bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advancing immunisation information systems: a proposal for the “unvaccinated registry”
Authors: Vigezzi G P , Maggioni E , Clavario L , Clerico Mosina L , Marjin C , Raso E , Parrini A , Fugazza S , Carbone M , Odone A 
Published: October 2024

Abstract
Through a systematic review of 253 studies, we identified significant advancements in IIS functionalities including real-time data access, interoperability, and life-course vaccination records, crucial for robust public health responses. Our review reveals that vaccinations are vital for public health and societal welfare; however, vaccine hesitancy is a significant barrier, driven by complex factors. Most IIS implementations predominantly utilise web-based platforms focused on children’s vaccinations with features that enhance data interoperability and public health surveillance. Despite these advancements, gaps in vaccine coverage and hesitancy mapping persist due to suboptimal data integration and system interoperability. Parallelly, we propose a comprehensive registry that includes unvaccinated individuals, aiming to address vaccine hesitancy by integrating demographic and socio-economic data. This initiative promises to enhance health equity by providing actionable insights into vaccination gaps and facilitating targeted interventions. Ethical considerations, particularly data privacy, are paramount, as well as adhering to regulations such as GDPR to ensure the protection of personal health information. The integration of IIS with a registry that includes unvaccinated populations represents a transformative approach to public health, potentially increasing vaccine coverage and effectively informing policy decisions. This dual strategy leverages not only technological advancements but also incorporates essential behavioural insights, offering a path forward in the ongoing battle against vaccine-preventable diseases. This model aligns with the Italian National Vaccination Prevention Plan and underscores proactive, evidence-based strategies to enhance vaccination uptake, serving as a cornerstone for broader application in other national contexts.
Polypharmacy and associated factors in the older population in Germany: Results Gesundheit 65+ study
Authors: Sarganas G , Grams D , Ordoñez-Cruickshank A , Fuchs J , Neuhauser H , Gaertner B , Thuermann P 
Published: October 2024

Abstract

Background
Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany.

Methods
Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented.

Results
96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines.

Conclusions
Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use.

Key messages
• Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use.
• Strategies to promote appropriate medication use are needed.
Prevalence and Correlates of Cannabis Use among Cancer Survivors
Authors: Gupta S 
Published: October 2024

Abstract

Background
Delaware has legalized marijuana use for both medical and recreational use. This study identified factors associated with cannabis use among adults with chronic relative to individuals without a history of cancer in the First State.

Methods
Combined data (2020, 2021 and 2022) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for Delaware. Multivariable logistic regression examined individual-level demographic, socio-economic, clinical, and behavioral predictors associated with marijuana use stratified by history of cancer.

Results
Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (6.76% vs. 13.43%). However, a higher proportion of cancer survivors reported use for medical purposes (75.13% vs. 64.28%). Marijuana use prevalence decreased with age among cancer survivors. After adjusting for sex, age, educational attainment, self-reported race/ethnicity, mental health status and physical health status, current smoking (odds ratio [OR], 4.24 vs. 2.74) and binge drinking (OR, 2.45 vs. 1.75) were associated with cannabis use in both groups.

Conclusions
Adults with cancer were more likely to use marijuana. Marijuana use prevalence decreased with age. Public perceptions of marijuana is becoming more acceptable. Risk of medical conditions such as cancer increase with age. As such, older adults might also become consumers of marijuana. Clinicians should screen for marijuana use among patients and initiate open discussions with patients about the benefits and risks associated with marijuana.

Key messages
• Need for ongoing cannabis research to better understand and inform its use for medical purposes.
• Development of high-quality standardized education materials and clinical practice guidelines for marijuana use.
Organizational health literacy in hospitals and primary health care - developing innovative tools
Authors: Finbråten H , Levin-Zamir D , Straßmayr C 
Published: October 2024

Abstract

Background
Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement.

Methods
The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording.

Results
The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process.

Conclusions
The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.
Assessing primary healthcare quality through avoidable hospitalizations: a systematic review
Authors: Pierri F , Mercuri D , Di Lorenzo G , Soccodato V , Anniballo A , Forcella C , Renzi E , Villari P , Baccolini V , Migliara G 
Published: October 2024

Abstract

Background
Avoidable hospitalization (AH) for ambulatory care sensitive conditions (ACSC) has been widely used as a measure of the performance of primary health care. However, the lack of a standardized definition of these conditions and the absence of conclusive evidence regarding their efficacy across diverse healthcare settings remain significant challenges. This review aims to systematically identify and synthesize the utilization of AH for ACSCs as a metric for evaluating the quality of primary healthcare (PHC) and factors influencing such quality.

