bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design primes to change health behaviour - Using aesthetic features for health behaviour change
Authors: Rehn J , Schuster K 
Published: October 2021

Abstract

Health behaviour is a crucial aspect regarding overall health and well-being. However, the role of aesthetics and the built environment in relation to this is often neglected. Disciplines such as consumer psychology use aesthetic features of objects and environments such as colour, lighting and haptic structures to increase sales, customer loyalty and brand awareness in various contexts. In many cases these designs prime a certain mental concept to influence subsequent thoughts, feelings and behaviours. While there is a growing body of literature regarding the profound effect these design decisions can have from a consumer perspective, this knowledge is hardly used in the context of health promotion. In contrary, in settings such as schools, universities and hospitals, the built environment does prime specific mental concepts however often randomly and without designers being aware of it. In a series of experiments in (a) a university (n = 83) and (b) a clinical context (n = 36), participants were confronted with primes (positive vs. negative) in the shape of lecterns that were supposed to prime health related mental concepts such as sense of control and health-related behaviour. In the clinical context participants confronted with positive primes mentioned significantly more sport-related words in an association task. Furthermore, the primes seem to influence whether participants choose healthy vs. unhealthy rewards after the task. In the university setting, for some resiliency related items (e.g. motivation regarding planned behaviour) students answered significantly more positively standing at the lectern resembling the positive prime. Although, only mild effects could be found, these results indicate that objects and interiors might influence health behaviour by priming certain mental concepts. More research is needed especially on the role of duration, intensity and extent of the design intervention for using objects to prime health behaviour change.

Key messages
The design of the built environment can be seen as a prime that might influence health behaviour change. In the context of public health, evidence-based and research driven design can be an effective tool for health behaviour interventions.
The Role of Community Health Workers in the COVID-19 Response in the Caribbean, an exploratory study
Authors: Rise N 
Published: October 2021

Abstract

Background
Pandemics begin and end in communities and to manage them, community engagement must be a priority. The use of community health workers (CHWs) during the COVID-19 response is key to engaging communities and strengthening their capacity to limit the spread of disease. Integration of CHWs into health systems is a key enabler and integral to their success and requires inclusion of CHWs into health policies. This thesis aims at exploring the role of CHW in the COVID-19 response in the Caribbean countries to identify practices which can potentially form basis for subregional policy and contribute to capacity building within human resources for health and health system strengthening in the subregion.

Methods
An exploratory study using a mixed-methods approach of reviewing policies and grey literature detailing COVID-19 community health initiatives, and key-informant interviews (KIIs) in the Caribbean.

Results
Preliminary results from the policy review finds that CHWs have been widely used in infection prevention and control, as well as for providing psycho-social support to vulnerable populations and supporting the delivery of basic health services. However, few formal policies on the work of CHWs are available. KIIs are yet to be conducted and may yet contribute new knowledge.

Conclusions
While CHWs have been widely used during the COVID-19 response in the Caribbean, the apparent lack of formal policies may be a barrier to their success. Developing such policy will not only strengthen community health interventions against COVID-19, but also support Caribbean countries in how to strengthen their post-COVID-19 health workforces and improve sanitary emergency response preparedness. The findings of this exploratory study can contribute to developing health policy guidelines on CHWs in the Caribbean.

Key messages
Community health workers are key for engaging and supporting communities and vulnerable populations during the COVID-19 pandemic. Lessons learned on community health workers during the COVID-19 pandemic should be integrated into health policies to strengthen the health workforce and improve sanitary emergency preparedness.
An overview of burden of disease studies in Europe
Authors: Charalampous P , Gorasso V , Plass D , Monteiro Pires S , Von der Lippe E , Pallari E , Mereke A , Devleesschauwer B , Haagsma J 
Published: October 2021

