bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching bioethics at the Medical School, University of Ibadan, Nigeria: Prospects and challenges
Authors: Akintola S 
Published: October 2020

Abstract

Background
Teaching bioethics (BE) is one way to contribute to reflecting if research on humans, health policies and interventions are legitimate. Nonetheless, BE and law have been a relatively new subjects in medical schools in Nigeria, with increasing interest only since the late 1990s following the Pfizer Trovan study. Literature in this emerging field mostly refers to experiences from high-income countries (HIC), literature on low-and middle-income countries (LMIC) is scarce.

Objectives
This presentation describes over 10 years’ experience of teaching BE in the residency program, to doctors and within a Masters in BE Program of the University of Ibadan, Nigeria. The paper discusses the content, skills, teaching approach and tools employed in these activities. Challenges of the teaching process are identified and future teaching strategies suggested.

Results
The crop of students are largely unemployed young graduates, health professionals, ethics committee members. They come from Southern Nigeria; there is a weak representation from the Northern states of Nigeria. Based on students and lecturer evaluation reports, we can report that it is important to teach BE in LMICs such as Nigeria. A country that has experienced many ethically challenging and even evil activities in medicine and medical research coupled with a radically changing value system. Teaching universal norms of BE in a country with a high level of illiteracy and cultural differences where religion plays a major role in defining what is right, wrong or appropriate remains a challenge.

Conclusions
For BE training to be impactful and result in systemic and structural changes in health policy and education in Nigeria, the government must invest in proper institutionalization of research and clinical ethics in curricula in Nigeria.

Key messages
Efforts need to be increased in Nigeria and other LMICs to teach BE. HIC institutions could offer guidance by becoming partners organizing ethics training.
Women who inject drugs in Russia: stigma as a barrier in access to HIV and drug treatment services
Authors: King E , Alexandrova O , Batluk J , Shaboltas A 
Published: October 2020

Abstract

Background
There are over one million people living with HIV in Russia. People who inject drugs experience major disparities in their susceptibility to the virus and in their access to HIV services. Women who inject drugs (WWID) have been shown to be at heightened susceptibility to HIV, through both unsafe drug use and unprotected sex. Less is known about the social determinants of engagement in care specifically among WWID.

Methods
We conducted a qualitative research study in St. Petersburg in order to assess what factors influence engagement in HIV-related and drug rehabilitation services. We conducted in-depth interviews with 20 service providers and 30 WWID from June-November 2018. We recruited providers to represent a range of services, including government clinics, non-governmental organizations, and family services. We recruited WWID through community outreach services. We used thematic analysis and a team-based approach to coding data.

Results
A major theme across our data was the stigma and discrimination that WWID experience in their everyday lives and in their interactions with the healthcare system. WWID are subjected to stigmatization related to gender norms about drug use, the capacity to fulfill their roles as mothers, (for some) engagement in sex work, and (for some) HIV-positive serostatus. WWID are often reluctant to seek HIV-related services, including testing and treatment, out of fear of being treated poorly because of their drug use. The omnipresent societal stigma manifests into self-stigmatization and many WWID questioned their deserving of and abilities to seek healthcare services, including drug rehabilitation and HIV-related care.

Conclusions
Interventions are needed to address the stigma and discrimination that WWID in Russia experience in families, communities, and health institutions. Additionally, psychosocial interventions may help to address the self-stigmatization that sometimes influences WWID's self-efficacy to seek services.
Prioritising health information needs in Europe: a Policy Delphi survey
Authors: Seeling S , Thißen M , Achterberg P , Carle F , Lyons R , Van Oyen H , Tijhuis M , Unim B , Zelviene A , Fehr A 
Published: October 2020

Abstract

Background
Health information (HI) includes data on population health, health determinants, health care systems, and health-relevant policy developments. Duly prioritised HI is essential to inform decision-makers, researchers and the public. Little can be found in the literature on HI prioritisation methods and procedures in Europe. Our study aims to close this gap.

Methods
We designed a two-round online Policy Delphi and addressed 119 contacts, mainly public health and health information experts, in 33 InfAct partner countries. The first round included structured and full-text questions; in the ongoing second round, participants rank prioritisation approaches according to 'desirability', 'feasibility', 'importance' and 'confidence'.

