bluuebunny/crossref_metadata_2025_split huggingface dataset:
An investigation of putative exposure of staff to novel psychoactive substances in a prison
Authors: Mark K , Waugh C , McCormick D , Joyce J 
Published: November 2019

Abstract

Issue
In a prison in Scotland, an increasing number of incidents occurred where staff became unwell secondary to potential exposure to novel psychoactive substances (NPS) smoked by prisoners. There were high levels of concern for the safety of individual staff, and for establishment staffing. NPS use is a significant problem in custodial settings, and impacts individuals and establishments.

Methods
HMP and HPT led an incident response: HMP focused on prevention and direct management of incidents; HPT focused on exposure circumstances, clinical presentation and toxicological testing of symptomatic staff. A protocol was agreed between all agencies involved. Over 8 months, all incidents’ initial assessment and any subsequent clinical and toxicological results were collated and analysed by HPT.

Results
There were 19 incidents involving 16 staff members. Cases presented in clusters, in one instance 13 people presented over 5 days. Five presented in early 2018.
Individuals reported a wide range of non-specific physical and psychological effects; some cases experienced severe impairment of day-to-day function. The most common effects were headache and fatigue but some reported sleep disturbance and confusion lasting up to 72 hrs. There were no significant clinical observations at hospital, and the 3 tests for toxicology were negative.

Lessons
The individuals affected by these incidents experienced physical and psychological distress, and impairment of daily functioning which impacted on the safe function of the establishment. It is unlikely staff presentations were due to toxicological effects from substances used by prisoners. It is possible their symptoms were psychosomatic. This could be further investigated, and consideration given to supportive intervention for staff affected by exposure to NPS. The investigation demonstrated excellent collaborative work between the prison, health services, and forensic laboratories in a novel investigation into NPS exposure in prisons.

Key messages
NPS use, and subsequent exposure to staff, is a growing issue in custodial settings. A combination of supportive interventions for staff, including reduction and mitigation of risk of exposure to NPS, plus control of substances use in prisons can help.
Occupational Eye Trauma: a major public health issue in Rabat, Morocco
Authors: Harrak Y El , Boutimzine N , Cherkaoui L O 
Published: November 2019

Abstract

Occupational eye trauma is a global cause of visual morbidity. According to the WHO, 55 million ocular lesions occur each year, and 1.6 million cases of total blindness caused by trauma. Although common in Morocco, these traumas have not been the subject of recent and targeted investigations.
The objective of our work is to evaluate the frequency of occupational eye trauma per projectile, and to encourage the reinforcement of safety measures. This is a cross-sectional descriptive study, carried out in the Ophthalmic Emergency Department, at the University Hospital of Rabat, Morocco, and including all patients who presented to the same doctor’s consultation, between December 2016 and December 2018. The study involved 914 patients, 406 women and 508 men, with an average age of 36. The average consultation time is 35 days after the onset of symptomatology.
In 2 years, and out of 914 people, 382 (42%) are victims of ocular trauma; and 167 are victims of projectile eye trauma during professional practice, an overall prevalence of 18%, or 51% of all trauma.
The average age was 32 years, 92% of males. The average consultation time was 2 days after the accident. In addition, 75% of consultants for occupational eye trauma have a similar history of trauma, 3 out of 4 people. As a consequence, the study shows that 85% of these patients had a superficial corneal foreign body; 11% presented with a corneal ulcer without individualization of a foreign body; while 4% of these had a corneal wound, an intraocular foreign body and posttraumatic retinal detachment. Therefore, eye trauma is a real public health problem. They account for 42% of consultations, half of which are associated with professional activities, mainly affecting young and active men. If they are benign in most cases, these traumas can nevertheless cause blindness in 4%.
The high number of recidivism (75%) highlights the lack of awareness of the target population for better prevention.

