bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pilot test of a train the trainer programmes on Road safety education
Authors: Papadakaki M , Kounali V , Lioliou S , Christoforidi E , Chatzidrosou D , Vasilakis E , Tamoutsidou A , Vagionaki K , Vasilaki I , Chliaoutakis J 
Published: October 2020

Abstract

Background
Road injury is the leading cause of death for young people aged 5-29 years worldwide. As the human factor has been shown to be responsible for more than 3/4 of road incidents, changing safety attitudes and driving behaviours among youth is crucial to combat this public health issue. The current study is part of a project implemented by the Laboratory of Health and Road Safety (LaHeRS), in collaboration with the Lead Authorities of Primary and Secondary Education of Crete and with the financial support of the Region of Crete. The project started in 2019 and aims at promoting a road safety culture among school teachers of primary and secondary education in Crete Region through improving their competence in designing and implementing road safety education in class.

Methods
The program consists of three phases: a) 20 hours face-to-face training (e.g. needs assessment techniques, teaching approaches and techniques addressing risky driving, evaluation methods, practical training using the advanced technology of the driving simulator of LaHeRS Lab &lt;&lt;Virage VS500M &gt;&gt; etc), b) 30 hours distant learning using an online training program and appropriately designed training handbooks to support personalized training and, c) small-scale pilot projects of road safety education in classrooms, upon the scientific guidance and supervision of the LaHeRS research staff. For the purposes of the evaluation a questionnaire was completed to detect changes in teachers' competence to design and implement road safety education as well as their knowledge and attitudes (e.g. DSI, DBQ questionnaires) towards road safety.

Results
A total of 160 teachers participated in the 2019-2020 training programme, including 129 women, 109 primary and 51 secondary education teachers with a mean age of 43.4 years and a mean teaching experience of 16.5 years. The programme met high acceptability and raised significant teachers' confidence in delivering road safety education.

Key messages
The project proved to be efficient in addressing the pedagogical gaps in road safety education. Road safety education should be part of health promotion initiatives targeting children and adolescents.
“Sagen – Fragen – Verstehen” – Towards health literate health organisations in Vienna
Authors: Zillmann N , Novosad H , Hübel U 
Published: October 2020

Abstract
The concept of health literate health care organisation (HLHO) was introduced in 2012. Organisational health literacy is defined as an effort to transform and develop organisations (in the health sector) to enable users and employees to navigate, understand and use information and services to take care of their health.
To support hospitals and long-term care facilities in Vienna to become HLHO the Vienna health promotion (WiG) has set up a project (2017 - 2021) with 11 pilot units from 5 care institutions. Starting with an interprofessional self-assessment tool (SAT) on HLHO, most modules, like employee and patient/next of kin empowerment, trainings to improve the quality of staff-patient communication as well as workshops on health literacy are being carried out concurrently and similarly by all pilot units. In addition, pilot units implement local organisational development projects addressing issues identified in their SAT. As part of process monitoring pilot unit project leads meet regularly in workshops to discuss their learnings and project progress.
Preliminary results show that health literacy workshops in participating institutions are well-received, also the joined learning in the regular project lead workshops. Many employees in the participating institutions took part in project-associated evaluation measures. Communication trainings were very popular, especially the use of simulated patients was rated highly. Project impact on doctor-patient-communication is currently being evaluated.
Health literacy workshops seem appropriate to sensitise employees for the importance of patient-staff communication, but are challenging in terms of organisation. The SAT was considered useful to approach the topic of HLHO, but was perceived as somewhat lengthy. The interprofessional approach to the SAT could be a barrier for some institutions. Developing handouts in cooperation with persons concerned can be challenging but is highly gainful.

