bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regulatory and legislative frameworks and their role in R&D, HTA and UHC
Authors: Lingri D , Petelos E 
Published: October 2020

Abstract
The fourth speaker will present the role of HTA in reimbursement, as well as existing pricing frameworks and HTA initiatives, and determining overall access. An overview of constraints and opportunities in terms of establishing legislative frameworks to enable deliberation, transparency will be further discussed. Their importance for national healthcare systems, i.e., payers, and for ensuring system sustainability. Affordability will be examined in terms of effect on individuals, on payers, and on systems.
The ASELPH Leadership Fellowship enhancing the performance of healthcare leaders in South Africa
Authors: Cloete S , Olorunju S , Buch E 
Published: October 2020

Abstract

Background
South African healthcare leaders face significant challenges and concerns are raised regarding the competencies of leaders to deal with such challenges. The Albertina Sisulu Executive Leadership Programme in Health (ASELPH) Fellowship was established to equip leaders with skills to perform optimally. The study evaluated the effect of ASELPH in enhancing the performance of leaders. The study proved the benefits of leadership training, established the factors affecting training effectiveness and the contribution of the Fellowship's unique features to training's success. It also contributed to the scant global literature on whether such programmes are effective.

Methods
A quasi-experimental study design was used, with pre-post assessments of ASELPH students at the University of Pretoria. Data were collected from a questionnaire, module assessments and reflective essays. A 360° assessment of 14 competencies and 56 performance indicators were done.

Results
Students improved significantly in 11 competencies and 44 performance indicators, in spite of adverse workplaces. Assessors observed the same improvements, which confirmed performance change at the students' workplaces. Factors influencing the effectiveness were poor leadership, increased workload, time and resource constraints. The unique features of the ASELPH i.e. case-based method, eLearning, group work, real-time assignments, continuous assessments and mentoring contributed to the success of the training.

Conclusions
The study showed how ASELPH enhanced the performance of public healthcare leaders in SA and their impact on the SA healthcare system. Recommendations include the continuous use of blended learning for training and all SA healthcare leaders to attend ASELPH. The findings of this study combined with the evidence in the literature showed that leadership training, together with ongoing assessment post-training, are necessary for leaders to perform effectively in their workplaces.

Key messages
Leadership training is imperative for optimal performance of leaders. The teaching approaches and pedagogy affect the effectiveness of the training.
The Knowledge Broker Mentoring Program: Developing capacity for evidence-informed decision making
Authors: Howarth C , Steinberg M , Neil-Sztramko S , Dobbins M 
Published: October 2020

Abstract

Background
Evidence-informed decision making (EIDM) is important to ensure that practice is evidence-informed and resources are used efficiently and effectively. However, public health professionals can face barriers to EIDM. Knowledge Brokers can support and champion EIDM within an organization. The National Collaborating Centre for Methods and Tools (NCCMT) developed a Knowledge Broker (KB) Mentoring program, a hands-on mentorship program to develop capacity for evidence-informed decision making.

Objectives
The objectives of the KB Mentoring program are to build individual and organizational capacity for evidence-informed decision making. The program takes place over 20 months and includes an organizational assessment, nine face-to-face workshop days, monthly webinars, completion of a rapid review, and a period post-program to connect with mentors. Participating cohorts are evaluated qualitatively.

Results
To date, two cohorts of five organizations each have completed the program (n = 56 participants). At the individual level, participants reported increased: confidence; EIDM knowledge and skills; and interpersonal connections. At the organizational level, the groups reported conducting rapid reviews, critically appraising evidence, and using evidence in program planning decisions. Additionally, organizations have put in place ongoing supports to build EIDM capacity. Participants noted that they would like more support both before and after the program. This recommendation was put in place for the third cohort, currently in progress.

Conclusions
Participants indicated the KB mentoring program was high quality and increased EIDM capacity and behaviour in their organizations. This innovative program is important across settings and countries as public health continues to face changes to public health practice. In order to scale up the program to diverse geographic settings, an online KB mentoring program is currently in development.

Key messages
Knowledge Broker mentoring supports public health practitioners to use evidence in practice. Knowledge broker mentoring raises the confidence, knowledge, skills, and connections of participants.
Microbiological surveillance in reducing potential infection risk
Authors: Tuvo B , Cristina M L , Spagnolo A M , Totaro M , Baggiani A , Privitera G , Casini B 
Published: October 2020

Abstract

Background
Failure in reprocessing of endoscopes has been reported as one of the top ten most important threats to patient health.

