bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Fundamentals of Advocacy: Designing an online learning course for health and social care staff
Authors: Duggan C , Taaffe C , Walshe C , Weir L , Rourke N O 
Published: October 2023

Abstract

Background
The Health Information and Quality Authority (HIQA) develops national standards for health and social care services and tools to assist with implementation. In 2023, HIQA developed resources to help health and social care staff support advocacy in their work. This followed a recommendation of the COVID-19 Nursing Homes Expert Panel Report (2020). As this project is founded in human rights-based practice and in lessons learned from COVID-19, it is relevant across health and social care.

Objectives
We wanted to know: 1. the barriers to advocacy in health and social care services; 2. how best to address this.
We found knowledge and understanding of advocacy to be a significant barrier, and therefore developed an online course. The course was informed by focus groups with health and social care staff, service-users and inspectors, and by user-testing. The objectives are that learners understand:
• what advocacy is
• the role of health and social care staff in advocacy
• how to support people to have their will and preference met
• the boundaries of their role as advocates, including any conflicts of interest
• how to raise awareness of independent advocacy services, and when to support people to access these services.
The course includes case studies, interviews and self-assessment. We are measuring impact through surveys, interviews and focus groups.

Results
Through stakeholder engagement and a review of evidence we identified knowledge and understanding as a significant barrier to advocacy. Since the course was launched in April 2023, 90% of participants report that, based on the course, they will make changes to the way that they work. A selection of these participants will be interviewed after six months to measure impact.

Conclusions
Our research identified a need to improve knowledge and understanding of advocacy among health and social care staff. The course evaluations to date have shown that the course has achieved this.

Key messages
• There is a need to improve knowledge of advocacy among health and social care staff. HIQA has developed an online learning course to address this, informed by extensive stakeholder engagement.
• Advocacy is about supporting and empowering people to communicate their will and preference, secure their human rights, or represent their interests.
Exploring methods and tools for estimating and measuring medical staff shortages
Authors: Parzonka K , Ndayishimiye C , Domagała A 
Published: October 2023

Abstract

Background
Healthcare systems face major challenges due to shortages in the healthcare workforce (HWF). In order to effectively plan for the future, it is critical to forecast the HWF needs. This study aimed to identify, map, and synthesize the tools, methods, and procedures for measuring medical staff deficits in Europe.

Methods
The study was performed in accordance with the Arksey and O'Malley scoping review methodology. The authors searched 4 scientific databases: Medline via PubMed, EMBASE, Web of Science, Cochrane Library, as well as manually, by searching for relevant reports. The results were analyzed using both qualitative and quantitative methods. The final searches were conducted until October 2022.

Results
The study included 38 publications published between 2002 and 2022. Among included publications, 25 were empirical studies, 6 theoretical papers, 5 reports, 1 a literature review, and 1 a guidebook. The majority of the publications estimated or measured shortages of physicians (14/38) and nurses and midwives (7/38), or the HWF generally (10/38). A variety of methods was used, including projections, estimations, predictions, simulation models, and surveys, which utilized tools such as special computer software or customized indicators, such as the Workload Indicators of Staffing Need method. HWF shortages were estimated at both national and regional levels, often based on demand, supply, and/or need.

Conclusions
While these methods and tools provide valuable insights, they may not always be suitable for the needs of a country or a medical facility. The problem of shortages in the health service is growing and its effects are already being felt, while data on the extent of medical staff shortages are usually outdated and underestimated, which highlights the need for further development, testing and implementation of validated methods.

Key messages
• Improvement of tools for measuring HWF shortages should be an integral part of HWF planning.
• Validated methods and tools are needed to measure, estimate, and prepare forecasts of HWF shortages.
The cost of psychological distress among healthcare workers during the COVID-19 pandemic
Authors: Lee B , Ling M , Boyd L , Chatterton M L , Sheen J 
Published: October 2023

Abstract

Background
Since it began, the COVID-19 pandemic has placed significant stress on healthcare workers (HCW) and have left them experiencing higher levels of psychological distress. These mental health impacts can persist long term, leading to lower workforce wellbeing and higher costs to organisations if unaddressed. This study aimed to identify those most at risks, modifiable factors, and the organisational cost of psychological distress among Australian frontline HCWs

Methods
In January 2023, 210 HCWs working in Australian hospitals completed an online measure of psychological distress (Kessler-six item: K6) and the Coronavirus Health and Impact Survey. Data was analysed using adjusted multivariate regressions and relative weight analysis to determine key predictors. To estimate organisational cost, K6 items regarding days out of role and days working at reduced capacity were used in combination with salary rates from public enterprise agreements.