Key messages
The results of this work prove that occupational ocular trauma, avoidable circumstances, are however frequent in our context and can cause severe lesions, with a reserved prognosis. Workplaces with a high risk of eye trauma should strengthen their protective measures and training programs should be put in place for both workers and occupational physicians.
Developing a Patient Advocacy Scale for Nurses
Authors: Sermet E , Kadioglu H 
Published: November 2019

Abstract

Background
Patients can sometimes become defenseless. Patient advocacy is one of the most important roles of nurses in healthcare. No valid and reliable instrument that evaluates nurses’ behavior as patient advocates has been encountered in the literature. The purpose of this study was to develop a patient advocacy scale for nurses.

Methods
This methodological study was conducted in Istanbul over the period October - December 2018 with 500 nurses. Initially, a scale of 57 items was devised after discussions with 14 academic and clinical nurses. The scale was tested for content validity using the Content Validity Index and for construct validity with Exploratory Factor Analysis, after which the scale’s reliability was evaluated for item-total correlations using Pearson’s correlation analysis and for internal consistency with Cronbach’s Alpha.

Results
Content validity index for the scale was found to be .97. The first factor analysis resulted in a 10-factor construct, where the eigenvalue for the scale was greater than 1 and the construct explained 63.43% of total variance. At the end of the factor analysis, items with factor loadings of less than .30 and those that appeared in more than one factor with differences of less than %10 were removed from the scale one by one and the analysis was repeated 18 times. In the last factor analysis of the 39-item scale, a 7-factor construct was found with an eigenvalue greater than 1 that explained 61.3% of total variance. The scale’s item-total correlations ranged between .42 - .75 and Cronbach’s coefficient alpha was calculated to be .95.

Conclusions
The newly developed instrument was found to be valid and reliable. The scale can be used to assess the patient advocacy behavior of nurses working in Turkey. Its intercultural adaptation for use with nurses working in other countries is recommended.

Key messages
The Patient Advocacy Scale for Nurses has been found to be valid and reliable. It can be used to assess nurses’ patient advocacy behavior.
Effectiveness of participatory interventions in improving clinical coordination in Latin America
Authors: Miranda Mendizabal A , Vargas I , Samico I , Eguiguren P , Mogollón-Pérez A S , López J , Bertolotto F , Vázquez M L ,   for Equity LA II
Published: November 2019

Abstract

Background
Evaluation of interventions to improve clinical coordination across care levels is scarce in Latin America.

Aim
to evaluate the effectiveness of interventions implemented through participatory action research in improving clinical coordination between care levels in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay.

Methods
Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN), were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying COORDENA® questionnaire to a sample of primary (PC) and secondary (SC) care doctors (174 doctors/network/year). Designed interventions promoted clinical agreement and communication across levels for patients’ follow-up. Outcome variables: a) intermediate: interactional and organizational factors; b) final: experience of clinical management coordination (care consistency and patients’ follow-up) and general perception of coordination between levels. Poisson regression models were estimated.

Results
Intermediate: interactional factors -personal knowledge and trust on the other care level-increased significantly in Brazil’ and Chile’ INs; and organizational factors -managers’ support- in the INs of Colombia and Mexico. Comparing to CN in 2017, INs of Brazil, Chile, Colombia and Mexico showed significant differences in some factors.
Final: care consistency items -agreement over the treatments- improved in the INs of Brazil, Colombia and Uruguay; and patients’ follow-up in the INs of Chile and Mexico. General perception of clinical coordination increased in the INs of Brazil, Colombia and Mexico. Compared to CN in 2017, only Brazil showed significant differences.

Conclusions
Improvements in intermediate and final care coordination results, consistent with expected results, were observed in all the INs. Reduced implementation time and some process and context factors may have limited their impact.

Key messages
First study assessing the effectiveness of participatory interventions in improving clinical coordination between care levels in public healthcare networks of Latin America. Results showed changes in the intermediate and final clinical coordination results in the intervention networks. Longer implementation and evaluation times are expected to achieve greater impact.
The assessment of the functionality of public health specialists’ activities in schools
Authors: Vladickiene J , Barkauskiene J 
Published: November 2019

Abstract

Background
The role of public health specialists (PHS) working at schools is continually growing to assure better health behavior and disease prevention in adolescent age. The aim of the study: to evaluate the functionality of health care activities performed by PHS at schools.

