bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Emergency Room’s overcrowding
Authors: Pedrazzoli G , De Luca A , Messina G , Guerreschi E M , Lorenzini C , De Marco M , Baragatti L , Leoncini F , D’Urso A , Nante N 
Published: October 2024

Abstract

Introduction
The ageing of the population and the consequent increase in the epidemiology of chronic diseases pose numerous challenges at both hospital and territorial levels. In this context, one phenomenon that deserves particular attention is the frequent use of emergency services by ‘frail’ people. The aim of our study was to identify the most frequent users of the University Hospital’s Emergency Room (ER) of Siena, based on their care at territorial level.

Materials and methods
A retrospective study was carried out on the data of accesses to the ER of the University Hospital’s of Siena from June to September 2023. Patients were stratified according to the number of admissions, excluding those with only one admission during the study period. After identifying those with four or more accesses, the USL-TSE management system ‘Astercloud’ was used to check whether they were in integrated home care (ADI) or planned home care (ADP). Descriptive analysis was performed using STATA software.

Results
During the study period, 2347 patients were admitted to the ER, 78.95% had two admissions, 14.96% had three, 4.26% had four, 1.24% had five, 0.34% had six, 0.13% had seven, 0.09% had eight and, finally, 0.04% had eleven admissions. 93.1% of the sample had fewer than four admissions (2,204 patients), while 6.1% had four or more admissions (143 patients). Of the 143 patients studied, 16.1% were in home care, 13.3% in ADI and 2.8% in ADP. 36.8% of patients in ADI died within 4 months of the last admission during the period studied.

Conclusions
Our results suggest that the identification of people at risk of frequent use of the ER seems essential. Equally important is the existence of effective coordination and cooperation between hospitals and the community, with special attention to certain categories of patients. All of this is aimed to achieve overall appropriateness and therapeutic effectiveness, thus avoiding inappropriate admissions to the ER.

Key messages
• Significance of identifying individuals prone to frequent use of emergency services to underscore the need for proactive management strategies to address their healthcare needs.
• Coordination and cooperation between hospital facilities and community-based services to enhance appropriateness of care and reduce inappropriate Emergency Room admissions.
Factors influencing an advanced nursing practice service for people with intellectual disabilities
Authors: Schulenkorf T , Ilskens K , Nadolny S , Gröndahl A , Grunwald M , Palmdorf S , Borchardt N , Grebe C , Maaß A , Latteck Ä-D 
Published: October 2024

Abstract

Background
People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention.

Methods
We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA.

Results
Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary.

Conclusions
This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network.

Key messages
• APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients.
• Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.
Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study
Authors: Rijpkema C , Ramerman L , Peters L L , Muris JWM , Colde Hartman T , Homburg M , Bos I , Verheij R A 
Published: October 2024

Abstract

Background
The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care.

Methods
In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses.

Results
Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021.

Conclusions
Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics.

Key messages
• Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care.
• This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.
Managing no-shows in healthcare: insights from an urban Health District in Northern Italy
Authors: Ragusa P , Russotto A , Catozzi D , De Angelis A , Durbano A , Orecchia S , Siliquini R 
Published: October 2024

Abstract

Background
Non-attendance at healthcare appointments, known as no-show, poses significant challenges to healthcare systems, disrupting patient care continuity, exacerbating waiting times, and straining resources. Addressing this issue is crucial for optimizing health care delivery and containing costs. This study explores the phenomenon of patient no-shows and aims to identify factors associated in a densely populated healthcare district in Turin, Northern Italy.

Methods
Data were extracted from the healthcare management system covering outpatient care appointments in the health district in 2022 and 2023. The analysis included various patient and service-related variables. Missing information on key variables were managed with listwise deletion. Descriptive statistics provided an overview of missed appointment rates, while multivariate analysis explored various patient and service-related variables.

Results
A 5.1% (n = 6198) no-show rate was observed out of 120,405 records. The total cost incurred due to missed appointment fees amounted to €127,244. Several factors were associated with a significantly increased likelihood of no-show (p &lt; 0.05), including initial visit (OR = 1.11), deferred priority (OR = 1.22), non-exempt status from healthcare co-payments (OR = 1.36), exemption based on income (OR = 1.82), age under 18 (OR = 2.46) and under 65 (OR = 2.32), male gender (OR = 1.17), residency outside the Piedmont Region (OR = 1.31) and outside Italy (OR = 2.46), and longer waiting time (OR = 1.01).

