bluuebunny/crossref_metadata_2025_split huggingface dataset:
An integrated, stepped care organizational model for diagnostic evaluations along the care trajectory of children with a developmental disorder.
Authors: Cloet Eva , Leys Mark 
Published: January 2024

Introduction: The field of multidisciplinary diagnostic evaluations for children with a developmental disorder in Flanders, Belgium, is heterogeneous and characterized by severe accessibility problems. However, children with a developmental disorder need timely and adequate diagnostics during their trajectory of care and support. This policy support research project develops an organizational model of integrated of care and networking adapted to diagnostic needs in different phases as well as the particularities of the Flemish institutional field.
Methods: Homogeneous focus groups were performed with stakeholders from six types of governmental regulated organizations offering specialized diagnostic evaluations in Flanders (Centres for Developmental Disorders, Centres for Ambulatory Rehabilitation, Autism Reference Centres, Mental Healthcare Centres, Pupil Guidance Centres, and Ambulatory Services for Paediatric Psychiatry). A topic list was developed, based on a literature review on relevant themes. Qualitative data was categorized and iteratively compared per theme between focus groups by researcher and data triangulation. A member check validation was organized.
Results: 59 experts participated in 6 focus groups. Because of poor participation, the focus group with stakeholders from paediatric psychiatry was cancelled. The focus groups learn that it currently lacks coordination of activities, there is no shared vision on the content and goals diagnostic evaluation, there is an unequal regional distribution of organizations. Interorganizational and interprofessional collaboration is restricted to referral, without integration of care. There is poor mutual trust in the quality of the diagnostic assessments between organizations. Mutual knowledge on activities and expertise, lacks. Regulations hamper interorganizational collaborations as well as different financing mechanisms between organizations. Current organization of the field focuses on organizations’ interests and do not take into account the specific children’s and context’s diagnostic needs during their trajectory.
Conclusion: A patient-centred, integrated, stepped care, network model integrating general specialized and highly specialized knowledge and expertise (for different developmental disorders) across organizations borders in a well thought regional approach, is expected by all stakeholders to improve accessibility to specialized diagnostic evaluations adapted to the care trajectory of the child with a developmental disorder.
Effectiveness of contact tracing for COVID-19 in Belgium
Authors: Willem Lander , Kremer Cécile , Boone Jorden , Arrazola de Oñate Wouter , Hammami Naïma , Faes Christel , Hens Niel 
Published: January 2024

Contact tracing and investigation can prevent infectious disease transmission when carried out promptly. Data obtained from contact tracing also provides unique information on transmission dynamics that can be useful for policy making. The proportion of secondary infections arising from index cases that were previously identified as a close contact, hence “known index cases”, has been indicated by ECDC as a key performance indicator for contact tracing. Few empirical studies have been published on the effectiveness of contact tracing and investigation during the COVID-19 pandemic.
Using data from the Belgian COVID-19 contact tracing (Sept 2020 – Dec 2021), we investigated the impact of contact tracing on onward transmission. Known index cases were compared to those not previously identified as close contact. More specifically, we compared their traced contacts and secondary cases as well as the serial interval, representing the time from illness onset in the primary case to illness onset in the secondary case. In addition, we investigated contact and transmission characteristics by age.
Known index cases, previously informed about their exposure, were linked to fewer high-risk contacts and secondary infections. In addition, they presented a lower secondary attack rate compared to those not previously identified by contact investigation, suggesting behavioural changes. Also, a shorter serial interval was observed for known index cases. In addition to breaking transmission chains, contact tracing provides important information on transmission characteristics. When exploring age-specific data, we observed increased transmission rates from children to adults during the circulation of Delta and Omicron variants without an increase in contact rates between these age groups.
The lower secondary attack rates for known index cases suggest that contact tracing in Belgium has been effective in reducing onward transmission. Their lower number of traced contacts and shorter serial interval are indicative that individuals aware of their exposure to SARS-CoV-2 were more reserved in their social contact behaviour. This reflects the mandatory quarantine for high-risk contacts. Our study also shows that in times of high burden on the healthcare system, key performance indicators of contact tracing should be interpreted with caution in light of changing intervention strategies. Many external factors influence the effectiveness of contact tracing like testing policy and compliance, the cooperation of index cases, and the imposed and adopted quarantine and isolation policies.
Assessed and self-perceived unmet needs for mental health care in the general population in Antwerp
Authors: Rens Eva , Van den Broeck Kris , Dom Geert , Remmen Roy , Michielsen Joris 
Published: January 2024

