bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-country comparison of the organisation and reimbursement of intensive care in Europe
Authors: Berger E , Rödiger H , Busse R 
Published: October 2024

Abstract

Background
During the pandemic, intensive care capacity was a heavily discussed topic in Europe. Many European countries have increased their intensive care capacities to ensure treatment of all COVID-19 patients. A study, however, revealed that organisational characteristics, among other factors, were associated with in-hospital mortality. Our study thus aimed at reviewing international models for the organisation and reimbursement of intensive care.

Methods
Based on a scoping review, a number of European countries (Denmark, England, France, Germany, Italy, the Netherlands, Sweden) was selected for a questionnaire-based expert survey.

Results
In most countries, intensive care is defined by law, while the definition in two countries has a recommendatory character and/or is driven by reimbursement. In line with the European Society of Intensive Care Medicine’s recommendations, the majority of countries has organised intensive care around 2-3 different (heterogeneously defined) levels of care for which reimbursement sometimes differs according to the level. For most countries, the number of physical (i.e., number of operable beds) as well as human resources (i.e., nurses) in intensive care is unknown. Many countries have an intensive care register which, in the case of Germany, was only implemented as a response to the pandemic. However, comparability is limited due to differences in indicators used. Although promising telemedical approaches in intensive care do exist, their use is not yet formalized in most countries.

Conclusions
Most countries rely on a level-based organisation of intensive care, even though clear evidence on their effect is missing. Heterogeneity of definitions as well as quality monitoring makes a comparison difficult. Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. Telemedical interventions could elevate (access to) high-quality care, especially in times of crises.

Key messages
• Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness.
• Telemedicine could elevate (access to) high-quality intensive care, especially in times of crises.
Preparing for future public health crises by fostering a conducive environment
Authors: Lionis C , Petelos E , Roumeliotaki T , Briggs S , Papadakis S , Anastasaki M , Angelaki A 
Published: October 2024

Abstract
Vaccination is considered one of the most cost-effective public health interventions. Zoonotic diseases, which are transmitted from animals to humans, represent an escalating global health concern. Environmental degradation, wildlife trade, and intensified farming practices have disrupted natural ecosystems. This has not only heightened the risk of pathogens crossing species barriers but exacerbated the migrant crisis and deepened global inequalities, as vulnerable populations disproportionally bear the environmental and health burdens. Despite decades of awareness about these risks, the COVID-19 pandemic highlighted our lack of preparedness. At the same time, vaccination hesitancy has been revealed as an important factor in implementing universal vaccination coverage at the population level. Urgency drove innovation. Within months, new multidisciplinary and interdisciplinary approaches were implemented that enhanced our capacity to understand, treat, and protect against the virus. This led to deploying novel technologies, curbing the crisis, and even opening the door to emerging health technologies across a wide spectrum of innovation, from new medicinal products, including vaccines, to evidence synthesis tools, including for modelling and forecasting. Shifting from emergency measures to long-term management of COVID-19, there lies a critical opportunity to strengthen resilience and to increase preparedness against future health threats. The EUVABECO project seeks to harness this momentum by initiating pilot projects that test innovative vaccination tools in evidence-based selected reference practices. These pilots are planned to use suitable theoretical frameworks and consensus meetings to design and develop comprehensive implementation plans that will be shared with EU MS, thereby enhancing Europe’s preparedness and response capabilities against communicable diseases.
Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study
Authors: Chong CZY , Chong RJR , Chng JJH 
Published: October 2024

Abstract

Issue
Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore.

Description
The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management.

Results
A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3)

Lessons learned
Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success.

Key messages
• Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus.
• Patient education is crucial to overcome patient scepticism and preference for specialists.
Barriers to young people’s use of sexual and reproductive health services in Asia-Pacific
Authors: Riabroi W , Gregory B , Mackay D , Germeni E 
Published: October 2024

Abstract

Background
Qualitative literature extensively documents young people’s barriers to accessing sexual and reproductive health (SRH) services in Asia-Pacific countries. However, efforts to synthesise this research for practical use in healthcare policy and practice are lacking. This systematic review aims to systematically review and synthesise published qualitative literature focusing on young people’s utilisation of SRH services and understanding common access barriers.

