bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incentives to attract and retain physicians to underserved areas - a case study from Portugal
Authors: Alidina S , Fronteira I , Cortes J 
Published: October 2024

Abstract

Issue
Physician shortages in underserved areas are a common challenge for governments and policymakers worldwide, including in Europe. Meanwhile, a knowledge gap exists on effective measures to address the issue.

Description
According to WHO Europe, one of ten actions to strengthen the healthcare workforce is to develop strategies to attract and retain health workers in rural and remote areas. Portugal faces geographical asymmetries in the distribution of physicians, and difficulties in retaining them in certain areas of the country. This case study seeks to describe and analyse the impact of an incentives package introduced in 2015 that aimed to attract and retain physicians in underserved areas. Financial incentives data was gathered via a national health human resources information system. Non-financial incentives data was reported by health institutions through an online form. Document analysis was conducted to understand the scope of the incentives package and its amendments.

Results
The incentives package implemented in Portugal effectively deployed physicians to underserved areas, since it led to a fourteen-fold increase in physicians settling in underserved areas. In terms of retention, an average of 59% of the physicians that took up the incentives package are still practicing in the same underserved area. However, the difference between the retention levels of physicians under the incentives package and those not covered is minimal. To further reduce health inequities and achieve universal health coverage, a need exists to review the financial and non-financial incentives to better suit physicians’ needs and expectations, as well as those of the National Health Service.

Lessons
The incentives package introduced in Portugal makes it clear that flexibility in the design of attraction and retention measures is crucial. It requires a long-term commitment and a recognition that each intervention should be assessed and adapted to local circumstances and context.

Key messages
• The incentives package introduced in Portugal attracted physicians to underserved areas and led to a fourteen-fold increase in physicians settling in underserved areas.
• More than half of the physicians are still practicing in the same underserved health institution but the difference in retention against those not covered by the incentives package is minimal.
Achieving integrated care through clusters of co-occurring diseases for people with multimorbidity
Authors: Beaney T , Clarke J , Woodcock T , Barahona M , Majeed A , Aylin P 
Published: October 2024

Abstract

Background
People with multimorbidity are often seen in many different specialist health services, resulting in fragmented care. Conventional services are designed around specialties based on anatomical systems, rather than diseases that occur together. We examined whether organising services around clusters of co-occurring diseases would lead to fewer interactions with unique services and so improve integrated care.

Methods
We used the Clinical Practice Research Datalink, a nationally representative sample of primary care data in England, including all patients registered on 1st January 2015 with multimorbidity (two or more of 212 long-term conditions (LTCs)). We used the assignment of 212 LTCs to 15 clusters of co-occurring diseases, derived from our earlier work. For each patient, we calculated the number of interactions with different specialists, under both the existing specialty-based model, and the hypothetical cluster-based model, under the assumption that a patient required review for each LTC.

Results
Of 6,200,973 patients with multimorbidity, the mean age was 53 years, with a median (interquartile range) of 8 (5 - 11) LTCs per person. There was considerable variation in the assignment of diseases comparing 15 clusters versus 15 specialties. Under the existing model, 409,708 (6.6%) patients interacted with only one specialty, and under the hypothetical cluster model, 584,446 (9.4%) patients interacted with only one cluster. On average, patients interacted with 3.66 specialties versus 3.30 hypothetical clusters (p &lt; 0.001 for difference).

Conclusions
Health services designed around clusters of co-occurring diseases might lead patients to interact with fewer different services and so experience less fragmented care. Further work is needed to understand which specialties collaborating, and how, would have the greatest impact on improving integrated care.

Key messages
• Health services designed around clusters of co-occurring diseases led to a small reduction in the number of interactions with different services per year.
• Designing services around clusters of co-occurring diseases might reduce fragmented care for people with multimorbidity.
The association between traffic noise and self-rated health within the German National Cohort (NAKO)
Authors: Slesinski S , Wolf K , Zhuang S , Lakes T , Bolte G , Peters A , Schneider A 
Published: October 2024

Abstract

Objectives
Traffic noise can cause stress and disturb sleep, impacting health in many ways. However, few large studies on this topic exist. We investigated the association between traffic noise and self-rated health (SRH) within the German National Cohort (NAKO).