Introduction: A public mental health care approach requires knowledge about which proportion of the population needs mental health care, and which people need it but don’t seek or receive it and why.
Who is it for? We investigated (unmet) needs for mental health care in the general population to optimize the distribution of mental health care services, which benefits all Antwerp citizens who need mental health care.
Involvement and engagement: Important stakeholders who were involved are the (Antwerp) psychiatric hospitals, who funded the research and were involved in the design of the study and interpretation of results. The involvement and engagement of (ex) patients in mental health care was limited, but a pilot test of the survey was conducted with this group.
Method: A representative sample was invited in 2021 to participate in a population survey about mental wellbeing and mental health care use in Antwerp. A total of 1208 individuals aged 15 – 80 years old participated. We investigated unmet needs for mental health care using a normative approach (assessed mental health problems) and subjective approach (self-perceived mental health problems)
Results: A total of 10.4% of the sample was defined as having a need for mental health care but only half of them used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Among all people who did not use mental health care, 12.1% perceived a mental health need (fully unmet), and 23.3% of mental health care users perceived the care as insufficient (partially unmet), leading to a total population prevalence of 14.0% perceived unmet needs. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people.
Learning: Estimates of met and unmet mental health needs are complex given the diversity of operationalizations of different levels of need, and can only be established by a dialectic of individual and populational perspectives. Assessed and perceived (unmet) mental health needs are both relevant and complementary but are related to different factors. Nonetheless, a general conclusion is that the prevalence of unmet mental health needs is high. Some vulnerable groups should be targeted for detection of mental health problems and interventions, for example through outreaching care.
Next steps: Further research should explore how assessed and perceived needs interact, and how this is predictive of help seeking and mental health outcomes.
Down to the bone: a pilot study into the effectiveness of 3D versus 2D learning in anatomy education.
Authors: Maldoy Marjan , Vandenbossche Vicky , Audenaert Emmanuel , Van Daal Tine , Uyttebroek Leen 
Published: January 2024

Possessing excellent anatomical knowledge is crucial for every health care trainee, including medical and physiotherapy students. Hands-on sessions in the dissection class form the cornerstone of anatomy education. Recent years increasing student numbers and decreased availability of time within the anatomy dissection room, forces the development of alternative teaching methods to use the dissection class as efficiently as possible. Most alternatives include video recordings and books (2D), but also 3D high-fidelity models (3D-HFM). These are anatomically accurate, morphable and dynamic 3D models that result from scanning cadaveric specimens. It is assumed that 3D-HFM have some learning benefits over 2D-models. Development of 3D-HFM is a cost- and time-consuming task and the effect of 3D learning into anatomy education needs to be further evaluated before it can be properly integrated into the program. Therefore, a pilot study is set-up to investigate the learning effect of manipulable 3D-HFM.
The pilot study focuses on the effect of using static 2D atlas-type models (2D-ATM) versus manipulable 3D-HFM on learning processes and outcomes when studying and preparing for hands-on osteology of the skull in first-year physical therapy students. 10 students will be randomly assigned into 2 groups (n=5). Students will be invited one-by-one to the Antwerp Social Lab. After having measured their prior anatomy knowledge and spatial ability, students will watch a knowledge clip explaining the basics of the skull. Then, depending on the condition, students are given either static 2D-ATM or manipulable 3D-HFM to study (as if for an exam) the osteology. While learning, students’ eye movements and electroencephalography (EEG) are collected to capture students’ cognitive load. Log data of their actual manipulation of the 2D-ATM or 3D-HFM is collected as well. When finished, students are given a post-test that maps their anatomical knowledge about the osteology of the skull using (1) nominal questions on pictures and x-rays, and (2) more complex questions capturing students’ insight. Finally, a practical test on a physical skull bone is administered that requires students to recognize certain structures and underlying relationships.

