bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surveillance of health and primary care of asylum seekers in reception centers: concept and results
Authors: Jahn R , Bozorgmehr K 
Published: November 2019

Abstract

Background
Reliable data on health and primary care among asylum seekers in reception centers are essential for the planning and provision of medical services, but haphazard care provision and lack of standards for health information systems in these centers preclude routine health monitoring. We aimed to establish a routine surveillance system in reception centers for asylum seekers in Germany, generating multi-center data on key health indicators.

Methods
To enable routine health surveillance, we established an electronic medical records system (RefCare©), a research network, and an IT-infrastructure for the automated analysis of health data in German reception centers. Within the network, 64 health and health care indicators on morbidity, care processes, quality of care and syndromic surveillance were identified. In November 2018, we analyzed 33 indicators using routine health data from nine centers in three federal states. We calculated single-center prevalence and pooled estimates for selected morbidity indicators stratified by age and sex, and process and quality indicators stratified by center.

Results
A total of 8,406 patients and 39,449 patient contacts were analyzed, with mean utilization of health services ranging from 2.33 (Standard deviation, SD: 2.0) to 11.49 (SD: 22.82). The morbidities with the highest prevalence were respiratory, digestive and certain infectious diseases, followed by consequences of external causes, musculoskeletal and mental health conditions. Irrational use of antibiotics was below the threshold for primary care settings.

Conclusions
For the first time in Germany, a harmonized infrastructure for the automated, anonymized surveillance of the health and health care of asylum seekers in reception centers was established in several federal states. The analysis of morbidity indicators shows a primary care-typical disease profile, with special needs regarding mental health and consequences of external causes, such as physical trauma.

Key messages
Routine health surveillance of asylum seekers in reception centers can be achieved through an innovative harmonized, cross-regional, multi-center, anonymous and automated surveillance system. Health issues of asylum seekers in reception centers in Germany mainly consist of primary care conditions with special vulnerabilities regarding mental health and consequences of external causes.
Treatment gap and mental health service use among Syrian refugees in Turkey
Authors: Fuhr D C , Ataturk C , McGrath M , Ilkkursun Z , Woodward A , Sondorp E , Roberts B 
Published: November 2019

Abstract

Introduction
Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey.

Methods
A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used.

Results
The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported.

Conclusions
To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness.

Key messages
This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.
Participatory practice with queer refugees in Germany
Authors: Gangarova T 
Published: November 2019

Abstract

Evidence shows that queer refugees in Germany neither have equal access to the health system, information, HIV-Testing and treatment, nor are they involved in HIV-Prevention. The community-based participatory health approach provides a valuable tool for building capacity and enabling queer refugees to create knowledge and develop appropriate prevention tools for their communities.
“Your health, your rights” (2017-2018) is a 2-year community-based participatory health project, which aims to improve the involvement of queer refugees in HIV-Prevention, as well as to create appropriate prevention media in collaborative way. It is conducted by the National AIDS Organization in collaboration with partners from different immigrant organisations, queer refugees and AIDS service organisations - all based in Berlin.
The components of the project include a multilingual participatory need assessment workshop, a series of capacity-building methodological workshops, a community-led art-based project and a participatory evaluation.
12 queer refuges choose to take part in the project and have been supported to document their lived experiences using community and concept mapping. Key topics and needs connected to sexual health have been jointly identified. Based on these results and in the framework of an art-based workshop participants created a design of multilingual website for queer refugees which delivers helpful information in appropriate way (www.queerrefugeeswelcome.de).
The involvement of queer refugees in HIV-Prevention is possible, if it is enabled. The usage of participatory visual methods has opened up ways of participation of even highly traumatised refugees who otherwise are not able to verbally express their thoughts and enabled the communication between participants who don’t share the same language.

Key messages
The resources of queer refugees are identified and mobilised and community building processes are supported. The participants improved their competencies (empowerment). Service providers are able to tailor their services better to the needs of queer refugees.
Multiple interventions to strengthen immunization services in an Angolan district
Authors: Fattorini M , Raguzzoni G , Cuccaro C , Nante N , Quercioli C , Ndilimondjo J M N , Caresia C , Putoto G 
Published: November 2019

Abstract

Background
Immunization represents one of the most effective intervention in public health. In the Sustainable Development Goals era, adequate vaccination services are still crucial for the prevention of infectious diseases and the reduction of under-5 mortality. However, in 2017 WHO estimated that children &lt;1 year who did not receive the third dose of Diphtheria-Tetanus-Pertussis (DTP3) vaccine were 19.2 million globally, and 600000 of these were located in Angola, a Sub-Saharan country with an estimated DTP3 coverage of 52%. Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activity of the hospital of Chiulo in the commune of Mucope (district of Ombadja, south of Angola). Aim of the study is to describe the interventions implemented to strengthen the immunization services performed by the hospital Public Health Staff (PHS).

Methods
In May 2018 the NGO started to implement multiple interventions to enhance the number of vaccine doses administered. Firstly, outreach immunization sessions were reorganized and reinforced, for example involving local Community Health Workers in the identification of villages with a high burden of unvaccinated children. Other actions were the continuous training of the PHS in data collection and the increased collaboration with the Ombadja District Health Department in order to develop a more efficient vaccine supply chain at local level.