Conclusions
This study sheds light on the widespread issue of patient no-shows and its economic implications. It provides clear direction for implementing tailored interventions in healthcare settings. As a response to these findings, a telephone recall project was launched. Its efficacy will be evaluated in subsequent assessments to determine if it can effectively alleviate the burden of no-shows, thus enhancing healthcare efficiency and ensuring continuity of care for patients.

Key messages
• The no-show phenomenon has important implications both organizationally and economically.
• The magnitude and major determinants of patient no-shows must be recognized to guide the deployment of tailored interventions in a real-world setting.
Cost-effectiveness analysis of Chagas disease screening in pregnant women and their infants in Italy
Authors: Nurchis M C , Heidar Alizadeh A , Raspolini G M , Marraffa P , Dentato M , Olivo L , Gianino M M , Damiani G 
Published: October 2024

Abstract

Background
Currently, Chagas disease (CD) is widespread in European nations that host notable populations from Latin America. Vertical transmission is a pathway for the spread of the disease in countries where it is not endemic. Due to socio-economic disparities, CD is a public health concern in non-endemic regions, raised by migration phenomena in vulnerable population groups who face similar hindrances as those most at risk in endemic areas. The aim is to evaluate the cost-effectiveness of CD screening versus no screening in pregnant women and their infants in Italy.

Methods
A Bayesian Markov model was employed to compare the CD screening versus the no screening alternative. Model parameters were sourced from pertinent scientific literature. A lifetime perspective was adopted, aligning with the perspective of the Italian National Health Service. The Eurozone threshold was applied. Costs and benefits were discounted at a rate of 3%. Gibbs sampling served as the algorithm for Bayesian inference. Uncertainty was addressed through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI), depicted via the Cost-Effectiveness Acceptability Curve (CEAC) and Expected Value of Perfect Information (EVPI). Results were presented as the Incremental Cost-Effectiveness Ratio (ICER).

Results
The base case results showed that CD screening was cost-effective, with an ICER of €5,112 [€1,850 - €10,043]. Furthermore, according to the CEAC, the screening option exhibited the greatest probability of being cost-effective across all thresholds. Additionally, the EVPI per mother was €818 based on a threshold of €50,000/diagnosis.

Conclusions
Implementing a structured CD screening program also in non-endemic countries has the potential for early detection and treatment. This contributes to SDG 3 by improving access to healthcare, preventing transmission, and reducing the disease burden as well as informing public health policies for marginalised populations.

Key messages
• This study proves that screening for CD in pregnant women and their infants in a non-endemic area is a cost-effective strategy and possibly cost-saving in the long term.
• Study findings could support a wider implementation of CD screening in Italy by informing health policy-makers in their decision-making process.
Documenting the availability and accessibility of reproductive health services for youth in Albania
Authors: Doci F , Foster A M 
Published: October 2024

Abstract

Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth.

Key messages
• Lack of knowledge and awareness prevent youth from accessing SRH services.
• Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.
Mapping patient pathways for NCDs from a policy perspective: a novel multinational initiative
Authors: Danhieux K , Monnet F , Safadi H , Surján C , Varga G , Lám J , Van Olmen J , Wouters E 
Published: October 2024

Abstract

Background
Chronic diseases like CVD and DM pose global health challenges. Understanding patient pathways is vital for effective disease management and reducing morbidity and mortality. However, until now, comprehensive multinational mapping of patient pathways from a policy or regulatory perspective in the context of chronic disease has not been undertaken. Previous investigations into patient pathways mainly focused on the perspective of individual patients, assembling trajectories of those patients, but did not delve into how these pathways were designed.

Methods
Patient pathways for CVD and DM will be mapped across 11 countries: Belgium, Finland, France, Hungary, Iceland, Italy, Latvia, Poland, Romania, Slovenia, and Spain. Using a survey tool, detailed descriptions and diagrams of healthcare pathways will be collected, stratified by Kaiser Permanente health pyramid strata. Stakeholder interviews on policy and practice level will refine mappings and identify gaps in the policies.

Results
Preliminary findings reveal diverse healthcare trajectories and identified multiple gaps in disease management across countries. For many countries, a complete well-developed patient pathway was not found; instead, the pathways were rather fragmented and lacking for some strata of the health pyramid. These insights underscore the need for tailored interventions and enhanced care coordination to optimize continuity of care and patient outcomes.

Conclusions
Comprehensive patient pathway mapping offers a strategic framework to address gaps in chronic disease management. Our study emphasizes the importance of collaborative efforts in developing context-specific interventions and strengthening healthcare systems to improve public health outcomes.