Results
In the first round, 19 questionnaires were fully completed; the presented results also include replies from interrupted surveys and drop-outs. 58% of the participants reported the existence of structured national HI prioritisation processes; 65% indicated stakeholder involvement, and 54% the application of defined criteria. National health targets or strategies played a major role in HI prioritisation. 17 respondents from 13 countries agreed to participate in the second round. Based on analysis of the first round, participants rank approaches to HI prioritisation, preferences for stakeholder involvement and coordination, partners and methods for criteria development, the role of national and international frameworks and options for good-practices in HI development. The expected outcome of our study is not one single recommendation for HI prioritisation, but a list of good practice-approaches.

Conclusions
Health systems in Europe are heterogeneous, and so are health information systems. Mapping, sharing and ranking HI prioritisation approaches will facilitate knowledge exchange in the context of building a sustainable EU HI-system and may inform relevant EU processes.
Developing recommendations for good practice in national health reporting
Authors: Thißen M , Seeling S , Achterberg P , Fehr A , Haneef R , Palmieri L , Tijhuis M , Unim B , Ziese T 
Published: October 2020

Abstract

Background
Health reporting should deliver up-to-date data and information on the population's health status, its determinants and on national (or regional) healthcare services. Establishing an information or discussion base for health policy is an important objective ('data for action'), but health reporting also addresses other target groups like scientists, the media or the general public. Depending on the needs and competencies of the respective target groups, requirements for health reporting formats will differ. At the same time, heterogeneity of health reporting practices in Member States causes, next to occasional language barriers, difficulties in facilitating access to EU-comparable information. To allow for alignment and identification of good practices, our study aims to provide a comprehensive overview of the health reporting formats in the EU.

Methods
A web-based desk research of health reporting formats and their target groups was conducted among EU Member States and associated InfAct partner countries. Good practice examples were identified on the basis of quality criteria derived from 'Good Practice in Health Reporting' for Germany and the Eva PHR (Evaluation of National and Regional Public Health Reports) project. Based on the findings of the desk research, a guidance document for health reports will be drafted in close cooperation with InfAct partner countries.

Results
The guidance should accommodate the heterogeneity of reporting practices at EU level while defining desirable and feasible good practice standards. Although the focus is on public health reports, recommendations for other formats of health reporting will also be included. It will facilitate the preparation, dissemination and access to EU-comparable and high-quality health information.

Conclusions
The guidance is expected to be a useful tool for making health information adequately available to the targeted groups while reducing inequalities in health reporting across the EU.
Well-being and Health among adolescents living in a rural area in Northern Germany (East Friesland) - Result of the WOGE study
Authors: Natan M , Sisenop F , Lindert J 
Published: October 2020

Abstract

Background
Relationship of wellbeing of adolescent and community determinants in rural areas are mainly unknown. The aims of this study is 1) to provide data on wellbeing of adolescents in a rural area, 2) to analyses the association of sociodemographic variables and satisfaction with their community with adolescents` wellbeing.

Methods
We conducted a representative cross-sectional study (June 2018 - May 2019) in a rural catchment area including adolescents aged 14-18 years. We included socio-demographics (age, gender, education status), and time spent with parents in our study. Additionally, we measured wellbeing with the Ryff wellbeing scale (42 Items) and satisfaction with the community with a self-developed scale (21 Items). Data were analysed with uni- and multivariate linear regression models.

Results
A total of n = 157 adolescents (n = 82 girls/n=73 boys, age mean=16.7 years) participated in this families health study. The majority (97%/n=152) lived with their parents, and 70% (n = 110) had siblings. Among them were n = 146 adolescents (93%) who are in school-based education, and n = 11 (7%) are under work training education. Overall, adolescents reported high well-being scores (mean=166.78, SD = 32.8, 95%CI=161.24-172.19) and high satisfaction with their community (mean=13.67, SD = 1.63, 95%CI=13.45-14.03). Surprisingly, adolescents loved to spend time with their parents. Multivariate analyses suggest no significant associations of age (p-value=0,565), gender (p-value=0.961), education status (p-value=0.271) with well-being. However, community satisfaction is associated with well-being (p-value=0,006).

Conclusions
Sociodemographic variables were not associated with adolescents' satisfaction but with well-being in this rural community. A potential explanation might be that adolescents rely on their families rather than the wider community. Further studies are necessary to investigate the role of family relations in explaining the high well-being of this population.
Health services for asylum-seekers: evidence from countries of arrival, transit and destination
Authors: Bozorgmehr K 
Published: October 2020

Abstract

Background
Systematic assessments of health services for asylum seekers are relevant to identify strengths and weaknesses of responses to migration movements. Building on recent research, the presentation maps and summarises health service responses in Germany and six countries of the European Union and derives lessons learnt.