Results
In 2018, among children &lt;1 year the PHS administered 19746 doses, with a 22.3% growth compared to 2017 (15349 doses). Doses administered during outreach sessions increased by 35.4% (6597 versus 4259 doses). Estimated DTP3 coverage in Mucope commune was 71% (2017, 59%).

Conclusions
The WHO “Reaching Every Community” strategy emphasizes the importance of high quality immunization services in hard-to-reach areas. The organisation of well-functioning immunization services requires a multifaceted approach by the involved stakeholders.

Key messages
In 2017, globally 19.2 million of children &lt;1 year did not receive the recommended three DTP doses. Six-hundred thousand were located in Angola. To obtain and sustain an adequate vaccination coverage, especially in hard-to-reach areas, multiple and well-coordinated actions should be implemented by all the involved stakeholders.
Towards a deliberative approach in public health policy making
Authors: Van Hoof W , Mayeur C 
Published: November 2019

Abstract

The time when public health policies could be based solely on expert opinion has gone. Public opinion has a real impact on the effectiveness of public health policy. However, for complex issues such as vaccination, screening, GMO’s, privacy and data governance, public opinion is divided. How to integrate divided public opinions into a well-structured health policy? In Belgium, as in many other countries, policy makers have started to turn to deliberative processes to guide policy making with citizen involvement, especially in ethically contentious areas.
Deliberative processes aim to involve citizens in policy making in a setting where individual opinions and interests are weighed honestly and fairly, so that through well informed deliberation common ground can emerge. Participants are informed by a neutral information package, a variety of experts and facilitated discussions. In a very transparent way, these positions are molded into tailored policy inputs. In Belgium, such initiatives have recently been organized on biobanking, genomics, e-health, reimbursement policies and more. In France, the government is obliged by law to organize a comprehensive deliberative public consultation on bioethical issues every seven years.
Especially in areas that require a large degree of trust, a deliberative approach ensures policies that can be supported by people with diverse views. They offer a viable alternative to traditional models of power and conflict that is more suitable to governance in 21st century democracies. They allow citizens to make a meaningful contribution to topics they may not have been familiar with beforehand, but that do touch on their private lives and interests.
The most recent Belgian initiative resulted in nine concrete policy inputs for the implementation of genomics in health care, presented directly by the citizens to the Minister of Public Health. The French initiative is the basis for the current review of the law on bioethics in parliament.

Key messages
Public health issues touch the interests of all citizens: citizen deliberation should be regarded as an important input for public health policies. A deliberative approach enhances public trust, especially in areas of social or ethical contention.
Health is not for sale, is it?
Authors: Plochg T , Hinrichs-Krapels S , Keijsers J 
Published: November 2019

Abstract

Issue/problem
Health is not for sale, given that one cannot buy health as a guaranteed commodity. Human beings co-produce their health every day together with their (social) ecosystems. As such, being healthy is a co-adaptive, complex, and self-organizing enterprise. However, our current economies thrive on citizens who consume themselves ill, and buy health care to fix their diseases. With spiralling costs of healthcare, a shift is urgently needed towards making a business case for health.

Description of the problem
From 2014 onward, the Dutch Federation for Health invested in the development of a business case for health. They explored the following questions: 1) Why is a business case for health warranted? 2) What could such a business model theoretically look like? 3) How could it be co-created in practice?

Results
We found there is a business case to keep diseases going, driving healthcare expenditure up. Literature suggests that this business case for disease is untenable. Inevitably we need new incentives that keep ‘health’ going rather than disease. We need a mechanism to make the business care for health. We have begun to model one approach named the ‘vitality contract’, featuring 10 organizational principles which provide guidance on how to construct the right market structure for health to be co-produced and sold on the premises of an ecosystem. The Federation for Health has been championing this vitality contract, and succeeded to get it on the national policy agenda. However, co-creation is essential for it to work: only few coalitions have risen to the challenge to make such a ‘vitality contract’ work in practice.

Lessons
The business case for health is needed. The vitality contract might provide one approach to demonstrate how it could be co-created in different local contexts and different public health systems. To be more impactful, further co-creation and collaboration from national coalitions and other European countries may be required.

Key messages
With spiraling costs of healthcare, a shift is urgently needed towards making a business case for health. The Dutch ‘vitality contract’ might provide one approach to demonstrate how a business case for health could be co-created.
Importance and feasibility of implementing child and parent centeredness in routine care
Authors: Eichinger M , Goerig T , Georg S , Philippi H , De Bock F 
Published: November 2019

Abstract

Background
Child and parent centeredness (CPC) are important determinants of the quality of care for children with chronic health conditions. However, little is known about the perceptions of healthcare professionals on the importance and feasibility of implementing CPC in routine care, although both might be key for the successful implementation of CPC. We therefore assessed the perceptions of healthcare professionals concerning this matter and analysed, how familiarity with the International Classification of Functioning, Disability and Health (ICF) might strengthen CPC.