This pilot will form the basis of a broader research into innovation in anatomy education. Further research is needed to investigate to what extent online 3D-HFM are appropriate to improve the learning process and outcome compared to 2D-ATM. These studies should also examine the effect of 3D-HFM can compensate for the decreased time spent in the dissection room.
National survey evaluating patient and organisational characteristics of short-term residential care facilities in the Netherlands.
Authors: Van Den Besselaar Judith , Arntzen Rebekka , MacNeil-Vroomen Janet , Hertogh Cees , Buurman Bianca 
Published: January 2024

Background: Short-term residential Care (STRC) is a recent, bed-based care concept for older adults aimed to avoid nursing home admission in the Netherlands.
Objective: To describe characteristics of patients admitted to STRC and the main organizational differences between facilities.
Methods: Patient characteristics were identified using a national STRC database (2018 and 2019). Organizational comparisons of STRC facilities were collected through an cross-sectional email survey sent to all facilities.
Results: Of the 68,682 older adults admitted to STRC, patients were mostly female (35%), living alone (64%), with at least 10 medications prescribed (60%). Of the 36660 patients admitted in 2018, 43.4% died within 24 months and 25.5% is living in a nursing home. Of the 176 STRC facilities that responded, 30.1% delivered care at an independent ward, 27.3% was within a geriatric rehabilitation care ward, and 33.5% at a ward in long-term care. The median number of beds was 8, with a range from 1 to 40. Most facilities admitted patients in evenings, nights, or weekends. Almost all wards employed registered nurses and paramedics.
Conclusions: Patients admitted to STRC have multiple medical problems, suggested by the high number of medication, and often have palliative care needs. Facilities providing STRC differ by the location of the ward, the number of beds, and frequency of medical rounds and multidisciplinary consultations. There is a pressing need to develop standards for STRC to effectively deliver care.
Avoiding Hospital Admissions and Delayed Transfers of Care by&nbsp;Improved Access to Intermediate Care: A Simulation Study
Authors: Arntzen Rebekka , Van Den Besselaar Judith , Bekker Rene , Buurman Bianca , Van der Mei Rob 
Published: January 2024

Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. For the city of Amsterdam, we propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements.
Design: Discrete Event Simulation (DES) study.
Participants: Data was used of older adults that received intermediate care in Amsterdam, The Netherlands, in 2019. For this target group, in- and outflows and patient characteristics of the intermediate care were identified.
Methods: A process map of the main pathways into and out of the intermediate care was. Non-public microdata of Statistics Netherlands was used to quantify the process map, after which a DES was performed.
Results: By means of a sensitivity analysis with the DES, we show that the waiting times are not a result of a lack in bed capacity, but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we estimate that the number of unwanted hospital admissions can be reduced from ca. 51% to 3%.
Conclusion: This study shows that the bottleneck in a care system is not always solved by increasing bed capacity. A data-driven approach is essential to identify problems’ true causes and appropriate solutions, which results in strongly increased cost-effectiveness and patient satisfaction.
Establishing the aims, format and core standards of a frailty at the front door model of care: a mixed methods consensus study
Authors: O'Shaughnessy Íde , Harnett Patrick , Fitzgerald Christine , Ahern Emer , Robinson Katie , O'Connor Margaret , Shchetkovsky Denys , Galvin Rose 
Published: January 2024

