bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing inequities in community health worker’s interaction and its impact in Uttar Pradesh, India
Authors: Gupta S , Tomar S , Dey A , Chandurkar D 
Published: October 2020

Abstract
Given the high Neo-natal mortality in the state of Uttar Pradesh, India, an emphasis has been given to community health workers (CHW). CHW provides behavior push to pregnant women for utilizing health services, through the strategies of household contact and messaging. However, the disparity in health outcomes and interaction of CHW is profoundly affected by socio-economic determinants; still, the evidence is limited. This study aims to explore socio-economic inequities in quantity and quality of contacts by the CHW and its differential effect on health service utilization.
Multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of Uttar Pradesh(n = 3703). Regression models described the relation between household demographics and CHW contact & specific messaging and interactions of demographics and CHW contact & messaging in predicting health service utilization ( &gt; = 4 antenatal care (ANC) visits, Institutional delivery and 100 iron folic acid (IFA) consumption).
No differential likelihood in contact of CHW and specific messaging is found. Further, association of CHW contacts and specific messaging with health outcomes were significantly affected by socio-economic determinants.2 or more contacts along with specific messaging increased the odds of 4+ ANC to a higher degree among illiterate women compared to literate women(AOR:3.39, 95% CI:2.28-5.04 vs AOR:1.44, 95% CI:1.09-1.92). Similarly, the odds of facility delivery increased to a higher degree among lower wealth women compared to higher wealth women (AOR:3.41, 95% CI:2.47-4.71 vs. AOR:1.53, 95% CI: 1.09-2.15).
Specific messaging, along with CHW contacts, have a higher magnitude of effects on the marginalized population. This study provides evidence for adjusting implementation strategies based on socio-economic determinants to achieve equitable health service utilization. However, further research on training of CHW on heterogeneous interaction is recommended

Key messages
There exists differential effects of quantity and quality of contact by community health workers on health service utilization across the different socio-economic strata. Implementation agencies in the LMIC can reduce health inequity by shifting from coverage-oriented target approach towards more prioritized and focused interaction across socio-economic groups.
Combining participatory research and Intervention Mapping to improve adolescents’ sleep behavior
Authors: Vandendriessche Anneke , Deforche B D , Verloigne M V 
Published: October 2020

Abstract

Background
Adolescent sleep deprivation is an important health concern, urging the need to develop effective interventions. Combining a participatory approach (i.e. actively involving the adolescents) and Intervention Mapping (IM) may improve effectiveness. Therefore, the aim of this study was to describe the development of an intervention to improve adolescents' sleep behavior that combined a participatory approach with IM. Secondly, we evaluated the participatory process, based on focus group research in adolescents.

Methods
In three secondary schools in Flanders (Belgium), an action group with 6-8 pupils and an academic facilitator had weekly sessions with the aim to co-create an intervention, following IM. Three focus groups within each action group were organized throughout the development process. Data were thematically analyzed using NVivo 12.

Results
During the sessions, each action group went through the different steps of IM: identifying the problem (step 1: needs assessment), deciding on what should be changed (step 2: program objectives) and how it can be changed (step 3: methods and applications), and designing the intervention (step 4: program development). Most adolescents were positive about the content of the sessions, the methods used, the level of participation and the collaboration with the others. Still, they felt more satisfied during the final, more concrete steps. Also, they seemed to lack support from their schools.

Conclusions
The unique approach of combining participatory research with IM is a promising way to develop an intervention to improve adolescents' sleep. Further research needs to investigate if it leads to more effective and sustainable interventions.

Key messages
Going through the different steps of Intervention Mapping in cooperation with adolescents is a feasible approach to develop an intervention to promote healthy sleep in adolescents. Adolescents mostly describe participating in the development of a healthy sleep intervention through Intervention Mapping as a positive experience.
The importance of respecting accreditation indicators to improve quality of care
Authors: Marino A F , Centurione E , Cofano R , Garau L , Ferrara A , Pannese C , Raimondi A , Verlengia L , Rivolta S , Castelli B 
Published: October 2020

Abstract

Issue
The health and social-care facilities (HSF) of the Lombardy Region provide services specifically conceived for fragile populations, including elderly, disabled, addicts etc. Through its Accreditation Units, the Agency for Health Protection (ATS) in the Metropolitan City of Milan is responsible for overseeing authorization and accreditation indicators of HSFs in all afferent districts. Assessed requirements include the qualitative standard (presence of mandatory professional figures) and the quantitative standard (guaranteed weekly minimum time of care per patient) of operating staff, based on current legislation.

