bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enacting multisectoral service chains and packages in the health and social care regions in Finland
Authors: Liukko E , Muurinen H 
Published: October 2023

Abstract
Several studies have concluded that about 10% of the users of the health care and social services use most services and produce about 80% of the costs of care. However, this client group and their needs for services, which are often complex and multisectoral, are poorly characterized. The new Act on Organizing Health and Social Care Services in Finland obliges the health and social care regions to identify the client groups who need integrated services and to define the multisectoral service chains and packages for these clients. The assumption is that an individual client's personal service path can be planned and enacted by utilizing the pre-defined service chains and packages. This study aimed at studying the definition, development and enactment of the service chains and packages. The study was based on a survey which was carried out in the 22 health and social care regions in spring 2023 for analyzing 1) to which client groups the service chains and packages are defined, 2) what needs there are in the background of defining service chains and packages, 3) what kind of goals are defined for the service chains and packages, 4) what the current developmental state of the service chains and packages is and how they manage to cross the sectoral and disciplinary boundaries, and 5) what successes and challenges there are in defining, developing and enacting the service chains and packages. The survey was the first part of a study which focuses on the development and enactment of service chains and packages in the health and social care regions. The survey results showed that most of the development activities were in the definition phase. The survey gives perspective and background knowledge to the second part of the study which focuses on one specific client group, the children with neuropsychiatric symptoms, and on the definition and enactment of their service chains and packages within three regions.
Psychoactive substances use among Tunisian adolescents: Trend analysis 2013-2021
Authors: Zribi M , Rejaibi S , Zid M , Silini A , Zoghlami N , Mallekh R , Ben Slama I , Ben Youssef S , Ben Salah N , Aounallah-Skhiri H 
Published: October 2023

Abstract

Introduction
Psychoactive substances (PAS) use among adolescents has been a growing concern in Tunisia in recent years. Their use can have a serious impact on the physical and mental health of young people, leading to addiction, academic difficulties and a range of social problems. We aimed to study the prevalence of PAS use among Tunisian high school adolescents and assess significant trends from 2013 to 2021.

Methods
Pooled data from Mediterranean school surveys on PAS conducted in 2013, 2017, and 2021 were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of PAS use (cigarettes, alcohol, cannabis, cocaine and ecstasy) and performed global trend analysis. STATA software was used for statistical analysis.

Results
A total of 14,723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cigarettes use increased from 22.6%, to 25.1% then to 30.7% for 2013, 2017 and 2021 respectively (p &lt; 10-3). Trend analysis concluded to significant increase in alcohol use (5.8%, 6,3% and 8% respectively in the three years) (p &lt; 10-3). The greatest increase was in cannabis use (1.5% in 2013, 3.0% in 2017 and 7.9% in 2021) (p &lt; 10-3). However, there was no significant change in cocaine and ecstasy use (p &lt; 0.05).

Conclusions
Although restrictive legislative measures have been reinforced, there has been a significant increase in the use of PAS among high school adolescents in Tunisia. Thus, it is crucial to delve deeper into this issue and its potential risk factors. The findings can help shed light on the scope of the problem and guide targeted efforts to mitigate the harm caused by these substances.

Key messages
• Trend analysis confirmed the significant increase in psychoactive substances use in high school adolescents in Tunisia.
• This alarming public health issue requires urgent legislation review and close multisectoral collaboration to reduce the impact of this phenomenon.
COVID-19-related changes at work and psychosocial work environment: a prospective cohort study
Authors: Airaksinen J , Aalto V , Kivimäki M , Ervasti J 
Published: October 2023

Abstract

Background
Stressful events and uncertain times are known to pose occupational risks. COVID-19 pandemic brought many changes to work, work arrangements, and work environment. Prospective studies are needed to assess the potential effects of these changes on psychosocial work environment.

Methods
We followed a large cohort of Finnish public sector employees using biennial survey data from 2016 to 2022 (n = 22,688). Those who reported a change (over to remote work, other tasks, or team reorganization) in work due to the pandemic in 2020 were compared to those who did not report such a change. Sex-, age, and socioeconomic status -adjusted means for psychosocial factors were calculated in four timepoints separately for the groups of employees with and without changes. Multilevel modelling was applied to examine the change in psychosocial factors accounting for autocorrelation between observations. To examine the potential difference in trends between the groups, time x group interaction was tested.

Results
Transfer to working from home in 2020 (n = 10,587, 47%) was associated with increased work time control (b = 0.07; 95% CI 0.05, 0.08) and social capital (b = 0.03, 95% CI 0.01, 0.05) over time. A transfer to other work tasks in 2020 (n = 1660, 7%) was associated with suboptimal trend in work time control (b= -0.06; 95% CI -0.09, -0.03), and procedural justice (b= -0.05; 95% CI -0.10, 0.00), particularly in 2020 compared to those not exposed to such transfer. Team reorganization in 2020 ((n = 1067, 5%) was associated with suboptimal trend in work time control compared to those not exposed to team reorganization (b= -0.06; 95% CI -0.10, -0.02).