Results
Severe psychological distress was present in 9.5% of participants. Risk factors include younger age (p &lt; 0.05, R2=2.5%), poor pre covid mental health (p &lt; 0.001, R2=15.4%), and outdoors time (p &lt; 0.001, R2=5.1%). Protective factors include positive relationship changes (p &lt; 0.05, R2=2.8%) and better supervisor support (p &lt; 0.01, R2=4.7%). Among the sample, 32.2% had at least one day out of role and 52.0% had at least one day working at reduced capacity, which combined costs organisations on average between $859 to $1461 AUD per person per month. Days out of role and working at reduced capacity were both predicted by K6 scores (p &lt; 0.001), pre covid mental health (p &lt; 0.001), physical health (p &lt; 0.01), supervisor support (p &lt; 0.01), and relationships stress (p &lt; 0.05).

Conclusions
Psychological distress continues to remain prevalent among frontline HCWs, highlighting the need for ongoing and targeted supports to mitigate long term mental health issues and the high organisational cost associated with it.

Key messages
• The COVID-19 continues to place significant psychological burden on HCWs and findings demonstrate that this has led to high costs to organisations.
• Findings highlight risk and protective factors for psychological distress that can be targeted to reduce both psychological distress and the high organisational cost associated with it.
How do medical students visit psychologists in Hungary?
Authors: Umami A , Zsiros V , Maróti-Nagy Á , Máté Zs , Molnár R , Paulik E 
Published: October 2023

Abstract

Background
Mental health problems are more common among medical students than other student groups, and although medical students as future physicians will be responsible to give advice people for seeking healthcare, they frequently avoid seeking advice for their own mental health problems. The aim of this study was to investigate the factors influencing medical students’ decisions to seek psychologist comparing international (IN) and Hungarian (HU) students.

Methods
A self-administered questionnaire based cross-sectional study included 688 medical students (IN: 326; HU: 362) at the University of Szeged in 2021. Multivariable logistic regression models were used to examine the correlations between the variables influencing students’ visits to psychologists.

Results
In the sample, 50.9% of students (IN: 49.7%; HU: 51.9%) had poor mental health, 17.2% of them (IN: 14.1%; HU: 19.9%) visited psychologists. Both IN and HU students were more likely to visit a psychologist when they reported poor mental health (IN: OR = 3.08, 95% CI 1.47-6.45; HU: OR = 2.45, 95% CI 1.31-4.60). IN female students had significantly higher odds of visiting a psychologist than male students (OR = 2.21, 95% CI 1.11-4.41), and HU students were more likely to visit a psychologist when they were in the clinical years compared to the preclinical years (OR = 1.74, 95% CI 1.00-3.01).

Conclusions
Although healthcare-seeking behaviour is influenced by many factors, this study showed that the main reasons were the students’ mental health problems. Another point is that visiting psychologist was more typical during clinical years among Hungarian students what should encourage medical schools to improve students’ oriented mental health services.

Key messages
• Minimizing dangerous behaviour and providing medical students with proper mental health care.
• Students have to get help during their final years to formal their career aims and reduce their stress level.
Behind the ‘creative destruction’ of human diets: an analysis of the structure and dynamics of the ultra-processed food manufacturing industry and implications for public health
Authors: Williams O , Baker P , Sacks G 
Published: October 2023

Abstract

Background
The role of ultra-processed food (UPF) manufacturers in driving unhealthy diets is coming under increasing scrutiny. While many of the strategies used by UPF corporations to push for and maintain high levels of UPF consumption are well documented, there has been limited analysis of how the UPF industry has evolved over time. This study aimed to examine trends in the structure and dynamics of the UPF manufacturing industry as part of efforts to understand and address the political economic drivers of the global UPF dietary transition.

Methods
We used multiple methods to examine the structure and market dynamics of the UPF industry, according to an adopted structure-conduct-performance model. Quantitative methods were used to analyse diverse metrics (e.g., industry size, market concentration, profitability). Data were sourced from several business and market research databases, with periods of analysis based on available data. We conducted a narrative literature review to supplement findings from the quantitative analysis, including on corporate strategy.

Results
Our findings show that, since the late-1800s, the global UPF manufacturing industry has been instrumental in transforming food systems around the world to the extent that many are now heavily geared towards the consumption and production of UPFs. A key explanatory factor behind this trend is that a group of major UPF corporations have developed an extensive and highly profitable network of large, concentrated UPF markets. Our study also suggests that, since the 1980s, the same corporations have been increasingly prioritising the financial interests of their shareholders above other concerns.

Conclusions
Reversing the UPF dietary transition will likely require substantial changes to the structural and regulatory conditions under which food systems around the world operate, such that population and planetary health are actively promoted and incentivised.

