bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global inpatient utilization from 1990 to 2020: effects of the COVID-19 pandemic
Authors: Nekliudov N , Hamilton E , Pasovic M , Moberg M , Murray C , Vos T , Lim S 
Published: October 2023

Abstract

Background
Inpatient service utilization rate is a key indicator for estimating the performance of health care systems on global, regional, and national levels.

Methods
We collected 1378 source-years of data, including administrative sources, nationally representative surveys, and government reports covering 130 countries overall, 29 of which are in the European region from 1990 to 2020. Inpatient admission was defined as an overnight stay at a formal healthcare facility for any cause. The data underwent age- and sex-splitting as per the available level of detail; survey sources were crosswalked to the gold-standard administrative data. The resulting data set was analyzed using Spatiotemporal Gaussian Process Regression (ST-GPR), a Bayesian meta-regression tool, to model the inpatient admission rate per capita across all countries, age groups, and sexes from 1990 to 2020. Admission rates were age- and sex-standardized to compute global proportions of hospitalized persons.

Results
In 2019, the global age-standardized inpatient utilization rate was 0.12 (95% uncertainty interval [UI] 0.09-0.15) admissions per capita. Globally, 0.93 billion (0.72-1.18) inpatient admissions were provided in 2019 compared to 0.68 billion (0.53-0.87) in 1990. In 2020, the global age-standardized inpatient utilization rate dropped to 0.057 (0.055-0.059) with a global proportion of hospitalized patients of 0.45 billion (0.43-0.46).

Conclusions
The increase in inpatient utilization from 1990 to 2019 may be attributable to population growth and increased capacity of health systems across most WHO regions. Health care utilization was highly variable between regions that was partly explainable by the variation in the socio-demographic index (SDI). The pandemic-mitigating measures limiting transportation and healthcare access were associated with the reduction in utilization in 2020.

Key messages
• The inpatient utilization rates were rising globally with large variation across regions, while decreasing in 2020 due the COVID-19 pandemic-related mitigating measures.
• Health systems may use the inpatient utilization estimates to assess the effectiveness of health care reforms, plan for future capacity, and to allocate financial and human resources appropriately.
Auctions Versus Fixed Prices: Lessons from a Procurement Pilot
Authors: Kuhmonen S 
Published: October 2023

Abstract

Objectives
Private health care providers are often acquired through procurement auctions to produce publicly financed services. In this study, we examine the costs and benefits of auctions compared to fixed price procurements. We analyze a procurement pilot that was conducted by Kela, the largest rehabilitation organizer in Finland. Kela piloted fixed prices instead of an auction in two different services in 2020.

Data and methods
Our data includes all procurements both for inpatient and outpatient rehabilitation courses by Kela in years 2012-22. The data includes 455 procurement auctions, which received 2584 bids, and 4 pilot procurements of fixed prices, which received 166 bids. Altogether 10 providers were contracted in the pilot procurements of the first service whereas the last two pilot procurements attracted 153 providers. Our preliminary results are based on simple statistical and graphical analysis regarding bid prices and their dispersion.

Results
Our preliminary main finding is that competition, calculated as number of bids per auction, is correlated with prices in the procurements. The main challenge of fixed prices is to determine the appropriate price-level. We find that the prices were set to be attractive in the pilots, as all providers who previously participated in auctions accepted the price, and several new providers entered the market in the pilot procurements of the second service.

Conclusions
Efficiently organized public procurements can yield large fiscal saving for the public economy. The procurements give information about the number of providers offering the service and their price. Fixed pricing eliminates the competitive setting, which means that the price is often set too high to ensure the availability of services.

Key messages
• Efficiently organized public procurements can yield large fiscal saving for the public economy.
• Fixed pricing eliminates the competitive setting, which means that the price is often set too high to ensure the availability of services.
Generic justification of medical exposure to ionising radiations in two European countries
Authors: Giusti M , O'Sullivan L , Harrington P , Ryan M , McGarry M , Dullea A , O'Brien K K , Persiani N 
Published: October 2023

Abstract

The European Directive 2013/56/EURATOM aims to safeguard patients, members of the public and workers by setting out basic safety standards for protection against the dangers arising from exposure to ionising radiation. However, each European member state must consider how the Directive should be transposed at a national level and this has led to different organisational models being adopted. With regard to medical exposure to ionising radiation (MEIR), Ireland and Italy are interesting countries to compare because they have transposed the Directive in contrasting ways. Comparison of these models may highlight ways to harmonise approaches and improve efficiency. Case studies were prepared by reviewing national laws, analysing scientific documents and conducting interviews with managers of organisations assigned the responsibility for MEIR. The case studies focused on the generic justification (GJ) of MEIR, determining if the benefits of a radiological practice outweigh the risks, at a population level. Ireland implemented a centralised model by designating responsibility for the regulation of MEIR to an independent competent authority, the Health Information and Quality Authority (HIQA). The Health Technology Assessment Directorate in HIQA has built upon their experience in conducting evidence synthesis to inform health policy, but it may experience challenges as the single gateway for GJ decisions. In Italy, GJ is entrusted to national professional scientific radiological societies. The decentralised Italian model facilitates an immediate response to GJ applications from stakeholders, but the absence of strong national coordination may lead to duplication, loss of information and or partial knowledge of processes. Collaboration between European member states in the area of GJ of MEIR could support the standardisation of practices in Europe. This could be facilitated through the creation of a European working group.