Methods
The presentation builds upon three pieces of evidence: 1. A health system assessment of Germany's response to refugee movements in 2015 using data from a national survey among public health services. 2. A scoping study of six EU countries in which 27 semi-structured in-depth interviews with first-line staff and health officials to collect information about existing guidelines and practices at each stage of reception in first-entry (Greece/Italy), transit (Croatia/Slovenia), and destination countries (Austria/Sweden). 3. A study assessing mental health care services in Germany from initial registration to follow-up after transfer in districts.

Results
The studies highlight system related shortcomings related to coordination of care, lack of standardisation, fragmentation of services and financing structures, inter- and sub-national governance structures, as well as limitations in communication and data collection systems that translate into poor health services, duplication of efforts, and discontinuity of care during the migration trajectory.

Conclusions
While the studies assessed the situation between 2015 and 2018, structural approaches, innovations and system level reforms will be needed to improve health system responses in the future. Such reforms, however, appear to be absent from the policy discourse so that increased efforts from the public health community are required to strengthen and improve health services for asylum seekers.
FAO/WHO GIFT: increasing the availability, harmonization and use of individual quantitative food consumption data worldwide
Authors: Ferreira de Sousa R , Balcerzak A , Bevere T , Padula de Quadros V 
Published: October 2020

Abstract

Introduction
Understanding the various eating habits of different population groups, according to the geographical area, is critical to develop evidence-based policies for nutrition and food safety. The FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT) is a novel open-access online platform, hosted by FAO and supported by WHO, providing access to harmonized individual quantitative food consumption (IQFC) data, especially in low- and middle-income countries (LMICs).

Methods
FAO/WHO GIFT disseminates IQFC data as ready-to-use food-based indicators in the form of infographics, and as microdata. The infographics intend to facilitate the use of these data by policy makers, providing an overview of key data according to population segments and food groups. The microdata is publicly available for download, and is intended for users that would like to do further analysis of the data.

Results
FAO/WHO GIFT is a growing repository. By June 2020, 14 datasets were available for dissemination and download, and an additional 44 datasets will be made available by 2022. FAO/WHO GIFT also provides an inventory of existing IQFC data worldwide, which currently contains detailed information on 268 surveys conducted in 105 countries.

Conclusions
FAO/WHO GIFT collates, harmonizes and disseminates IQFC data collected in different countries. This harmonization is aimed at enhancing the consistency and reliability of nutrient intake and dietary exposure assessments globally. FAO/WHO GIFT is developed in synergy with other global initiatives aimed at increasing the quality, availability and use of IQFC data in LMICs to enable evidence-based policy-making for better nutrition and food safety.
Equity in local health: participatory tool to assess physical and socioeconomic settings in Spain
Authors: Ocaña A , Peiró-Pérez R , Pérez Sanz E , Legaz Sánchez E , Paredes-Carbonell J 
Published: October 2020

Abstract
To address local health with a focus on equity and social determinants in a participative way, an intersectoral health analysis must be within reach, with the participation of citizens in every step of the process, as well as the support and commitment of policy-makers. Tools that allow collective evaluation of the people's places and organized data collection are also required.
In June of 2019, the translation and transcultural adaptation of the Place Standard Tool, as well as its validation in two municipalities was launched to have available a Spanish tool to evaluate places focusing on equity and social determinants, including equity in all the phases of the assessment process of the territory, promote and facilitate participation of vulnerable populations in every step, analyze results and interventions taking into account axes of inequality, build capacity at different levels, and address the resulting health necessities with an intersectoral focus on social determinants.
A Spanish participatory tool with a focus on social determinants was validated. Equity was addressed through focus groups consisting of vulnerable people, analyzing the results by axes of inequality. The participation of citizens was included in the place assessment, and in the prioritization of actions to be developed in the areas with the worst evaluation. An intersectoral group is currently working on the planning of the proposed actions. The first action is a plan to foster the use of bicycles and a mobility analysis to improve urban transportation.
The tool allows the participatory place assessment, and facilitates the connection of results and interventions to social determinants of health. It offers organized results which facilitates the intersectoral approach of derived interventions. The support of policy-makers is essential to carry out actions that impact social determinants of health, and to avoid creating false expectations among the citizens.
Mexico’s health system: in longstanding pursuit of universal coverage and integration
Authors: González Block M , Reyes H , Cahuana Hurtado L , Balandrán A , Méndez E 
Published: October 2020

