bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA) - the cost evaluation of life-style related NCD interventions
Authors: Koot J 
Published: October 2020

Abstract
Vietnam, Myanmar, and Indonesia are trying to create innovative synergies within and between sectors to prevent and treat NCDs. Universal Health Coverage (UHC) is the objective of these countries. The challenge for decision makers in healthcare is to implement programmes and interventions that effectively contain NCDs at the lowest possible cost both in community-based and primary care facilities. The value of implementation and upscaling is assessed by estimating costs, savings and health gains. The presentation focuses on cost-effectiveness evaluation of the entire scaling-up, allowing for comparison within and among countries and generate recommendations for achieving UHC in low- and middle-income countries.
Mandatory immunization: Empirical examination of governance instruments in 28 Global NITAG Network (GNN) countries
Authors: MacDonald N , Harmon S H E , Faour D , Graham J , Steffen C , Henaff L , Shendale S 
Published: October 2020

Abstract

Background
In the Global Vaccine Action Plan 2017 Assessment Report, WHO's SAGE noted need to understand ways in which legislation and regulation are used to advance or undermine immunization. The NITAG Environmental Scan Project sought to address this in a pilot study.

Methods
Data was collected via a secure online survey of GNN members (40 countries Sept 2018). Respondents reporting a mandatory element were asked: (1) what vaccinations were required by law; and (2) what population groups were subject to mandates; (3) what grounds, if any, were available for requesting exemptions.

Results
28 (70%) countries responded, representing every WHO region and World Bank income level. While mandatory immunization programs / elements within broader NIPs were relatively common, jurisdictions varied with respect to immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We observed some loose associations with geography and income level. Children were the most common population group subject to mandates at some stage of childhood development (28/28); healthcare workers were second (8/15 (53%)). Sanctions for failure to immunize varied broadly, ranging from no penalty, to loss of access to social services e.g. admission to school, monetary fines, and incarceration. A variance between countries as to how strictly immunization mandates are enforced was noted.

Conclusions
A variety of approaches existed ranging from Narrow/Permissive to Broad/ Inclusive in scope with enforcement mapping loosely to this continuum from Loose/Permissive to Tight/Coercive. Jurisdictions with few/no vaccines mandated, and few/no target groups identified, Loose approach is expected; for those closer to Broad approach, Tighter controls expected. Coercive measures may be 'positive' (vaccination as a gateway to public services, with possible work-arounds), or 'negative' (failure to vaccinate = penalties).
Charting mandatory vaccination policies worldwide
Authors: Vanderslott S , Marks T 
Published: October 2020

Abstract

Background
Mandatory vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. However, the evidence about which countries have mandatory vaccination policy worldwide and discussions surrounding their impact has largely been limited to high-income countries. While many recent publications discuss the issue, none provide a comprehensive list. This is an obvious gap in the discussion about the merits of introducing mandatory vaccination into countries.

Methods
We draw on extensive desk-based research analysing a mixture of sources, including national, regional, and international vaccination policy reports, international health institution websites, ministry of health websites, and media reports. We supplemented this material by contacting a variety of health authorities, such as PAHO and the WHO as well as country's ministries of health.

Results
We have compiled the first comprehensive list of vaccination policies worldwide, covering 149 countries. This list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across four levels. We provide an overview of the state of mandatory vaccination across different countries, set out the general trends and issues, and engage into a discussion about why, how, and where mandatory vaccination is put in place. We also provide several case studies, which highlight the limitations of vaccine mandates because other factors such as exemptions, penalties or enforcement play an important role in their actual effect on immunisation rates.