Conclusions
COVID-19 pandemic induced changes at work were associated with mixed changes in the perceived psychosocial work environment.

Key messages
• COVID-19 -induced changes at work may have had unequal impacts on different groups of employees in the public sector.
• Promoting the resilience of the most vulnerable employee groups needs attention in the future.
When a home is no longer the best place – older adults’ use of health and care services in the context of a major healthcare reform
Authors: Aaltonen M , Häsä J , Edgren J 
Published: October 2023

Abstract
This study investigates the association between insufficient home care and the use of health and social care services among older adults. Data was collected from the Resident Assessment Instrument (RAI) home care register linked to registers for health care and primary health care (N = 33,493). The results show that one in six respondents felt that they would be better off living elsewhere than at home with home care, and these respondents used more hospital, emergency, and home care services than those who preferred living at home. The findings suggest that when older adults perceive their home care to be insufficient, they are more likely to utilize a range of health and social care services. Improved service integration could potentially mitigate the increased use of health and social care services by older adults who perceive their home care as inadequate. Furthermore, the ongoing healthcare reform in Finland aims to promote the integration of health and social services, which could lead to improved care outcomes for older adults. The study's findings can inform policymakers and healthcare providers on the importance of identifying and addressing the needs of older home care clients, particularly in the context of the ongoing healthcare reform in Finland.
Influenza's burden: an umbrella review about complications, hospitalizations and mortality
Authors: Properzi S , Santolini G , Bonanno E , Giacchetta I , de Waure C 
Published: October 2023

Abstract

Background
Influenza virus infection is a major cause of morbidity and mortality worldwide, placing high costs to health systems, yet the quantification of its clinical burden remains debated and undervalued. We conducted an umbrella review to provide a summary of current knowledge on the topic.

Methods
We searched PubMed-MEDLINE, Web of Science, and the Cochrane library for both systematic reviews and metanalysis of observational studies reporting quantitative assessment of seasonal influenza clinical burden in terms of complications, hospitalizations, and deaths, published up to 30th April 2022. English records were considered for inclusion. We collated together quantitative measures across different outcomes.

Results
We identified 17 systematic reviews and 10 systematic reviews with meta-analyses published between 2005 and 2022, which included 1321 primary studies conducted from 1918 to 2020 and covering more than 15 million subjects. Of the 27 systematic reviews, 9 (33%) focused on the general population of all ages, 3 (11%) on subjects aged 18 years or older, and 10 (37%) on the paediatric population. Lastly, three reviews (11%) focused on pregnant women, and 2 (7%) on other special populations. Twenty-one (78%) reviews included studies from different countries. Preliminary results show children aged ≤5 years, and adults aged ≥65 mostly contribute to the morbidity and mortality burden of influenza: the hospitalization rate for influenza-related complications is higher in paediatric subjects than in adults (0.27-10% vs 0.02-0.43%) while the highest mortality rate occurs in over65, ranging from 0.12% at community level to 13% among inpatients. Results suggest also a triggering role by influenza for hearth attack in at-cardiovascular risk patients.

Conclusions
Despite variability in estimates, depending on the setting, the geographic area, and the population considered, influenza carries a significant clinical burden, especially - but not only - in fragile groups.

Key messages
• Influenza still poses a significant threat to health systems, which should be addressed with appropriate preventive strategies.
• The best preventive strategy to reduce the flu burden is vaccination, especially in at-risk groups.
Can ChatGPT follow an algorithm for ethical decision-making in public health?
Authors: Anov A , Statev K , Stateva A , Seizov A , Aleksandrova-Yankulovska S 
Published: October 2023

Abstract

Background
With the rapid development of AI, especially chat bots based on Large Language Models like OpenAI ChatGPT and Google Bard, the question of the day is can AI replace (partially or entirely) experts in certain fields - for example in Medical Ethics. The aim of this work is to test the application of ChatGPT to public health ethics (PHE) cases.

Methods
ChatGPT was given the task to analyse Ebola quarantine case in Sierra Leone by applying methodology for ethical analysis of its own choice and by applying a 4-step model for ethical analysis developed in Medical University - Pleven. The tests were done with simple and detailed tasks. No additional plugins to ChatGPT were included.

