bluuebunny/crossref_metadata_2025_split huggingface dataset:
An overview of reviews: what do we know about task shifting and skill mix change in healthcare?
Authors: Meda F , Cantarelli P , Vainieri M 
Published: October 2023

Abstract

Task shifting is a globally recognized strategy to respond to healthcare challenges (WHO, 2008; Simms et al., 2019). This research contributes to the academic debate on task shifting by providing a comprehensive overview of the current knowledge and interpreting the results through the theoretical framework by Sibbald et al. (2004), describing task shifting as enhancement (extending roles of a workers group); substitution/delegation (exchanging tasks between groups of workers); innovation (creating new jobs by introducing new skills or technological innovation). The study is a systematic review of reviews (Smith et al., 2011). The search was performed on Scopus, completed in February 2023, confined to English published article reviews, from 2004 onwards, coherently with publication year of Sibbald et al. (2004). The search keywords defined: type of publication (review), health personnel (doctor/physician, nurse, technician, therapist, social/community worker) and focus of the article (task shifting or skill mix). Of the 692 publications identified, 37 met the inclusion criteria: 23 systematic reviews, 8 non-systematic/narrative, 3 scoping and 3 meta-analyses. In total, 815 papers are reviewed by the studies. 19 are focused on developing countries, 2 on developed and 16 do not specify it. 8 are focused on non-communicable diseases, 7 on surgery/acute care, 6 on HIV, 6 on primary care, 10 studies do not indicate it. Task shifting is not only of doctors and nurses: mental health specialists, surgeons, general practitioners, midwives, technicians, therapists, community workers, volunteers are examples of professionals considered. 31 reviews conceive task shifting as substitution; 4 as enhancement; 1 as innovation. Task shifting is mostly intended as tasks exchange from qualified to less-qualified workers, mainly to respond to staff shortages. It can be performed by different categories of professionals, being applicable to different contexts, services and treatments.

Key messages
• Task shifting is a globally recognized strategy to respond to healthcare challenges. This research contributes to the academic providing a comprehensive overview of the current knowledge on the topic.
• Task shifting can be performed by different categories of professionals, being applicable to many care services. It should be designed according to the specific context and professionals involved.
Workers needed: a needed assessment of the workforce in local public health services in Portugal
Authors: Vasconcelos R 
Published: October 2023

Abstract

Background
Portugal is planning to reform its public health services, which have been struggling with a shortage of professionals, even after hiring more staff during the COVID-19 pandemic. Meanwhile, in 2023, new local health units will be created to reorganize the local public health services (LPHS). Therefore, it is essential to examine and discuss how many and where the professionals in LPHS are in Portugal.

Methods
A cross-sectional descriptive analysis was conducted using hiring data, in the second trimester of 2023. The number of professionals in LPHS in mainland Portugal was described and compared between the 55 LPHS and the 5 health regions. They were classified into categories, with a special attention given to medical specialists, nurses, and environmental health technicians, who have specific regulations.

Results
More than 20 different professions can be found in the different LPHS. The total number of professionals in public health services in mainland Portugal was 1720, of which 380 (22.1%) were medical specialists, 304 (17.7%) were nurses, 443 (25.8%) were environmental health technicians. The highest number of professionals was found in ACES Baixo Vouga with 70. The health region with the highest number of professionals was ARS Norte with 635. When considering full-time equivalents, only 18 (32,7%) LPHS have the legally recommended ratio of one medical specialist per 25 000 inhabitants, the ratio of one nurse per 30 000 inhabitants is attained in 18 (32,7%) LPHS, and only 12 (21,8%) have the indicated one environmental health technician per 15 000 inhabitants.

Conclusions
This study provides a comprehensive overview of the number and distribution of professionals in LPHS in mainland Portugal, at a time of change, with concerning results. These can be useful to plan and evaluate policies and interventions regarding public health personnel recruitment and organization, considering impending the reforms.

