difficulties in daily work and informational/ communicational gaps based on what was said by CHW if compared with the Ministry of Health protocol towards dengue control. These gaps were the basis for an action strategy to develop with CHW. Students developed strategies based on knowledge acquired on public health and experienced practices in medical school: meetings with CHW and other health professionals using lectures, conversation circles, role-playing and problem-situations. All activities were previously prepared by students under supervision. After all, we held the second focus group with the same CHW to evaluate the impact of the strategies adopted. 60% said their routine is now more dynamic and effective, only 10% state that their routine remains difficult. 80% said that after the training meetings the manager of the PHCU invited them to participate more actively.

Conclusions
This project brought the students to the reality of CHW health practices, what is a great opportunity to increase their commitment with the local health system and social accountability.

Key messages
The partnership between academy and health service is a challenge but when succeeded it enables changes in and may result in improvement processes in the public health system. The role of community health workers to achieve behavioral change in the community and to improve the public health of a country.
Second Victim Experience and Support Tool: cultural adaptation and psychometric evaluation in Italy
Authors: Scarpis E , Ruscio E , Bianchet B , Doimo A , Moretti V , Cocconi R , Farneti F , Castriotta L , Quattrin R 
Published: October 2020

Abstract

Background
”Second victims” are defined as “healthcare workers (HCWs) involved in an unanticipated adverse patient event, who experienced professional and psychological distress”. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context.

Methods
The translation and cross-cultural adaptation process was performed according to the World Health Organization’s guidelines, from March to May 2019. Then HCWs involved in direct patient care (a potential second victim) were asked to complete the Italian version of SVEST in a validation survey, from June to November 2019 at the Academic Hospital of Udine. SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables and 7 support options. The IT-SVEST was assessed for internal consistency through Cronbach’s α, for content validity with Content Validity Index for Scales (S-CVI) and for Item (I-CVI) and for construct validity with Confirmatory Factor Analysis (CFA).

Results
Collected surveys were 349. Women were 79.4%. Nurses were 40.1%, 18.9% were doctors and 8.6% were residents. HCWs involved in a patients’ adverse event were 205 (58.7%). Out of these, 66.3% were near misses. The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α = 0.88 (95% C.I.=0.86). S-CVI was 0.94 and I-CVI was 0.70. The CFA results showed a good model fit for the nine-factor structure (chi2=676.18, 327 df, p &lt; 0.001). Root Mean Squared Error of Approximation, Akaike’s information criterion, Comparative Fix Index Tucker-Lewis Index values also suggested a good fit to the data.

Conclusions
The Italian version of the SVEST (IT-SVEST) can be used to evaluate second victim experiences, demonstrating adequate validity, reliability and good psychometric properties.

Key messages
Healthcare institutions need an instrument that can direct efforts to prevent and reduce the second victim experience. IT-SVEST is a reliable and valid instrument to obtain accurate information on second victim experience.
Transforming health: Introduction of new management structure at secondary healthcare of Pakistan
Authors: Chaudary N A , Navid Tahir MN , Mubin G 
Published: October 2020

Abstract
While public awareness on health issues is increasing, it has become more significant for the public funded health sector to retain the trust of its patients. It is specifically important in a country like Pakistan where the burden of patients in terms of number is compounded by recurring diseases outbreaks. Recent evidence shows that well-thought management systems can ease the pressure on provision of health services to a larger extent than previously anticipated. To address the managerial challenges of secondary care hospitals, health policy planners of the Punjab (Pakistan) had introduced a New Management Structures (NMS) 'team of non-clinical management graduates' under the Revamping Program of District & Tehsil Headquarter D/THQ hospitals in 2016. After 3 years of execution, a study was designed to evaluate the effectiveness and impact of this initiative. 24 in-depth interviews were conducted with the relevant stakeholders and 10 FGDs were conducted with the NMS teams. Thematic analysis & field observations were used to facilitate the presentation of results. The findings show that NMS teams have ensured greater efficiency in management operations of hospitals. Most of the research participants were appreciated for their skills and dedication to work. The hospital and district Health administrators were satisfied with the concept and need of NMS in healthcare system. They claimed that the need for NMS was justified and the intervention has significantly contributed to address the shortcomings inherent in the old management system. However, few stakeholders highlighted the need for further capacity building and robust service structure of NMS teams. The NMS initiative across all secondary hospitals of Punjab has improved the overall quality of healthcare service delivery in D/THQ Hospitals. It can be safely concluded that a specialized workforce in form of NMS is vital in ensuring smooth transition and up-gradation of hospitals under the revamping project

Key messages
Healthcare delivery is moving towards more specialized skills in terms of both healthcare services and management. NMS is vital in ensuring smooth transition and up-gradation of D/THQ hospitals.
Empowering students to innovate health services: Teaching transferability of health interventions
Authors: Schloemer T , Schröder-Bäck P 
Published: October 2020

Abstract

Background
To improve the health of different populations, health systems need healthcare professionals who are able to innovate health services. In order to empower students from various healthcare professions to change health service practice in a sustainable way, a training was developed based on the PIET-T models of transferability (Schloemer & Schröder-Bäck, 2018). It was evaluated at three universities in Germany and the Netherlands.

Objective
The aims of the training were to enable students to: 1. Critically analyze existing evidence about successful and unsuccessful transfers of evidence-based interventions to specific “real-world” contexts (1 day), 2. Conduct an assessment of transferability with case studies using problem-based learning (1 day), 3. Practice implementation research in a healthcare organization (4 months, 4 hours/week). The training was evaluated through discussions, a written reflection and a questionnaire in order to understand students' learning experiences.

Results
Two bachelor programs for occupational, physical and speech therapists, and one master program for public health professionals took part from 09/2019 to 03/2020, including 66 students. Students valued the training as important, 73 % found it helpful for professional practice. They reflected various ideas how to use the PIET-T models for practice change. Although the implementation research process was perceived as high workload, students valued the experience of getting to know barriers and solutions in a practical setting.

Conclusions
The students of all programs value the practical relevance of teaching with profession-related specifications. Practical application of the PIET-T models opens up new approaches in teaching in order to educate knowledge on improvement of health services in different contexts.

Key messages
Empowering students to improve healthcare requires practical training. Training on transferability helps students develop skills for improvement of health services.