Key messages
• The creation of a European working group focused on generic justification in radiation protection exposure is advocated.
• A European working group would lead to less duplication of effort and a more streamlined process for generic justification.
PHC service resilience during COVID19 in Brazil’s Northeast
Authors: Vieira-Meyer A , Guimarães JMX , Morais APP , Machado MFAS , orte FDS F , Pequeno AMC , Nascimento E F , Farias S F , Dias MSA , Vasconcelos MIO 
Published: October 2023

Abstract

COVID19 affected health system, including its ability to care for other health issues. Health System Resilience is related to the ability of a health service to continue to offer ongoing care for health issues while under a stressor. Brazil has a public-funded unified health system with a Primary Health Care (PHC) organized by the Family Health Strategy (FHS), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). The CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, and act as liaisons between health units and communities-key informant on the reality faced in the public services during COVID19. Brazil's northeast region is one of the country's poorest regions, with poor social indicators, including low HDI and high illiteracy, utilization of Brazil's conditional cash transfer program and COVID19 mortality. This study evaluated aspects regarding the impact of COVID19 in PHC activities related to diabetes&hypertension, tuberculosis, leprae, pre-natal care, pap smear and oral health care in Brazil's northeast region public service. Questionnaires were applied to CHAs from 8 different cities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed. The data show unequal COVID19 impact in PHC (different impact of COVID19 in the various municipalities and health care services). For 21.3% of CHW, the activities related to pre-natal care diminished during 2021 COVID19 pandemia, this percentage was 25.6%, 30.2%, 41.9%, 79.9% and 79.3% for tuberculosis, leprae, diabetes & hypertension, pap smear and oral health respectively in the PHC. The lack of a unified federal plan, due to a political misleading perspective may have negatively influenced the PHC. Understand how PHC was affected in different scenarios is important to strength the system in a more resilient manner, which is central in the event of other stressful events

Key messages
• There was an unequal impact of COVID19 on different PHC public services, which may be due to political tension and lack of federal guidance of the health system.
• Understand how PHC was affected is important to reorganize the system in a more resilient manner, which is central in the event of another COVID19 wave or other stressful event.
Maternal predictors of timeliness & uptake of Measles, Mumps & Rubella vaccine: A birth cohort study
Authors: Skirrow H , Foley K , Costelloe C , Bedford H , Lewis C , Whittaker E , Saxena S 
Published: October 2023

Abstract

Background
In the United Kingdom (UK) measles, mumps & rubella (MMR) vaccine uptake is below national recommendations. We aimed to identify maternal predictors for missed or late vaccination, including the association with pregnancy pertussis vaccination, added to the UK schedule in 2012.

Methods
We used electronic primary care records from the Clinical Practice Research Datalink to create a UK birth cohort following babies born between 01.01.2000 to 12.12.2020 and linked to their mother's record from birth. We estimated the proportion who received their 1st MMR vaccine by 2 years and 1st & 2nd MMR vaccines by 5 years and examined associated maternal predictors using survival analysis and Cox proportional hazard models. We examined a sub-cohort of babies born from 01.01.2013 to estimate the impact of pregnancy pertussis vaccination on children's subsequent MMR uptake.

Results
Overall, 92.6% (736,495/795,497) children had 1st MMR by 5 years with 89.4% (710,797) by 2 years. Among children still in the cohort when eligible for 2nd MMR, 85.9% had two MMRs by 5 years (478,480/557,050). Lower 1st & 2nd MMR uptake was associated with living in more deprived areas of England, being Black or Black British ethnicity or having mothers aged &lt;20 years (1st MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively). Children of mothers vaccinated in pregnancy were more likely to have 1st & 2nd MMRs after adjusting for ethnicity, deprivation and maternal age (1st & 2nd MMRs by 5 years adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53).

Conclusions
There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics. Mothers vaccinated against pertussis in pregnancy are more likely to have a child vaccinated with MMR. Health professionals should promote pregnancy and childhood vaccinations during pregnancy and consider how families can be supported to access childhood vaccines.