Description of the problem
These standards are evaluated at site-inspection by examining staff qualifications and by matching staff working hours to actual daily presence of patients, randomly selecting a recent past week. The resulting standards may thus not be fully representative of the whole year. In 2019, the Health and Social-care facilities Accreditation Unit of ATS began a retrospective quali-quantitative analysis of health service staffing data for 2017 and 2018. Data were extrapolated from two main databases: “Scheda Struttura”, a data collection tool regarding work hours, qualifications, waiting lists etc. compiled yearly by HSF managers; and economic data detailing reimbursements by the regional health service, based on effective daily presence of patients at the HSF.

Results
Preliminary results relating to 2017 showed that around 4% of HSFs do not guarantee qualitative staffing standards, and almost 30% do not guarantee quantitative staffing standards throughout the year.

Lessons
The proposed tool is useful for emphasizing potentially critical situations and may help define the annual inspection schedule with the aim of continuously improving quality of care among regional HSFs.

Key messages
Data management tools can help local health authorities monitor and identify facilities at risk of falling below the defined standards of care. Qualitative and quantitative analysis of health service staffing is useful for emphasizing potentially critical situations and may help define the annual inspection schedule.
For which population groups will strong identification and thus eHealth services use not be possible?
Authors: Vehko T , Lilja E , Parikka S , Aalto A-M , Kuusio H M 
Published: October 2020

Abstract

Background
Digital services are expected to improve the availability of public social and health care services in many European countries as well as in Finland. eHealth and eWelfare services often require strong electronic identification which may form barriers in the availability of care. This study focuses on recognising population groups who are vulnerable to exclusion either by not having access to web or by lacking a strong electronic identification.

Methods
The data were gathered from the cross-sectional survey on well-being among people aged 20-64 with foreign background (PFB) (FinMonik), conducted in Finland 2018-19 (N = 12 877; response rate 53%). The data from the National survey of health, well-being and service use (FinSote 2017-18) were used as reference data for the overall population, (N = 26 422, response rate 45%). Surveys asked respondents “Do you have at your disposal internet access at home, your workplace, library or some other place?” and 'Do you have at your disposal online banking codes or a mobile certificate for electronic identification online?”. PFB were defined by background country into seven country-groups. The age-standardized proportions with confidence intervals were examined by socio-demographic background variables.

Results
Almost all (98%) of the overall population reported access to internet, but the proportion was lower (92%) among PFB (p &lt; 0.001). Proportion of having a strong electronic identification was higher among general population (98%) than among PFB (88%) (p &lt; 0.001). In both populations, younger age increased the likelihood of having a strong electronic identification. PFB students reported lower level of strong electronic identification compared to the employed.

Conclusions
Although most had access to internet and a strong identification, there were statistically significant differences between country-groups and by employment status.

Key messages
Designing and developing of eHealth and eWelfare services must ensure that everyone has the opportunity to have a strong electronic identification. Development of digital services requires user guidance, which takes into account the varying needs and operating environments.
Femtech Fatale: Access to Femtech in Public Health Insurance Systems
Authors: Tonti L 
Published: October 2020

Abstract
From a smartphone ping signifying the start of a fertile window to controlling a breast pump with a few clicks in a mobile app, “femtech” has readily integrated into women's daily lives. Femtech, a term coined to describe the realm of technology catering to female health needs, encompasses a range of digital technology addressing women's health, including fertility tracking, pregnancy and nursing counseling, and online contraception provision. While femtech puts autonomy and information in the hands of its users, access to the technology is not yet equitably distributed.
As insurance reimbursement can increase and equitize that access, this research examines what legal duties exist for increasing access to femtech. In analyzing how insurance schemes have integrated femtech, this research compares how select femtech products fare across reimbursement systems, using fertility algorithm, smart breast pump, and pelvic floor trainer case studies in the U.S, U.K, and Sweden.
Insights reveal a duty to promote access to femtech, as well as varying degrees of integration in respective health systems. Insights also reveal which elements of the female life course are overlooked in reimbursement schemes.

