bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children with disabilities and inclusive education in general schools: pricipals’ attitudes
Authors: Austys D , Bartkutė N 
Published: October 2024

Abstract

Background
As inclusive education is being implemented nationwide in Lithuania, various attitudes towards education of children with disabilities in general schools are observed. We aimed to assess the attitudes of heads of general schools towards the provision of education to children with disabilities in general education schools of Lithuania.

Methods
Heads of all schools in the Lithuanian capital and its surrounding municipalities implementing general education programmes were invited to take part in this study. 115 persons agreed to participate and completed the questionnaire in spring of 2024. The distribution of the respondents by their answers to the questions about the attitudes towards the provision of inclusive education was compared according to gender, age, education level, work experience, school location (municipality), language of education, type of school, subordination, number of pupils, teachers, teaching assistants and pupils with disabilities.

Results
The most frequently indicated barriers for inclusive education provision were the lack of specialists, compensatory measures, methodological tools, adaptation of the physical environment, and high number of pupils (87.8%, 84.3%, 78.8% and 76.6% respectively). Attitudes of the respondents were similar in most of the cases when compared according to socio-demographic factors (p more than 0.05). Negative attitudes towards the possibilities for provision of inclusive education were more common among respondents from schools with fewer pupils and higher relative number of teachers, positive attitudes - among those from schools located in municipalities with lower number of residents and schools with more teaching assistants (p less than 0.05).

Conclusions
While attitudes of heads of general schools towards the provision of inclusive education for children with disabilities are similar in most of the cases, negative attitudes are more common among those from schools with fewer pupils and more teachers.

Key messages
• While attitudes of heads of general schools towards the inclusive education are similar in most of the cases, negative attitudes are more common among those from smaller schools.
• Higher number of teaching assistants and smaller municipalities were associated with positive attitudes towards inclusive education of children with disabilies in general schools.
Decoding healthcare strategies: providing comprehensive care for type II diabetes in Ecuador
Authors: Bravo Díaz A , Pinto Delgado J , Barrera Guarderas F , Torres A , Peralta A , Blanes C , Parker L 
Published: October 2024

Abstract

Background
Diabetes is a major global health challenge, impacting millions and disproportionately affecting low- and middle-income countries (LMICs), where approximately three-quarters of affected individuals reside. Despite abundant guidance on diabetes management, most evidence is derived from high-resource settings, potentially impeding effective application in low-resource settings. This study explored issues related to the application of the current clinical practice guidelines (CPG) for diabetes management in Ecuador, from the perspective of local health professionals.

Methods
We developed 5 focus groups in Quito, the capital of Ecuador, in a low-income district. The groups included doctors, nurses, and health promoters; they discussed four sections of the CPG concerning their daily practice. Qualitative results are contrasted with quantitative research based on patient records.

Results
The Ecuadorian health system considers patients with diabetes a priority group, yet a patient may wait up to 4 months to receive their first appointments and once they receive their diagnosis several criteria set out in the CPG are not followed due to lack of time and resources, particularly the delivery of multidisciplinary attention. Access to specialized consultations, such as an ophthalmological assessment is severely restricted, and it can take up to a year to get an appointment. Clinicians expressed difficulties in adapting the nonpharmacological recommendations to different socioeconomic backgrounds, while at times, prescription choices are determined by medicine stock regardless of the patient’s actual needs.

Conclusions
Healthcare professionals have developed a series of ad-hoc strategies to ensure healthcare for their patients, pointing out the difficulties of applying CPG within a health system that lacks basic resources. Healthcare is intertwined with social inequalities among the Ecuadorian population that have worsened since the covid19 pandemic.