Key messages
As result of this project the 11 participating pilot units are one step closer to becoming HLHO. The concept of HLHO seems useful in improving health literacy.
Family vulnerability to support the organization of demand for public dental health service
Authors: Peres Neto J , Laura Cortellazzi Mendes K , da Luz Rosario Sousa M 
Published: October 2020

Abstract
The objective of this study is to analyze vulnerability/family risk instruments with socio-demographic and dental care factors, and to approach spatially the instrument. This was a cross-sectional study carried out in 2017 that included 114 families from Ubirajara, Sao Paulo, Brazil. The dependent variable was vulnerability/family risk instruments proposed by Coelho and Savassi, classified as “no risk” and “presence of risk”. The independent factors were selected based on theoretical model of access concept proposed by Andersen and organized into three hierarchical blocks: predisposing factors, facilitators and perceived needs. We conducted a bivariate analysis and estimated hierarchical logistic regression model, which was adjusted and evaluated using the Akaike's information criterion (AICC), remaining in the final model a p ≤ 0.05. The Kernel density estimation was used for spatial analysis of concentration of families. In bivariate analysis, vulnerability/family risk was associated with less years of formal education (OR = 2,42; 1.13-5.19), household with more than 4 individuals (OR = 3.25; 1.47-7.20), lower family income (OR = 2.53; 1.04-6.13), dissatisfaction with oral health (OR = 3.18; 1.45-6.98), shame to smile and to speak (OR = 4.08; 1.52-10.94) and inability to sleep (OR = 2.90; 1.10-7.60). Household with more than 4 individuals (OR = 3.46; 4.66-8.16), individuals who were unsatisfied with oral health (OR = 2.38; 1.00-5.67), and who had shame to smile and to speak (OR = 3.03; 1.01-9.13) had more chance of “familial risk”. Spatial analysis enabled to observe great concentration area “familial risk”, which indicated that this area has priority for development of actions. The association of the analyzed instrument, by including socio-demographic and dental care factors, in addition to help to observe and determine the most vulnerable areas, also helped us to conclude that such instrument may be adopted by oral health care teams in order to promote high equity access

Key messages
Help to observe and determine the most vulnerable areas. The instrument may be adopted by oral health care teams in order to promote high equity access.
Moving out of the silos through interprofessional education: what do we know and where do we go?
Authors: Bonello M 
Published: October 2020

Abstract
Interprofessional education (IPE) is increasingly being recognised as one way how to develop a collaborative health workforce better equipped to deal with the diversity and complexity of future healthcare contexts [1]. IPE could also contribute towards blurring some of the institutionally demarcated professional boundaries and silos, so widespread in most health professional education and health systems. However, despite the rhetoric of IPE, the development of this pedagogy remains variable worldwide. The challenges of developing, implementing and sustaining interprofessional education are often underestimated or overlooked. Achieving an interprofessional agenda is a wicked problem [2] and is at odds with the prevalent and privileged medical narrative, sharp professional domains, traditional curricula and scarce resources.
This presentation which stems from primary research and a systematic search and review of the literature, aims to de-construct IPE by moving beyond the rhetoric of this pedagogy; precisely by acknowledging its complexity, and the myriad of micro, meso and macro level determinants that influence its development. It will map out key recommendations of what is needed to move IPE forward. It is only when we reflect and engage in such dialogues that we can start to develop a range of context-specific IPE curricula aspiring towards a collaborative health workforce. Kuhlmann, E., Batenburg, R., Wismar, M., Dussault, G., Maier, C. B., Glinos, I. A., ... & Groenewegen, P. P. (2018). A call for action to establish a research agenda for building a future health workforce in Europe. Health research policy and systems, 16 (1), 52.Varpio, L., Aschenbrener, C., & Bates, J. (2017). Tackling wicked problems: how theories of agency can provide new insights. Medical education, 51(4), 353-365.

