bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding how to improve the use of clinical coordination mechanisms between levels of care
Authors: Esteve-Matalí L , Vargas I , Plaja P , Cots F , Mayer EF , Pérez-Castejón JM , Escosa A , Ramon I , Abizanda M , Vázquez ML 
Published: October 2021

Abstract

Background
Clinical coordination mechanisms (CCM) can play an important role in improving clinical coordination between primary (PC) and secondary care (SC) doctors, being necessary to understand the reasons hindering their use. The aim is to analyse the level of use of CCM, and the difficulties and factors associated to it.

Methods
Cross-sectional study based on an online survey using the COORDENA-CAT questionnaire (October-December 2017). Sample: 3308 doctors of the Catalan national health system. Outcome variables: frequent use of six CCM and difficulties in their use. Explanatory variables: sociodemographic, labour characteristics, organizational and interactional factors. Stratification variable: level of care. Analysis: descriptive bivariate and multivariate by logistic regression.

Results
The level of use differed according to the CCM and level of care, being lower for the different cross-level consultations (via electronic medical record -EMR: 52.36%, email: 26.11% and phone: 21.73%). Shared EMR of the organisation (81.27%) and of the region (65.89%), and joint clinical case conferences (63.28%) were the most frequently used, especially by PC doctors, and the ones presenting more difficulties in use. While the difficulties pointed to organizational problems, mostly related to computer and schedule problems, the analysis of factors pointed also to some individual factors. Working in integrated areas or with local hospitals were factors positively associated with the use of CCM. Interactional factors, such as personally knowing the other level doctor, were associated among SC doctors.

Conclusions
The use of CCM differed across mechanisms and level of care, and was clearly improvable. Difficulties and factors affecting their use were mostly organizational, so managerial support is required to create the appropriate conditions for their use. It is also important to strengthen interaction between doctors of different care levels to improve the use of CCM.

Key messages
The level of use of CCM differed according to the mechanism and level of care, and was clearly improvable. This study identifies difficulties and factors affecting their use, mainly organizational. These results are useful for managers promoting strategies to improve clinical coordination by the effective implementation of CCM, which require managerial support and interaction between doctors.
Socioeconomic differences in metabolic syndrome development and the role of perceived stress
Authors: Hoveling LA , Liefbroer AC , Bültmann U , Smidt N 
Published: October 2021

Abstract

Background
Metabolic syndrome (MetS) incidence strongly varies by socioeconomic position (SEP), but to date, no studies have assessed the mediating role of perceived stress from long-term difficulties (chronic stress) in this association. This study examines the mediating role of chronic stress in the associations between SEP measures education, occupational prestige and income, and incident MetS and whether the associations between chronic stress and MetS are moderated by sex.

Methods
An adult subsample (n = 53,216) of the Lifelines Cohort Study without MetS at baseline was used. MetS incidence was measured at follow-up (median follow-up time 3.9 years) defined according to the NCEP-ATPIII criteria. Chronic stress was measured with the Long-term Difficulties Inventory (LDI) and consists of 12 items evaluating (on a 3-point Likert scale) to what extent various domains of life had been perceived as stressful during the last year. Direct associations between SEP, chronic stress and incident MetS were estimated using multivariable logistic and linear regression analyses, adjusted for age, sex, the other SEP measures and follow-up time. The mediating percentages of chronic stress explaining the associations between SEP and incident MetS were estimated using the Karlson-Holm-Breen method.

Results
At follow-up 7.4% of the participants developed MetS. Years of education and occupational prestige were inversely associated with MetS incidence. Chronic stress suppressed the association between education and MetS incidence (5.4%) as well as the association between occupational prestige and MetS incidence (6.0%). No effect modification of sex in the chronic stress-MetS pathway was observed.

Conclusions
Chronic stress does not explain educational and occupational differences in developing MetS. In fact, individuals with more years of education or a higher occupational prestige perceive more chronic stress, compared to their lower SEP counterparts.

