bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic
Authors: Rohova M , Koeva S 
Published: October 2024

Abstract

Background
Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022.

Methods
The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019).

Results
After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery.

Conclusions
During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes.

Key messages
• Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes.
• Investing in service delivery innovations can boost resilience during disruptive events.
Advanced nursing practise as a preventive approach for adults with intellectual disabilities
Authors: Grunwald M , Nadolny S , Groendahl A , Grebe C , Ilskens K , Schulenkorf T , Borchardt N , Palmdorf S , Maaß A , Latteck Ä-D 
Published: October 2024

Abstract

Background
Various barriers impede access to preventive health services for people with intellectual disabilities in Germany. As a result, they are more likely to suffer from certain chronic diseases. Internationally, Advanced Nursing Practice (ANP) has proven to be a suitable approach to care for this group. In Germany, ANP is not yet widespread. The aim of this study is to improve healthcare for people with intellectual disabilities through ANP-led case management.

Methods
A randomized controlled trial was conducted in an urban community setting. Inclusion criteria were: ICD-10 diagnosis F70-F79, age ≥18 and care level ≤3. The intervention group (IG) received four outreach home visits focused on prevention and health promotion. The control group (CG) received usual care. Allocation was done using computer-assisted, permuted block randomization. Researchers were blinded during data collection and analysis. The primary outcome was health status after 12 months (t2) (WHODAS). Secondary outcomes were health status after 6 months (t1), health-related quality of life (HQOL) after 6 and 12 months (EQ5D-VAS), and resilience after 6 and 12 months (RS-11). Analysis was performed via ANCOVA with Bonferroni correction at a significance level of 0.025.

Results
214 participants were randomized. At t2, 176 participants remained (IG: n = 85, CG: n = 91). Health status at t2 showed a mean difference (MD) of -4.58 points in favor of the IG (p = 0.01). For resilience, a MD of + 1.95 (t2) points in favor of the IG was obtained (p = 0.05). We measured a MD for HQOL of -1.19 (p = 0.72) in favor of the CG.

Conclusions
A clinically relevant effect of ANP-led case management was achieved on the health status, but not on resilience and HQOL. ANP for people with intellectual disabilities can contribute to health promotion and thereby improve the community health. Therefore, ANP can be used as an innovative approach in the course of reorganization of healthcare for vulnerable populations in Germany.

Key messages
• ANP-led case management can have a clinically relevant effect on the heal status of people with intellectual disabilities over the course of one year.
• ANP-led case management can be seen as a new approach to health promotion and disease prevention in Germany.
Assaults against pandemic heroes: an observational study in the Metropolitan City of Genoa in Italy
Authors: Spatari G , De Mite AML , Cantova E , Reggiani S , Re M , Mercogliano M , De Martini M , Gallo A , Caltabellotta M , Rebagliati B 
Published: October 2024

Abstract

Background
Escalating violence against healthcare workers is a significant public health issue that undermines care quality and workers’ health. This descriptive study aims to examine trends in aggression across different pandemic phases.

Methods
The study analysed reported violence among healthcare workers from 2018 to 2023 within a Local Health Authority in Genoa, Italy. Variables of interest included the severity of aggression, the professionals affected, and the locations of incidents. Data was analysed using appropriate statistical methods, including multinomial logistic regression, to assess relationships across pandemic phases.

Results
Reported aggressions rose from 48 incidents in 2018 to 103 in 2023, totaling 463. Pre-pandemic physical violence was at 39%, dropping to 27% during and after the pandemic (χ²=7.4, df = 2, p &lt; 0.025). Nurses experienced the highest violence rates, with an average of 72% pre-pandemic and 74% post-pandemic, reducing to 51% during the pandemic if compared with doctors (Coef -0.80; 95%CI -1.45|-0.15). Over half of incidents occurred in Emergency and Psychiatric Services, from 77% before to 51% after pandemic. Conversely, violence in Local Services rose from 7% before to 24% during and 28% after pandemic (χ²=56.9, df = 6, p &lt; 0.000). If compared to Hospitals, violence in Local Services increased during (Coef 1.44; 95%CI 0.40|2.48) and post-pandemic (Coef 1.001; 95%CI 0.13|1.87), and in Psychiatric Services decreased post-pandemic (Coef -0.98; 95%CI -1.67|-0.29).

Conclusions
Violence against healthcare workers shifted during and post-pandemic, mirroring the decentralisation of healthcare due to pandemic. The urgent development and implementation of effective violence prevention strategies are imperative. These should include training, psychological support, security enhancements, and a strong organisational culture that prioritises safety and respect. Protecting healthcare workers is crucial for their well-being and to ensure high healthcare quality.