Methods
NAKO enrolled &gt;200,000 adults ages 20-74 at 18 sites in Germany. We used logistic regression to test whether 1) annual mean 24-hour ambient traffic noise levels at or above 55 dB(A) within a 10-meter residential buffer and 2) subjectively reported nighttime traffic noise annoyance were associated with higher odds of reporting fair/poor SRH. We calculated these associations within the full sample, stratified by sex, and stratified by age group (≤39 years, 40-59 years, ≥60 years). We adjusted for study site, age, sex, marital status, education level, and migration background.

Results
Among participants without missing data (n = 121,232), moderate annoyance was associated with 1.27 higher odds (95% CI 1.21-1.32) and strong annoyance with 1.75 higher odds (95% CI 1.65-1.84) of fair/poor SRH, while annual mean noise ≥55 dB(A) was associated with 1.07 higher odds (95% CI 1.03-1.12). Females who reported strong annoyance had especially high odds of fair/poor SRH (OR 1.81, 95% CI 1.69-1.95), as did those aged 40-59 years who reported high annoyance (OR 1.78, 95% CI 1.66-1.92). Those 39 and under had no significant increase in odds of fair/poor SRH if they reported moderate annoyance or if they were exposed to ≥ 55 dB(A) annual mean noise. In single exposure models, noise annoyance and objectively measured noise were both significantly associated with higher odds of reporting fair/poor SRH, but in combined models, the effect of objectively measured noise became insignificant while the effect of annoyance remained strongly significant.

Conclusions
These findings confirm that traffic noise is an important public health issue. Further analyses on most affected populations should inform noise protection policies.

Key messages
• Higher levels of traffic noise are associated with worse self-rated health.
• Ambient noise is an important public health issue for which more research is needed.
Knowledge, behaviours, practices, and expectations on climate change among French health workers
Authors: Guihenneuc J , Cambien G , Blanc-Petitjean P , Bernard N , Jourdain B , Barcos I , Saez C , Dupuis A , Ayraud-Thevenot S , Migeot V 
Published: October 2024

Abstract

Introduction
Hospitals face a dual challenge with climate change (CC): reducing emissions and preparing for its impacts. The main objective of this study was to evaluate the knowledge, behaviours, and practices (KBP) of health workers (HWs) in French hospitals regarding CC and environmental sustainability (ES). The secondary objectives were to understand their expectations and identify associated factors with the KBP of HWs.

Methods
A multicenter cross-sectional KBP study was carried out among HWs of six French hospitals from June 2021 to December 2022. A structured questionnaire was designed and consisted of five parts: i) participant characteristics, ii) CC knowledge and perceptions, iii) behaviours, iv) practices concerning ES actions, and v) expectations. A multilevel logistic regression model assessed associations between HWs’ KBP and both individual and hospital characteristics.

Results
Out of 57034 HWs, 4552 (8.0%) participated in the study. Only 15.4% identified the activities with the greatest environmental impact. On a scale of 1 (Not a priority) to 10 (High priority), the average median rating attributed to commitment to ecological transformation in their hospitals was 5.0/10. Among the participants, 1079 (23.7%) had already initiated at least one ES action. To implement ES-related projects, main barriers were reported including lack of dedicated time (40.4%), hierarchical support (32.5%), methodological support (28.9%), and training access (23.7%). The presence of a sustainable development steering committee, especially active for over 5 years, positively correlated with better information for HWs (ORa=1.78 [1.29-2.45]), better knowledge (ORa=1.83 [1.32-2.53]), and more ES actions initiated (ORa=1.74 [1.33-2.29]).

Conclusions
French HWs demonstrate a commitment to making their hospitals more environmentally sustainable. Some drivers and barriers were identified to further support these essential transformations.

