bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contradictory explanatory models of doctors and ischemic heart patients with low health literacy
Authors: Rasmussen A , Overgaard C 
Published: October 2020

Abstract

Background
Health literacy has been used to explain the social inequalities in ischemic heart disease that exists globally. However, most conceptualizations of health literacy employ an isolated focus on the patient's cognitive abilities without considering the social context. By using the cultural health capital framework, this paper aims at exploring how differences in social dispositions influence the interaction between doctors and ischemic heart patients with low health literacy and low socioeconomic status.

Methods
The paper is based on 30 qualitative interviews with Danish ischemic heart patients with low health literacy and low socioeconomic status and supplementary, contextual observations. The data collection was nationwide and carried out between October 2018 and August 2019.

Results
The findings showed that the patients and the doctors derived from different social spheres, which meant that they had developed dissimilar habitus and therefore used different explanatory models to understand and articulate the patient's problem. The doctors were primarily oriented towards the biomedical understanding of the malfunctioning of the body and therefore less aware of the patients' psychosocial illness experience. For the patients, these contradictions resulted in feelings of not being acknowledged, lack of trust in the healthcare system and disruption of treatment.

Conclusions
The findings suggest that to understand barriers for treatment of socially disadvantaged ischemic heart patients it is not only relevant to look at the patient's individual cognitive abilities but also to explore class-based contradictions in explanatory models between the patients and doctors.

Key messages
Health literacy should be understood as something embedded in the interplay between social structures and interpersonal dynamics. Contradictions in explanatory models may help explain barriers for treatment of socially disadvantaged ischemic heart patients.
The use of health services by non-resident patients in a border region with mixed health systems
Authors: Pumi Alliana F , Nampo F 
Published: October 2020

Abstract

Background
Access to health services in Brazil is universal, comprehensive, and equate, offering free healthcare to anyone, regardless of its country of residence. Cross-border patients may theoretically overload the healthcare services, mainly when the health systems or healthcare quality differ between countries. Sometimes, Brazilian politicians of border areas claim that non-residents overload local health services.

Methods
We collected data on the medium and high complexity Oncology and Cardiology care provided to in-patients by a reference Brazilian hospital located in the most populous international border of the country. This border is a conurbation that includes the cities of Foz do Iguassu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazu (Argentina), totaling around 900,000 inhabitants, of which 264,044 live in Foz do Iguassu. In addition to the poor migration control of citizens crossing these borders - especially the border with Paraguay - the Brazilian Unified Health System differs from that of the other two countries for being free of charge, and also for offering better healthcare.

Results
From January 2014 to December 2018, 107,434 procedures were performed, of which 240 (0.22%) on non-resident patients (Paraguay, [n = 236]; Argentina [n = 4]). Additionally, 238 (0.22%) other procedures were performed on foreign patients who did not declare their city/country of origin (Paraguay [n = 229]; Argentina [n = 8]; Portugal [n = 1]).

Conclusions
The use of medium and high complexity procedures by the non-residents on the Brazilian side of its most populous international border is low. Non-residents may benefit from medium and high complexity healthcare services of neighboring countries without overloading the health system.

Key messages
Advocating that non-residents overload medium and high complexity health services in Brazil is dishonest and may segregate people. Efforts should move toward integrating healthcare in border regions.
SosCaregivers: piloting of a psycho-social service for family caregiver in a hard-to-reach setting
Authors: Graffigna G , Barello S , Morelli N , Gheduzzi E , Masella C , Corbo M , Ginex V 
Published: October 2020

Abstract

Background
”Ageing-in-place” may improve elderly citizens' quality of life and the sustainability of welfare systems. In this process engaging family caregivers is crucial.

Methods
A community-based participatory research in the remote area of Vallecamonica was enacted. First, we surveyed unmet needs of family caregivers. Then, a scoping literature review on existing interventions for engaging family caregivers was performed. Third, 4 co-design workshops were conducted to co-generate a new service. Finally, the service was piloted for a period of 6 months and evaluated.