Key messages
Interprofessional education could contribute towards a collaborative health workforce. The road map for sustainable IPE curricula needs to be context-specific acknowledging both enablers and challenges.
Medical students’ knowledge of their future supervisory role of a new cadre
Authors: Wolvaardt L , Koortzen M , Biggs L W , Turner A C , Bac M , Volpes M 
Published: October 2020

Abstract

Background
Clinical associates (ClinAs) are mid-level health professionals in South Africa who must practice under the supervision of a medical doctor. Not only are they a new category of health professional, but it is the first time that medical doctors are directly responsible for the clinical work done by some-one else. By extension medical students should also be prepared for this responsibility. This study explored whether final-year medical students at one university were aware of their future supervisory role, felt prepared and were aware of the ClinAs' scope of practice.

Methods
This descriptive cross-sectional study used a questionnaire adapted from an American study. Final year medical students (n = 151) were invited to participate. Data were analysed with Stata and Microsoft Excel. Ethical permission was granted (53/2017).

Results
The response rate was 77.4% (n/N=117/151). The majority of participants (76.1%, n = 86) had worked with a qualified ClinA or ClinA student before and they were positive (81.4%, n = 70) about working together. Almost half (47.8%, n = 56) thought that ClinAs' scope of work was similar to registered nurses rather than a doctor's (38.2%; n = 44). Most (65.8%; n = 77) were unaware that they would be required to supervise ClinAs once qualified. Among the few who were aware of this future supervisory role (12.8%; n = 15), almost half (46.7%; n = 7) felt adequately trained. A 20-item 'knowledge test' on the ClinAs' scope of practice revealed that on average, participants selected 12/20 treatments or procedures that a ClinA may legally perform.

Conclusions
Despite having worked with ClinAs, participants appeared largely unaware of their future legal obligation. Knowledge of the scope of practice was variable in this study. Main messages: Adequate clinical supervision is based on the knowledge of the scope of practice. Working with ClinAs is not adequate preparation for supervision and formal training is needed to prepare future doctors.

Key messages
Working with ClinAs is not adequate preparation for supervision. Formal training and preparation is needed to prepare future doctors for this new role.
Interprofessional collaboration and chronicity management: a systematic review of clinical trials
Authors: Pascucci D , Riccardi M T , Sapienza M , Nurchis M C , Ricciardi W , Morano C , Damiani G 
Published: October 2020

Abstract
The increasing prevalence of chronic disease generates significant financial, social and psychosocial burden for patients, families and healthcare system. Interprofessional collaboration (IPC) is becoming recognized as a discipline among health and social care professionals and medical training institutions worldwide. Literature research suggests that following interventions could be particularly useful in the management of chronic patients. The objective of this systematic review was to assess the impact of IPC on chronic patients compared to standard health-care practice.
The PICO model was adopted and three electronic databases (Medline, EMBASE, Web of Science) were searched using appropriate keywords. Selected trials were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analyzed using descriptive statistic, and comparison of outcomes among teams with or without pharmacist was performed using t-Student test (p &lt; 0,05).
Out of 11.128, 24 studies met the inclusion criteria and 58 indicators were identified: 62% improved significantly, 38% did not show any variation, no indicator worsened after intervention. In particular, systolic blood pressure (SBP) showed a statistically significant improvement in 70.0 % of trials in which was considered while did not show any difference in the rest. The presence of a pharmacist in the team show a statistically significant improvement on SBP (p = 0,002) in patients with hypertension while no statistically significant effect is observed on glycated hemoglobin (p = 0,193) in diabetics.
The results support that IPC contributes to positive patient, provider and institutional level outcomes, in particular for chronic conditions. Future research should focus on the inclusion of patient/caregivers in the collaborative team, and on the role of interprofessional education (IPE) on collaborative practice in the management of the patient with chronicity.