Methods
Cross-sectional data was collected in 12 specialized interdisciplinary outpatient centres providing treatment for children with chronic health conditions in Germany. The standardized questionnaire covered (1) the importance of implementing child (CC) and (2) parent centeredness (PC) as well as (3) the feasibility of implementing CC and (4) PC in routine care (based on Arnetz et al. 2008, Patient Involvement Subscale) and (5) the prior use of the ICF. Bivariate associations were assessed with permutation tests.

Results
In total, 206 healthcare professionals were surveyed (response rate: 47 %). The perceived feasibility of implementing CPC fell short of their importance (p &lt; 0,001). Moreover, CC was ranked lower than PC in terms of both importance and implementation feasibility (p &lt; 0,001, respectively). Prior use of the ICF was associated with higher importance of CC (p &lt; 0,001) and PC (p = 0,01).

Conclusions
While the importance of CPC to healthcare professionals was high, the active involvement of children and the routine implementation of CPC were perceived as challenging. Interventions to facilitate the implementation of CPC should therefore comprise hands-on implementation strategies and put a special focus on how to involve children in routine care (e.g., through special communication techniques). Including the ICF as a conceptual framework in interventions to foster CPC could be a facilitator.

Key messages
While child and parent centeredness are important to healthcare professionals, their implementation in routine care and the active involvement of children are challenging. Interventions to foster the implementation of child and parent centeredness should include concrete practical implementation strategies and put a special focus on the involvement of children.
The necessity of applying Rasch measurement theory in questionnaire-based public health research
Authors: Finbråten H S , Kleppang A L , Steigen A M 
Published: November 2019

Abstract

Background
Questionnaires are frequently used in public health research. In order to provide valid and reliable results to generate recommendations for practice and policies, scales with sound psychometric properties are required. Classical test theory such as factor analysis is most frequently used to assess the psychometric properties of scales. However, classical test theory may have limitations in confirming the validity of scales. Only Rasch measurement theory meet the requirements of fundamental measurement, such as additivity, invariance, sufficiency and specific objectivity. The objective is to exemplify how Rasch measurement theory can be used to evaluate the psychometric properties of a scale. Validation of the Hopkins Symptom Checklist-10 is used as an example.

Methods
This study is based on cross-sectional data from the Youth Data Survey. In total, 6777 adolescents responded to a web-based questionnaire. Data collection was carried out in lower and upper secondary schools in Norway during 2018. The data were analysed using the partial credit parameterization of the unidimensional Rasch model.

Results
Preliminary results indicated that the scale had acceptable reliability (person separation index: 0.82). However, one pair of items shows response dependence. The targeting could have been better (mean person location: -1.445). All items had ordered thresholds. Three items under-discriminated. Several items displayed differential item functioning with regard to gender and school level.

Conclusions
Applying Rasch measurement theory measurement problems that would go undetected using classical test theory approaches were observed. Scales used in public health research should be thoroughly validated applying Rasch measurement theory before the data are used to support claims about public health and used to provide recommendations for policy and practice.

Key messages
Public health practice and policy should be based on information from valid and reliable scales. Rasch measurement theory should be used to evaluate psychometric properties of scales used in public health research.
Impact of the Govan SHIP case management project on emergency hospital admission and GP interactions
Authors: Levin K , Crighton E 
Published: November 2019

Abstract

Background
The Social and Health Integration Partnership (SHIP) project was implemented in Govan, a deprived area in Glasgow in 2015. This involved multidisciplinary teams, including GPs and social workers, identifying and supporting vulnerable patients at risk of attending A&E and GP surgeries. This study measures the impact of SHIP on A&E presentations and GP interactions.

Methods
Rate of A&E presentations per 1000 population in 3 participating GP practices in Govan was compared before and after onset of the service, using segmented linear regression with 9-month pre- and 36-month post- intervention periods. Rates of GP interactions were also compared, using 21-month pre- and 36-month post- intervention periods. Rates of A&E presentations and GP interactions for practice population in Drumchapel- an area with similar rates of deprivation - were used as a control. Models included autoregressive and moving average terms, and a fourier term to adjust for seasonality.

Results
Govan had a lower rate of A&E presentations than Drumchapel. A&E presentations did not change significantly over time prior to SHIP in either area. At April 2015, SHIP onset, a level change of -4.34 (-7.44, -1.24) A&E presentations per 1000 was observed in both areas, however , onset of SHIP was not associated with a reduction in level or trend in A&E presentations. Rate of interactions with GP was greater in Govan than Drumchapel prior to SHIP, increasing over time in both areas. After SHIP implementation there was a significant level change of 33.78 (19.57, 47.99) per 1000 across both areas. GP interactions in Govan however saw a further reduction of -1.48 (-2.87, -0.09) per 1000 per month. This is equivalent to SHIP being associated with an absolute reduction of 37 GP interactions per thousand and a relative reduction of 7.2% by March 2018.

Conclusions
The Govan SHIP initiative was associated with no significant change in A&E presentations and some small reduction in GP interactions.

Key messages
The Govan SHIP initiative was associated with no significant change in A&E presentations and a small significant reduction in GP interactions. A cost effectiveness analysis of the project is recommended, given the relatively small benefits observed.