Key messages
• Escalating violence undermines care quality and healthcare worker well-being. Effective prevention strategies are essential, including training, support, and an organisation that prioritises safety.
• Nurses are the main victims of violence. Violence is higher in Emergency Departments, but incidents are increasing in Local Health Services, due to organisational changes during and post-pandemic.
Increased feelings of nervousness among older Europeans post-pandemic
Authors: Queen C , Sabzevari R , Pasupathy R 
Published: October 2024

Abstract

Background
Feelings of nervousness are typically associated with situational factors and are temporary, less intense, and manageable with self-care. Study

Aim
This study examines which situational conditions are significant for feeling nervous among European older adults during the second wave of COVID-19.

Methods
Using data from Wave 9, COVID-19 Survey 2 (Summer, 2021) of the cross-national panel dataset the Survey of Health, Aging, and Retirement in Europe (SHARE), this study utilizes a sample of 49,253 adults over 50 years old from 27 countries in Europe. Analysis: Binary logistic regression indicates all variables are significant predictors of feeling nervous: Gender [Wald= 498.7, p = 0.001 (&lt;0.05)]; chronic disease [Wald= 1635.002 p = 0.001 (&lt;0.05)], employment [Wald= 164.544, p = 0.001 (&lt;0.05)]; home care [Wald= 138.4, p = 0.001 (&lt;0.05)], technology [Wald= 20.66, p = 0.001 (&lt;0.05)]; social support [Wald= 106.66, p = 0.001 (&lt;0.05)], and financial support [Wald=35.5, p = 0.001 (&lt;0.05)] [Chi-Square=3216.401, df = 6 and p = 0.001 (p &lt; 0.05)].

Findings
The odds ratio (OR) for gender is .627 (95% CI .601- .653), for chronic disease, is 2.659 (95% CI: 1.716 - 4.119) and employment is .675 (95% CI: .635-.717) and homecare is (OR)3.47(95% CI: 2.83-4.28); OR for social support is 855(95% CI:.830-.881), financial support 1.779 (95% CI: 1.47-2.15), and technology (OR).956 (95% CI: 938-.975). The model correctly predicted 94% of cases without feeling nervous and 16% of cases where people did feel nervous, giving an overall percentage correct prediction rate of 68%. Implications for Policy and Practice: Knowledge from this study can inform the introduction of public health interventions for older adults targeted toward specific situational circumstances that reduce nervousness.

Key messages
• While feelings of nervousness can be situational, the impact on mental health can go beyond the contextual environment.
• Public health policies can support targeted interventions aimed at developing the coping skills necessary to better respond in times of crisis.
Generating qualitative evidence of the validity of the Health Literacy Questionnaire Parent
Authors: Belfrage S , Faulkner J , Husted M , Fraser S , Patel S 
Published: October 2024

Abstract

Background
Health literacy refers to the skills needed to access, understand, and navigate health information and services. The Health Literacy Questionnaire (HLQ) is a widely used validated measure of health literacy capturing nine distinct domains. The HLQ-Parent is a recent adaption of the HLQ which has been designed to capture the nuanced health literacy skills required by primary care givers of children. Generating qualitative evidence of validity of such tools is an important element of the validation process as it captures understanding and interpretation of items which is not achievable by quantitative methods alone. Therefore, the purpose of this study was to generate qualitative evidence of the validity of the HLQ-Parent.

Methods
A qualitative study implementing the HLQ-Parent during face-to-face cognitive interviews with concurrent probing was conducted. Primary carers of children aged 16 or under living in England were recruited via voluntary organisations supporting families. Qualitative data analysis was conducted on the audio recordings in the form of text summaries. Parents’ chosen HLQ-Parent responses were compared to their narrative responses and coded by the researcher as match, no match or unclear. Parents’ narrative responses were also compared to the HLQ-Parent item intent descriptions and coded as concordant, discordant, or unclear.

Results
Overall, participants (n = 9, mean age 40 years, 88.9% female) narrative responses matched to their chosen HLQ-Parent response, while their narrative responses were concordant with the HLQ-Parent item intent descriptions. Two participants narratives did not match their responses for the item:’ I have enough information to help me deal with my child’s health’.

Conclusions
The qualitative data provided evidence that participants understood and answered the HLQ-Parent items as intended. Study results contribute validity evidence for the use of HLQ-Parent to measure parental health literacy.

Key messages
• This study contributes evidence to the validity of the HLQ-Parent.
• Qualitative methods provide valuable insights that enhance the overall understanding of health literacy measurement tools.
Predictors of infectious disease-related behaviors among adolescents in Armenia
Authors: Hayrumyan V , Sargsyan Z , Agopian A , Musheghyan L , Harutyunyan T 
Published: October 2024

Abstract

Background
We explored the behaviors related to infectious diseases (ID) and its predictors among 15-17 years old adolescents in Armenia.

