bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology
Authors: Miani C , Ouma M , Alaze A 
Published: October 2024

Abstract

Background
Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism.

Methods
We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically.

Results
Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations.

Conclusions
Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care.

Key messages
• Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers.
• Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.
Characteristics of applicants with a first-time recognition of need for long-term care
Authors: Schnitzer S , Haeger C , Baldenius T , Jürchott K , Kuhlmey A , Schwinger A , Blueher S 
Published: October 2024

Abstract

Background
The increasing number of care-dependent individuals requires approaches to prevent care dependency or reduce loss of independence. Long-term care assessments can provide valuable insights into this. In Germany, the Medical Service is responsible for the long-term care assessment (care level) that focuses on limitations in independent living.

Objectives
The aim of this contribution is to describe initial applicants with identified need for long-term care.

Materials and methods
The nationwide database consists of long-term care assessments conducted by the German Medical Service of health insured people aged 60 and above who received a care level (1=smallest till 5= largest limitations) for the first time in 2021. Long-term care-relevant information is analyzed descriptively.

Results
339,486 individuals with an average age of 79.6 years (SD: 8.4) were analyzed. The age distribution shows that the 80-89 age group comprises half of the sample (49.9%), whereas those aged 90+ encompass the smallest proportion of the sample (9.3%). More women than men received a care level (59.0% women vs. 41.0% men), with women predominant in care level 1-2 and men in the higher care level 3-5. Overall, approximately half of the sample received care level 2, 32.4 % received care level 1. Care levels 3-5 were assessed less frequently (16.2 % vs. 4.8 % vs. 1.7 %). The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03).

Conclusions
Over three quarters of initial applicants are classified into the lowest care levels (1 and 2). Accordingly, tertiary prevention measures are recommended, as these may delay the further progression into a higher care level.

Key messages
• Over three quarters of initial applicants for long-term care are classified into the lowest care levels. Accordingly, tertiary prevention measures may recommended to delay further care progression.
• The most frequent care-relevant diagnoses were senility (R54), polyarthrosis (M15), and dementia (F03).
Developing regional Diabetes Registries in Italy: pilot projects implementation within JACARDI
Authors: Armocida B , Cappai G , Di Martino M , Gnavi R , Monasta L , Pompili M , Galeone D , Mariani L M , Formenti B , Onder G 
Published: October 2024

Abstract

Issue/Problem
In Italy a National Diabetes registry is planned but not yet set up at the Ministry; JACARDI is contributing to speed up the process so that critical gaps in health data availability can be filled. While some regional registries exist, the lack of cohesion and standardization hinders the tracking of prevalence, incidence, and sequelae, crucial for evidence-based policymaking amidst rising diabetes rates.

Description of the Problem
The JACARDI project, supported by EU funding and running for four years, engages 76 partners from 21 countries and includes 142 national-level projects. Among its focus areas is enhancing data availability, aiming to establish harmonized regional Diabetes registries in Italy to tackle this issue. These efforts aim to create a scalable model enabling data linkage, diabetes type differentiation, and socio-demographic integration. Collaboration with health authorities and societies, drawing insights from existing registries, informs the development process.

Results
A total of 11 regional Diabetes registries are currently in the design phase of implementation. They adhere to a clearly defined methodology, with established essential parameters and data linkage. Consensus on these parameters and linkage was reached through stakeholder discussions, drawing on past registry experiences. The primary goal of the registries is to monitor diabetes prevalence, stratify incidence by demographics, and track sequelae to inform targeted interventions and resource allocation. While scalability beyond Italy may encounter administrative challenges, standardized protocols facilitate transferability. Data Protection stands out as a significant implementation obstacle.

Lessons
Standardized data collection, stakeholder collaboration, and sustainability are vital in registry development. Leveraging data availability for surveillance demonstrates adaptability and scalability, offering valuable insights for enhancing diabetes management.