Abstract
Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: non-communicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area “European region”) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop.
A systematic literature review of burden of disease studies in Europe: next steps and implications for researchers
Authors: Devleesschauwer B , Charalampous P , Gorasso V , Plass D , Monteiro Pires S , Von der Lippe E , Haagsma J 
Published: October 2021

Abstract
Facing the considerable variation in the computation of disability-adjusted life years (DALY), the European Burden of Disease Network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key variations in the assumptions used in the European burden of disease (BoD) assessments. The studies were evaluated in terms of pre-defined criteria, focusing on data sources used and on specific methodological and normative choices to assess BoD. Preliminary results show a wide variety in methodological assumptions used to quantify DALYs, but also important inconsistencies in the reporting of methods and particular assumptions. For instance, the quantification of uncertainties is not a common practice, even though most authors seem to be aware of the uncertainty in their DALY estimates and discuss uncertainties as an important study limitation. When uncertainties were quantified, different approaches were used, and described using inconsistent nomenclature. The results of the SLR show that there is a clear need for standardized reporting guidelines for DALY estimates. Such a tool could be based on quality assessment checklists already in place for clinical trials and observational studies (PRISMA, STROBE, CRD), and would require inclusion of the DALY's key methodological and normative choices. Standardized DALY reporting guidelines could serve multiple purposes. First and foremost, they would allow to increase the quality of reporting, thereby increasing the transparency and comparability of BoD studies. As a reference document, such guidelines would also help to harmonize nomenclature, which would further increase transparency and comparability. Last but not least, it would also serve as a capacity building tool, supporting researchers in understanding which methods and assumptions underlie the DALY metric. To address this need, the burden-eu network aims to play a driving role in the development of standardized DALY reporting guidelines.
Relationship between clinical record completeness and occurrence of adverse events within hospitals
Authors: Mellace F , Scarpis E , Brunelli L , Tullio A , Cautero P , Londero C , Farneti F , Valent F , Cocconi R 
Published: October 2021

Abstract

Introduction
Clinical record (CR) is an appropriate source for adverse events (AEs) detection and Italian law requires its compilation. Its completeness is used as an indicator of the quality of care provided and offers guidance on system changes to improve professional practice. This study aimed at assessing the completeness of CRs, describing AEs' rate and triggers, and investigating the relationship between CR completeness and the occurrence of AEs.

Methods
A retrospective review of CRs was conducted, randomly selecting patients discharged from Internal Medicine (IM), General Surgery (GS) and Obstetrics (O) between June and September 2020 at the Academic Hospital of Udine (Italy). The completeness of CRs was assessed using a 65-items checklist developed by the hospital Quality Unit. Triggers and rate of AEs were detected by using Global Trigger Tool. Relationship between AEs and completeness of CR was analyzed using nonparametric tests.

Results
Among 93 reviewed CRs, 91.4% were from the GS, 5.4% from IM and 3.2% from O. Patient mean age was 64.6±18, women were 51.6%. The average completeness of CRs was 50.4% [30.4%-83.5%]. Identified triggers and AEs were 125 and 29 respectively, with at least one AE every 23.7% admissions, 31.2 AEs per 100 admissions and 40 AEs per 1000 patient-days. The most frequent AEs were surgical damage (51.7%; 15) and hospital-acquired infection (24.1%; 7). Hospitalization length for patients with at least one AE was 12.6 days, whereas it was 6.3 days without AEs. A significant positive correlation (R = 0.36; p &lt; 0.001) was found between length of hospitalization and number of AEs. The increase in CR completeness is associated with the decrease of the total number of AEs (R=-0.18; p = 0.083).

Conclusions
These findings suggest a direct association between the number of AEs and the length of hospital stay. The correlation between CR completeness and AEs suggest that patient safety could benefit from the improvement of clinical record compilation.