Conclusions
Our key finding is that the majority of low- and middle- income countries have mandatory vaccination policies but low vaccination rates because of problems with vaccine supply, delivery, and access.
9.K. Workshop: Public health monitoring and reporting – Examples of how to fill the gaps of health inequalities
Authors:   Organised by: Public Health Agency of Sweden,   Chair persons: Fatima Azerkan - Sweden
Published: October 2020

Abstract
There is a need for cross national border exchange of experience by sharing best practices for monitoring and reporting on public health with a sustained driving force, to ensure that evidence-based approaches are continuously improving and informing best practices for reducing inequality and inequity gaps.
By doing this, the emerging field of evidence based public health programming, covering different aspects of inequalities and unequal distribution of determinants of health, is improved. The workshop intends to introduce a global and intercontinental collaborative approach to jointly identify necessary tools and understand the mechanisms of monitoring and reporting on public health, to combat health inequalities.
The workshop will encourage the building of practical culture and community of public health professionals to share lessons, evidence and best practices. It will also enable the support of ongoing assessment, communication of gaps in health that are emerging and caused by barriers at different levels of societies. There is need for an increased understanding of the emerging public health threats in contexts, such as increasing inequalities in health and social determinants of health, climate change disasters, disease outbreaks, influx of migration and political popularism threatening evidence informed decision making and policies.
Despite being high-income countries with universal health coverage Australia, Canada and Sweden share similar public health challenges. The interactive workshop intends to contribute to an exchange of experiences from countries that are geographically located far from each other with differently organized health systems but united with a common agenda to act on health inequalities.
The exchange of shared knowledge and experiences between the participating countries will shed light and focus on functionality of public health monitoring and reporting mechanisms and tools used in the above-mentioned countries. This will be a way of identifying areas of improvement in addressing inequality gaps. Evidence based interventions in public health depend on solid monitoring, analysis and reporting frameworks. With continuous changes in the public health environment, improvements on what and how public health is analysed is needed to identify existing gaps. To further address equity, with a focus on vulnerable groups for improved public health, solid public health monitoring and reporting mechanisms are vital to supporting credible advocacy and policy actions.

Key messages
Monitoring and reporting health and social determinants of health are imperative ingredients of decision-making. A joint approach to use monitoring tools to improve global public health is needed. Countries geographically located far from each other, with differently organized health systems but similar public health challenges are united with a common agenda to act on health inequalities.
Brain drain of Tunisian competencies: The case of health professionals
Authors: Labidi L 
Published: October 2020

Abstract
The world is witnessing mobility of human resources facilitated by globalization and by international agreements on trade in services GATS. The advanced demographic transition in developed economies and increase in aging population have put pressures on demand of professionals from countries of the south to sustain economic growth. Health systems in countries of the south are facing increasing rate of migration of health workforce including physicians and allied personnel. Such situation led WHO to promote the code of ethical recruitment of international health professionals. The optional nature of the code did not allow its wider implementation.
The brain drain of scare resources represents a real challenge for health systems in several countries including Tunisia. Since 2011, the pace of migration of Tunisian health professionals and particularly physicians have increased because of worsening working conditions, limited career path and uncertainty about the future. Europe and particularly France, Canada, Germany and Gulf states constitute the main destination of Tunisian migrants partly explained by cultural aspects including Arabic and French languages and similarity of Francophone model of medical education.
The present qualitative study including focus group discussions with main stake holders aims at: Measuring the brain drain of Tunisian health professionalsAssessing the impact of brain drain on the Tunisian health systemSharing initiatives aimed at retaining health professionals in public sector and inside the country.Learning lessons from other countries on working models for well organized and mutually beneficial migration of health professionals.
How upstream policy reforms enable the use of industry data and science
Authors: Gilmore A 
Published: October 2020

Abstract
Corporations have worked to promote and embed policymaking reforms which increase reliance on and provide a conduit for industry-favourable science. Such systems have become increasingly mainstream in policy making across the world, yet most are unaware of the corporate influence behind them.
We will present evidence that diverse corporations worked collectively to promote and embed 'Better Regulation' (now known as 'Smart Regulation') in the European Union. The desired outcome was to reduce policymakers' ability to pass public health policies which could be detrimental to corporate interests and profits. We will illustrate how these regulatory frameworks have now been embedded. Delegates will hear examples of the ways in which corporations have gone on to use these systems to feed misleading science into the policymaking process, ultimately in attempts to dilute, delay or prevent public health policies.
The role of public procurement in promoting healthy and sustainable diets
Authors: Bergmann Madsen Betina 
Published: October 2020