Background: Substantial investment has been given to scale up of Frailty at the Front Door (FFD) teams in Ireland. These teams reflect a component of an integrated model of care developed by the National Clinical Programme for Older People (NCPOP) and give practical expression to implementing bespoke pathways for older people living with frailty. The aim of the FFD team is to improve the experience and outcomes of older people >65 living with frailty presenting to emergency and acute care services. Whilst scale up is advancing, further collaborative work is required to agree a set of core standards and recommendations to ensure consistency of design, implementation, and evaluation.
Aim: To build national multi-stakeholder consensus on the core components and standards of the FFD model of care for older adults.
Methods: This was a mixed methods study comprising World Café focus groups and a Delphi methodology. Utilising a participatory approach, World Café focus groups were conducted with FFD key stakeholders (n=88) including patient representatives. Participants discussed key pillars of the FFD model of care with the aim of developing a set of evidence-based interventions and recommendations. Thematic analysis was completed using NVivo software. Insights from the World Café focus groups were used to develop the online Delphi survey. Engagement with a Public and Patient Involvement (PPI) panel of older adults and informal caregivers were incorporated to guide the development of the survey. This was designed using an online survey tool, Qualtrics. The survey was designed to obtain specific information from participants in Likert scale format. The Delphi survey was emailed to participants from the initial World Café consensus event in November 2022 and a real time approach is being employed whereby participants will be informed of aggregated responses until formal consensus is reached.
Results: Data collection is ongoing with consensus on the core components and standards of the FFD model of care expected in Spring 2023.
Impact: FFD teams are a valuable component on an integrated care pathway for older persons. Differences have emerged in terms of operational delivery, clinical design and evaluation as a result of their emergent nature. This mixed methods study using a co-design approach will support an evidence-based, patient sensitive model of care that will ensure consistency of approach and outcomes.
"I am not just a place for implementation. I should be a partner": A qualitative study of patient perceptions of their involvement in care in Saudi Arabia
Authors: Alkhaibari Reeham Ahmed , Smith Merry Jennifer , Forsyth Rowena 
Published: January 2024

Introduction: Patient involvement in care is a major component of high quality care and is becoming recognized worldwide with many benefits for improving patient outcomes. However, little is known about patient involvement in care in the Middle East region.
Objectives: To evaluate patients’ perceptions of their involvement during their interactions with health care providers in Saudi Arabia.
Methods: A qualitative exploratory study using semi structured interviews was conducted from February 2022 to March 2022. Responses were transcribed and analysed using a thematic data analysis approach.
Results: We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients’ perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care
Conclusion: There is a clear need to improve education and awareness of patient involvement in health care in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand and establish frameworks which acknowledge the impact of culture on patient centred care in Saudi Arabia.
Key words: patient involvement, patient centered care, Saudi Arabia
Understanding the Role of Social Support in the Adherence to the Hypertension Continuum of Care in Cambodia
Authors: Savina Chham , Buffel Veerle , Van Olmen Josefien , Chhim Srean , Ir Por , Wouters Edwin 
Published: January 2024

Introduction: Hypertension (HTN) is a major public health problem and a leading cause of cardiovascular diseases and deaths globally. A continuum of HTN care is necessary for people living with HTN since this chronic disease requires comprehensive life-long healthcare management. Several studies have examined the factors influencing the adherence to HTN care. Socio-demographic and economic characteristics are commonly studied as influencing factors of each step of the cascade of HTN care, yet little is known about the effect of social support on the cascade of HTN care. Therefore, our study aims to assess the role of social support on the cascade of HTN care in Cambodia.
Method: We performed a population-based survey (5070 individuals aged over 40 and over) to generate a cascade of care for HTN and assess the levels of social support in Cambodia. The cascade shows the patients’ flow in the health system and where they are lost (dropped) along all steps of the cascade from (i) prevalence, (ii) screening, (iii) diagnosis, (iv) treatment in the last 12 months, (v) treatment in the last 3 months, (vi) to being under control. Social support was assessed using the 8-item Medical Outcomes Study Social Support Survey. Multivariate logistic regression was used to determine the effect of social support (from a family member) on each step of the cascade.
Results: Among people living with HTN, 22.4%, 27.0%, 21.6% and 28.9% reported receiving low, medium, high and very high levels of social support respectively. Higher levels of social support were found in female adults, married adults, adults aged over 60, as well as those living in a household of 4 to 5 members and those receiving some or having completed primary education. Participants who received medium and very high levels of social support had two times the odds of receiving treatment for HTN as participants with low levels of support both in the last 12 months and the last 3 months. While, participants who had high level of social support had five times the odds of receiving treatment for HTN (both in the last 12 and 3 months) as participants with low levels of social support.
Conclusion: Social support from a family member is strongly associated with treatment compliance in the HTN cascade of care in Cambodia. Our findings suggest an exploration of using social support as a tool to promote adherence to treatment programs for HTN care.
Implication for applicability/transferability
Families are a potential source of social support for hypertensive patients to overcome social barriers and execute disease management tasks especially for treatment compliance. Promoting social support through a social intervention could be a viable path to improve care for hypertensive patients since chronic illness care poses challenges for isolated patients, but could be made easier with the assistance from family.