Key messages
• We identified significant challenges in applying the CPG in low resource settings. Clinicians adapt by introducing novel ways to overcome limitations at times to the detriment of the patient’s health.
• CPGs need to be tailored to the context considering socioeconomic realities of the population and limited resources in the health setting.
What Makes a Home.Evaluating a Novel Low Support Homeless Accommodation Model Using Co-design Methods
Authors: Frazer K , Darley A , Duffy C , Doyle O , Kroll T , Bhardwaj N 
Published: October 2024

Abstract

Background
Homelessness is a global challenge, with a prevalence of 4%; the problem is underestimated due to limitations in data collection. In Ireland, 1% of the population, including children, adults, and families, experience homelessness due to housing shortages and systemic complexities. Homeless accommodation is defined as emergency and temporary; the wording is used interchangeably. The ETHOS typology of homelessness comprises two dimensions - housing-focused and support-focused. Supports range from high to low levels. This study evaluated an emergency housing accommodation with low support to assess its feasibility and impact.

Methods
Previous residents of an urban residential area with low support [introduced in August 2021] and key stakeholders, including policymakers and health and social care professionals, were invited to collaborate in a half-day co-design workshop [February 2024]. The workshop modified Stanford D’s five-stage design thinking processes to consider ‘How might we harness strengths and abilities to create a home and beyond’. Qualitative data were captured on flip charts, post-its, and via photographs over three rounds of activities following initial reflection regarding 1) identifying emerging challenges, 2) exploring potential solutions, and 3) considering resources for advocacy and success.

Results
Data analyses from 16 participants highlight 1)Personal insights: silence, freedom in decision-making, feeling overwhelmed, valuing independence and understanding accommodation transitions; 2)Organisational insights: developing and promoting independent skills, managing resident preferences and personalities, balancing regulations within emergency accommodation, and staff training. Space was critical in fostering therapeutic well-being and a sense of home environment.

Conclusions
Effective organisational structures are required to facilitate coherent transfers and transitions. Using co-design methods enabled real-world partnerships and engagement.

Key messages
• Homelessness is a significant public health challenge, and a model of low support emergency accommodation has value in supporting transition through and out of services.
• Engaging with people with lived experience of homelessness is essential for developing supported accommodation models.
Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017
Authors: Yeob K E , Kim S Y , Park J H 
Published: October 2024

Abstract

Aims
The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea.

Methods
To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables.

Results
The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Conclusions
Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HC23C016500).

Key messages
• The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017.
• In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.
Unmet needs and satisfaction with healthcare in patients with multimorbidity
Authors: Lopez Rodriguez F , Rodriguez-Blazquez C , Falcon M , de Tena-Davila M J , Romay-Barja M , Escobar C , Tortosa A , Carrascal P , Alvaro-Compostela P , Forjaz M J 
Published: October 2024

Abstract

Background
Health outcomes of patients with multimorbidity are associated with the satisfaction with the care received. The objective of this study is to describe and compare the needs, adequacy of and satisfaction with the received healthcare in patients with complex chronic diseases in Spain.

Methods
Data from a convenience sample of patients participating in the Access to Diagnosis and Treatment and Healthcare Survey (Spanish Patient Organizations Platform, 2022). The chronic conditions were grouped into osteoarticular, cardiovascular, neurological, respiratory, diabetes, rare diseases, digestive, vision diseases, cancer and others. The main variables included were satisfaction with the received care (0-10), perceived adequacy of care (1-5) and unmet needs (yes/no). Bivariate analyses (chi-squared and Mann-Whitney tests and correlation coefficients) were performed.

Results
1133 patients answered the survey: mean age 49.5 years (standard deviation, SD: 14.8), 55.1% women, mean of 2.9 chronic health conditions (SD: 1.7). Participants showed higher levels of satisfaction with routine follow-ups and control of diseases than with access to rehabilitation and specialized care. Satisfaction with healthcare was associated with perceived adequacy of follow-ups (r= -0.79, p &lt; 0.01). Patients with osteoarticular pathologies reported a higher number of unmet needs (57%), rated the care received as less adequate (mean 3.4; SD: 0.9) and less satisfactory (mean 4.2; SD: 2.8). Patients with cancer reported fewer unmet needs (6%), considered the care adequate (mean 2.9; SD: 0.9) and satisfactory (mean 6.8; SD: 3.1). Similar figures were also seen in patients with cardiovascular diseases.

Conclusions
Knowledge on patients’ perceived unmet needs and demands may lead to improving satisfaction with the health system. Comprehensive care for people with multimorbidity, including assessing patients’ perception, is a challenge that must be addressed by healthcare systems.