Abstract
For diets to meet the FAO definition of sustainable, they must be accessible and secure. One aspect of this is the food available in supermarkets and in people's homes; another is that available in public institutions such as schools, hospitals and workplaces. Public procurement officers are responsible for sourcing food in such spaces; it is therefore necessary for these agents to be empowered with knowledge on sustainable and healthy diets. Ministries need to unite around the common goal that is sustainability.
In Copenhagen an innovative approach has been adopted to drive this. The Copenhagen Food Strategy is a multisectoral initiative that has been embedded at the contractual level, changing mindsets and practices with a two-way dialogue between those providing the food and those delivering it.
It is important to communicate good examples to demonstrate how policy can work to achieve sustainable and healthy diets for all. A practical manual has been developed to train procurement officers so that best practice can be disseminated across the country. Using the SDGs as a common language, processes can be streamlined and disseminated across multiple sectors and councils to achieve healthy and sustainable diets for all.
Health workforce financing in Uganda: challenges and opportunities
Authors: Koutsoumpa M , Odedo R , Banda A , Meurs M , Hinlopen C , Kramer K , Bemelmans M , Omaswa F , Ojoome V , Kiguli-Malwadde E 
Published: October 2020

Abstract

Background
For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope.

Methods
The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings.

Results
The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth.

Conclusions
The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce.

Key messages
The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.
Agreement towards task sharing among gynecologist and general practitioners in north-eastern Germany
Authors: Schuster A , Grittner U , Dini L 
Published: October 2020

Abstract

Background
In Germany, a higher life expectancy of women coincides with shortages of health professionals. Besides gynecologists (Gyns), the main providers of ambulatory healthcare for women 50+ are general practitioners (GPs), which do not provide gynecological care. However, GPs and Gyns willingness share tasks has not yet been analysed systematically. The aim of this research project is to explore approval among and consent between GPs and Gyns for task sharing in women 50+.

Methods
In a quantitative postal survey (March-May 2018), a random sample of 66% of all GPs (n = 3,514) and all Gyns (n = 1,031) in the three German states was interviewed. The response rate was 25.5% for GPs and 51.2% for Gyns. The approval for task sharing (yes/no) was collected for 21 medical consultation themes (83 sub items) regarding women's health and general health of women 50+. For each sub item, the approval rates among and consent between the professional groups was calculated and sub items were group into medically coherent modules for interprofessional care. Multivariable regressions were calculated in order to explore the association of professional group with the medically coherent modules adjusted for covariates.

Results
In both professional groups, highest approval was reached for shared care of urinary incontinence, vaginal complaints and recurrent urinary tract infections. High approval and consent was present only for the sub items counselling for sexual health (GP = 52.30%, Gyn=48.91%) and colorectal cancer screening (GP = 48.66%, Gyn=44.70%). Approval was higher for counselling as compared to diagnostics and therapy. Cancer related task went along with low approval rates in both professional groups. Approval towards task sharing was higher among Gyns for all modules except for cancer screening.

Conclusions
The analysis identified single tasks for sharing in both groups and allows setting priorities through the classification according to approval and consent.

Key messages
Task sharing among GPs and Gyn could be an opportune answer to improve access to care of women 50+. Knowledge on GPs and Gyns attitudes towards task sharing can serve as common empiric ground for meaningful dialogues between research, policy and practice.
Are international travelers from Portugal aware of malaria? Pre-travel assessment between 2019-2020
Authors: Malcata F , Faria B , Saldanha G , Antunes D 
Published: October 2020

Abstract

Background
Malaria is the main cause of death by infection among travelers. It may be prevented via chemoprophylaxis and personal protection. In 2017, European Centre for Disease Prevention and Control reported 8401 cases in Europe-8023 imported (99,8% travel-related). Misperception of the risk and inadequate pre-travel preparation are some of the reasons for these case numbers. The main goal of this study was to assess travelers' knowledge of malaria to improve medical advice in pre-travel consultations in the Oporto international vaccination centre (OIVC), minimizing the risk among travelers going to malaria endemic regions.