Key messages
More studies are needed to understand if the occurrence of AEs to patients may cause a prolonged length of hospitalization. A better compilation of CRs should allow to reach a more effective communication between healthcare workers, creating a work environment less prone to errors and AEs.
Audit and feedback strategies: study protocol and preliminary results from the EASY-NET project
Authors: Agabiti N , Grilli R , Valent F , Ciccone G , Marchesini Reggiani G , Marenzi G , Di Carlo C , Bramanti P , Davoli M 
Published: October 2021

Abstract

Background
In Italy there is evidence of a large variability in health care services and health outcomes. This multi-regional project is funded on Ministry of Health and Health Regional Authorities (code NET-2016-02364191). The aims are: 1) To test the effectiveness of Audit and Feedback (A&F) interventions in improving health professional practices and patients' outcomes in different settings using both a quantitative and a qualitative approach. 2) To examine factors that may explain variations in the effectiveness of A&F. 3) To evaluate the impact of A&F in reducing avoidable differences in access to effective health care interventions in socioeconomically disadvantaged populations.

Methods
In the 7 participating Regions (about 33 million inhabitants) experimental study designs have been implemented in different clinical areas (e.g. before-after controlled study, cluster randomized trial): in Lazio emergency care and chronic diseases care, in Friuli Venezia Giulia emergency care, in Piemonte oncology care, in Emilia Romagna chronic disease care, in Lombardia cardiovascular care, in Calabria deliveries and maternal health, in Sicilia emergency care. The effectiveness of different types of A&F are compared in term of outcomes using health information system databases.

Results
Preliminary results show large heterogeneity in developing and conducting A&F, in term of team project composition, type of intervention, clinicians' behavior to be changed, outcomes indicators, professionals involved, structure and timing of data reporting, actions to be implemented after the intervention. Limited awareness and interest of clinicians in A&F interventions was found.

Conclusions
The project represents a unique opportunity to explore how A&F interventions could be better designed. Different A&F strategies will be compared in term of clinical outcomes. The identification of barriers/facilitating factors will supply knowledge on mechanisms and tools to enhance A&F effectiveness.

Key messages
The project supports providers in reducing gap between knowledge and practice. The project promotes culture of interprofessional collaboration as a key point for high quality care.
Hospital hand hygiene monitoring: internal audits and the role of public health residents
Authors: Moro M , Vigezzi GP , Chiappa F , Salvati S , Cocciolo G , Oradini Alacreu A , Capraro M , Nizzero P , Odone A , Signorelli C 
Published: October 2021

Abstract

Background
Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions.

Methods
San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication.

Results
8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data.

Conclusions
Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19.

Key messages
Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.
The impact of smoking on mortality in the face of population ageing: the example of Germany
Authors: Mons U 
Published: October 2021

Abstract

Background
Despite weak tobacco control, smoking in Germany has steadily declined over the last 25 years. As policymakers often expect that this trend will also reflect in a declining associated public health burden, I sought to quantify trends in smoking-attributable mortality (SAM) and to explore the impact of population ageing.

Methods
Smoking and mortality statistics from 1992 to 2018 were obtained from the German Statistical Office, from which SAM was calculated separately for each cause of death causally associated with smoking using Levin's formula for population-attributable fractions. The impact of population ageing was explored by comparing crude and age-standardized SAM, respectively. To estimate the impact of population ageing on future SAM, a forward projection until 2040 was modelled assuming continuation of smoking trends and constant mortality rates.

Results
About 126.900 deaths were attributable to smoking in Germany in 2018. Since 1992, total SAM declined only slightly, while stronger decreases were seen in age-adjusted SAM. Differences between crude and age-standardized SAM seem to be particularly striking in men. The forward projection of SAM suggests that recent increases in smoking in the middle aged as well as population ageing dynamics will lead to further steady increases within the next two decades in both sexes to about 138.250.

Conclusions
Results indicate that past decreases in SAM due to declines in smoking were largely compensated by population ageing. In the next two decades, current smoking trends and population ageing will lead to a steady increase in SAM. Only by taking determined immediate policy action could significant inroads into reducing the smoking-associated disease burden be achieved. Also, given still significant smoking rates in middle and old age, there is tremendous potential to curb the associated public health burden by intensifying cessation programs.