Methods
We systematically searched five electronic databases from inception until 24 June 2022: MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science. Google Scholar and reference lists of all included studies were also searched. We used the Critical Appraisal Skills Programme (CASP) checklist for appraising the quality of included studies and analysed the data using a thematic synthesis approach.

Results
We included 31 papers reporting the experiences of over 1800 young people from 16 Asia-Pacific countries. Thematic synthesis identified several factors affecting adolescents’ utilisation of SRH services, which were grouped into six descriptive themes: navigating puberty; lack of SRH knowledge; embarrassment and confidentiality concerns; low decision-making autonomy; traditional practices and religious beliefs; and socio-cultural norms. Our overreaching analytical theme highlighted the role of shame as a key emotion hindering young people’s utilisation of SRH services.

Conclusions
Direct communication about SRH issues is crucial for teenagers. Embarrassment, privacy concerns, and stigma significantly affect their service utilisation decisions. Inclusive interventions for both youth and their communities by addressing socio-cultural factors are essential for optimising service accessibility and guiding evidence-based interventions and policies across diverse cultural contexts.

Key messages
• Understanding young people’s SRH service barriers in Asia-Pacific countries: Socio-cultural norms are highlighted as crucial for optimising service utilisation among young individuals in this area.
• Inclusive interventions and policies are needed for enhanced accessibility.
GIS and statistics to analyze scale change consequences on medical desert classification in France
Authors: Padilla C , Bonal M , Chevillard G , Lucas-Gabrielli V 
Published: October 2024

Abstract

Background
Accessibility is a crucial way to overcome geographical restrictions and provides a path for alleviating the medical desert. Less attention has been paid to the choice of spatial unit in the effect of healthcare multi-accessibility. Inside the OASES European program, the France team proposes to create medical desert classification at the municipality level. The contribution of this study is to highlight the consequences of the choice of spatial scale on spatial distribution and the discrepancies between medical desert classifications.

Methods
Analyses were carried out in metropolitan France and overseas departments, at the commune scale and two other supra-communal scales used by public policies in France. For each spatial unit, a multidimensional and professional classification has been conducted using a three-step method: scores, principal component analysis and clustering. To demonstrate the presence of spatial dependence and to measure homogeneity between classifications joint count autocorrelation indicators and Theil’s indexes were applied.

Results
Our results present 7 classes of municipalities, and 5 classes of EPCI or living territories according to their level of healthcare accessibility, the dynamic of supply, and the needs of the population. Spatial representation of the classification demonstrates greater variability at the municipality level than other supra scales. Informative contrasted classes at the municipality level disappeared in favor of the middle class in all accessibility at supra scales. The results demonstrate that spatial dependence between areas at the municipality level reduced the scale effect.

Conclusions
Spatial approaches have become increasingly popular since they enable decision-makers to identify priority areas and allocate resources. Recognizing the instability across various scales is therefore crucial for thinking about the optimal unit of data aggregation when investigating the medical desert.

Key messages
• Choice of the scale is a mix between public policy decisions and data availability.
• Contiguity constraint is a way to reduce the loss of information after aggregation.
Rehabilitation delivery models to foster healthy ageing - a scoping review
Authors: Maritz R , Seijas V , Fernandes P , Bernard R M , Lugo L H , Bickenbach J , Sabariego C 
Published: October 2024

Abstract

Background
Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing.

Methods
We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis.

Results
Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions.

Conclusions
Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing.

Key messages
• The scoping review identifies six rehabilitation delivery models for older adults.
• The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.
Organisation of medical care in large scale incidents: a practice-oriented research in Belgium
Authors: Cornelis J , Dauvrin M , Desomer A , Gerkens S , Primus-de Jongh C , Christiaens W 
Published: October 2024

Abstract

Background
CBRNe incidents are emergency situations involving the release of chemical (C) or biological (B) substances or radiological/nuclear (RN) contamination, sometimes through an explosion (e). They can result from intentional malicious acts (e.g. terrorism) or unintentional situations (e.g. accidents). In this context, people (victims, care providers, witnesses), equipment (infrastructure, vehicles), animals, objects and/or the environment (buildings, ambulances) may be contaminated by a substance that could pose a threat to health. CBRNe incidents can quickly overwhelm the response capabilities of the affected region and put the healthcare system under great pressure. This research investigated ways of improving the organisation of medical care in CBRNe incidents in Belgium.