Materials/Methods
The study was conducted in two digestive endoscopy centres of a teaching hospital (29,000 endoscopies/year, of which 550 endoscopic retrograde cholangiopancreatography (ERCP). Following two cases of bacteremia due to KPC-producing Klebsiella pneumoniae temporally related to ERCP and 89% of non-compliance detected on endoscopes subjected to microbiological surveillance, the reprocessing activities were audited and implemented to ensure guideline compliance. Clinical and microbiological surveillance were reinforced and all responsibilities for each phase identified according to UNI/TR11662. Microbiological surveillance was performed according to the 'Duodenoscope Surveillance Sampling and Culturing Protocols' protocol, CDC, 2018.

Results
In the 11 months of surveillance, 47 endoscopes were sampled (13 colonoscopes, 9 gastroscopes, 23 duodenoscopes and 2 echoendoscopes), 19 washer-disinfector machines and 9 medical cabinets. 36% (17/47) of endoscope internal channels resulted non-compliant, 17% (4/23) in duodenoscopes. NDM-producing K. pneumoniae was isolated in 2 gastroscopes always associated with the use on a colonized patient. The inlet and final rinsing water of washer-disinfectors and medical cabinets resulted always conformed. Non-conformities were managed immediately in order to avoid infectious risks for patients.

Conclusions
Microbiological surveillance of endoscopes after reprocessing allowed to prevent infections in patients undergoing endoscopic procedures.

Key messages
Training of health workers followed by strict adherence to guidelines is the most appropriate tool in preventing and controlling infections related to the use of endoscopes. Endoscopy and reprocessing staff should follow a formal recognized endoscopy reprocessing training program, followed by regular practice and periodically updated training to maintain competency.
Medicolegal Alienation in Physicians Practising in Informal Clinics Servicing Undocumented Migrants
Authors: Greenbrook J T V , Reichenberg K 
Published: October 2020

Abstract

Background
Globally, undocumented migrants have relied on informal clinics for their healthcare services. Empirical explorations of physicians' moral, ethical, and legal consciousness surrounding practising within this context remain lacking. The present study sought to contribute to this gap.

Methods
Constructivist grounded theory was applied to qualitative interviews with 16 physicians working in informal humanitarian clinics in Sweden.

Results
Physicians' experiences were synthesised into three categories: Ambiguity in navigating illegality, due to awareness of vulnerabilities surrounding patient-safety and own involvement, whilst simultaneously feeling enriched through interactions in the clinic; Being exposed to patients' accounts of structural violence and social injustice; Experiencing isolation in practice, when discovering professional limitations and feeling severed from the conventional medical institution. In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of alienation synthesised in physicians in medical, ethical, and legal terms; identified as a novel dimension of legal consciousness theory, a process coined medicolegal alienation.

Conclusions
The process of medicolegal alienation occurs when, functioning as arbiters of patients' rights within the conventional medical institution, questions surrounding undocumented migrants' deservingness force physicians into a position of moral, ethical, and professional dissonance. Struggling to dictate their own practice, they are propelled out into informal clinics, in search for congruence. Through this process, physicians become alienated from both their profession and from legality. Though able to navigate freely between the medical institution and humanitarian clinics, the burden of insight into the threshold between legal realms and the plight of the undocumented patient is heavily ambiguous, being both transformative and isolating.

Key messages
In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of medical, ethical, and legal alienation synthesised in physicians. When undocumented migrants’ deservingness is questtioned, physicians are forced into a position of moral, ethical, and professional dissonance, giving rise to the process of medicolegal alienation.
Implementation of the German Prevention Act: Municipal Public Health Units as a Bottleneck?
Authors: Arnold L , Starke D , Szagun B 
Published: October 2020

Abstract

Background
The German Prevention Act (PrävG) came into force in 2015. As a federal law, it remains vague with regard to municipal structure. The municipalities, as those public health units that have direct access to the living environment, play a central role in the implementation of health promotion and prevention. The evaluation by the National Prevention Conference in 2019 showed that the involvement of the municipal public health services (ÖGD) has not yet been sufficiently achieved. A major problem is the heterogeneity of ÖGD units in Germany's federal structure, about which little information is available.

Methods
In order to fully capture this heterogeneity for the first time, a systematic online screening was carried out. For this purpose, the websites of all 358 ÖGD units were screened independently of two researchers according to structural conditions.

Results
70% of all municipal ÖGD units are located at district level, 18% at city district level and 12% cumulatively. Population varies from 35,000 to about 1.5 million inhabitants. The allocation of the ÖGD units to youth service planning and social welfare varies in the federal states from 18.7% to 94.4%, within regulatory agency and veterinary office from 27.8% to 79.2%.

Conclusions
The heterogeneity makes the establishment of municipal standards difficult. Due to the diverse administrative allocation, different levels of policy-making must be considered on the way to health in all policies. The political classification reflects in roughly equal parts an ÖGD orientation towards health protection or social determinants of health, as recommended for the PrävG. A one-sided orientation towards health protection was shown by the temporary suspension of the use of financial resources for prevention in the course of the 2nd pandemic law to combat the COVID-19 pandemic. For the announced reform of the German ÖGD it is necessary to homogenize essential structural characteristics and to prevent a one-sided orientation.