Key messages
• Standardized data collection and stakeholder collaboration are pivotal in establishing effective diabetes registries, fostering equity and improving health outcomes.
• Leveraging data availability for surveillance offers a scalable and sustainable approach to diabetes management, facilitating informed policymaking and interventions.
Plan for the crisis!
Authors: Sturm N , Kretschy S , Prauhart N , Hofmann R , Stelzhammer D , Tacha S , Hirsch T 
Published: October 2024

Abstract

Background
The COVID-19-crisis has posed major challenges for organisations providing care in terms of fulfilling their contracts as well as maintaining their quality standards. This project aimed to analyse the implementation of gender and diversity sensitive crisis preparedness in health and social care organisations in Austria. The innovation of this project lies in the organisational crisis preparation including the interfaces of all organisations and actors involved in the care of a vulnerable person.

Methods
A comprehensive survey and analysis of existing structures and processes was carried out. A participatory approach was used to develop modular guidelines tailored to different crisis scenarios. This was followed by a detailed process analysis, integration of good practices and the creation of assessment tools for practical evaluation. Staff training and technology needs were identified, followed by an assessment of the applicability of the findings to other social sector organisations.

Results
This project created guidelines with modular structures that enable preparation for crises and their consequences. Thereby strategies for risk mitigation and good practice examples, e.g. from the COVID-19 pandemic, were developed. A self-assessment of the status of crisis preparation as well as the continuous monitoring with special consideration of the intersectional diversity of the target groups and their vulnerability was developed and made available on the web.

Conclusions
The project results in guidelines as well as a self-assessment and monitoring tool directly benefiting the participating organisations. Through its transferability to other organisations the project promotes overall crisis resilience and sustainably strengthens the care for vulnerable groups in times of crisis. In addition, solidarity-based help in crisis situations is promoted. The project promotes not only organisational, but also individual as well as macro-social and economic benefits.

Key messages
• The project developed guidelines for gender and diversity sensitive crisis preparedness for health and social care organisations, including risk mitigation strategies and self-assessment/monitoring.
• Crisis preparation must be systematically implemented in health and social care organisations involved in care of vulnerable persons.
Identifying gaps in health system governance to eliminate informal patient payments
Authors: Tambor M , Koufopoulou P , Bygvraa D A , Eklund Karlsson L , Buch Mejsner S 
Published: October 2024

Abstract

Background
Informal patient payments continue to exist in many European countries. These payments might take various forms but can be broadly defined as any payments in addition to formal fees determined by the terms of entitlement. Poor health system governance is considered one of the main factors contributing to their presence, although different aspects of governance might be relevant in each country. The aim of this study was to develop an assessment instrument to help identify gaps in health system governance that contribute to informal patient payments.

Methods
The study has been performed in 2022-2023 in three stages. In the first step, relying on the TAPIC framework and available literature on informal patient payments, we developed a list of questions for each domain of governance: Transparency, Accountability, Participation, Integrity, Capacity. In the second step, the questionnaire was assessed by external experts to ensure it covers the full range of relevant aspects. We then applied the instrument to three European countries, i.e. Denmark, Greece, and Poland, where informal payments differ in scale.

Results
The developed instrument includes 22 questions in the five TAPIC domains. They particularly refer to the role of governance in eliminating underlying reasons for informal patient payments (poor quality of health care) and effective penalization of these payments. The application of the instrument showed that in two countries where informal payments are more common, i.e. Greece and Poland, quality and waiting time guarantees are poorly defined, monitored, and incentivized, while existing mechanisms only penalize payments proven to be bribes.

Conclusions
There is a broad range of health system governance aspects that can be directly or indirectly linked to informal patient payments. The proposed instrument can facilitate the development of long- and short-term policies to eliminate informal payments in European countries.

Key messages
• Policy makers need to take greater account of the role of governance in ensuring health care quality to eliminate informal patient payments.
• The lack of mechanisms to penalize all types of informal payments may contribute to the commonness of these payments in Europe.
Leaders’ perceptions of integrating health and social services after a structural reform in Finland
Authors: Paatela S , Karreinen S , Huhtakangas M , Tynkkynen L K 
Published: October 2024

Abstract

Background
Health and social service system was reformed in Finland at the beginning of 2023. The responsibility for organizing health and social services was transferred from c. 300 municipalities to 22 well-being services counties (WBSCs). One aim of the reform was to support integration between and within health and social services. The purpose of this study is to describe strategic leadership approaches to implementing integrated care. The study highlights the issues that should be paid attention to when integrated care practices are implemented.