Key messages
Education and occupational prestige are inversely associated with metabolic syndrome incidence. Chronic stress does not explain SEP differences in developing metabolic syndrome.
Sociological approach of differential care in Down syndrome screening based on maternal place of birth
Authors: Sauvegrain P , Cognet M , Azria E 
Published: October 2021

Abstract

Background
In recent years, differential care in the field of perinatal medicine between women from sub-Saharan Africa and natives, such as suboptimal screening of preeclampsia or more frequent use of C-section have been identified. The objective of this study, in connection to the other parts of the BiP project, was to document differential care between these categories in regard with information on Down syndrome screening.

Methods
Prospective qualitative study by audio-recording and/or observation of prenatal visits, ultrasound examinations and genetic screening consultation, and semistructured explicitation interviews with care providers was conducted in 3 maternity units in Paris area. Two midwives and 2 obstetricians in each unit were included, such as their patients who consent to participate. The content of the consultations was classified thematically, and the interviews were analyzed using the grounded theory framework.

Results
47 prenatal visits, 19 ultrasound examinations and 11 genetic screening consultations have been audio-registred and/or observed. Participation rate was 85% for the women. Semi-structured explicitation interviews were conducted among 11/12 care providers. Despite a probable inclusion bias (participants were informed of the purpose of the research and were volunteers), differences in care provider - patient interactions according to women's place of birth have been identified. A tendency to speak more loudly with women with lower French proficiency was noted and less detailed information on the screening strategy and on Down syndrome was provided. The use of an interpreter was very rare in situations of language barrier, challenging the information quality on Down syndrome screening.

Conclusions
Beside showing differences in care provider - patient interaction according to women's place of birth, this study provides an opportunity to discuss the benefits and limitations of qualitative approaches to the study of differential care.
The other side of COVID-19: a cross-sectional study on mental health in a sample of Italian nurses
Authors: Renzi E , Baccolini V , De Vito C , Migliara G , Marzuillo C , Villari P , Massimi A 
Published: October 2021

Abstract

Background
The COVID-19 pandemic and the resulting drastic increase in the workload for healthcare professionals, particularly nurses, has had serious consequences on the psychological well-being of these professionals. Our study aimed at (i) identifying demographic, work-related factors, and clinical predictors of Post-traumatic stress disorder (PTSD) and Generalized Anxiety Disorder (GAD) in nurses employed during COVID-19 pandemic and (ii) assessing problem-focused coping strategies implemented by nurses.

Methods
We carried out a cross-sectional study between December 2020 and April 2021, addressed to nurses employed during the COVID-19 second wave (October - December 2020). PTSD and GAD were assessed by Social Readjustment Rating Scale, Impact of Event Scale - Revised (IES-R) and General Anxiety Disorder -7 scale.

Results
Overall, 359 nurses were included in the study, whose mean age was 31.75 years (SD ± 9.77). Most were female (80.8%), unmarried (53.2%) and employed in the central (52.5%) and northern (36.4%) regions of Italy. A total of 59.7% of all participants had clinical predictors of PTSD, recording a mean score of IES-R of 38.2, SD ± 19.2, range 1- 84 (cut-off &gt;33 for PTSD). Furthermore, 45.6% of respondents reported moderate - severe symptoms consistent with generalized anxiety disorder. Statistical significance was found between GAD and nurses being employed on the front line (Intensive care unit and emergency department) during the COVID-19 second wave (p = 0.016), and between GAD and clinical predictors of PTSD (p = 0.001). Furthermore, we found a statistically significant association between PTSD and nurses who were employed in hospitals or institutions dedicated to COVID-19 (p = 0.028).

Conclusions
PTSD and GAD represent a public health problem to be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

Key messages
The levels of PTSD symptoms and anxiety among nurses were high during the pandemic. It is necessary for health systems to differentiate between temporary and long-term mental disorders in order to provide the health workforce with appropriate rehabilitation.
Mapping levels of COVID-19 vaccine hesitancy worldwide: preliminary results of a systematic review
Authors: Massimi A , Renzi E , Baccolini V , De Vito C , Migliara G , Marzuillo C , Villari P 
Published: October 2021

Abstract

Background
Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants.

Methods
A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328).

Results
Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively.

Conclusions
Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies.