Key messages
The heterogeneity of municipal health services makes it difficult to implement the German Prevention Act. In the course of the upcoming ÖGD reform, essential structural characteristics should be homogenized and a one-sided orientation of the municipal ÖGD units towards health protection should be avoided.
Knowledge and behaviors regarding salt intake according to urinary Na excretion and blood pressure
Authors: Silva-Santos T , Moreira P , Padrão P , Abreu S , Pinho O , Gonçalves C 
Published: October 2020

Abstract

Background
Understanding salt-related knowledge, attitudes and behaviors can help the design of effective health interventions. Therefore, our objective was to describe knowledge and behaviors related to salt intake according to urinary sodium excretion and blood pressure in University workers.

Methods
We performed our study in a subsample of the participants of the iMC Salt project (n = 60 subjects, 60.5% women, mean age 48±9.5 years). Sodium excretion were measured by one 24-h urinary collection, validated by creatinine excretion and participants were grouped according to the WHO sodium recommendations (&lt;2.0 g/day; high, ≥2.0 g/day). Subjects were classified as hypertensive if the systolic blood pressure was ≥130 mmHg and/or diastolic blood pressure was ≥80mmHg. Knowledge and behaviors regarding salt intake were assessed by the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance.

Results
About 74.6% of the participants reported that reducing salt in their diet was very important and 93.2% think that salt is harmful to health. However, 76.3% always add salt during cooking, 42.4% said that they always or often consume processed foods high in salt, 79.7% reported that they don't look at the salt on food labels, 50.8% don't buy low salt alternatives and 30.5% don't use spices as one substitute for salt when cooking. Hypertensive subjects had a higher mean sodium excretion (3710±1508mg/day vs 2478±871mg/day, p = 0.002) and reported a significant higher frequency of consumption of processed foods high in salt (53.1% vs 29.6%, p = 0.024). No significant differences were found with the other variables.

Conclusions
Most university workers were aware that high salt intake can cause health problems, but they reported low adherence to behaviors to control their salt intake. Hypertensive subjects recognized that frequently consume processed foods high in salt, so reduce salt content on those products could have important impact on their daily salt consumption.

Key messages
This study provides evidence on knowledge and behaviors regarding salt intake to guide salt reduction policies. Hypertensive participants reported a higher frequency of eating processed foods rich in salt.
Coping strategies predicting quality of life in diabetic and obese NAFLD patients
Authors: Funuyet-Salas J , Martín-Rodríguez A , Pérez-San-Gregorio M A , Romero-Gómez M 
Published: October 2020

Abstract

Background
To date, coping strategies have not been studied in patients with nonalcoholic fatty liver disease (NAFLD), despite evidence of their relevance in chronic liver pathology, Type 2 diabetes mellitus (T2DM) and obesity (OB). We therefore analyzed which coping strategies predicted quality of life in diabetic and obese NAFLD patients.

Methods
Four hundred and ninety-two biopsy-proven NAFLD patients (290 men and 202 women, mean age 54.90±11.74) were evaluated using The Brief COPE, 12-Item Short-Form Health Survey (SF-12) and Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease (CLDQ-NAFLD). A stepwise multiple linear regression analysis was performed on four groups (G1, n = 335, absence of T2DM; G2, n = 157, presence of T2DM; G3, n = 249, absence of OB; and G4, n = 243, presence of OB) to analyze which coping strategies predicted patient quality of life (physical component summary SF-12, mental component summary SF-12, and total CLDQ-NAFLD).

Results
In both diabetic and obese patients, active coping (T2DM, p = 0.003, β = 0.26; OB, p = 0.000, β = 0.33) and denial (T2DM, p = 0.027, β=-0.19; OB, p = 0.004, β=-0.18) predicted the physical component summary. Denial (T2DM, p = 0.000, β=-0.30; OB, p = 0.001, β=-0.19), positive reframing (T2DM, p = 0.000, β = 0.28; OB, p = 0.000, β = 0.29), self-blame (T2DM, p = 0.000, β=-0.24; OB, p = 0.000, β=-0.26) and self-distraction (T2DM, p = 0.033, β=-0.13; OB, p = 0.023, β=-0.11) predicted the mental component summary. Denial (T2DM, p = 0.000, β=-0.34; OB, p = 0.000, β=-0.31), positive reframing (T2DM, p = 0.000, β = 0.30; OB, p = 0.005, β = 0.15) and self-blame (T2DM, p = 0.000, β=-0.26; OB, p = 0.000, β=-0.28) also predicted the total CLDQ-NAFLD in both groups.