Key messages
• There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics with MMR uptake lower among children living in more deprived areas.
• Maternal vaccination and subsequent childhood vaccination uptake are related; pregnancy offers an opportunity to promote childhood vaccines and ensure families can access childhood vaccine services.
Varying faecal immunochemical test positivity thresholds impacts colorectal cancer detection
Authors: White P , Muraleedharan R , Mooney T , Smith A 
Published: October 2023

Abstract

Background
Colorectal cancer (CRC) is screened for by the faecal immunochemical test (FIT) in Ireland. The FIT positivity threshold in Ireland is 45 micrograms (µg) of haemoglobin per gram (g) of stool. FIT positivity thresholds influence both demand for screening colonoscopies and CRC detection rates through screening. This study aimed to assess the impact of varying FIT positivity thresholds on CRC detection rates through screening in Ireland.

Methods
This study used data from BowelScreen - The National Bowel Screening Programme, to retrospectively assess the impact of altering the FIT positivity threshold, adjusting it to correspond with neighbouring European countries, on CRC detection rates through screening in Ireland between 2013 and 2021. All analyses were conducted on Stata 17.

Results
1,552 individuals were diagnosed with CRC in Ireland after a positive FIT performed through BowelScreen between 2013-2021. Adopting the same FIT positivity thresholds as the Netherlands (47µg/g), Scotland (80µg/g), England (120µg/g) and Wales (150µg/g) would have resulted in 21 (1.4%), 262 (17.1%), 458 (29.8%) and 556 (36.2%) fewer diagnoses of CRC through BowelScreen during this period, respectively. Additionally, increasing the positivity threshold to correspond with these countries would have resulted in between 1.7-41.9% fewer stage 1, between 1.0-30.9% fewer stage 2, between 1.4-32.9% fewer stage 3 and between 0-5.6% fewer stage 4 CRCs detected.

Conclusions
Changing the FIT positivity threshold in Ireland to correspond with that of other neighbouring European countries would have reduced the detection of CRC through screening to varying degrees. The detection of stage 1 CRCs would have been most greatly reduced, but up to almost a third of all stage 2 and stage 3 CRCs would not have been detected if some alternative, higher positivity thresholds were adopted.

Key messages
• Increasing the FIT positivity threshold in Ireland will need careful consideration to keep the optimum positive predictive value of a colonoscopy.
• Lower stage 1-3 CRC detection rates may occur as a result.
What are doctors’ strategies to improve care coordination? Results in six Latin-American countries
Authors: Oliver-Anglès A , Vargas I , López-Vázquez J , Samico I , Campaz-Landazábal D , Mogollón-Pérez A S , Eguiguren P , Amarilla D I , Bertolotto F , Vázquez M L 
Published: October 2023

Abstract

Background
Given the problems generated by health care fragmentation, the coordinated provision of health care has become a priority, particularly in Latin America. This communication analyses the strategies for improving clinical coordination proposed by primary and secondary care doctors from public health service networks in six countries of the region (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and their changes between 2015 and 2017.

Methods
Two cross-sectional survey-based studies (2015 and 2017) were analysed with application of the COORDENA questionnaire to a total of 4311 primary and secondary care doctors from two public health service networks in each country. A descriptive analysis was carried out, stratified by country and year, of the suggestions proposed in the open question ‘What do you propose to improve clinical coordination between primary and secondary care doctors in the network?

Results
In all countries, the introduction or improvement of strategies and mechanisms that facilitate interaction and mutual knowledge between professionals at different care levels were highlighted, especially joint meetings, direct communication mechanisms (such as telephone and/or e-mail) and strategies to strengthen the use of the referral and counter-referral sheet. Less frequently, other organisational strategies aimed at strengthening the primary care model, improving access to secondary care and coordinating the management level of the network, were also suggested.

Conclusions
The results contribute to generate recommendations for the improvement of clinical coordination in health systems, based on the suggestions of doctors, a perspective that is not usually considered in the design and implementation of interventions in health services. The need to promote strategies based on mutual feedback in the design of public health policies stands out.

Key messages
• The design of effective interventions aimed at improving coordination requires doctors’ participation.
• Strategies based on mutual feedback and communication should be promoted by healthcare organisations to improve clinical coordination.
Economic management and depression in healthcare workers during the COVID-19 pandemic in Czechia
Authors: Kuklová M , Fryčová B , Kucera M , Pekara J , Wolfová K , Janoušková M , Novák D , Šeblová J , Čermáková P , Seblova D 
Published: October 2023

Abstract

Background
Inequalities in the regional management of healthcare systems can have impact on mental health of healthcare workers. We examined the relationship between regional economic management and depression among healthcare workers during the COVID-19 pandemic in Czechia.