Results
Given a simple task ChatGPT applied 4-step model to the case - Facts, Stakeholders, Ethical principles (Autonomy, Non-maleficence, Beneficence, Justice), Potential consequences. A brief argumentation was provided for each point. ChatGPT identified key ethical concepts for the case (limiting autonomy and freedom, limiting access to resources). When asked to analyse the case with the principles of PHE as defined in The Cambridge Textbook of Bioethics, ChatGPT still used Beauchamp and Childress principles of bioethics. When introduced to PHE principles ChatGPT identified limiting access to resources, creating social and economic hardship for those affected by quarantine as key issues. ChatGPT managed to apply the 4-step model for ethical analysis developed in Medical University - Pleven to some degree. It produced detailed discussion but didn't use any ethical standards, patient's rights or public health policies that could help with decision-making. Individual autonomy was disregarded by ChatGPT in the most detailed analysis.

Conclusions
ChatGPT has basic knowledge of methodologies for ethical case analysis. With proper guidance and detailed instructions, it could follow complex methodologies and produce a decision.

Key messages
• AI will continue to develop and its inclusion in medicine and public health practice and teaching is inevitable.
• Public health professionals should always be critical of AI decisions and double check the information that was provided by AI.
Multimethod study on patient-reported measures for routine assessment of primary care
Authors: Drexler S , Kiss N , Harrison H L , Bilger M 
Published: October 2023

Abstract

Objectives
Health systems across the Organization for Economic Cooperation and Development (OECD) spend around 9% of their GDP on health, but we know surprisingly little about whether health systems are truly delivering the care people need. One solution is the routine collection of patient reported outcome measures (PROMs) and patient reported experience measures (PREMs), i.e. patients’ subjective health status and experiences of care. The aim of this study is to evaluate whether validated generic PROMs and PREMs measure criteria relevant to routine performance assessment of and monitoring in primary care.

Methods
This is a multimethod study. First, we collected qualitative data using the nominal group technique to identify the roles and tasks of primary care from the perspective of patients, providers, and decision-makers in healthcare. Second, we conducted a systematic literature search in EMBASE supplemented by a grey literature search to identify self-administered, validated, and generic PREMs and PROMs for adults used in primary care.

Results
The role of primary care is not limited to improving health, but also includes, for example, patient empowerment and support in navigating the healthcare system. Experiences of care and the supportive structure of primary care were rated as more important than health outcomes. Six of 14 questionnaires identified in the literature review address both PREMs and PROMs. PREMs largely focused on experiences with healthcare providers. Comparison of both data sources revealed a lack of PREMs addressing experiences with care structures.

Conclusions
The results suggest that care experiences are an outcome in their own right in primary care and should thus be considered in routine evaluation of primary healthcare services, which additionally allows pointing to quality improvements. Future questionnaires should address experiences with care structures and the relationship between care experience and health outcomes.

Key messages
• Alongside health outcomes, care experiences are a primary care outcome in their own right and should thus be considered in routine assessment.
• Future routine assessment tools should address experiences with care structures and the relationship between care experiences and health outcomes.
Investigating the longitudinal impacts of frontline work on healthcare workers family functioning
Authors: Sheen J , Lee BEC , Clancy E M , Considine J , Dwyer A , Tchernegovski P , Reupert A , Taylor N , Herrick C A , Boyd L 
Published: October 2023

Abstract

Background
At a time when many families were sheltering at home, frontline healthcare workers (FHWs) worldwide continued to work in the community, often under significant stress. While it has been well documented that frontline work during the COVID-19 pandemic has had impacts on healthcare workers’ mental and physical health, the impacts on their family functioning remain unclear. This study investigates the longitudinal impact of frontline work on family functioning amongst Australian healthcare workers.

Methods
Semi-structured interviews were conducted with Australian FHWs working in high-risk areas such as Emergency Departments, Intensive Care Units, COVID wards, Hospital in the Home, and Aged Care. Interviews occurred across three timepoints (Dec 2020=39 participants, June 2021=34 participants, Jan 2022=31 participants). Transcripts from each timepoint were analysed separately using reflexive thematic analysis, then whole group comparisons were made between timepoints to identify changes and the nature of the changes.

Results
Flexibility and the need for constant adaptation were consistent themes across the three timepoints, as FHWs struggled to balance the demands of workplace changes alongside lockdown and COVID-19 related changes in their personal lives. In the early stages of the pandemic, families with pre-existing vulnerabilities reported significant challenges whereas others reflected on family resilience and growth. Two years on, even those families that articulated resilience and growth have observed declines associated with the persistent demands of their healthcare roles.

Conclusions
While healthcare organisations globally have made efforts to support their staff, these challenges observed by participants highlights the need for more targeted workplace and public health strategies within healthcare systems, particularly with respect to family support.