Key messages
IPC is an innovative strategy to address the complex health needs of chronic populations. Further studies are needed to evaluate the role of IPE in achieving better IPC and improving chronic patients’ outcomes.
Mortality amenable to health care services and health inequalities across the regions of Italy
Authors: Adja Y , Reno C , Lenzi J , Fantini M P 
Published: October 2020

Abstract

Background
Amenable mortality is an indicator that measures the extent to which health services contribute to the improvement of the health of a population. It can also highlight geographical and socioeconomic inequalities. Therefore, it is used to assess quality and performance of health care systems, both at national and subnational level. The Italian National Health Service sets the essential levels of care (Livelli Essenziali di Assistenza, LEA), a health-benefit package for all citizens. Because every region is responsible for providing the LEA and can offer additional health care, monitoring the performance of the Regional Health Services (RHSs) is of increasing interest.

Methods
We used Nolte and McKee's list of amenable conditions to analyze the temporal trend of the standardized mortality rate (per 100.000) in Italy from 2006 to 2015, overall and by gender. We also examined the standardized rate at regional level by comparing the two-year periods 2006/7 and 2014/5, overall and by gender.

Results
Between 2006 and 2015, the overall mortality rate decreased from 81 to 68 per 100.000 population; this reduction was more pronounced in men (91 to 76 per 100.000, -16.5%) than in women (72 to 62 per 100.000, -13.9%). The decreasing trend in amenable mortality affected Italian regions differently, with northern regions showing steeper reductions as compared to southern regions. As a result, 2014/5 was the first time men's mortality in North Italy (68 per 100.000) was lower than women's mortality in South Italy (72 per 100.000).

Conclusions
The overall reduction of amenable mortality shows that Italy's health care services keep contributing to the improvement of population health. Nevertheless, by analyzing RHS performance we saw that differences in organization of care lead to differences in health care quality and performance across regions. Deaths amenable to health care services contribute to inequalities between Northern and Southern Italy.

Key messages
Because universal health coverage is necessary but not sufficient to reduce health inequalities, investing into better-quality services should be recognized as a priority. Amenable mortality can highlight areas of intervention to reduce inequalities in the provision of health care services.
Old-aged patients’ experiences with patient-centered primary health care in Serbia
Authors: Vojvodic K , Wolf G W 
Published: October 2020

Abstract

Objective
The population in Serbia is getting older, with the population aged 65+ increasing from 17.2% to 19.6% (2007-2017). As people age, their health needs become more complex and health services must be adopted to their needs. Patient-centeredness is regarded as the basis for modern healthcare services. Patients' satisfaction surveys are widely used to identify experiences of patients, including old ones. The aim of this study was to assess old-patient centeredness of primary healthcare (PHC) in Serbia according to patients' experiences with healthcare workers.

Methods
Between 2009 and 2015 cross-sectional studies were conducted in 169 Serbian PHC centers (160.948 patients), thereby using a questionnaire referring to socio-demographic characteristics, preventive care counseling, experiences with general practitioners (GPs) (knowledge of patients' health status, listening, giving clear explanations concerning illness and medicines), nurses (friendliness and provision of information), co-payment for healthcare and the overall satisfaction with PHC. Non-parametric tests (Chi-square and Kruskal-Wallis) were used for statistical analyses.

Results
A large portion of the respondents asserted to be satisfied or very satisfied with the obtained PHC services, the majority had positive experiences with GPs and nurses. About one third (32.7%) of patients were 60 years or older. Significant differences concerning the number of positive experiences in contact with GPs and nurses were found between age groups. In both domains patients 60 years or older, had more positive experiences and were overall more satisfied with PHC services than younger (p &lt; 0.001).

Conclusions
The results show that old aged patients have positive experiences with GPs and nurses in Serbian PHC. Primary health care meets their needs and can be regarded as patient-centered. The main limitation of the study was the lack of a questionnaire specific for old aged, which could better explore their needs and experiences.