Methods
Anonymous survey of PHS was conducted in April 2018. Participants of the survey represent PHS working at schools in Lithuania. In total 179 forms where distributed, 139 were included into analysis, response rate - 77.7%. The data were analyzed by using χ2 criterion and the statistical significance p.

Results
PHS stated that past 12 months, bullying was the least important problem for children, but according to the prior plans prevention programs for it were organized most often (40.3%) and sports activity program - least often (21.6%), even though it’s the most relevant children health problem these days. 52.3% of PHS claims that schoolchildren learn the most about keeping good health from them. 44.6% of PHS noted that they aren’t able to do all their responsibilities during working hours, because paperwork takes up most of their time, and too little time remains for communication with the school community. One in three thinks, that they provide services for too many schools, one in seven assumes, that they have excessive requirements. Those who have longer work experience and too much workload were more unsatisfied with work in comparison with those with less work experience and proper workload (p &lt; 0.05). Ability to communicate, knowledge and initiative are marked as the most important features, whilst work experience - as the least important, to pursue required activities of PHS.

Conclusions
Health improvement activities of PHS working at schools do not fully meet the most important health problems of schoolchildren. PHS with longer experience and higher workload indicated more problems regarding their work compared with those that have less work experience and accurate workload.

Key messages
The assessment of the opinion of school community’s on the most important children’s health issues should be analyzed prior to preparing health activities plans in municipality level. Workload of public health specialists working at schools should be optimized according to health activities plans.
Impact of an intervention to activate unemployed people on the use of primary health care services
Authors: Hakamäki P , Impinen A , Lounamaa A , Ståhl T 
Published: November 2019

Abstract

Background
Promoting well-being and health is a key policy instrument in municipalities. There are many ways to support the work ability of long-term unemployed people. Short term subsidized employment (300-500 €/person/month) being one widely used measure. The purpose was to study what kind of influence a short term employment has on the use of social and health care services of long-term unemployed people in sparsely populated area. Specifically, the aim was to investigate the use of primary health care services among people in subsidized employment, intervention (n = 67) and control group (n = 85) during five years period (2012-2016).

Methods
Individual-level data were extracted from registers (age: 19-65 years old, gender: 61 % men, 39 % woman, N = 152). The use of primary health care was examined in the case study by means of annual averages, cumulative percentages and regression analysis.

Results
According to preliminary results, there were differences in the prevalence of primary health care services use and how the use of services changed among intervention and control groups. The use of services in intervention group increased until the end of the intervention year, but decreased in the following year, 2016. The use of services in control group increased until 2016. Regression analysis was carried out to study the change; a year and an intervention for 2014-2016 were made as a predictor. It was found out that the number of visits increased each year by looking at both groups together (p = 0.012). The subsidized employment that started in 2014 had a statistically significant reducing effect on the use of services (p = 0.034) in intervention group in 2014-2016.

Conclusions
Municipalities’ health promotion and subsidized employment work can have positive impact on disadvantaged groups such as long-term unemployed people in sparsely populated area. Creating data for the use of services from local registers was very time consuming and challenging process, but possible.

Key messages
Promoting well-being and health is a key policy instrument in municipalities. Municipalities’ health promotion and subsidized employment work can have positive impact on disadvantaged groups such as long-term unemployed people in sparsely populated area.
Using routine data to benchmark quality and outcomes of diabetes care in the EU HEALTHPROS project
Authors: Carinci F , Meza Torres B , Cunningham S G , Mainz J , Groene O , Massi Benedetti M , Klazinga N S , Kringos D , de Lusignan S 
Published: November 2019

Abstract

Background
The EU-funded Marie Curie project HEALTHPROS aims to foster a new generation of “Healthcare Performance Intelligence Professionals” through a cohesive stream of 13 doctoral projects (www.healthpros-h2020.eu). Over 48 months, researchers will investigate key levers of healthcare improvement in 7 different countries, using methods drawn from the diverse fields of biostatistics, medical informatics and health services research.