Methods
We conducted a systematic search for peer-reviewed studies on 3 electronic databases. Studies that used AH for ACSCs to investigate the quality of PHC were included. The following characteristics were extracted: study design, ACSCs definition, AH rates, intervention if applicable, PHC and or patients’ characteristics associated to AH rates, such as accessibility, continuity of care, demographics, socio-economic status, and comorbidities.

Results
73 relevant articles were identified, published between 1994 and 2023 and mostly in USA. Preliminary findings based on 56 articles indicate that the majority (48.2%) employed the list of ACSCs from the AHRQ (i.e. the prevention quality indicators) (48.2%). Meanwhile, 12 studies (17.9%) used lists developed or modified by the authors, and another 7 (12.5%) adopted lists previously utilized in other research. Studies conducted in Brazil, Canada and USA employed lists issued by relevant national institutions.

Conclusions
Although preliminary, these findings highlight two main trends. Firstly, in countries where health authorities have established a standardized set of ACSCs, a notable uniformity is observed. Conversely, in the absence of such standards, variability in defining these conditions is likely to increase. This variation could hinder the comparability across different Primary Health Care (PHC) service organizations and affect the analysis of care quality.

Key messages
• Most studies used established indicators for the measuring of primary healthcare quality.
• Diverse ACSC definitions across countries impair the generalizability of healthcare quality analysis.
Are early emotional and behavioral problems related to subsequent asthma in preschool children?
Authors: Fabian H , Durbeej N , Dahlén J , Dahlberg A 
Published: October 2024

Abstract

Background
The most common mental health problems in preschool children are emotional and behavioral problems, and one of the most common chronic inflammatory diseases in children is asthma. Most research on the relationship between emotional and behavioral problems and asthma includes school-aged children. The current study aimed to explore the association between emotional and behavioral problems during preschool years and the risk of asthma in a Swedish context.

Methods
The study was a longitudinal cohort study, with 6954 children aged 3-5 years for which data on emotional and behavioral problems through the Strengths and Difficulties Questionnaire were collected in Uppsala Region, Sweden, between 2013 and 2017. The cohort was followed with data from the National Patient Register from 2013 to 2022. Asthma was defined as having at least three diagnoses (ICD-10 codes: J45-J46) during follow-up. Unadjusted and adjusted cox regression models were used to analyze data.

Results
A total of 269 children (3.9%) had diagnosed asthma during follow-up. Preliminary results show that children with emotional symptoms, rated separately by mothers (HR: 1.62, 95% CI: 1.20-2.20), fathers (HR: 1.49, 95% CI: 1.10-2.03), and preschool teachers (HR: 1.53, 95% CI: 1.08-2.16) had increased risk of being diagnosed with asthma according to unadjusted cox-regression models. In addition, children with total emotional and behavioural problems, rated by fathers (HR: 1.51 95% CI: 1.10-2.07) were also at higher risk of being diagnosed with asthma. These associations remained significant when adjusting for background and sociodemographic factors.

Conclusions
Our findings point to the significance of a clinical awareness of the relation between emotional and behavioral problems and asthma in young children. Our findings highlight the importance of also considering somatic problems, including asthma, in children with early signs of emotional and behavioral problems.

Key messages
• Emotional and behavioral problems in preschool children is related to being diagnosed with asthma.
• Somatic problems, as asthma, needs to be considered in children with emotional and behavioral problems.
Public health innovation labs framework development: a design study of GGD West-Brabant Netherlands
Authors: Essafi S , van Eck E , Tabeau K 
Published: October 2024

Abstract

Introduction
Innovation Labs are spaces that encourage the creation, development and testing of novel ideas within organizations.While there are known frameworks for the organization of such labs in the private sector, current literature does not reflect a framework for developing a public health Innovation Lab (PHI-Lab) specifically.The aim of this study was to develop an evidence-based framework for a PHI-Lab together with the Dutch Municipal Health Service(GGD).

Methods
Our design thinking study consisted of 4 phases: Discovering, Defining, Creating and Evaluating.An initial framework was developed based on the public and public health sectors in the literature.To create and evaluate the framework,a document analysis of the GGD was performed,and co-creation and testing sessions were organized with 11 internal and 11 external stakeholders of the GGD.

Results
The final PHI-Lab framework is composed of: rationale, enablers and barriers, environment, approach, outcomes and values. Findings emphasized practical reasons for investing in a PHI-Lab, such as the shortage of health professionals.Stakeholders highlighted that proactive leadership and innovation culture are crucial enablers for the setup of the PHI-Lab.The right space and human resources (environment) and methods including design thinking and cross-collaboration (approach) were highlighted as important strategies for overcoming innovation challenges.Despite barriers such as bureaucracy and resource limitations, tailoring solutions to organizational objectives is key to the PHI-Lab’s success and sustainability, with added values of inclusiveness, adaptability and fun.