Key messages
Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance.
Perinatal mental health services for mothers from ethnic minority and migrant backgrounds
Authors: Soltani H , Watson H , Fair F , van den Muijsenbergh M , Papadakaki M , Jokinen M , Sioti E , Raben L , Burke C , Vivilaki V 
Published: October 2021

Abstract
Perinatal mental health disorders are among the most common morbidities of the perinatal period with considerable adverse effects on mothers and their offspring. Members of ethnic minority groups, particularly those from migrant backgrounds, are at higher risk of developing mental illness with evidence of ongoing inequality in access to support. We will present an exploratory mixed-methods study scoping ethnic minority and migrant women's experiences accessing perinatal mental health services in the UK. Results showed how women perceived access to services as very challenging and how they experienced ‘suffering in silence', a ‘need for a safe space to talk and to be listened to', and a ‘need of finding other women like them'. We will complement these findings with the lessons learned from a related project, a three-site European study (ORAMMA) evaluating the feasibility of implementing an integrated perinatal care model for migrant mothers comprising maternity peer supporters (MPSs)-women from migrant backgrounds who had lived in the country for a longer time and were trained to support other migrant women during the childbearing continuum-. Results showed that MPSs supported migrant women accessing maternity care, overcoming language barriers, and advocating for them in their encounters with healthcare professionals. Besides, they provided emotional support and increased women's confidence, helping them overcome loneliness, encouraging them to build relationships with others and promoting bonding with the new baby. Bringing these two projects together, we will discuss how MPSs have the potential to help overcome barriers that immigrant women experience in seeking perinatal mental health and how the benefits of maternity peer supporters have the potential to reduce perinatal mental health risks amongst migrant mothers. Findings will point to the need for future research to evaluate the direct impacts of MPSs on immigrant's mother perinatal mental health.
7.C. Workshop: Dashboards for COVID-19: Lessons learned
Authors:   Organised by: EUPHA-PHMR, PHIRI, Norwegian Institute of Public Health, Sciensano (Belgium), HealthPros Network, WHO/Europe,   Chair persons: Heidi Lyshol (Norway), Petronille Bogaert (EUPHA-PHMR)
Published: October 2021

Abstract

Visual analytics dashboards illustrate analytic processes, compiling huge amounts of data to visualize trends and occurrences, aiming to present both specialists and the general public with critical information using a quick and efficient modality. The resulting views, that could comprise graphs, time lines, different kinds of charts and diagrams or maps, can be shared with many users and stakeholders, and are meant to help to better communicate statistics, actionable results and disseminate information. During the COVID-19 pandemic, we saw an emergence and rapid development of analytical dashboards for epidemiological and public health monitoring purposes. They were initiated by public health institutes, academia, media outlets, international organisations and/or citizen initiatives, and were generally open to all interested parties, both inside and outside the public health field. Public, web-based COVID-19 dashboards allow for communication on a large scale, to and between data providers and public health organizations, and to citizens, journalists and special interest groups, such as patient organisations and have therefore been widely adopted during the pandemic. The plethora of such dashboards (around 200 in April 2021) have showcased the limitations and difficulties inherent in the format, which may be related to the differing rationales, the heterogeneous definitions and widely varying choice of indicators that are included, along with shifting practices over the waves of the pandemic, from diagnosis to testing to vaccination rates. This has highlighted the need for collaboration between public health authorities, the field of medical informatics and academic groups when developing epidemic dashboard tools opened to a large public. This workshop will address the theoretical aspects behind the use of visual analytical dashboards. We will show examples of dashboards, with the goal of understanding and comparing the main reasons driving their development, maintenance and improvements. We will show how the choices of indicators, the access to data, the technology used as well as how time pressure and expectations, including from policy makers, were handled. Finally, we will make recommendations on how existing dashboards, both pre- and post COVID-19, can be adapted to handle the data needs of the next international incident or pandemic, and also look at the broader picture, namely he policies underlying the whole picture.

Key messages
Dashboards are a useful tool, used extensively to support decision-making during the COVID-19 crisis. These dashboards must be fine-tuned to make policy response possible.
Health-related lifestyles: how they have changed after the COVID-19 pandemic occurring in Italy
Authors: Minardi V , Contoli B , Possenti V , Lana S , Luzi P , Masocco M 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has fully affected the global community and will generate long-term consequences on social and individual life overall.