Key messages
Patient-centeredness is regarded as the basis for modern healthcare services and doctors and nurses have leading role in providing patient-centered healthcare. Old aged patients have specific healthcare needs and health systems have big challenge in obtaining adequate health care with good health outcomes.
Integrating PET/CT unit into the NHS of a small sized EU state: A financial cost efficiency study
Authors: Giannakou K , Kefallonitou D , Polycarpou I , Souliotis K 
Published: October 2020

Abstract

Background
According to the Ministry of Health in Cyprus, since 2009, every year more than 3.000 new incidents with neoplasm are diagnosed. The National Health System (NHS) of Cyprus aims to offer adequate health services, comparing them with European Union standards. However, it is lacking a Positron Emission Tomography-Computed Tomography (PET/CT) unit. The present study aims to examine whether an investment by the Cyprus NHS of a PET/CT unit can be financially sustainable.

Methods
A financial analysis of the operating revenues and expenses of a departmental PET/CT with F18-FDG was performed taking into consideration all related parameters. A detailed estimation of the unit's operation expenses (PET/CT unit supply, overheads, salaries, etc.) and incomes was produced for a 15-year period. This initial scenario was not financially viable and therefore two alternatives are also examined.

Results
After performing a detailed analysis and projection for the evaluation of the feasibility study in the initial scenario, the overall outcome is estimated negative deriving to a €2,2 million losses in the cumulative results by 2035. The second scenario concluded that the required number of incidents to reach a neutral cash flow after a 15-year period should increase from 8.971 to 23.430. The third scenario reached the conclusion that a parallel investment to the purchase of the PET/CT unit by installing a cyclotron unit in the Cypriot NHS provides cumulative results positive of €1,7 million for the PET/CT, in the same period, that can finance the largest part of the €2,5 million required for the installation of the cyclotron unit.

Conclusions
Our findings show that an investment of a sole PET/CT unit is not a financially viable. Alternative possibilities such as usage of a PET/CT operated by the private sector or supporting patients to travel to another country are within the economic terms recommended.

Key messages
From a financial viewpoint, the scenario of investing in a PET/CT unit by the Cyprus NHS is not viable. Examining alternative options for patients in need of a PET/CT unit, where the initial investment cost for the state is not financially viable.
Team-based care intervention: views and perspectives from patients and healthcare professionals
Authors: Pais B , Wuerzner G , Chiolero A , Schaller P , Cloutier L , Paradis G , Burnier M , Santschi V 
Published: October 2020

Abstract

Background
Blood pressure (BP) control is poor in European countries. Team-based care (TBC) intervention involving different healthcare professionals has the potential to improve BP control. Within a patient-centered approach, we evaluated patients' and healthcare professionals' opinion about a TBC intervention involving nurses, pharmacists, and physicians (MD).

Methods
As part of the TBC study, a pragmatic randomized controlled study to evaluate the impact of a TBC interprofessional intervention on BP control, we collected opinion of patients and team-based members (nurses, community pharmacists, and MD) at the end of study period using specific questionnaires. A mean TBC-satisfaction score was computed, assessing various aspects of the intervention, and ranged from 0 to 60, where a higher score represents a greater satisfaction.

Results
All patients (100%), pharmacists (100%), MD (92%) and nurses (80%) were satisfied with TBC intervention. Most patients considered that TBC can help improving BP control (92%), drug intake (71%), and lifestyle habits (84%). Furthermore, patients reported that TBC improved their relationship with nurses (66%), pharmacists (55%), and MD (50%). Patients also reported that their discussion with nurses (95%) and pharmacists (89%) helped improve medication intake. Healthcare professionals considered that TBC improve the quality of care (91%) and an added value for the management of chronic disease (79%). Mean TBC-satisfaction score was higher among MD [42 (SD: 9)] and pharmacists [45 (SD: 6)] compared with nurses [36 (SD: 9)].

Conclusions
Overall, patients and healthcare professionals were highly satisfied regarding TBC engaging different healthcare professionals in a primary care setting.

Key messages
TBC intervention seem to be well appreciated by patients and healthcare professionals. Favourable patients’ and healthcare professionals’ perspectives will help implementing TBC intervention.