Methods
this study involved a mixed method approach in 2022-2023 with scoping and in-depth interviews with actors at operational and strategic levels (public health, Internal Affairs, army, fire departments), participative workshops with stakeholders, contextual desk search, ad hoc literature review and international comparison completed with interviews with national experts (Norway, The Netherlands, France and United Kingdom, United States of America).

Results
hospitals need to be distinguished in type 1 specialized hospitals for decontamination, major trauma management and advanced care for severely burned patients and in type 2 hospitals managing spontaneous arrivals of victims and non-specialised care. All hospitals need to have a strict lock-down policy. On the incident site, an emergency medical mobile team needs to manage the decontamination with the firefighters before the transfer to the most appropriate facility. Additional conditions were found to improve the efficiency of medical care.

Conclusions
this practice-oriented research contributes to a better organization of medical care in case of CBRNe incidents, with the emergence of practical and feasible solutions.

Key messages
• Hospitals need to be distinguished according to the need for specialised care in case of CBRNe incidents.
• On site decontamination needs to be performed by health professionals and firefighters.
Innovations in residential treatment that promote multi-drug addiction recovery
Authors: Currie C L , Swisterski M 
Published: October 2024

Abstract

Background
As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada.

Methods
This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens.

Results
Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge.

Conclusions
The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery.

Key messages
• A stronger evidence base is needed to inform in-patient multi-drug addiction treatment.
• Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.
Barriers and enablers towards integrated care for sexual violence victims in humanitarian settings
Authors: Sawah E , Kielmann K , Michielsen J 
Published: October 2024

Abstract

Background
Sexual violence (SV) is a complex public health issue that necessitates a coordinated multisectoral response. Ideally, this response should be provided through an integrated care package to strengthen timely access and comprehensive care for victims. However, in humanitarian settings with high levels of SV, care is often offered through fragmented silos, exacerbating the burden on the health workforce and victims.

Methods
Using the Valentijn framework, a qualitative, real-time Delphi study was conducted with 17 SV care experts representing 7 geographical subregions to gain informed opinions on key contextual and health system barriers and enablers for integrated care for SV victims in humanitarian settings.

Results
Challenges and enablers reported across the diversity of the participants’ contexts showed consistency. Contextual challenges included volatile contexts, collapsed health systems, and poor infrastructure. Professional challenges included a lack of expertise among healthcare providers (HCPs), high staff attrition, and compassion fatigue among HCPs. Health systems challenges included poor referral and coordination mechanisms, insufficient resources, misaligned donor-programme priorities and low prioritisation of SV comprehensive care. Key enablers reported were effective networking, community engagement, capacity building, co-locating services, participatory management, promoting staff’s sense of ownership, digitalised information systems, and joint patient files.

Conclusions
The sustainability of integrated care for SV victims can be strengthened by ensuring HCPs access regular psychological support and training and are incentivised to provide quality care. Regular coordination among actors, including donors, can support integrating care that responds to patients’ holistic needs. Further research is needed to assess HCPs’ and SV victims’ experiences of current service delivery and how to optimise integrated care in humanitarian settings.

Key messages
• Addressing care providers challenges in humanitarian settings, such as high attrition, lack of training, psychosocial support, and burnout, can ensure proper integration of sexual violence care.
• Integration of sexual violence care demands systemic changes, including aligning donor-programme goals, building accountability mechanisms and the buy-in of political and community leaders.
Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America
Authors: Oturai O , Vargas I , Vázquez M L , Mogollón-Pérez A S , Eguiguren P , Torres A L , Peralta A , Rubio-Valera M , Dias S , Jervelund S S 
Published: October 2024

Abstract

Background
Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador.

Methods
This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination.

Results
In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador.

Conclusions
The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination.

Key messages
• Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors.
• Strengthening primary care and cross-level coordination is needed.