Conclusions
Active coping and positive reframing predicted better quality of life, while denial, self-blame and self-distraction predicted worse quality of life in diabetic and obese NAFLD patients, suggesting the inclusion of coping strategies in future multidisciplinary NAFLD treatments.

Key messages
Importance of coping strategies for NAFLD patients: active coping and positive reframing predicted better quality of life, while denial, self-blame and self-distraction predicted worse quality. This study shows the need to design multidisciplinary strategies for managing NAFLD and improving patient quality of life, in which intervention in coping strategies should be a major element.
Risk stratification for the safety of patients and hospital health workers during Covid-19 emergency
Authors: Zilli E , Madia A , Giuriato P , Bonaldo D , Napolitano R C , Callegaro R G , Fioretto M , Arseni A , Benini P , Scibetta D 
Published: October 2020

Abstract
Covid-19 emergency has forced hospitals to face enormous organizational challenges in order to implement solutions to minimize the impact of the infection and guarantee at the same time the quality of health services provided and the safety of patients and health workers. ULSS 6 Euganea - Health Trust (District of Padua) has defined four levels of risk for Hospital Units (from the highest to the lowest risk: Red, Yellow, Green and White) based on the following parameters: type of patients hospitalized (SARS-CoV-2 positive, Covid-like, negative), type of health services provided, time of assistance and care for hospitalized patient.
This risk stratification in the Hospital of Cittadella - ULSS 6 Euganea has been applied to different contexts, such as distribution of personal protective equipment, health surveillance, frequency of cleaning and sanitation. Since February 21 (first confirmed case in Veneto Region), in the Hospital of Cittadella personal protective equipment has been delivered daily to health workers; the quantity and quality of devices provided have been carefully monitored, with particular regard to high-risk settings (Red Areas: Intensive Care Unit, Emergency Room, Covid Wards, Operating Room, Radiology, swab samples Area, Morgue).
The performance of nasopharyngeal swabs has been periodically organized for every health worker, according to the level of risk of their Unit: every 10 days for Red Areas, every 20 days for Yellow and Green Areas, every 30 days for White Areas. The frequency of cleaning and sanitation has been intensified in Red and Yellow Areas, following the guidelines released by the World Health Organization.
The definition of four levels of risk for Hospital Units is proving to be a useful and flexible tool in the management of Covid-19 emergency; further research in the next months needs to be made to assess the impact of risk stratification on the different aspects covered (ex. number of health workers infected).

Key messages
Covid-19 emergency has forced hospital to face enormous organizational challenges to minimize the impact of the infection and guarantee the safety of patients and health workers. The definition of four levels of risk for Hospital Units is proving to be a useful and flexible tool in the management of Covid-19 emergency.
Deindustrialisation and health: mapping the mechanism of impact in the Hungarian rust belt
Authors: Scheiring G 
Published: October 2020

Abstract

Background
Industrial countries are undergoing a prolonged period of deindustrialisation, characterised by declining labour in manufacturing and extractive industries. Considering the urgent need to decrease humanity's overall environmental footprint, industrial transformation is imperative. Research showed that deindustrialisation correlates with worsening ill health; yet, little attention has been paid to mapping the complexity of the mechanism of impact.

Methods
Hungary experienced significant deindustrialisation in the 1990s and a parallel decline in life expectancy. Four medium-sized towns were identified in the Hungarian rustbelt: two moderately (25-50%), and two severely (&gt;50%) deindustrialised. Between September 2016 and January 2017, 82 semi-structured interviews were conducted in these towns with subjects who were working-age adults in 1989 and who lived and worked in the interview towns in the following decades. The 816,118 words-long interview-corpus was analysed with qualitative thematic analysis using NVivo.

Findings
The interviews revealed that deindustrialisation affects health through multiple channels. Short-term mechanisms impact individuals directly, such as unemployment, deprivation and increased work-related stress. Medium-term mechanisms impact health through disrupting social hierarchies, social capital, local services, and workplace identities. Long-term impacts are latent, and influence health through territorial stigma, loss of working-class culture, and accumulated perceptions of injustice.

Conclusions
Deindustrialisation is a crucial contextual factor affecting ill health over the short, medium and long term. Going beyond the direct individual channel, involving communities and localities, the health effect of deindustrialisation represents a complex and layered mechanism with multiple explicit and latent components. Complex research approaches and policy responses are needed to address explicit and latent structural mechanisms alike.

Key messages
The study maps the mechanism of impact that links deindustrialisation and ill health in four Hungarian towns using thematic analysis of 82 qualitative interviews. Deindustrialisation affects health over the short, medium and long term going beyond the direct individual channel, necessitating complex research approaches and policy responses.