Key messages
• The analysis of the differences between pathologies in their demands will better describe the reality of patients with multimorbidity in Spain.
• The perception of healthcare adequacy and satisfaction greatly varies across the type of chronic condition.
Adapting a cultural dance program to prevent cognitive decline: insights from experts and educators
Authors: Look M A , de Silva M , Hermosura A , Agard J K , Antonio JKW , Iseri D , Haumea S , Solatorio C , Yoshimura S , Kaholokula J K 
Published: October 2024

Abstract

Leveraging activities such as cultural dance shows promise as an effective basis for chronic disease prevention and management with at-risk populations. In fact, recent WHO reports and resolutions advocate utilizing cultural context to achieve health equality. Hula, the Native Hawaiian indigenous dance has been successfully utilized in interventions with statistically significant improvement in medication resistant hypertension management and heart disease prevention. In this study, Alzheimer’s Disease and Related Dementia (ADRD) experts and kumu hula (hula experts and educators) provide insights to developing a hula-based lifestyle program for prevention of cognitive decline. Informant interviews were used to collect information for developing a hula-based program for individuals with mild cognitive impairment from 4 ADRD experts and clinicians, and 4 kumu hula. The 60-90 minute semi-structured interviews were conducted, recorded, then transcribed. Separate thematic analysis allowed distinct themes for each group to emerge. Themes with greatest between group alignment informed the adaptation of an existing hula-based chronic disease intervention. The clinical and cultural experts were unanimous on multiple themes. First, a hula-based program was well positioned to promote social functioning. Second, hula facilitated integrated multi-dimensional benefits including physical, cognitive, social, and cultural. Third, facilitating learning included: repetition done in creative forms; utilization of aids such as dance notation and audio recordings; and educational approaches such as project-based learning. Cultural activities such as dance have been underutilized in health promotion initiatives. A significant challenge in health promotion programs is engagement and retention of participants. Cultural dance programs are popular and can be effective interventions, particularly when both clinical and cultural experts are engaged in program development.

Key messages
• Inclusion of clinical and cultural experts in health promotion program development leads to unique collaboration and impactful insights.
• ADRD clinicians and Hawaiian cultural dance educators identify social, cultural, physical, and cognitive benefits of hula as instrumental for individuals with mild cognitive impairment.
Measurements and medication data are indispensable for population blood pressure monitoring
Authors: Neuhauser H , Büschges J , Sarganas G , Gärtner B , Perlitz H , Fuchs J 
Published: October 2024

Abstract

Background
The National Study on Health of Older People in Germany “Gesundheit 65+” included blood pressure (BP) measurements at home by a study nurse and classification of all current medication.

Methods
Nationally representative examination survey of the population aged 65 years and older residing in Germany using two-stage population registry sampling from 128 sample points, with a standardized examination at home from June 2022 to April 2023. Three standardized blood pressure measurements at two-minute intervals were taken after 5 minutes rest with an oscillometric device (Mobil-O-Graph) using one of five cuffs according to upper arm circumference. The mean of the second and third measurement was used for analysis. Hypertension was defined as mean systolic BP (SBP) at or above 140 mmHg, or mean diastolic BP (DBP) at or above 90 mmHg, or the use of antihypertensives (antihypertensives, diuretics, beta-blockers, calcium-channel blockers, ACEI and ARB) in participants with self-reported hypertension diagnosis. Provisional weights account for unequal sampling and participation probabilities.

Results
The “Gesundheit 65+” examination part included 1,493 participants of whom 1,475 (98.8%) had successful BP measurements (763 men and 712 women, aged 66 to 101 years). Based on self-reported diagnoses alone, the prevalence of hypertension would be 58.3% [95% CI 53.2-63.3] in men and 59.5% [53.8-64.9] in women. However, overall hypertension prevalence was estimated at 70.4% [65.8-74.7] in men and 72.3% [66.9-77.1] in women based on the study definition which combines self-reported diagnoses, standardized BP measurements and medication.