Abstract
Mexico's system is dominated by corporatist, social insurance organizations governed by employer and employee trade unions in close relationship to the federal government, supplemented with government services for the uninsured, and a thriving private sector. Social insurance covers about half the population, although coverage for most is sporadic. Furthermore, these organizations have divergent service, financing, and governance structures, posing inequities and barriers in responding to beneficiary needs. Profiting from a growing capacity gap, the private sector now provides almost half of total outpatient consultations. Major public health challenges include obesity and diabetes, and social and health inequalities. Fiscal policy and improved preventive programs across institutions have had some effect on reducing health risks. Health policy has aimed towards universal coverage through coordinating government providers and strengthened public health programs. Since 2004 Seguro Popular had made progress toward universal health coverage, protecting about 85% of the population, reducing catastrophic expenses, and increasing coverage of high-cost interventions. However, to address health care package limits, attain universal financial protection and respond to corruption, President Lopez Obrador's administration canceled Seguro Popular from 2020 and established the National Health Institute for Wellbeing (INSABI). INSABI aims to equalize benefits across the insured and uninsured and re-centralize health authority by establishing the federal government as sole funder and provider of coverage for the uninsured. The separation of funding and provision, a hallmark of Seguro Popular, was replaced with supply-side funding, following the social insurance model. While these policies have challenges, they could facilitate integrating social insurance and tax funding into a single-payer capable of increasing efficiency and continuity of care as well as achieving greater equity.
Care integration as means for developing efficiency in budget constraints
Authors: Sinervo T 
Published: October 2020

Abstract

Background
Care integration has been an aim in government policies since 2000s in Finland. In 8 counties municipalities have created regional joint health and social care authorities in responsibility of all health and social services to boost service integration. Joint management gives possibilities to change organizational structures and organizing care paths in new ways. Most of these joint authorities suffer from severe budget constraints and layoffs has been done. Care integration has been seen as alleviating in budget constraints and to increase efficiency. In this study the views of top and middle managers and personnel on care integration as means to develop efficiency is explored.

Methods
A large, newly established joint authority of 200000 inhabitants participated the study. The joint authority had a large gap in its budget, hence layoffs were planned. We compiled a data of regional policy documents, carried out individual and group interviews of management (21) and a survey to employees (N = 2047). In the interviews, views of top and middle managers on how efficiency should be developed and on views of care integration in relation to efficiency were studied. The views of employees were explored in the survey.

Results
The joint authority was launched in a very short time and care paths were not planned before the organizational change. The managers saw that siloed practices created inefficiency and care integration increasing efficiency although the research evidence was seen insufficient. In the survey the views of the employees of developing efficiency and care quality were more negative than managers. Both groups, however saw that care integration was underdeveloped. Developing integration especially at primary level became also a key strategy of the joint authority.

Conclusions
Joint management creates a good basis for integration. The implementation of care integration, however, requires managers' collaboration and organisational culture supporting integration.

Key messages
In managers views care integration can increase efficiency. Joint management is a good basis for integration, but care processes have to be planned.
A case control study for factors of Multidrug Resistant Tuberculosis in East Sikkim, India
Authors: Zaman F A , Mehta V K 
Published: October 2020

Abstract

Background
Tuberculosis (TB) remains a major public health problem in the developing world and India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year. The emergence of Multidrug Resistant Tuberculosis (MDR TB) is posing threat to global efforts of TB control. The hilly state of Sikkim has the highest proportion of MDR TB cases in India. Hence there is an emerging need to identify the factors for the rapid rise of MDR TB in Sikkim.

Methods
All the MDR TB cases registered under Revised National TB Control Programme in East district of Sikkim in the first & second quarter of 2019 was compared with double the number of matched controls taken from the same geographical area and ethnicity but not from the same family members.

Results
A total of 78 cases and 156 controls were studied. The mean age of the study participants was 43 years (SD ± 14 years). The most statistically significant risk factors were as follows: overcrowding (OR 2.68); household air pollution (OR 2.55); inadequate ventilation (OR 2.05); previous history of tuberculosis (OR 4.03) with history of relapse/failure; known contact of MDR tuberculosis (OR 4.01); having diabetes (OR 3.96); smoking (OR 3.96)

Conclusions
This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting. Information was obtained on why Sikkim being a small State with very less population and a good per capita expenditure in health has the highest proportion of MDR-TB in India.

Key messages
Sikkim is the smallest state in India with the highest proportion of MDR TB. Previous history of TB with history of relapse/failure, contact of MDR TB emerged as the most significant risk factors.