Speakers/Panelists
Samuele Tonello
Eurohealthnet, Brussels, Belgium
The social gradient in adolescent mental health problems and the role of physical activity
Authors: Dahlstrand J , Friberg P , Petzold M , Chen Y 
Published: October 2023

Abstract

Background
In Sweden, the share of 13 and 15-year-old students reporting ≥ 2 psychosomatic symptoms (PSS) more than once a week doubled between 1985/1986 and 2017/2018, during which there were increases in both income inequalities and adolescents with insufficient physical activity (PA). PA during non-school time has been shown to be negatively associated with stress and PSS among adolescents. We aimed to explore whether there is a socioeconomic status (SES)-related gradient in adolescent mental health problems, and if so, whether non-school sedentary time (SED) and PA mediate this social gradient.

Methods
We used data from STARS, a prospective and observational cohort study of 2283 7th grade students in Västra Götaland, Sweden. A total of 1235 participants (mean age 13.6±0.394 years, 59% females) returned with valid accelerometer data (≥ 10 hours per day for ≥ 4 days), answered questionnaires regarding stress and PSS, and had parents’ earned income registry data. Ordinary least square for linear regressions and bootstrapping for mediation analysis were used with 95% CI, repeated for males and females separately.

Results
We found that higher income was associated (α = 5%) with less stress (-0.1108, p ≤ 0.001 and PSS (-0.1315, p ≤ 0.001). For stress, we found that non-school PA partly mediated this association. This was true for light PA (LPA) (-0.0040, [-0.0093-0.0003]), moderate to vigorous PA (MVPA) (-0.0077, [-0.0152-0.0023]) and vigorous PA (VPA) (-0.0090, [-0.0166, -0.0031]). When separated by sex, mediation via PA was found only in females. For PSS, mediation effect was found for MVPA (-0.0071, [-0.0137, -0.0018]) and VPA (-0.0103, [-0.0182, -0.0039]), but not when separated by sex.

Conclusions
There is a social gradient in both stress and psychosomatic symptoms among adolescents, mediated by physical activity although to a relatively small part. This shows the relevance to inform policy on the need to enable extracurricular sports activities for adolescents.

Key messages
• Physical activity partly explains the social gradient in adolescent mental health.
• Supporting extracurricular sports activities may help to reduce the social gradient in adolescent mental health.
Shared decision-making in a medicalized birth environment: mixed-methods exploratory study, Cyprus
Authors: Middleton N , Koliandri I , Hadjigeorgiou E , Christodoulides V , Nicolaou C , Kouta C , Karanikola M , Orphanides I , Kolokotroni O ,   Baby Buddy Forward team
Published: October 2023

Abstract

Background
Maternity care practices are not always supportive of participation in decision-making; a fundamental pillar of the WHO Respectful Maternity Care framework. With the highest caesarean section (C/S) rate in the EU (&gt;60%), high episiotomy rates (70.9%) etc, the medicalised birth environment in Cyprus raises questions about Informed Choice.

Methods
Following focus groups (N = 12) with pregnant women and new mums (N = 62), an online survey was shared via the Baby Buddy Cyprus webapp. Women responded to the Maternal Autonomy in Decision-Making (MADM) scale along a battery of scales, including perceived efficacy in patient-provider interaction (PEPPI) and Kim Alliance Scale (KAS).

Results
Based on MADM classification, 54.3% of 387 participants (64% primiparas, 42% C/S, 80% private sector) were classified as having high autonomy, while one in five were classified as low or very low. There were lower scores among primiparous women (p = 0.02) and higher among those receiving care in the private sector (p &lt; 0.001). Perceived efficacy in interaction was related to educational attainment (p-value for trend=0.02). In regression models, KAS (b coeff= 1.25 95%CI 1.06, .1.45; p &lt; 0.001) and PEPPI (b coeff = 0.38 95%CI 0.24, 0.52; p &lt; 0.001) were independently associated with MADM after adjusting for socio-demographic and pregnancy characteristics. Consistently, having a “confident voice” in an ‘unsupportive system’ where the ‘art of communication’ is often left to the women themselves emerged as themes from the qualitative study.

Conclusions
Participation in decision-making among pregnant women in Cyprus is problematic. Given that reduction of C/S, most classified as elective by maternal request, was identified as national Public Health priority, further research is necessary. Continuous professional training along with population-level interventions to promote self-agency may be needed, especially since childbirth rights were further compromised during the COVID-19 pandemic.