Results
51 caregivers participated in the survey: they were mainly females, mean 60 y.o and with medium-low level of education. The scoping review resulted in only 14 interventions targeted to elderly's caregivers in remote areas. The workshops involved 27 caregivers and co-designed a new psycho-social service (SOSCargivers) articulated into: 1) a structured informative platform to facilitate health literacy and information seeking; 2) a tailored educational program focused on medical and practical aspects related to elderly care; 3) a set of peer-to-peer meetings for experience sharing and mutual support; 4) a “caregivers board” was created to lead the service. In the piloting 5 training sessions, 5 peer-to-peer meetings, 3 meeting with the “citizens board” were enabled.

Conclusions
The service was positively received by caregivers, although participation wasn't high. Co-designing the service with its expected users facilitates the depth understanding of local people's needs and expectations. SOSCaregivers may support family caregivers of elderly citizens in hard to reach areas by both delivering more value and giving them an active role in the social-care network.

Key messages
Family caregivers’ engagement is crucial for integrated and sustainable services in hard to reach communities. Co-designing the service with its expected users facilitates the Department understanding of local people’s needs and expectations.
Measures to manage, reduce and prevent medicines shortages in European countries in 2020
Authors: Vogler S , Fischer S 
Published: October 2020

Abstract

Background
Several countries have seen an increase in medicines shortages that constitute a major public health threat as they can negatively impact the health outcomes of patients. The study aims to survey measures that European countries apply or consider introducing to address medicines shortages.

Methods
A questionnaire was sent to the public authorities, as involved in the Pharmaceutical Pricing and Reimbursement Information (PPRI) network, in 47 countries, thereof 44 countries of the WHO European region. Respondents were asked to report measures in place or being discussed as of the first quarter of 2020.

Results
Preliminary data from 8 countries (Albania, Austria, Finland, Germany, Italy, the Netherlands, Romania, Sweden; further responses are expected) show that national registers to which manufacturers notify, usually on a mandatory basis, upcoming and existing shortages (including end dates and causes in some countries) are common (all countries but Albania). Medicine reserve supplies that have to be kept for defined medicines exist in Albania and Finland; they are being established the Netherlands and are under discussion in Germany and Sweden. Finland and Italy allow issuing export bans for targeted medicines; this possibility is before implementation in Austria, was planned and then withdrawn in Romania and is under discussion in the other countries (except Albania). Further measures include simplified import permits (with patient information leaflets in foreign language), working groups with relevant stakeholders and financial sanctions for manufacturers in case of non-supply.

Conclusions
Governments have been reacting to shortages by implementing appropriate measures and adapting existing ones. Actions taken differ with regard to stakeholders addressed, the degree of obligation and the focus (optimising the management of existing shortages vs. prevention of future supply limitations).

Key messages
A mix of measures to address medicine shortages is applied in European countries. Recently, the number of measures increased, and actions requested from stakeholders tend to have become mandatory.
FinChildren Register: National monitoring of child and adolescent health and well-being in Finland
Authors: Lundqvist A , Haapala E , Jääskeläinen S , Sundman J , Mäntymaa P , Nieminen T , Ruokokoski E , Peltomäki H 
Published: October 2020

Abstract

Background
Comprehensive and up-to-date data on child and adolescent health and well-being is essential for monitoring, service development and decision-making. Although nearly all children and adolescents in Finland attend annual health check-ups at child health clinics and school healthcare, the utilization of collected data has been limited. The objective is to produce timely and representative information on the health and well-being of children, adolescents and their families based on routinely collected register data.

Methods
Data are collected from health check-ups performed at child health clinics and school health care. Recorded data are transferred through patient information systems to the Register of Primary Health Care Visits. The data can be linked to other national registers with personal identity codes. The first phase aimed to evaluate the availability and quality of register-based data through inspection of data coverage on height and weight data of children and adolescents aged 2 to 16 years.