Key messages
• Comprehensive patient pathway mapping reveals numerous gaps in global chronic disease management, prompting the need for enhanced strategies.
• Collaborative efforts are key to addressing gaps in chronic disease care.
Assesing health needs of women with breast cancer in a Regula Hospital Dispensary in Crete, Greece
Authors: Markakis G , Maniou M , Neofitos K , Ioannou N , Papadakaki M 
Published: October 2024

Abstract

Background
Understanding the health needs of women with breast cancer is essential for tailor-made care. Socio-economic factors impact care access and outcomes. Previous research has indicated variations in healthcare experiences based on factors such as education level, employment status, and income. However, specific insights into the health needs of women with breast cancer in Crete, Greece, remain limited.

Purpose
The current study aimed at assessing the health needs of women with breast cancer.

Methods
A total of 161 women were surveyed between June 2023 and December 2023 in a regular Hospital Dispensary at a General Hospital in Heraklion, Greece.

Results
The majority were married (46%) and had an average of 2 children. 16% were graduates of secondary education and 42 % graduates of higher education, 33% retired and 19% full-time employees. Most participants (45%) reported a family income between 10,001 to 20,000 €, 29% under 10000 € and 26 % between 20001 to 30000 €. The majority had received additional medical treatment (75%), with surgery being the most common (30.6%). Other treatment included radiation therapy (28%), chemotherapy (23%), and hormone therapy (18%). Prevalence of comorbidities was high, with hypertension (97%), coronary heart disease (92%), cholesterol issues (43.5%), arrhythmias (82%), thyroid disease (81%), diabetes mellitus (79.5%), and bleeding disorders (43.5%) being reported. Smoking was also prevalent among participants (79.5%).

Conclusions
This study highlights the complex health needs of women with breast cancer in Crete region, Greece and emphasizes the prevalence of comorbidities and the importance of tailored support services and comprehensive care approaches for this population.

Key messages
• Considering socio-economic factors is critical in healthcare planning and intervention strategies.
• Emphasizing the importance of tailored support services and comprehensive care approaches for this population.
Associations between bedtime media use and sleep outcomes in an adult population-based cohort
Authors: Schrempft S , Baysson H , Chessa A , Lorthe E , Zaballa M-E , Stringhini S , Guessous I , Nehme M 
Published: October 2024

Abstract

Background
We aimed to extend existing research on associations between bedtime media use and sleep in adults by taking relevant covariates into account and testing hypothesised mediating and moderating pathways.

Methods
Frequency of bedtime media use and sleep outcomes were examined by questionnaire in 4188 adults (59% women, aged 19-94 years) from the Specchio cohort in Geneva, Switzerland. We tested: 1) associations between bedtime media use and sleep (bedtimes, sleep latency, sleep duration, sleep quality, insomnia symptoms, and daytime sleepiness), adjusting for prior sleep, mental health, and health behaviours (physical activity, binge drinking, smoking, total leisure screen time), 2) whether bedtime media use mediates associations between individual susceptibility factors (age, chronotype, and mental health) and sleep, and 3) whether individual susceptibility factors moderate associations between bedtime media use and sleep.

Results
Often using a screen in the 30 minutes before going to sleep at night was associated with a late bedtime (≥midnight; OR [95% CI]=1.90 [1.44, 2.51], p &lt; 0.001), short sleep duration (&lt;7 hours; 1.21 [1.01, 1.46], p &lt; 0.05), and excessive daytime sleepiness (Epworth score &gt;9; 1.47 [1.25, 1.74], p &lt; 0.001) after adjustment for all covariates. Bedtime media use partly mediated the association between younger age and an evening chronotype and these sleep outcomes. Mental health moderated the association between bedtime media use and sleep quality/insomnia, such that the former was associated with poorer sleep quality/insomnia among individuals with better mental health, but not among those with poorer mental health.

Conclusions
Frequent bedtime media use was associated with various sleep outcomes, independently of relevant covariates. Limiting the use of screens at bedtime is important to promote sleep among adults. Individuals with poorer mental health likely require additional support to improve their sleep quality.

Key messages
• Frequent bedtime media use is associated with a late bedtime, short sleep duration, and more daytime sleepiness in adults, and these associations hold after adjustment for relevant covariates.
• Frequent bedtime media use mediates the association between individual susceptibility factors and sleep outcomes. Mental health moderates the association between bedtime media use and sleep quality.