Methods
The qualitative study utilized semi-structured interviews collected from the upper-level leaders of the WBSCs (n = 25) responsible for the implementation of the reform. The interviewees represented 11 WBSCs. The data were collected in May-August 2023. Inductive content analysis was used for data analysis.

Results
Four strategic leadership approaches to implementing integration were identified: 1) service user-based leadership approach, 2) partnership-based leadership approach, 3) service system-based leadership approach, and 4) knowledge-based leadership approach. Most of the interviewees combined several different leadership approaches in their talk. Each approach emphasized different aspects of implementing integration and the contextual factors that have to be addressed at different levels of the health and social service system.

Conclusions
While the macro level reform toward more integrated health and social service system was implemented, the findings reveal that more efforts are required at the meso and micro levels of the system to fulfill the goal of integrated services. The paper highlights the importance of strategic leadership and its different aspects in implementing integrated care at different levels of the system.

Key messages
• The paper provides a way of comprehending integration from the perspective of strategic leadership.
• The conceptualization through the different leadership approaches may facilitate forming a shared vision for integration among leaders and managers.
Tackling health inequalities by creating new practices of integrated health access
Authors: Mejsner S , Fehsenfeld M , Burau V 
Published: October 2024

Abstract

Background
Health inequalities often emerge in-between health and social care sectors, as part of transitions between providers across the two sectors. Integrated health access is important for addressing these inequalities. Therefore, we need to understand processes of organising integrated health access and how these shape pathways of accessing care. We draw on sociological understandings of organising as practice that emerges as part of interactions between professionals and users.

Methods
We did observations of interactions between professionals and users (n = 18 days) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in 3 municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis.

Results
Each team had distinct cultures of collaboration and different levels of cross-sectoral collaboration. Creating new, more integrated practices seemed to rely on both, supportive organisational structures and committed engagement in inter-sectoral spaces to change professional meaning systems. When teams were able to collaborate closely, it was easier to retain hard-to-reach users in treatment. However, professional differences could easily create division and therefore maintaining and building relationships were highly important. These mechanisms illustrate the importance of ensuring meaningful spaces for cross-sectoral work, where professionals can interact and create the needed changes.

Conclusions
Organising integrated health access is not merely about providing structures but is also highly dependent on interactions between professionals and users. Analysing interactions between professionals from across sectors, is important to understand the sustainability of integrated health access. In turn, this could help to tackle social inequalities in health.

Key messages
• Introducing integrated health access is highly dependent on interactions among professionals.
• Integration of professional practices across sectors helps retain hard-to-reach users in treatment.
Effectiveness of a policy to reduce non-urgent night-time consultations in out-of-hours services
Authors: Ramerman L , Rijpkema C , Verheij R 
Published: October 2024

Abstract

Background
The utilization of Out-of-Hours General Practice (OOH-GP) services in the Netherlands has been increasing steadily. This has placed significant pressure on triagists and GPs to provide accessible and high-quality care, particularly because of patients with low-urgency health problems, who can wait to visit their GP during regular working hours. To alleviate the strain on OOH services during the night, the “spoed=spoed” policy has been implemented. This policy stipulates that only patients with urgent health problems can consult with a GP during the night (11 p.m. to 8 a.m.). However, it remains unclear whether this policy has effectively reduced consultations during the night.

Methods
For this study, we used pseudonymised data from electronic health records of 2/3 of Dutch OOH services (catchment area of 12.3 million), from Nivel Primary Care Database, from 2020-2023. We analysed the effects of the policy on contact rates and proportion of high-urgency health problems, by comparing OOH services that did and did not implement the policy, by comparing 6 months before and after implementation and by analysing variances across OOH services.

Results
Overall, there were no differences in the number or proportion of high-urgency consultations across OOH services that did and did not implement spoed=spoed. In those that did, there were no differences before and after implementation. However, certain OOH services exhibited a decrease in consultation, while also showing a higher proportion high-urgency health problems.

Conclusions
There is currently no definitive evidence regarding the effectiveness of “spoed=spoed”. However we should learn from the varied effects and experiences in different OOH-services, to facilitate further implementation or adaptation of the policy.