Conclusions
This study highlighted some practical additions to the initial framework that are specific to the public health setting, although mostly an adaptation from the public sector.Findings emphasize that there isn’t a one-size-fits-all solution to develop a PHI-Lab.This framework has the intention of benefiting other public health organizations.

Key messages
• The framework has the intention of benefiting other public health organizations within established networks and partnerships.
• Proactive leadership and innovation culture are crucial enablers for the organizational setup of the innovation lab.
Organizational health literacy strength and learning opportunities in Italian hospitals
Authors: Lorini C , Bonaccorsi G , Capecchi L , Biagi C , Zanobini P , Unim B , Lombardo C , Cacciuttolo M G , Paladini A , Palmieri L 
Published: October 2024

Abstract

Background
Organizational Health Literacy (OHL) implies responsiveness and friendliness of healthcare organizations. In the context of the WHO Action Network M-POHL, Italy evaluated OHL in a hospital as a pilot.

Methods
The international self-assessment tool OHL-Hos explores 8 standards using 141 items. It was firstly translated and culturally adapted to Italy, and then tested to assess OHL in the public general hospital of Pistoia (Central Italy). A physician, 6 staff members of the healthcare management unit, and 3 medical residents in public health from the Florence University were involved in the pilot. The Pistoia hospital has 1,300 employees (44% nurses, 24% physicians) to face 18,000 hospitalizations per year.

Results
Completing the questionnaire took more than 5 hours. A comprehensive agreement was reached, even though different approaches aiming at improving HL in healthcare and non-healthcare staff emerged. Scores resulted acceptable/good for standard 5 (communication with patients) and 7 (promoting staff HL with regard to occupational risks and personal lifestyles), low for standards 1 (implementing OHL overall the hospital), 2 (involving stakeholders in developing documents, materials, services), 3 (staff training for personal and organizational HL) and 8 (contributing to local population personal HL improvement), which would apply more peculiar for other settings than hospitals.

Conclusions
The participation of the hospital working group in the assessment using the OHL-Hos raised interest toward this matter. It results time consuming for its excessive length, and some standards do not fit to the Italian hospital context, resulting more useful to assess the territorial organization. Reduction of the number of items and revision/reformulation of some of them are suggested. Nonetheless, the tool proved to be useful in indicating the most critical areas needing ad hoc interventions, such as training all the hospital staff.
Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland
Authors: Romanova A , Oetterli M , Landis F , Balthasar A , Käppeli P , Messerli N , Mantwill S 
Published: October 2024

Abstract

Issue/problem
Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care.

Description of the problem
Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders.

Results
The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions.

Lessons
Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions.

Key messages
• Co-creation with stakeholders is a promising way to develop innovative solutions for health systems.
• Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.
Collection and use of patient-reported experience measures: approach to improve health care
Authors: Zile-Velika I , Mavcutko V , Cudina E , Liepina I , Gavare I 
Published: October 2024

Abstract

Background
Patient experience is one of the fundamental determinants of healthcare quality. There is progress in the collection of PREM in national level for hospitalized patients since 2020 in Latvia.

Aim
Analyze (2020.-2022.) in-patients Top-box rates about communication, share-decision making, patient safety and Net Promoter Score (NPS).

Methods
Project starting point was 2019. Agreement with EC, Sant’Anna School, Ministry of Health and Centre for Disease Prevention and Control of Latvia. Since 2020, the collection of PREM has been taking place regularly in hospitals (around 40% from all hospitals) and on average 20% response rate of those who agreed to participate in the survey. PREM questionnaire according to HCAHPS (Consumer Assessment of Healthcare Providers and Systems) standards, including Picker Institute patient experience questions. In line with OECD (Organization for Economic Co-operation and Development) recommendations, patient safety issues are also included. Top-box rates (most positive response) and percentiles (25th - 75th) were calculated.

Results
Totally 17019 adult (18 years and more) patient responses were analyzed with response rate 20.3% (n = 83983). 74.6% (67.5-78.2) during hospital stay doctors always explain things in a way you could understand and sufficiently involved in the decision-making process of treatment - 75.0% (70.1-81.4). During hospital stay 4.1% (n = 601) experienced patient safety incidents which were patient-reported. The most common groups were wrong patients, medication errors, incl. adverse drug reactions and falls. Hospitals achieved a NPS of 61 for 3 year period (2020.-2022.).

Conclusions
Collecting information about the patient experience may be the starting point for engaging patients and moving to more patient-centered health care. The results of these in-patient PREM data can be used to identify areas of improvement and make changes to better meet the needs and expectations of their patients.

Key messages
• It is a good practice for the implementation of new health care quality data - patient experience reported measures at the national level.
• Feedback about the patient experience on regular basis provides insight into patient needs, preferences and values, which can help to improve the quality and safety of care.