Key messages
Femtech has the power to put agency and information in the hands of millions of women. Yet, access is not equitable given significant financial and regulatory barriers. Comparative studies of fertility algorithms, smart breast pumps, and pelvic floor trainers in international health systems demand increased advocacy to realize the duty to enable femtech access.
Mobile Apps for Vaccination: an in-depth scan of Apple App Store
Authors: Catozzi D , Gualano M R , Voglino G , Corradi A , Bert F , Siliquini R 
Published: October 2020

Abstract

Introduction
In a recent estimation, time spent engaging with smartphones is 3h43m in 2019 in US population, surpassing conventional media such as TV. However, smartphones are not just a distraction from everyday life, but also a powerful tool by which to search for information and interface with institutions and services providers. National Healthcare Systems are not an exception, in particular for tackling vaccine hesitancy and fake news: in this frame, we have focused our research on mobile apps for vaccination.

Methods
We scanned Apple App Store through an API (Application Programming Interface) made available from Apple Inc. itself searching single words related to vaccination (no Boolean operators available) from both Italian and English-speaking markets, then exporting and merging the results. The univocal 121 apps obtained were then classified according by category, description, target population, informative materials and n° of reviews.

Results
The majority of apps falls under the “organizer” category (49 apps, 40.5%) with almost half of them (22) with vaccination as main topic (vaccine reminders and recorders), the others as part of a health management tool, mostly designed for parents. Just 32% of these apps give information regarding vaccines or preventable diseases. The second one is medical education apps (26.4%) focused on healthcare workers with guidelines and updates, mainly in English, then games (11.6%), Local Healthcare Service booking services (9.1%) of which only 4 from Italy, and lastly travel management apps (2.5%).

Conclusions
Organizers and reminders are a recognised tool to increase vaccine adhesion, but a complete plain-language information should be provided together with the service, to answer the most frequently asked questions from parents and dispel their doubts. In the meanwhile, Italian NHS results rarely adequate in providing a fully digital experience, from planning shots to registration of vaccine status.

Key messages
Mobile vaccination organizers are a helpful tool for parents, but they are undervalued as a first-hand source of knowledge about vaccination programs. Italian NHS should develop a modern mobile interface in order to book vaccination services as a big nudge towards the increase of vaccine adherence.
Socioeconomic inequalities in type 2 diabetes among different population subgroups
Authors: Safieddine B , Sperlich S , Beller J , Lange K , Epping J , Tetzlaff J , Tetzlaff F , Geyer S 
Published: October 2020

Abstract

Background
Type 2 diabetes (T2D) is a rising global epidemic with lower socioeconomic status (SES) groups being more affected. Considering specific population subgroups to examine prevalence and SES inequalities in T2D is rare. In addition, using only one indicator to depict SES inequalities in health has been a common practice despite evidence on differences in what different indicators measure. This study examines the prevalence of and SES (school education, occupation and income) inequalities in T2D in the three population subgroups: employed individuals, nonworking spouses and pensioners. This study also determines the SES indictor with the highest explanatory power.

Methods
This study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. T2D prevalence in the period between 2013 and 2017 was examined in 1,345,841 employed individuals, 180,949 nonworking spouses and 773,427 pensioners. Multivariate logistic regression analysis was applied to examine SES inequalities in T2D in the three subgroups. Explanatory power of the three SES indicators was compared by deviance analysis.

Results
T2D prevalence was four times higher in male nonworking spouses (24.2%) and 2.6 times higher in female nonworking spouses (12.7%) compared to employed men (6.4%) and women (4.7%) respectively, while it accounted for 40% of men and 36% of women in pensioners. Clear gradients in T2D inequalities emerged for all three SES indicators and were observed in the three population subgroups. School education had the highest explanatory power in employed men and women and male nonworking spouses.

Conclusions
Nonworking spouses are an important target group in T2D prevention interventions. The three SES indicators differ in their explanatory power where low school education appears to be a major risk factor. It can be discussed that health literacy and the associated health behavior play a role in mediating the association between education and T2D.

Key messages
The population subgroup “nonworking spouses” is an important target group for type 2 diabetes prevention interventions. The level of school education is a substantial determinant of socioeconomic inequalities in type 2 diabetes.
Health professional mobility and the Global Code of Practice: joint EUROSTAT/OECD/WHO survey data
Authors: Williams G , Jacob G , Scotter C , Rakovac I , Wismar M 
Published: October 2020

Abstract

Background
This study assesses the impact and continuing relevance of the Code of Practice on the International Recruitment of Health Personnel in the WHO Europe region by analysing trends over time in intra- and inter-regional health worker mobility.

Methods
Data from the joint EUROSTAT/OECD/WHO questionnaire are analysed to determine 1) the proportion of foreign-born and foreign-trained doctors and nurses working in WHO Europe Member States, 2) trends in health workforce mobility over time by country of origin and destination, and 3) how the Global Code has impacted mobility patterns.