Key messages
• OOH services can and should learn from each other on what solutions are implemented to lower the care-burden during the night.
• Policies aimed at reducing the utilization of OOH serviced should consider the conaxt from the patient, health care provider and organization.
Health literacy in the evolving era of personalised medicine and digital health
Authors: Beccia F , Causio F A , Porcelli M , Proto L , Van El C , Calabrò G E , Pastorino R , Boccia S 
Published: October 2024

Abstract

Health literacy is pivotal for advancing public health, empowering individuals to grasp health information and make informed decisions. However, health literacy levels are often influenced by social and economic factors, with lower levels correlating with reduced disease-specific knowledge and underutilization of preventive health services. As healthcare technology rapidly evolves, particularly with the advent of personalised medicine (PM) and novel genetic testing methods, there’s an increasing demand for heightened health literacy to effectively navigate these transformative innovations and optimize health outcomes. The European ExACT project aims to assess the understanding of PM and related technologies across the EU. In this context, through a survey conducted in several European countries, including Italy, France, Spain, Poland, the Netherlands, Romania, Hungary, and Germany, demographic data and attitudes towards PM, genetic testing, health portals, and big data were gathered. Logistic regression analysis identified factors influencing knowledge and attitudes. Among 6581 respondents, the results highlight a broad awareness of genetic testing (81%) and health portals (54%) yet a lesser familiarity with PM (48%) and big data (37%). Education level, age, and gender influenced awareness, with Hungary showing significant awareness across all topics (OR 2.09 95%CI 1.46-2.98), Spain excelling in big data (OR 1.88 95%CI 1.55-2.27), and Poland leading in genetic testing knowledge (OR 2.68 95%CI 1.82-3.96). Differences between countries may indicate successful policies and factors that can be replicated. Overall, the study emphasizes the importance of enhancing health literacy and sheds light on the predicting role of sociodemographic factors. It underscores the significance of bolstering health literacy to effectively navigate the advancements in PM and digital health, improving health outcomes in light of these evolving healthcare landscapes.

Key messages
• In Europe, awareness of personalised medicine, health portals and big data is lacking. Educational initiatives are crucial for effective navigation of innovations, considering regional differences.
• Social and economic factors affect health literacy levels, impacting disease-specific knowledge and healthcare utilization.
How to improve informal caregiver’s quality of life and health literacy? – a NGT approach
Authors: Pedro A R , Brandão D , Raposo B , Cunha A S , Escoval A 
Published: October 2024

Abstract

Background
Previous studies revealed that informal caregivers have a large number of unmet needs, reinforcing the necessity of national policies that ensure an adequate sustainability of the provision of informal care and takes into account the needs of caregiving dyads in the planning process. This study aimed to identify and consensualize initiatives and action strategies to improve the Portuguese Informal Caregiver’s reality and health literacy levels.

Methods
A Nominal Group Technique (NGT) was conducted with 10 experts. The NGT panel was asked about feasible action strategies to improve informal caregiver’s reality, consensualized and voted them according to perceived relevance in a semantic differential (1 pts to nothing relevant and 6 pts to very relevant), allowing a score calculation.

Results
Thirty-two initiatives emerged from the NGT. The five most relevant initiatives were identified based on an average score namely: 1) Pressure political decision-makers on the need for an effective implementation of the Informal Caregiver status, which is not being done (score=56); 2) Creation of a specific emergency social line for informal caregivers, as a measure of greater equity (score=52); 3) Raise employers awareness about caregiving demands (score=52); 4) Creation of a proximity social manager, linked to primary care services, that facilitates caregiver connection to health and social care services (score=51); 5) Decentralization of respite care services support, with multidisciplinary teams (score=49).

Conclusions
The informal caregiver’s role needs to be recognised and understood by healthcare and social care providers. (Re)design political, economic and social policies that address both caregiver and care recipients’ needs is critical to enable the continuity of informal care provision.

Key messages
• Informal caregivers play a fundamental social role but still have many needs to be addressed, particularly at the level of the official definition of their role.
• (Re)design political, economic and social policies targeted to informal carers is imperative to enable the continuity of informal care provision.