Conclusions
The prevalence of hypertension is greatly underestimated in the absence of examination survey data with standardized measurements and recording of medication use. In addition, measurement and medication data are needed for monitoring the hypertension cascade, i.e. awareness, treatment and control of hypertension.

Key messages
• Hypertension prevalence is underestimated in the absence of health examination surveys with measurements and medication data.
• The hypertension cascade, i.e. assessment of awareness, treatment and control of hypertension needs population surveys with measurements and medication assessment.
Advancing Dementia Care in Austria: developing a Dementia Registry using a multimethod approach
Authors: Cartaxo A , Herz T , Juraszovich B , Rappold E 
Published: October 2024

Abstract

Background
Austria faces an increasing demand for dementia care in an ageing population. However, a lack of representative data hampers evidence-based policy development and evaluation of care. To address this gap, the Austrian National Institute of Public Health is undertaking the task of developing the Austrian Dementia Quality Registry (ÖDQR).

Methods
Based on the AIHTA Good Practice Framework for Dementia Registries, the development and testing of the ÖDQR has unfolded in 4 distinct phases: 1) planning; 2) registry design (including definition of quality indicators and minimum data set, recruitment, and governance); 3) definition of data collection, sources, and management; 4) pilot testing. A steering committee of government representatives and dementia care experts was convened to oversee the project. A scientific committee provided oversight and ensured methodological rigor. Working groups of national and international dementia care experts focused on standards for diagnosis and therapy, activities of daily living and quality of life, legal aspects, and technical implementation, thus contributing to the content development of the ÖDQR.

Results
An initial systematic literature review informed the selection of quality indicators in the working groups. A conceptual framework of 15 descriptive and 30 quality indicators was developed. Preliminary results of pilot testing indicate feasibility and content validity. As a result, the ÖDQR will be established as a longitudinal survey-based registry, based on an instrument comprising 163 variables and emphasizing data collection across care settings. Legal and technical frameworks are being developed.

Conclusions
The öDQR holds the promise of informing evidence-based policy and improving the quality of dementia care in Austria. Careful planning and collaboration have laid the foundation for a data repository that will inform policy and improve care for people with dementia and their caregivers.

Key messages
• Dementia registries require a complex development to assure validity and adherence.
• The Austrian Dementia Registry aims to establish best practice by focusing on the life situation of those affected by this condition.
Implementing a chronic disease self-management program in Moldova: a roadmap for sustainability
Authors: Secula F , Berari D , Holm Faber N , Rimis C , Silitrari N , Curteanu A , Prytherch H 
Published: October 2024

Abstract

Chronic disease self-management programs are evidence-based interventions but achieving their sustainability can be challenging. We propose a roadmap to sustainability that examines the transferability of intervention components and fosters multi-level and multisectoral partnerships.
Since 2019, the Swiss Agency for Development and Cooperation’s Healthy Life project, in cooperation with the Ministry of Health of Moldova, has implemented a self-management program in rural communities. At pilot stage, we achieved a 53% increase in participants’ self-efficacy (Palmeirim et al, 2024). To date, the program has reached 1432 beneficiaries in 70 communities. The intervention cost per participant was approximately 74 Euros. Our evidence supported the inclusion of self-management in the national non-communicable disease program 2023-2027. We designed a roadmap to hand over this innovation to Moldovan public health institutions. Firstly, we unpacked the intervention into transferable resources, processes and roles. These included human resources (a network of 140 facilitators), pedagogical resources (culturally adapted facilitator training and self-management workshop content) and key operational processes (coordination, resource management, partnership building, monitoring and evaluation). Then, we convened a national workshop to discuss the transfer of these components to relevant institutions. We emphasized working in a coordinated partnership across institutions for intervention delivery. Finally, we launched a national working group that will work on the operational modalities of this multi-stakeholder partnership. Achieving an enabling policy environment for self-management created favorable conditions and accountability for institutional partnership building. A strategic reflection on our partner ecosystem was key to leverage local and national interests in continuing self-management approaches.

Key messages
• We have established priorities among transferable intervention components to match country stakeholders’ ability and readiness to sustain innovative approaches.
• We are building an institutional partnership across sectors based on complementarity of experience to sustain the delivery of a self-management intervention.