Key messages
• Against physician dominance in communication, birthing women in Cyprus do not rate participation in decision-making favourably.
• Further research is needed around Informed Choice, including educational and population-level interventions targeted at healthcare providers as well as women.
The mental health of children and adolescents at Matosinhos: characteristics and obstacles to care
Authors: Barbabela R , Duarte G , Leão T 
Published: October 2023

Abstract

Background
Mental health disorders are a public health issue. Most mental disorders begin during childhood and adolescence. Epidemiological studies regarding the diagnosis, prevalence, and access to treatment by children and adolescents are scarce, especially in Portugal. This research protocol aims to characterize the referral process and waiting times for these consultations at a Portuguese Local Health Unit between 2017 and 2022 (covering about 180,000 people); and to identify barriers to adequate health care for children and adolescents from the perspective of healthcare professionals from the hospital and primary care units.

Methods
We used a mixed methods study. Qualitative data allowed interpretation and reflection of quantitative data, with validation and integration of results. We conducted a descriptive analysis of the variables obtained through the local Health Information System and semi-structured interviews with a sample of healthcare professionals involved in mental health care for children and adolescents at the hospital and primary care unit levels.

Results
Preliminary results show a break in the number of consultations in 2018, due to the lack of professionals, and a yearly increase after COVID-19. Follow-up appointments and evaluation processes have long waiting times since there is a focus on ensuring shorter waiting times for the first consultation, and there is a shortage of professionals in mental health teams. The staff identified the need to integrate schools into care - referral and evaluation - and to promote community-based programs that train skills in children, adolescents, and caregivers.

Conclusions
Health indicators allow the assessment of epidemiological data and access to care, yet it is fundamental to listen to the professionals in the field to identify barriers, needs, and possible actions that more effectively promote mental health in this population.

Key messages
• Mental health disorders in children and adolescents are a significant public health issue in Portugal, yet there are scarce epidemiological studies on diagnosis, prevalence, and access to treatment.
• There is a need to address the shortage of mental health professionals and integrate schools and community-based programs into mental health care to improve access and promote mental health.
Designing and planning natural experimental evaluations with good practice recommendations
Authors: Craig P 
Published: October 2023

Abstract

Background
There have been significant developments in methods, infrastructure, and data availability for natural experimental evaluations. The rise in the use of natural experimental approaches means it is important that researchers, public health practitioners, funders, and users of intervention research understand the phases involved when designing and planning a natural experimental evaluation and are aware of good practice considerations.

Methods
Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project included an oversight group and an advisory group of independent experts.

Results
The design and planning of an evaluation involves understanding the definition of a natural experiment, being aware of opportunities for a natural experimental evaluation and the relevance of a systems perspective and mixed methods approaches. The practicalities of planning an evaluation involve assessing the evaluability and feasibility of the evaluation and identifying and involving stakeholders throughout the process. Good practice considerations include understanding the evaluation design and planning processes, engaging stakeholders, and recognising the respective strengths of different analytical approaches. Recommendations for policymakers, public health practitioners and commissioners of evaluations include recognising and using high quality evaluations and incorporating evaluation plans into the implementation of new policies and programmes.

Conclusions
Understanding the processes involved in designing and planning a natural experimental evaluation are important to successfully conducting and evaluating natural experiment interventions.
Addressing inequality: a school-based intervention to improve pupils’ well-being and social inclusion
Authors: Myhr A , Ekmann L 
Published: October 2023

Abstract

Issue
Educational achievement, health, and well-being among children varies greatly. Early interventions in primary education are among the most effective policy tools to reduce such gaps. A coherent and cross sectoral school approach, as well as a specialized school leadership, can promote social equality among pupils.

Description of the problem
A lower secondary school in Mid-Norway discovered problems related to social exclusion and well-being among the pupils. Between 2020 and 2023 the school engaged its employees, pupils, parents, and broader local community in a common dialogue and learning process about diversity and mental health. In order to understand whether and how this intervention impact on a) pupils’ well-being, sense of inclusion and social cohesion, and b) attitudes and behavior among pupils, parents, school employees and the community members, interviews with principal and pupils were conducted, as well as surveys among pupils, school employees, parents, and local community members.

Results
The pupils experienced that the school environment became more inclusive, positive, and supportive. They reported less bullying, bad language and social exclusion, and improved cohesion and wellbeing at school. The problems turned out to be embedded in both the school and broader local community context. A large share of the pupils, school employees, parents, and local community members reported that they had changed towards more inclusive attitudes and behavior, and that they had become more socially included in the local community.

Lessons
The intervention promoted a culture of inquiry within the school context, where active and critical engagement generated personal meaning and mutual understanding. The school became a ‘community active school', linking pupils, parents, school employees and the extended local community in meaningful dialogue and activities, promoting social inclusion and wellbeing in a powerful way.

Key messages
• A culture of inquiry in the school context can address and promote public health issues among pupils.
• A ‘community active’ school can be a powerful means to promote social inclusion and well-being in school as well as within the broader local community context.