Key messages
Contrary to common expectations among policymakers, the smoking-attributable public health burden will strongly increase in the next decades in Germany. Determined immediate policy action is required to halt or attenuate these trends.
Health literacy needs among unemployed adults: Triangulating interview and scoping review data
Authors: Samkange-Zeeb F , Singh H , Lakeberg M , Kolschen J , Schüz B , Zeeb H , Christianson L , De Santis K , Brand T 
Published: October 2021

Abstract

Disadvantaged populations, including unemployed adults, often exhibit low levels of health literacy. Exploring subjectively perceived health literacy needs in these populations can serve as an entry point for participatory intervention development. We aimed to assess health literacy needs of unemployed adults by triangulating qualitative interviews data and a scoping review. Using a parallel approach, we combined results of an interview study with 10 participants of a job-reintegration program in Germany and a scoping review. The interviews, conducted in early 2021, focused on health topics of interest to the participants and their sources of health-related information. Data were analysed using thematic analysis. For the scoping review, we searched MEDLINE, CINAHL, PsycInfo and SCOPUS up to January 2021 for studies containing “unemployed” AND “health literacy” in titles/abstracts. Study selection and data extraction were done independently by two researchers. Nutrition and physical activity emerged as core themes during the interviews, with some participants referring to the importance of both for mental health. Doctors and the institution running the job-reintegration program were the sources of health-related information often mentioned. The Corona pandemic was reported to have limited physical activity and affected psycho-social well-being. Five out of 2696 studies were included in the review. Four focused on mental health literacy, the fifth assessed information seeking practices in unemployed adults. The qualitative analysis revealed that health literacy needs of unemployed adults go beyond mental health literacy. As nutrition and physical activity impact mental health, interventions targeting such topics might also improve mental health literacy in unemployed adults. Study findings will be discussed with unemployed persons and social workers in co-production workshops that aim to identify and prioritize health literacy needs for intervention development.

Key messages
Health literacy programs for unemployed adults should target nutrition and physical activity. Workforce re-integration programs play a pivotal role in improving health literacy of unemployed adults.
Socioeconomic inequalities in health: the role of daily hassles and the importance of health
Authors: Verra SE , Poelman MP , Mudd AL , de Vet E , de Wit J , Kamphuis CBM 
Published: October 2021

Abstract

A low socioeconomic position (SEP) adversely affects health outcomes and is associated with a lower perceived importance of health. It has been suggested that people with a low SEP disproportionately face daily hassles, as a result of which health may be perceived as less important for those with a low SEP compared to those with a high SEP. A lower perceived importance of health likely influences health-related behaviours that affect health outcomes. This study examines whether socioeconomic inequalities in self-assessed health are mediated by daily hassles and/or the perceived importance of health, and whether there is sequential mediation of daily hassles and perceived importance of health. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults. Participants rated the extent of eleven commonly experienced daily hassles (e.g., financial hassles, legal issues), and indicated the perceived importance of two health-related domains (not being ill, living a long life). Inequalities in self-assessed health according to SEP (indicated by income and education) were examined using structural equation modelling, with daily hassles and perceived importance of not being ill or living long a life either as single or sequential mediators. Daily hassles and perceived importance of health individually mediated the relationship between SEP and self-assessed health, but importance of health did not mediate the association between by daily hassles self-assessed health. Socioeconomic inequalities in self-assessed health were explained by the experience of daily hassles, and by differences in the perceived importance of health individually, but the perceived importance of health did not explain the influence of the experience of daily hassles. Addressing the challenging circumstances (e.g., financial or housing hassles) associated with a low SEP, may contribute to improving self-assessed health. Further research should examine how daily hassles affect health.

Key messages
Daily hassles and the perceived importance of health mediated the relationship between socioeconomic position and health. There was no association between daily hassles and the perceived importance of health.