Methods
We surveyed adolescents from public and private high schools in Yerevan and one province in 2023. The instrument explored ID-related behaviors, health literacy (HL), interest in health, and socio-demographics. ID-related behaviors were measured with five Yes/No questions about sharing a toothbrush, covering their mouth when coughing or sneezing, and washing hands with soap and water - before eating, after using the bathroom, and when coming home. HL was assessed with ten questions on a scale from ‘Strongly disagree’ to ‘Strongly agree’. Summative scores were calculated for ID-related behaviors and HL. Multivariable regression analysis explored factors associated with ID-related behaviors.

Results
Overall, 366 students completed the survey, most of them being females (64.4%). The majority were interested in health issues (80.7%). Almost all respondents reported not sharing a toothbrush with other persons (97.9%) and usually covering their mouth when coughing or sneezing in public places (94.1%). Somewhat lower percentages reported washing hands with soap and water before eating (82.0%), after using the bathroom (89.2%), and when coming home (86.6%). The mean behavior score was 4.52 out of 5 (SD = 0.92) and the percent score was 90.4%. The average HL score was 17.41 out of 30 (SD = 4.47). In the regression analysis, being female vs. male, being interested in health vs. not, studying in private vs. public schools, and having higher HL were independent significant predictors for higher score of ID-related behaviors.

Conclusions
Armenian adolescents reported high levels of compliance with ID-related behaviors. Improving health literacy and fostering interest in health can help further enhance the performance of preventive behaviors. Interventions targeting public schools and male adolescents are particularly pertinent.

Key messages
• Being female, studying in private schools, having higher interest in health issues, and better health literacy independently positively influence infectious disease-related behaviors.
• Promoting health literacy and fostering interest in health in high schools have the potential to further enhance infectious disease prevention behaviors among adolescents.
Cross-sectional survey of health literacy among high school students in Armenia
Authors: Sargsyan Z , Hayrumyan V , Agopian A , Musheghyan L , Harutyunyan T 
Published: October 2024

Abstract

Background
We assessed the level of health literacy (HL) and explored its predictors among 15-17 years old adolescents in Armenia.

Methods
We conducted a survey among adolescents in public and private schools in the capital Yerevan and an adjacent province in 2023. The instrument included items on HL, general interest in health and socio-demographics. Ten questions measuring HL with four answer options were summed into the HL score (0-30). Multivariable regression model explored the independent associations of socio-demographic factors and interest in health issues with the HL.

Results
Overall, 366 students completed the survey. About 64% were females. The majority were interested in health issues (80.7%). Most participants felt they, in general, received sufficient health information (75.1%), could follow physician’s instructions (80.1%), were confident in advising family or friends on health improvements (70.5%), could easily give examples of health-promoting actions (76.8%), and explain their choices for health (77.6%). Additionally, 82.2% could judge the environmental impact of their actions, 82.0% could find understandable health information when needed, and 85.3% could assess how their behavior affects their health. Fewer respondents were confident in figuring out if the health information is correct (68.2%) or identifying correct health information when faced with conflicting data (67.1%). The average HL score was 17.41 (SD = 4.47), with a 58.0% percent score. In the regression analysis, being from private school vs. public and being interested in health vs. not were significant predictors of higher HL.

Conclusions
Despite having moderate HL level, a significant portion of Armenian adolescents lacked confidence in discerning correct health information. Interventions should prioritize enhancing HL, emphasizing critical evaluation skills and providing accessible and reliable health information resources tailored to adolescents, particularly in public schools.

Key messages
• The health literacy among Armenian adolescents was moderate with many lacking confidence in identifying correct health information and differentiating when faced with conflicting data.
• Attending a private school and having an interest in health were significant predictors for higher health literacy, emphasizing the need for targeted health and policy interventions.
Culture for Health – Example from Serbia
Authors: Jevtic M , Miljkovic A , Vujkov G , Palkovljevic Bugarski T 
Published: October 2024