Methods
Before their pre-travel consultation in OIVC, 452 travelers filled the questionnaire with demographic issues, journey characteristics and answers about malaria's etiology, prevention and treatment. All travelers signed an informed consent form. Data were collected between July 2019 and January 2020 and analyzed via descriptive statistics and hypothesis test for comparing two populations proportions for each question.

Results
40,4% of travelers age was 26 - 35 years; 52,3% were female; and 67,5% of the planned trips were 1-3 week-long, mainly for tourism (n = 285). For most of malaria questions, travelers holding a university degree (n = 352) exhibited a statistically significant difference (p &lt; 0,005) in knowledge with an average of 70,5% correct answers compared to 58.5% of those with lower education level. However, regarding previous pre-travel appointments: for the majority of questions knowledge was similar (p &gt; 0,005) comparing to those who had first pre-travel consultation (n = 287), with an average of correct answers of 73,7% and 65,5%, respectively.

Conclusions
A stronger focus on malaria in pre-travel medical advice is necessary to increase travelers' knowledge. It is also essential to adapt malaria information to travelers' characteristics- in view of the lower percentage of correct answers by those with a lower education level.

Key messages
Malaria is a potential health risk for international travellers and an important cause of death among them. This may be caused by inaccurate perception of risk and sub-optimal pre-travel preparation. This study is the largest in Portugal to assess traveleŕs knowledge about malaria. It is crucial in order to improve medical advice and minimize the risk.
The epidemiology of chlamydia, gonorrhoea and syphilis in Portugal: where do we go from now?
Authors: Pinho-Bandeira T , Cabral Veríssimo V , Sá Machado R 
Published: October 2020

Abstract
Chlamydia (CT), gonorrhoea (NG) and syphilis (TP) infections are rising and have an important burden in the EU/EEA. This study aims to describe the epidemiology of these infections in Portugal, between 2015 and 2018, in order to set a baseline for the recently created National Strategy for STI Control and to generate hypothesis on areas for improvement.
We analysed data from the national system of epidemiological surveillance (SINAVE®) and described all probable and confirmed cases of CT, NG and TP notified in Portugal between January 1st, 2015 and December 31st, 2018.This reports the overall case evolution as well as specific characteristics of different groups.
Throughout the analysed 4-year period there were 1267 cases of CT, 1917 of NG and 3240 of TP (probable and confirmed). Of CT cases, 70% (n = 891) occurred in males, 66.3% (n = 840) in people aged 18-35, 52.9% (n = 670) in heterosexuals and 42.9% (n = 543) in men who have sex with men (MSM). Of NG cases, 87.9% (n = 1686) were males, 90.8% (n = 1741) were &lt;45 years-old and 51.2% (n = 982) were MSM. Of TP cases, 76.0% (n = 2462) were males, 64.8% (n = 2101) were &lt;45 years-old, 41.1% (n = 1333) were heterosexuals and MSM accounted for 39.9% (n = 1294). The notified cases have doubled from 2015 to 2018 (1159 to 2354) and tripled in MSM (440 to 1312), with a 7.9, 4.1 and 1.6-fold increase in CT, NG and TP, respectively. For each infection, symptomatic cases contributed to 42.9% (CT), 14.6% (NG) and 81.9% (TP) of the overall.
In similarity to European trends, CT, NG and TP infections seem to be rising in Portugal. Changes in patient behaviour, clinical practice, screenings, settings of diagnosis and notification should be further explored to better understand this trend, including clinical features. From our results, MSM and people aged &lt;45 should be prioritised within the National Strategy for STI Control. A surveillance system evaluation could be considered for sensitivity and usefulness.

Key messages
The number of chlamydia, gonorrhoea and syphilis reported cases in Portugal raised in the four-year period between 2015 and 2018, with MSM accounting for 54.6% (1312/2403) of the cases in 2018. This sets up a baseline to guide the adoption of specific measures and the prioritisation of interventions. MSM should be given special attention when addressing new prevention strategies.