Objectives
To describe barriers and enablers in the conduction of two doctoral projects aimed at exploring the impact of personal risk factors and organizational arrangements on lower extremity amputations in diabetes, through the use of large-scale databases from England, Scotland, Denmark and Germany.

Results
The research plan included a systematic review, structured comparison of data sources, predictive modelling and software development for automated international comparisons. Barriers encountered by researchers were: knowledge and access to data sources from different countries, dealing with data protection rules and the ability to carry out international comparisons when individual records are not easily allowed to leave national boundaries. Enabling factors included: a targeted educational process for risk modelling in diabetes and a multidisciplinary support team to help doctoral students overcoming the above barriers across different sites. Further clinical insight and contextual knowledge of data systems in place at different locations were needed in addition to the statistical, epidemiological and technical skills initially foreseen by the program.

Conclusions
The success of studies within a general educational program on health systems performance may depend from the continued support of a multidisciplinary team helping students in their educational process as well as with the practicalities of their research. International comparisons using routine data may require prioritisation to meet the tight timelines of doctoral theses.

Key messages
Academic programs for international comparisons in health care may be hampered by different type of barriers including technical aspects, legal regulations and a range of contextual factors. The establishment of multidisciplinary support teams may be essential for training doctoral students aiming to conduct international comparisons using routine data.
Waiting times for diagnosis and surgery in a large obstetric-gynecological hospital in Italy
Authors: Scaioli G , Bert F , Plazzotta C , Corezzi M , Voglino G , La Valle G , Rabacchi G , Falco S , Scarmozzino A , SIliquini R 
Published: November 2019

Abstract

Issue
Diagnostic testing and surgical waiting times are related to quality of healthcare services. An extension of waiting times, indeed, could lead to a diagnostic or therapeutic delay, with potential consequences on patient health outcomes. Several policies have been implemented in different European countries in order to improve these indicators. Our study aims to analyse the waiting times of the largest obstetric and gynaecological hospital of Northern Italy, in order to identify potential issues in women’s health services.

Description of the problem
Data of “Sant’Anna Hospital” (Turin, Italy) about the waiting times in the period 2016-2017 for outpatient and surgical services addressed to women were collected. Specifically, number of health care procedures and mean waiting times (MWT) for “Obstetric-Gynaecological Echography” (OGE), “First Endocrinological Visit” (FEV), “First Gynaecological Visit” (FGV), “Surgical Intervention for Breast Cancer” (SIBC) and “Surgical Intervention for Uterus Cancer” (SIUC) were retrieved. Results were compared with the benchmark identified by the regional law.

Results
A total of 21,735 OGEs were performed, with a MWT of 3 days in 2016 and 5 days in 2017, below the benchmark (11 days). The total number of FEVs was 1,234, with a MWT of 19 and 23 days in 2016 and 2017 respectively, again below the benchmark (30 days). The FGVs were 21,096 with a MWT of 9 (2016) and 24 (2017) days (benchmark 30 days). The number of SIBCs (N = 89) performed within 30 days (benchmark) were 87 (98% of SIBCs), while SIUCs (N = 90) were 84 (93%).

Lessons
The waiting times of the “Sant’Anna hospital” were, for all the performances considered, shorter than the regional benchmarks. This is an indicator of the quickness of diagnosis and treatment and, indirectly, of the quality of care. An international comparison among the main European hospitals should be encouraged in a perspective of continuous improvement of health care provided to European citizens.

Key messages
Diagnostic testing and surgical waiting times are useful to assess the quickness and quality of health care provided in European hospitals. “Sant’Anna hospital”, leader for women’s health care, provides care with waiting times shorter than benchmarks. It would be interesting to compare its results with other large European hospitals.
Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review
Authors: Schröder S L , Hoebel J , Roick J , Markert J , Spallek J , Knesebeck O v.d. , Richter M 
Published: November 2019

Abstract

Background
The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population.

Methods
This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria.

Results
The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged.

Conclusions
The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians.

Key messages
Socioeconomic inequalities in the utilisation of physicians exist and differ between primary and specialist care. Inequalities to the disadvantage of the population with low SES are more pronounced in the utilisation of specialists compared to general practitioners.