Abstract
Using the possibility of social prescribing at the community level integrates several sectors, primarily the health sector and the culture sector. The goal of this project was to strengthen intersectoral cooperation (culture and health) and consider the possibility of providing conditions in the local community for continuous prescribing of the culture ‘on prescription’. Institute for Public Health of Vojvodina invited Matica Srpska Gallery to participate together with the Novi Sad Healthcare Center in a unique project that connects culture and health. The ‘Culture on prescription - culture for health’ consisted of two phases: curatorial guidance and group workshops. Curatorial guidance means the selection of individual works of art whose narration is planned and methodologically adapted to different groups of participants and which evokes different feelings related to quality of life and health. The second part of the program consisted of workshops in the Museum, enriched with works of art and a pleasant atmosphere.The workshops are based on group analytical methods and participants had the opportunity to reflect their observations, experiences and feelings on individual works of art, and they often reflected with personal life experiences that were not only aesthetic, but also pleasant and therapeutic. Participants came in two sessions, with two different curatorial guides, carefully thematically prepared, and which were later the source for substantive reflection. The positive outcomes of these innovative workshops was confirmed through written and oral facts, through which the participants emphasized that the stay in the museum space was therapeutic in itself. The possibility of the so-called ‘depot’ or prolonged effect of the unique prescription was observed, emphasizing that the participation in the workshops left an impression on the participants and that they will stay with a positive feeling and pleasantness after receiving a ‘dose’ of culture for health.
Making health information understandable: the COVID-19 patient guideline
Authors: Oeser A , Messer S , Schneider S , Lund N , Haase R , Janssens U , Kreuzberger N , Skoetz N 
Published: October 2024

Abstract

Issue
Evidence-based practice guidelines offer a reliable source of information, providing recommendations based on the most recent evidence. However, these guidelines are complex and difficult to understand for laypersons. This creates a knowledge gap, affecting shared-decision making, treatment acceptance, understanding of a disease and recommendations of disease prevention.

Description of the problem
Patient guidelines (PatG) aim to bridge this knowledge-gap by providing simplified versions of practice guidelines in lay language. This is a common practice internationally. An example is the German evidence-based COVID-19 practice guideline, published in 01/2024. In March, a multidisciplinary team, including a patient representative, created and reviewed a PatG outline, prioritising topics based on patient relevance, and discussed relevant information. The authors translated guideline recommendations into lay language, researched additional information, and created supporting graphics. A methodology chapter explaining both guidelines and a short medical term dictionary were also included.

Results
In 05/2024, the COVID-19 PatG, around 70 pages long, was finalized including information on treatment, diagnostics, intensive care, and support resources. A feedback round was initiated. Comments will be incorporated for the final version to be published in the national guideline registry by end of 05/2024. Updates of the PatG and practice guidelines will occur frequently.

Lessons
We faced challenges in simplifying medical concepts and interventions and accurately translating recommendations without losing key information. The length of the PatG may discourage readers. Despite these challenges, we are committed to enhancing accessibility, using simpler language, and adding supporting graphics to improve the PatG in the future.

Key messages
• Despite some challenges, patient guidelines pose as a reliable form of patient information.
• The COVID-19 patient guideline is a reliable and evidence-based source of information.
Vaccination health literacy: cultural validation and pilot testing of the HLS19-VAC instrument
Authors: Brankovic J , Stevic I , Krajnovic D 
Published: October 2024

Abstract

Introduction
VaccinÐ°tion health literacy (VHL) is considered an extremely important aspect of health literacy. HLS19-VAC questionnaire is a 14-item ‘subjective’ perception-based instrument used for measuring VHL in the M-POHL Health Literacy Survey 2019-2021, which Serbia was not part of.

Aim
Translation and cultural validation of the HLS19-VAC questionnaire and using the validated Serbian version (HLS19-VAC_RS) for pilot study research.

Materials and methods
The English version of HLS19-VAC was translated using a systematic approach; three forward and one back-translations were synthesized and compared by an expert committee. Thereafter, cognitive interviews with 11 participants produced a version that was culturally validated by an expert panel. We conducted a cross-sectional pilot study using a HLS19-VAC_RS, on a convenient sample of the general population in Serbia. VHL was assessed by calculating the score for 4 out of 14 questions. Additional data were collected through a general questionnaire with 30 questions. Descriptive and inferential statistics were used.

Results
Cognitive interviews showed some problems in wording, and cultural adaptation resulted in minor refinements to eight out of 14 items. The instrument was pretested by 11 experts who adjusted it accordingly to produce culturally validated HLS19 -VAC_RS. Of 439 respondents in a pilot study, 15% had problematic VHL, while the levels of sufficient and excellent VHL were nearly the same (38.5% and 35.1%, respectively). There was difficulty in deciding whether to receive the flu vaccine (15.0%) and to find information about recommended vaccines (12.3%). There was a significant statistical difference in responses to VHL and monthly income and alcohol consumption. Most of the respondents contacted pharmacists as primary sources of information about medication (42.7%).

Conclusions
HLS19 -VAC_RS could be implemented in a local context as culturally appropriate. Further testing on a population level is needed.

Key messages
• HLS19-VAC_RS Questionnaire is culturally appropriate for assessing vaccination health literacy in Serbia.
• Majority of respodents had sufficient or excellent vaccination health literacy.