Key messages
• First national study on knowledge, behaviours, practices, and expectations on climate change and environmental sustainability among French health workers.
• Among the drivers to strengthen dynamics within hospitals, the need for training among French health workers and institutional support has been identified.
Scanning the horizon- environmental health indicator surveillance
Authors: O’Connell A , Casey M , Cosgrove B 
Published: October 2024

Abstract

Aim
This work aimed to conduct a comprehensive literature review with narrative synthesis of evidence in relation to the surveillance of environmental health indicators by Public Health agencies internationally. This will strengthen the All-Hazards approach to Health Protection in Ireland.

Methods
The project proposal was registered on PROSPERO. Preferred Reporting Systems for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A systematic search was conducted across five databases. In addition, relevant websites, reference lists and the grey literature were searched. Data were extracted following TIDieR-PHP guidelines. Risk of bias was considered and quality appraisal was performed using SANRA and AGREE-HS tools. A narrative synthesis of the evidence was completed.

Results
12 papers were included in the final review. Four were narrative review articles describing European and worldwide initiatives and the remaining eight described a single health system. Only three papers were deemed high quality. The number of indicators monitored varied widely from one in Italy to over 400 in the USA. The most established programmes described the use of a framework such as Drivers-Pressures-States-Exposures-Effects-Actions (DPSEEA) and indicator selection criteria were applied. The papers described a variety of public health actions arising from the surveillance of environmental health indicators. The knowledge provided by this review can inform the implementation process. Establishment of a project team, and beginning with monitoring one domain is suggested. Air quality is the most frequently monitored domain internationally. The DPSEEA framework is recommended, and Briggs’ indicator selection criteria should be applied to any indicator under consideration. The system should measure both hazard and outcome measures. Finally, meaningful public health action should result from the monitoring.

Key messages
• Environmental health indicator surveillance is essential to all-hazards health protection.
• Few public health agencies internationally are systematically monitoring environmental health outcomes.
A selective diesel vehicle ban’s impact on NO2 concentrations in Munich: a quasi-experimental study
Authors: Leibinger A , Rehfuess E , Burns J 
Published: October 2024

Abstract

Background
The European Union’s current NO2 concentration limit of 40 μg/m³ is regularly exceeded in Munich, Germany. This limit is likely to be reduced towards the WHO recommended target of 10 μg/m³. In response, the city enacted a selective ban on older diesel vehicles, specifically those categorized as Euro 4 or older, within the current low-emission zone in February 2023. Our study examined how Munich’s selective ban on diesel vehicles impacted NO2 levels, concentrating on the six-month period after its introduction.

Methods
We employed a synthetic control approach in the primary analysis and a controlled interrupted time series approach in the secondary analysis. These quasi-experimental methods establish a ‘counterfactual’ no-intervention scenario, allowing for comparison with the actual observed scenario and estimation of the impact of the intervention. Historical data from monitoring stations within and outside the low-emission zone from 2014 to 2022 were utilized as controls, while potential confounders were considered.

Results
NO2 concentrations within Munich’s low-emission zone decreased across the study period. Effects of the selective diesel vehicle ban at monitoring stations within the low-emission zone were minimal, with wide confidence intervals indicating uncertainty. At Landshuter Allee, the average intervention effect was -2.67 μg/m3 (95%-CI = [-12.72; 7.38]), at Stachus it was -2.74 μg/m3 (95%-CI = [-9.91; 4.42]) and at Lothstrasse, it was -1.03 μg/m3 (95%-CI = [-7.75; 5.69]). The secondary analysis confirms these findings.

Conclusions
Munich’s selective diesel vehicle ban had limited effects in reducing NO2 concentrations. Factors such as its narrow focus on Euro 4 diesel vehicles, numerous exemptions, and unclear enforcement may explain this outcome. Comprehensive strategies and continuous monitoring and evaluation are crucial for effectively addressing urban air pollution and protecting public health.

Key messages
• Munich’s selective diesel vehicle ban had minimal effects on reducing NO2 levels, possibly due to its narrow scope, many exemptions, and unclear enforcement.
• Current guidelines and court rulings signal the need for more effective solutions beyond selective bans, emphasizing the importance of well-designed interventions and rigorous evaluation.
Physical activity promotion in Aged care: a participatory approach
Authors: Frahsa A , Hahn L S , Thiel A 
Published: October 2024

Abstract

Introduction
Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs.