Methods
Since their start, the two Italian population-based surveillance systems PASSI (18-69yy) and PASSI d'Argento (65+) have investigated health-related lifestyles. The continuous monthly data collection allows observation of changes in the short, medium and long terms. We compared prevalence of tobacco and alcohol use, physical activity, PA, or inactivity, PI, before and after March 2020, to evaluate temporal trends with particular concern to changes due to the pandemic.

Results
Sedentariness has been growing among inactive adults but in pandemic time, we observed a 10% significant reduction compared to 2019, due to a significant increase of spare time PA from 42% (2019) to 45% (2020) and a reduction of spare time PI from 42% to 39%. Despite a stable trend, elderly increased significantly PI, from 40% (2019) to 43% (2020). PI goes from 46% to 52% among Southern residents and from 45% to 53% in poorly educated people. Since 2008, at-risk alcohol consumption gradually increased in adults because of binge-drinking and between meals modalities. In 2018, a tendency inversion started and finds confirmation during the pandemic: binge-drinking decreases significantly from dal 9.5% (2019) to 8.2% (2020), between meals from 9.4% to 8.6%. During the pandemic, elderly increase alcohol consumption significantly, from 39% (2019) to 45% (2020), attributable to changes in moderate use by women: 17% in 2019 vs. 25% in 2020 overall; from 20% to 30% in highly educated and from 15% to 21% in poorly educated. It seems the pandemic did not change smoking percentages.

Conclusions
Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases that, even in pandemic, represent the main burden to disability and deaths in Italy.

Key messages
Monitoring the impact of the COVID-19 pandemic is crucial to understand strategies for tackling behavioural risk factors for noncommunicable diseases. Having an ongoing Behavioral Risk Factor Surveillance System is an opportunity to misure and evaluate the impact of a shock as Covid-19 pandemic.
Trends in obesity among adults in Estonia, 2000–2018
Authors: Pärna K , Kender E 
Published: October 2021

Abstract

Background
The global rise of obesity has serious health effects as high body mass index (BMI) is an important risk factor for cardiovascular diseases, diabetes, many cancers and musculosceletal disorders. The aim of this study was to describe trends in the prevalence of obesity and to explore prevalence of obesity according to age group, nationality and education in Estonia in 2000 − 2018.

Methods
This study was based on 25 − 64-year-old adults (n = 20,901) of the postal cross-sectional surveys of Health Behaviour among Estonian Adult Population in 2000-2018. The standardized (European population) prevalence of obesity (BMI at least 30 kg/m2) with 95% confidence intervals (CI) was calculated for each study year. Chi-square test for trend was used to find statistically significant changes (p &lt; 0.05) in the prevalence of obesity over the study period. Joinpoint regression analysis was used to calculate annual percentage changes (APCs) to identify whether there was a significant change in the prevalences.

Results
The prevalence of obesity increased significantly in 2000-2018 from 14.3% (95% CI 11.1-17.9) to 22.8% (95% CI 20.1-25.7) among men (p &lt; 0.001) and from 17.7% (95% I 14.8-20.8) to 18.9% (95% CI 16,8-21,1) among women (p = 0.023). Standardized prevalence of obesity in 2018 was 22.2% among men and 17.9% among women. Joinpoint regression analysis showed that the increase in obesity was statistically significant among men (APC=4.4%, 95% CI 0.8-8.1) in 2000-2008 and among women (APC=1.8%, 95% CI 0.1-3.5%) in 2000-2014. Obesity among men increased significantly in older age groups, among Estonians and non-Estonians and in the group with secondary education, but among women among Estonians and in the group with secondary education.

Conclusions
Obesity increased significantly among 25-64-year-old adults in Estonia in 2000 − 2018. To avoid an epidemic of obesity, a well-thought-out health policy should be implemented in Estonia.

Key messages
Obesity increased significantly among 25–64-year-old adults, especially among men, in Estonia in 2000 − 2018. A well-thought-out health policy should be implemented to slow down and to stop the increase of obesity in Estonia.