Results
The size of the foreign-trained health workforce in Europe varies widely, with foreign-trained doctors comprising over a quarter of the workforce in Norway, Switzerland and the UK, but below 2% in Estonia and Serbia. While annual in-flows across the region have been stable since 2009, the share of foreign-trained doctors and nurses have both increased by over 30%. Mobility between The Commonwealth of Independent States has remained steady, but an increase in East-West and South-North migration is observed, driven by European Union expansion in 2004 and the economic crisis. Migration of health workers into Europe from developing countries covered by the Code has fluctuated, with increased numbers seen from some origin countries (e.g. Nigeria, Pakistan). Some Western countries remain reliant on a foreign-trained health workforce. This contributes to a high outward flow of health professionals from other European countries and creates challenges for sustainable workforce development.

Conclusions
The Global Code remains highly relevant, but other factors have more impact on migration flows, such as free movement in the EU. Health workforce mobility data can be improved to support a 'whole of workforce' approach to policy and planning by including more professional groups, and by adding qualitative indicators, e.g. individual perceptions and intention to leave.
Struggles for a universal health system in Brazil: successes, obstacles and setbacks
Authors: Machado C V , Silva G A 
Published: October 2020

Abstract
Brazil is a populous middle-income country, characterized by deep economic and social inequalities. Like most Latin American nations, Brazil historically constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare, which only covered formal workers. This study analyzes the implementation of a universal health system from the mid-1980s to the present, focusing on the context, political agendas, government orientations, and actors. Research techniques included a literature review, interviews with national health authorities, analysis of documents and selected health indicators. In the 1980s, against the backdrop of democratization, Brazil's health reform movement proposed a Unified Health System (SUS), which was incorporated into the 1988 Constitution. The combination of a democratic system with opportunities for interaction between various developmental and social agendas and actors has played a key role in shaping health policy since then. However, the expansion of public services has been hampered by insufficient public funding and by the strengthening of the private sector, subsidized by the state. Private enterprises have expanded their markets and political influence, in a process that has accelerated in recent years. Despite these obstacles, SUS has produced significant health-status improvements and some reductions in Brazil's health inequalities. A combination of long-term structural and contingent factors, international agendas and interests, and domestic political struggles, explains the advances and obstacles to building a universal system in an economically important yet unequal peripheral country. Further consolidation of SUS and reduction of health inequalities hinge on the uncertain prospects for democracy and national development, on enlarging the political coalition to support a public and universal health system, and on strengthening the state's ability to regulate the private sector.

Key messages
The implementation of a universal health system in Brazil has favored health improvements but has been hampered by insufficient funding and by state subsidies to the expansion of the private sector. A combination of structural and institutional factors, international and domestic political agendas and interests explains the advances and obstacles to building a universal system in Brazil.
The Health Survey for England in 2020, tracking children’s health for 30 years
Authors: Moody A , Mindell J , Scholes S , Ng Fat L 
Published: October 2020

Abstract

Background
Prior to their inclusion in the Health Survey for England (HSE), there was a dearth of information about children's health in England. Official data recorded use of health services and uptake of national programmes such as school vaccinations. Birth cohorts provided longitudinal data, including risk factors and non-clinical measures, but were spaced far apart due to cost. The annual HSE has been tracking child health since 1995 and the health of older adolescents (aged 16-19) since the surveys began in 1991. The survey uses a multi-stage design to deliver a nationally-representative random probability sample of the general population in private households in England. Over 110,000 children aged 0-15, and 16,000 16-19-year olds have been interviewed since 1995 and 1991 respectively. Questionnaire content has varied, but includes general health and longstanding conditions, smoking and drinking, fruit and vegetable consumption, physical activity, respiratory problems, childhood diabetes, and parental perception of strengths and difficulties. Regular measurements include infant length, height and weight, blood pressure and cotinine levels.

Results
As well as general monitoring overall and across socioeconomic groups, e.g. height, weight and obesity, HSE data have been used to infer the impact of government policies on child- and adolescent-health, e.g. changes to smoking legal age, advertising, and the smokefree law. This presentation describes in more detail the sample, measurement protocols, questionnaire, published results and research-policy case studies such as the smoking ban. Novel results using the full sample as a synthetic cohort, tracking BMI, smoking, drinking, and general health, are presented for the first time.

Conclusions
Child health monitoring, in terms of trends, inequalities and policy evaluation; is enhanced by regular surveys representative of the general population, which include both subjective and objective measures.