Methods
We conducted cross-sectional analyses of 3 waves (2020 n = 1,282; 2021 n = 1,510 & 2022 n = 956) from the Czech COVID-19 HEalth caRe wOrkErS (HEROES) Study. The cost-to-income ratio for 2019 was used to capture regional healthcare economic management prior to the pandemic. Based on this indicator, regions were grouped into 3 categories (poor, adequate=capital region, good). Depression was defined as ≥ 10 points on the Patient Health Questionnaire. We estimated odds ratio (OR) with 95% confidence interval (CI) for the association of regional healthcare economic management with depression using logistic regression, adjusting for age, sex, and occupation in Model 1 and for self-reported COVID-19 exposure and regional COVID-19 incidence rates in Model 2.

Results
In 2020, there was a statistically non-significant trend towards a graded relationship between the regional healthcare economic management and depression with OR 1.8 (95%CI:0.8-4.2) for poor management and OR of 1.3 (95%CI:0.6-2.5) for adequate management, when compared to regions with good management. No substantial differences were apparent (OR for poor=0.9; 95%CI:0.6-1.3 & OR for adequate=0.9; 95%CI:0.6-1.3) in 2021. In 2022 showing an increased chance for depression with adequate management (OR = 1.4; 95%CI:0.6-3.2) but a lower chance of depression for regions with poor management (OR = 0.7; 95%CI:0.4-1.5).

Conclusions
We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers. There was an indication that in regions with poorer management, healthcare workers showed an increased chance of depression in the early phase of the pandemic.

Key messages
• Poorer regional economic healthcare management may play a role for depression of healthcare workers, especially in early phases pandemic or other crisis situations.
• We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers.
Norwegian inmates’ experiences of a shift to self-catering: promoting health through empowerment
Authors: Hervik SEK , Hervik A K , Thoresen T , Thurston M 
Published: October 2023

Abstract

Prisons have been described as important settings for health promotion. Health promotion, in which empowerment is a key process, is challenging in prisons since inmates’ individual choice and control is constrained. Empowerment through increased individual choice and control regarding food could be one way to promote health in prison. The aim of this presentation is to explore how inmates experience a shift from ready meals to self-catering and how they perceive the consequences of this for their health. The context of this study is Bastøy Prison, situated on an island in the Oslofjord. It is Norway's largest low-security prison with a capacity of 115 male inmates. In advance of the study, the canteen had been closed and ready meals were introduced as a substitute. This resulted in protests among inmates, who argued for the possibility to cook their own food. Consequently, the prison shifted to self-catering. In the spring of 2022, 20 individual semi-structured interviews were carried out, with inmates with differing age, social backgrounds, and ethnicity. The interviews were transcribed verbatim and analysed inspired by the principles of framework method. Empowerment through introduction of self-catering was expressed as having several positive consequences for the inmates related to their physical, mental, and social wellbeing. These consequences included, for example, developing food skills such as planning and organizing meals, cooking, and keeping the kitchen clean, eating healthier foods, building and expressing identity and strengthening social relations among inmates. The findings from this study suggest that empowerment through self-catering can have positive ripple effects that may be important for health promotion. Such understandings are important to bear in mind if the aim is to create health-promoting prisons.

Key messages
• Empowerment through increased individual choice and control regarding food could be one way to promote health in prison.
• A shift to self-catering was expressed by inmates as having several positive consequences for their physical, mental, and social wellbeing.
Functional social support and physical activity in community-dwelling older adults: A scoping review
Authors: Steinhoff P , Reiner A 
Published: October 2023

Abstract

Background
Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for healthy ageing, as it can prevent noncommunicable diseases, improve mental health, cognitive functioning and quality of life. However, PA decreases with age. About two-thirds of those aged 65-74 years and three-quarters of those aged 75 or more do not meet PA guidelines. A systematic review from 2017 showed that social support (SOSU) and loneliness are associated with PA in older people. The aim of this scoping review was to update that systematic review by identifying and mapping all of the available knowledge, including results from mixed-methods and qualitative studies, and to explore associations between functional SOSU and PA in older people.

Methods
A scoping review was conducted using the Joanna-Briggs manual. Empirical studies investigating associations between functional SOSU and PA levels in older adults were identified through a systematic search of the electronic databases Web of Science, PubMed, ProQuest, PsycInfo, PSYINDEX, SocINDEX and Scopus up to March 2022, without time or geographic restrictions. After removing duplicates, 17,196 articles were screened for titles and abstracts by two independent researchers. Strict inclusion and exclusion criteria were set in advance.

Results
88 articles matched the inclusion criteria; 71% were quantitative studies and 29% qualitative studies. Most studies used self-reported PA measures, only 13% of the studies used objective-reported PA measures. Most studies showed a significant positive association between functional SOSU and PA. The results were analysed separately for the different SOSU types.

Conclusions
Functional SOSU is positively associated with PA while lack of SOSU is a major barrier to exercise. The study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.

Key messages
• Older adults have lower levels of SOSU and PA.
• One way of promoting PA in older age is facilitating high levels of SOSU.