Key messages
• Healthcare workers have faced considerable challenges through the course of the COVID-19 pandemic, with declines in mental health and family functioning observed.
• Beyond resilience and wellbeing interventions, healthcare workers need workplaces that acknowledge and support their family lives.
The “Cristo Re” hospital experience on telerehabilitation for treatment post thyroidectomy neck pain
Authors: Nasi G , Princi P , Galeoto G , Brandimarte G , D'Avino A , La Penna M L , Nigro C , Lombardi C P , Tempera S E , Brandimarte G 
Published: October 2023

Abstract

Background
Thyroidectomies are one of the most frequently performed endocrine surgical procedures and are mostly consequent to thyroid cancers with about 80% of patients develop neck pain and stiffness. For better management in a public health setting, Cristo Re Hospital in Rome has designed specific physiotherapy based on selective stretching and strengthening of neck muscles combined with breathing.

Methods
The study enrolled 26 patients with a mean age of 51.2 years: 20 were treated with total thyroidectomy and 6 with thyroid lobectomy. Follow-up was performed at 1 day, 1 week and 1 month after surgery. We used for assessment: Visual Analog Scale (VAS), Neck Pain and Disability Scale-I (NPDS-I), Short Form-12 (SF12), Disability of the Arm, Shoulder and Hand (DASH), Neck Disability Index Questionnaire (NDI). The patients performed 10 therapeutic sessions: the first in the hospital on the first post-surgery day, the others in telerehabilitation 3 times a week (40 min. each) for 3 weeks. A nonparametric Friedmann test was analyzed the differences between the scale averages at T0/T1 and T2. Using case-control analysis the effects of treatment duration (&lt;vs&gt;90 min.) were assessed with the U-Mann-Whitney test.

Results
A statistically significant improvement was shown in the Physical Component Summary- SF12 at 1 week and 1 month after treatment (+3 pts at T1, +13.2 at T2 p &lt; 0.001), while no significant changes in the Mental Component Summary. The averages of NPDS-I, NDI and DASH also decreased at T1 and T2 demonstrating the effectiveness of the protocol (-37.7 median points,-18.3 mp,-34.5 mp,-35 mp, respectively p &lt; 0.001). No significant change in VAS scale at T1 and T2 and in patients treated for more or less than 90 minutes.

Conclusions
This protocol is useful for reducing neck pain and improving quality of life and can be recommended as a therapy after thyroidectomy with a strong reduction in cost and morbidity, being able to treat patients even in telerehabilitation.

Key messages
• Therapy after thyroidectomy that, by being able to treat patients even in telerehabilitation, reduces hospitalization rates, costs, and morbidity due to neck pain, with increased quality of life.
• New low-cost methodology for neck physiotherapy after thyroidectomy, also performed in telerehabilitation, which improves quality of life and ability of movement while greatly reducing pain.
Predictive model for patient blood management in elective cardiac surgery: blood bag saving 2013-2020
Authors: Limaj S , Cartocci A , Simeone F , Cevenini G , Messina G , Nante N 
Published: October 2023

Abstract

Background
Blood shortage is a worldwide persistent emergency: it is a relevant topic in scientific research and policy making. There are several research topics about blood management strategies, but there is not much evidence on the quantity of blood bags needed for an elective cardiac surgery. Once they are unfrozen and prepared, they can't be stored anymore even if unused. This study aims to show how many blood bags are saved with the usage of a model, developed by Siena University researchers, that estimates the need for each elective cardiac surgery.

Methods
Data about the number of blood bags predicted by the model for patients that underwent elective cardiac surgery in University Hospital of Siena from 2013 to 2020 were retrospectively collected. Surgeries for aortic dissection, heart transplants and artificial heart implant were excluded. Before developing the model, the general policy of the hospital was to use about 10 blood bags for each patient. The algorithm establishes the number of blood bags based on HCT, therapy, combined and/or a redo operation, Euroscore2 threshold, comorbidities, and type of operation. 4 extra bags were added to every prediction as safety buffer.

Results
This study included 2307 surgical interventions. The sum of all the bags calculated by the model and, thus, prepared for the surgeries, with 4 extra bags as safety buffer per operation, was 13044, compared to the 23070 calculated with the previous criteria. Euroscore 2 score had the closest algorithm prediction to real usage and a mean of 5,4 bags per operation for Euroscore2 &lt;6% and 6,6 for Euroscore2 &gt;6%. Roughly 1.814.706 euros were saved, considering only the rough price of the single blood bag (181€ each).

Conclusions
Machine-learning odels like the one used in this study can improve patient blood management by predicting how many blood bags a patient needs for elective cardiac surgery.

Key messages
• An algorithm can improve patient blood management by predicting how many blood bags a patient needs for elective cardiac surgery.
• Euroscore2, among other criteria such as therapy, comorbidities, and type of operation, improves the accuracy of this algorithm.