Methods
Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20.

Results
Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated.

Conclusions
Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change.

Key messages
• Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being.
• Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.
Understanding compliance with smoke-free environments: a realist review
Authors: Jooren SJA , Garritsen H , Troelstra S , Willemsen M C , Jansen M , Bommelé J 
Published: October 2024

Abstract

Background
Local governments increasingly implement outdoor smoke-free environments to decrease adolescent smoking and denormalize smoking behavior. Recent research indicates that compliance with smoke-free outdoor spaces is often lacking. We examined compliance with outdoor smoke-free environments and examined the mechanisms that affect compliance in different contexts.

Methods
We performed a realist review, an exploratory approach that synthesizes existing evidence into a program theory that links elements of compliance with outdoor smoke-free environments with specific mechanisms and outcomes. A search was performed in PubMed, Web of Science, Embase, and PsycINFO, resulting in 25 relevant English language articles.

Preliminary results
Our analysis showed that the kind of enforcement (voluntary or enforcement with sanction options etc.) influences smokers’ compliance. Additionally, how implementation of the smoke-free environment was done (with supporting signs, size of the environment, attention for smoking cessation etc.) also influenced smokers’ compliance. For instance, with the implementation of an outdoor smoke-free environment (context), smokers get used to non-smoking. They are reminded they can quit smoking at any time (mechanism), leading to more compliance (outcome). If however, their social environment continues smoking (context), they are more inclined to keep smoking (mechanism), which leads to less compliance (outcome).

Conclusions
Compliance of smokers with smoke-free outdoor environments is influenced by the type of enforcement and the type of outdoor smoke-free environment. These mechanisms are important to understand so that policymakers may consider smokers’ reactions and are better able to anticipate upon them.

Key messages
• Type of enforcement and type of implementation influence compliance with smoke-free outdoor environments.
• This realist review helps policymakers consider smokers’ reactions while implementing smoke-free environments.
Students’ attitudes towards and willingness to intervene in partner violence against women in Sweden
Authors: Svalin K , Wemrell M , Ivert A-K 
Published: October 2024

Abstract

Intimate partner violence against women (IPVAW) is a global public health problem, shown to be related to gender equality and to attitudes towards IPVAW. In Sweden, however, the reported prevalence of IPVAW is high, despite high levels of gender equality and a clear condemnation of such violence on the societal level. This phenomenon has been referred to as The Nordic paradox. One potential explanation for this paradox is that gender equality measures at the public level are not necessarily comparable to gender equality at a private level. One way to find out more about this is to investigate attitudes towards IPVAW at an individual level, which has so far been done to a limited extent in a Swedish context. In the current study, the aim was to investigate different aspects of attitudes to IPVAW (perceived acceptability, perceived severity, victim-blaming and ambivalent sexism) among university students in Sweden, and whether those attitudes were related to studentś willingness to intervene in cases of IPVAW. Any gender differences related to IPVAW attitudes and willingness to intervene were also examined. The respondents (n = 656, ≥18 years old) were recruited from three different universities and represented different scientific fields (e.g. social, behavioral, and technical sciences). Most of the respondents were undergraduate students and the majority were women (81%). The results showed that the students had rather non-accepting attitudes towards IPVAW overall, but viewed victims as to some extent responsible of the violence they are subjected to. There were no gender differences regarding willingness to intervene in cases of IPVAW, and attitudes to IPVAW were related to willingness to intervene. There were both similarities and differences between male and female students, in terms of how attitudes were linked to willingness to intervene. The presentation will discuss the results and their implications for future research, policy and practice.

Key messages
• Increased knowledge on attitudes towards IPVAW in Sweden may shed light on the Nordic paradox.
• While non-accepting attitudes were found overall, gender differences and tendencies towards victim-blaming were identified.
Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium
Authors: Vermote M , Debognies P , Demarest S , Braekman E 
Published: October 2024

Abstract

Background
Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders.

Methods
Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities.

Results
Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%).

Conclusions
Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities.

Key messages
• Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support.
• Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.