Key messages
• There is a lack of professionals in local public health services in Portugal, with few meeting the legally recommended ratios of medical specialists, nurses, and environmental health technicians.
• The incoming changes in public health services organizations are a good opportunity to reorganize and invest in their workforce, which is essential to improve public health in Portugal.
MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings
Authors: Gannon J , Greenan K , Takenoshita M , Hettle D , Duffy O , Nygren D , Lynch R , Buttigieg S , Phiri J , Margetts Ben 
Published: October 2023

Abstract

Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings.
On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients.

Key messages
• Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia.
• A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.
Effect of prenatal passive tobacco smoke exposure on full-term birth weight of born neonates:SR
Authors: Niranjan V , Manat A , Stokes D 
Published: October 2023

Abstract

Prenatal smoking increases the risks of pre-term birth, stillbirth, neonatal death, and perinatal death as well as neurodevelopmental disorders in children. However, there is a lack of consistency in research published about association/impacts of passive smoking and low birth weight (LBW). Hence, we carried out this systematic review to determine whether or not there is a relation between prenatal tobacco smoke exposure and full-term LBW infants. Following PRISMA guidelines, we carried out systematic searches with PubMed, CINAHL, PsycInfo, and Embase for cohort case-control studies the 31-year period from 1991 - 2022. Of the 2,877 articles identified, 835 duplicates were removed. Title screening was done for 2,126 articles. 25 articles met the inclusion criteria that were Peer reviewed full-text articles in the English language and related to LBW due to passive smoking only. We found 20/25 articles showed a significant relationship with an OR ranging between 2.14 and 54.9 respectively between exposure to environmental tobacco smoke (ETS) and LBW infants at term and 5 articles showed no association with an OR ranging between 0.48 and 1.51. A significant difference found between the sample size among the studies included influencing the outcome of the study (ranging from smallest (n = 208) and largest (n = 17412). Mean age of mother was 29.6±3.8 and mean birth weight was 3,212±467.1. Nicotine level &gt; 4.1 ng/mL or duration of exposure 24.4 hours/week gives strong evidence of prevalence of LBW among SHS exposed mothers. Compiled evidence suggests that, there is a significant association between prenatal passive smoke exposure and neonatal birth-weight at full term. There is a need for health researchers and public health experts to design and implement targeted programmes to reduce LBW due to passive smoke in our societies.

Key messages
• Exposure to ETS from domestic sources has a substantial influence on birth weight.
• Combining educational programmes and legislative interventions is required to eliminate infants’ contact with tobacco smoke in utero and throughout childhood.
Early life social and health determinants of higher education across three generations
Authors: Hossin M Z , Björk J , Grünberger I 
Published: October 2023

Abstract

Background
Associations of social and health disadvantages at birth with educational attainment are well-documented. Less is known about the magnitude of the associations across different historical contexts. We investigated associations between a range of early life disadvantages and higher educational attainment across three successive generations.

Methods
The data were from the register-based Uppsala Birth Cohort Multigenerational Study in Sweden. The study samples include three generations born in 1915-1929 (G1, n = 10 587), 1933-1972 (G2, n = 6566), and 1973-1978 (G3, n = 6684). The outcome was attainment of higher education (more than senior high school) assessed at age 30+ years. Exposures were parental socioeconomic position (SEP), mother's marital status, parity, gestational age and birth weight for gestational age. Multiple logistic regression models were fitted to evaluate the associations across three generations. Results are presented as Average Marginal Effects (AME).

Results
Low parental SEP was associated with lower probability of higher educational attainment in all three generations. The difference between low versus high parental SEP among men declined by 32 percentage points in G2 (AME: 0.32; 95% CI: 0.27, 0.38) and 27 percentage points in G3 (AME: 0.27; 95% CI: 0.21, 0.33) compared to G1. Among women, the corresponding declines in G2 and G3 were 35 and 28 percentage points. Mothers’ unmarried marital status and high parity were associated with lower probability of education, with no evidence of decline across generations. The association between small for gestational age and education among men persisted across generations while showing a decline in G3 women.