Results
In 2018, the coverage of height and weight data ranged from 0% to 100% between municipalities depending on age group. Results were published through an interactive map application and municipality-specific summaries by gender and age group at national and municipality levels. The data enabled reporting up-to-date results on the prevalence of child and adolescent overweight and obesity in Finland.

Conclusions
Data from health check-ups form an excellent database for monitoring child and adolescent health and well-being in Finland. The challenges of utilizing register data are mainly caused by difficulties in data transfer from patient information systems resulting in insufficient data coverage. Publishing local-level reports on data coverage as well as on the results promotes data availability and quality while enabling evaluation of actions needed for promoting the health and welfare of children and their families.
Setting the scene: controversies on trends in mental health among adolescents in the Nordic countries
Authors: Eriksson C , Arnasson A M , Lyyra N , Madsen K R , Torsheim T , Thorsteinsson E B , Välimaa R , Damsgaard M T , Due P 
Published: October 2020

Abstract
At present there are different positions regarding trends in adolescent mental health. Can we trust trend data on the mental health among adolescents in the Nordic countries? Some question the trustworthiness of adolescent self-reports, which describe ordinary daily hassles as health complaints, which cannot be interpreted as signs of mental disorders. In addition, today there is a more open climate for talking about mental issues, which can lead to an overestimation of the prevalence of mental disorders.
Statistics on mental health services statistics report increased psychopharmaceutic prescriptions as well as consumption of professional care. Such data argues for increased governmental investment in adolescent mental health services. Is this pattern due to increased availability of mental health services and/or increased prevalence of mental health problems in the adolescent population?
A concern is that data availability influences policymaking and allocation of resources. If there is an emphasis on self-reported data from adolescents that may an increased risk of medicalization of young people's dealing with their daily lives. If on the other hand the reported problems among young people is disregarded, this would be against the UN Child Convention.
The survey data has important qualities especially if the data is analysed and reported properly. The validation of survey measure has been done both regarding psychometric quality and content validity. Advanced analysis of the data can draw a more nuanced picture. Moreover, some screening instruments have been developed as a first step towards making diagnosis. Instead the HBSC surveys ask boys and girls about their health and well-being, social environment and health behaviours. HBSC uses findings at national and international levels to gain new insights into young people's health and wellbeing, understand the social determinants of health, and inform policy and practice to improve young people's lives.
What methods and challenges for taking account of context when transferring complex interventions?
Authors: Villadsen S , Dias S 
Published: October 2020

Abstract
For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.
Benchmarking the implementation of recommended food environment policies in Norway using the Healthy Food Environment Policy Index (Food-EPI)
Authors: Torheim L E , Løvhaug A L , Henjum S , Terragni L , Roos G 
Published: October 2020

Abstract

Background
Obesity prevalence in Norway has increased over the past decades despite political objectives and strategies for obesity prevention. Healthy food environments have the potential to improve the diet of the population and decrease the burden of disease. Governments play a critical role to form such environments. The aim of the study was to assess the efforts of the Norwegian Government towards creating healthier food environments and suggest actions using the Healthy Food Environment Policy Index (Food-EPI) methodology.

Methods
Evidence of policy implementation was assembled and verified by government stakeholders for 45 good practice indicators across 12 policy and infrastructure support domains. Independent public health nutrition experts from academia and civil society (n = 34) assessed the level of implementation of each indicator compared with international best practices, using an online tool.

Results
Most indicators were rated at “medium” level of implementation (51%). An almost equal number of indicators were rated at “high” and “low” level of implementation (21% and 28%, respectively). None of the indicators were rated as “very low, if any” level of implementation. More indicators under the infrastructure domain were rated at “high” or “medium” as compared with the policy domain. The expert panel developed a list of priority actions that should be implemented to improve the food environment, including actions regarded as most effective in decreasing social inequalities in diet. The top priority action was that the Government should to a larger extent use price and taxes to change food consumption.

Conclusions
The Food-EPI framework and process can be used to identify gaps in national policy implementation and to develop recommendations for strengthened policy action supported by a coalition of public health experts.
Patients’ first experiences with the German psycho-oncological care programme isPO
Authors: Cecon N , Salm S , Dresen A , Krieger T 
Published: October 2020

Abstract

Background
The new, complex care programme 'integrated cross-sectoral Psycho-Oncologý (isPO) aims to reduce anxiety and depression in newly diagnosed cancer patients. It offers psycho-oncological care after diagnosis for twelve months dependent on patients' individual needs. Parallel, it is externally evaluated with a tripartite mixed methods evaluation design that includes a prospective, formative and summative evaluation. In 2019, isPO was implemented in four newly established care networks of certified oncological center hospitals cooperating with local oncological practices in North-Rhine Westphalia, Germany. During the formative evaluation, quantitative data on patients' first experiences in the new programme were collected that reflect the first year of its implementation (optimisation phase).

Methods
During the first year of its implementation, 372 newly diagnosed cancer patients were contacted three months after their enrollment, to complete a questionnaire concerning patientś experiences with the programme and further patient reported outcomes, e.g. quality of life. Preliminary analyses were conducted descriptively.

Results
The questionnaire was completed by 219 patients (response rate: 58.9%). Results show that the majority of surveyed patients were satisfied with their care in isPO (79,5% n = 174; missings n = 24) and felt support was provided according to their individual needs (69,9% n = 153; missings n = 30). 49,3% of patients (n = 108; missings n = 34) report that their quality of life improved due to the isPO care and 59,4% (n = 130; missings n = 28) wouldn't have utilised psycho-oncological care by themselves without the active offer to enroll in isPO.

Conclusions
Findings indicate that the new care programme isPO is well accepted by most patients during the first three months of their care. However, this does not apply for all patients. Further findings may help to optimise the new programme.

Key messages
The care programme isPO is well accepted by most cancer patients as they feel supported according to their needs. Understanding why patients aren’t satisfied, might lead to programme optimisation.
Unified Agenda of the Golden August: a perspective to promote breastfeeding in Mato Grosso, Brazil
Authors: Carvalho R C O , Fonseca L B , Pires R R , Taveira J K V , Gajardo Y Z , Souza K S 
Published: October 2020

Abstract

Issue
Mato Grosso, Brazil has a low average of exclusive breastfeeding. Breastfeeding promotion actions usually focus on transmitting information to pregnant or nursing mothers about the benefits of breast milk, although cultural factors interfere in this practice, and so, needs to be more explored by public health actions and policies.

Description of the problem
Since 2013, Mato Grosso State Department of Health annually carries out, in August, the project 'Unified Agenda of the Golden August', whose goal is to organize and to publicize in a map all breastfeeding promotion actions carried out by the municipalities of the state. To focus on the cultural meanings of breastfeeding, in 2019 the project was expanded with the inclusion of an artistic-cultural activity.

Results
The First Week of Art and Culture of Breastfeeding was an action lasting 30 days, which included four short courses, the exhibition and debate of the film 'Tigers', the musical show 'Strength Woman', the art exhibition 'The Breastfeeding Art' with ceramic sculptures, canvas paintings, photographs and installations, guided tour and a special invitation from elementary school students. The central issue of all activities was breastfeeding. All actions were free with the participation of 30 regional artists. For the first time, in 2019, the project mobilized 140 of the 141 municipalities in the state, totaling 475 actions and 15,485 participants. We highlight the participation of a curricular internship in the nutrition course of a public university and volunteer students in the project, which contributed to the exchange of knowledge between management/service and academia.

Lessons
This practice allowed us to reflect on the act of breastfeeding from the perspectives of art and culture, taking the theme to other age groups and institutional spaces. This practice provided the opportunity to promote breastfeeding among the entire community and mobilized almost all municipalities in the state.

Key messages
Breastfeeding may be promoted by different perspectives and methods, not only in healthcare centers and with the transmission of information. Health policies about breastfeeding promotion may include people of all age groups and sex.