Conclusions
Associations between early life factors and education persisted across three generations. The influence of parental socioeconomic background on educational attainment appeared to level off in the youngest generation after becoming attenuated in the preceding generation.

Key messages
• Association between small for gestational age and educational attainment persisted across generations, with an attenuation among the youngest cohort of women.
• High parity was associated with lower chance of educational attainment, with no evidence of effect attenuation across generations.
Psychosomatic complaints at age 15-16 and later educational achievement in upper secondary school
Authors: Wahlström J , Östberg V , Åhlén J , Låftman S B 
Published: October 2023

Abstract

Background
Psychosomatic complaints are common among adolescents, and the reporting has increased in recent decades. Yet, knowledge on the potential consequences of such complaints is scarce. Given the importance of educational success for health throughout life, investigating the relationship between psychosomatic complaints and academic outcomes is important. This study's aim was to investigate the prospective links between psychosomatic complaints at age 15-16 and, firstly, the likelihood of not completing upper secondary school, and secondly, grade point average (GPA) among those who graduated from upper secondary school.

Methods
Data was obtained from Futura01, a national cohort study of Swedish adolescents attending grade 9 in 2017 (n = 5,198). Psychosomatic complaints were measured by self-reports on the frequency of headache, stomach ache, and difficulties to fall asleep, which were summed to an index. Information on graduation and GPA from upper secondary school was based on registry data from 2020-21. Binary and linear regression analyses were performed stratified by sex. Covariates included parental education and country of birth, medication for depression and anxiety, and conduct problems.

Results
Higher levels of psychosomatic complaints were prospectively associated with an elevated risk of not completing upper secondary school (males: OR = 1.08, 95% CI 1.03-1.14; females: OR = 1.10, 95% CI 1.04-1.16). Among those who graduated from upper secondary school, higher levels of psychosomatic complaints were prospectively associated with lower GPA for males (b=-0.04, 95% CI -0.07, -0.00), but not for females (b=-0.01, 95% CI -0.04, 0.02).

Conclusions
Psychosomatic complaints in adolescence may have long-lasting consequences for individuals’ living conditions and health by affecting later educational performance and success. Interventions targeting youth with self-reported mental health issues could positively impact later academic achievements.

Key messages
• Psychosomatic complaints at age 15-16 are associated with later educational achievement in upper secondary school.
• Interventions targeting youth with self-reported mental health issues could positively impact future academic success.
Quality Improvement Process in Childcare Facilities: Results of a Qualitative Study
Authors: Decroix C , Essilini A , Duboys Fresney M I , Casso-Vicarini N , Côté S M , Alla F 
Published: October 2023

Abstract

Introduction
Access to quality educational facilities is a major determinant of children's well-being and a means to tackle social health inequalities. In France, ‘Accompagne-moi...!’ (AM) intervention, tested in a pilot study, was adapted from evidence-based interventions developed in Quebec. The objective of AM was to improve professional practices allowing children to develop their social and emotional skills. This research aimed to assess viable validity of AM. Viable validity “refers to stakeholders’ views and experience regarding whether an intervention program is practical, affordable, suitable, evaluable and helpful in the real-world” (Chen, 2010).

Methods
A qualitative study was realised in 13 childcare facilities from 4 French deprived areas (2019-22). Eight exploratory interviews, 33 semi-structured interviews with professionals were conducted. A comprehensive thematic analysis was performed.

Results
Childcare facilities were systems characterised by involved professionals evolving in difficult working conditions amplified in times of health crisis. The interviews showed the potential of the approach to address needs (e.g. professional training, increased awareness of children's emotions) and perceived positive effects (e.g. support for management in implementing change in the facilities, perceived effects on children). Professionals expressed a negative experience of AM (e.g. sense of failure, insufficient appropriation of the approach by the group) linked to the challenges of deploying an intervention in highly stressed environments.

Conclusions
This study highlights: i) potential of AM, ii) that children's well-being cannot be separated from the professional's well-being, iii) inflluence of certain structural determinants on educational practices and the quality of childcare facilities, iv) need to address these structural determinants prior to the intervention implementation. Prior to the deployment of AM on a larger scale, adaptations were proposed.

Key messages
• The well-being of children and professionals in childcare facilities are interdependent.
• Structural determinants are key determinants of the quality of childcare facilities.
Qualitative communication research with environmental health scientists and stakeholders
Authors: Friedman D B , Altman K , Yelton B , Viado H F , Carson M A , Schandera L , Kelsey R H , Porter D E 
Published: October 2023

Abstract

Effective research translation and science communication are necessary for successful implementation of environmental health initiatives to improve public health. The Community Engagement Core (CEC) of the Center for Oceans and Human Health and Climate Change Interactions in the southeastern United States conducted a trio of qualitative studies to assess perceptions, experiences, and training needs relative to science communication and research translation of investigators and stakeholders. Interview transcripts were coded using open and axial coding and analyzed for emergent themes. (1) Interviews were conducted with 13 Center investigators. Most preferred in-person and written communication channels and felt comfortable communicating uncertain findings to the public despite no formal training. They asked for training on plain language messaging for communities, assessment of audience needs, and formatting research findings for various groups. (2) Interviews were conducted with 13 CEC stakeholders to learn more about their research translation needs, communication and dissemination tactics, and experiences interacting with scientists. Findings indicated the need for collaborative scientist-stakeholder training to include plain language development, communication evaluation, and audience engagement. (3) Follow-up interviews with 7 stakeholders examined specific topics of understanding, trust, and access and how those can become barriers or facilitators of public engagement with environmental activities. Findings showed the public may have limited understanding of scientific processes, establishing trust takes time, and ensuring access should be incorporated into all programs. Together, these analyses demonstrate the importance of engaging investigators and partners on all aspects of research. This presentation is relevant to other partner-engaged research and provides insights on practices for equitable and effective stakeholder engagement and collaboration.

Key messages
• Effective research translation and science communication are necessary for successful implementation of water resources management initiatives.
• Qualitative research is important for assessing perceptions, experiences, and training needs relative to science communication and research translation for researchers and community partners.
Impact of COVID-19 on DTP3 Vaccination Trends in Africa: A Joinpoint Regression Analysis
Authors: Guillen Grima F , Aguinaga-Ontoso I , Guillén-Aguinaga S , Guillén-Aguinaga L , Alas-Brun R , Onambele L , Aguinaga-Ontoso E 
Published: October 2023

Abstract

Background
Vaccine-related death is one of the leading causes of death among African children. Vaccine coverage is a very important measure to decrease infant mortality. WHO has set a 90% vaccination coverage target of 3 doses of DTP (DTP3) by 2015. Covid-19 Pandemic has affected the healthcare system and may have disrupted vaccine coverage.

Methods
DTP3 Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) was calculated for Africa and the regions. Countries’ DTP3 vaccination rates in 2019 and 2021 were compared to see if they complied with the WHO target of 90% DTP3 coverage.

Results
According to the findings, vaccine coverage decreased by an absolute 4% between 2019 and 2021, with a negative annual percentage change (APC) of -2.9% starting in 2019. With a relative fall of -6.25 percent, Eastern and Southern Africa have experienced the largest relative decrease in coverage. A joint point was found in Sub-Saharan Africa in 2019, with a downward tendency from 2020 onward. In East and South Africa, the APC turned negative in 2020, with an APC of -3.5 percent. The number of African countries meeting the WHO's 90 percent coverage goal for the third DTP dose fell by 22.7 percent, from 22 in 2019 to 17 in 2021. This decrease suggests that the COVID-19 pandemic has harmed DTP vaccination trends in Africa, with half countries reporting a drop in vaccination coverage

Key messages
• The COVID-19 pandemic disrupted DTP3 vaccination in Africa, causing a 4% absolute decrease in coverage between 2019-2021.
• The number of African countries meeting WHO's 90% DTP3 coverage target dropped by 22.7% due to the pandemic impact.