bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integration of Social Return on Investment with Health Impact Assessment and evaluation frameworks
Authors: Ashton K , Cotter-Roberts A , Dyakova M , Green L 
Published: October 2023

Abstract

Background
To enable sustainable investment in public health to aid recovery from the COVID-19 pandemic and other global adversities, it is necessary to incorporate social, economic and environmental outcomes and value measurement into decision-making processes. Holistic frameworks, such as Social Return on Investment (SROI), look to capture this through understanding stakeholder impact and committing to valuing and monetizing their perceived outcomes. However, opportunities for conducting standalone SROI analyses may be limited due to resources. A solution is to undertake an SROI analysis alongside other analytical frameworks, impact assessments or evaluation methods.

Methods
In 2023, two innovative case studies in Wales, United Kingdom, integrated SROI into evaluations and assessments. The first is in conjunction with a Health Impact Assessment (HIA) on a sexual health self-testing service in a prison setting, while the second is in combination with an evaluation of a breastfeeding and infant nutrition programme.

Results
SROI offers a broad framework through which to integrate a holistic health economics lens to different types of evaluation and impact assessment. Traditional evaluations and HIA share common elements with SROI, for example developing a theory of change in evaluations and the screening and scoping stages of a HIA. Learning reflections for future integration were identified, for example ensuring quality assessment approaches align and ensuring design is scoped to enable effective integration from study outset.

Conclusions
SROI is the predominant tool used to assess the wider value of policies or programmes by identifying and evaluating holistic outcomes which have traditionally been difficult to measure. However, opportunities for standalone SROI studies may be limited for several reasons. As demonstrated, integrating SROI into different methods and approaches offers the opportunity to expand thinking on understanding value in a resource efficient way.

Key messages
• Social Return on Investment (SROI) can be effectively integrated into different evaluation approaches and Health Impact Assessment.
• Integration of approaches has been shown to be resource efficient and beneficial to better understanding value and impact on health and well-being.
Strengthening Public Health Wales’ Global Health offer: refreshing our International Health Strategy
Authors: Clark E , Holt L , Malcolm A , Ezenwugo G , Green L , Dyakova M 
Published: October 2023

Abstract

Problem
Public health is inherently global. Public Health Wales (PHW) is the only public health institute with an International Health Strategy, published in 2017. Due to significant global and national contextual changes such as COVID-19, a refresh was required.

Description
The refresh, commenced in April 2022, aimed to evaluate the impact of the existing strategy, map global health work across PHW, and deliver an inspiring yet feasible update. Data were collected using a mixed methods approach: a scoping review of global health developments since 2017; wide consultation via online surveys for internal and external stakeholders; and key informant interviews. Qualitative data determined experiences, benefits, and priorities in international health work. Thematic analysis of findings, triangulation, and synthesis informed the strategy refresh. Emerging themes and priorities were presented across PHW for feedback.

Results
There are over 100 active international health projects/partnerships in PHW. Engagement findings identified their benefits including contributing to global challenges, sharing learning, and health system strengthening. Facilitators of global work included access to networks; practical support; and shared priorities. Participants emphasised the strategy's role in contributing to overarching organisational priorities; national aims such as the Well-being of Future Generations Act goals; and highlighted the strategic importance of international partnerships.

Lessons
The strategy strengthens PHW's global health offer. There is high recognition of the value of global work but still opportunity to reap benefits such as system leadership and staff development. Access to existing networks facilitated global health activities; strengthening this is a key vehicle to maximise bidirectional learning for policy and practice innovation. The methods and engagement findings may be transferable to other national Public Health Institutes planning a global health strategy.

Key messages
• International health activities are diverse, accessible, and integral to public health work; with wide-ranging benefits to staff, the organisation, and partners within and beyond Welsh borders.
• The organisational International Health Strategy will enable Public Health Wales to reach its overarching goals through recognition of and building on the benefits of international health work.
The NAVICARE Network for patient-oriented health services research - experiences and lessons learned
Authors: Schwengler S , Gödde K , Klein C , Rieckmann N , Holmberg C , Heintze C 
Published: October 2023

Abstract

Background
In 2017 NAVICARE was established as a Berlin/Brandenburg-based network for patient-oriented health services research. The overall aim is to reduce barriers for patients with age-associated diseases and multimorbidity in the fragmented German health care system. The networks structural goal was to develop a research environment in which scientifically developed regional health services interventions for better coordinated care are piloted.

Methods
During two funding periods, an overarching infrastructure was built in the network to connect and support participating researchers as well as external stakeholders from different disciplines, support education and coordinate the network's dissemination and events. In a critical reflection process between participating researchers, we collected experiences and lessons learned from work in the multidisciplinary research network.

Results
A shared coordinating infrastructure, including monthly meetings, to bring in different competencies, perspectives, methods and research questions has been described as beneficial. This includes expertise from participating researchers as well as connected external partners. Experienced challenges are high time effort of networking, bringing together different views as well as logistical-organizational barriers in building overarching and permanent structures.

Conclusions
Work in a research network can provide structural support by collating information and expertise to support better health services research and allowing the integration of different perspectives from internal as well as external partners involved in health care. An overarching coordinating infrastructure should provide an effective flow of information and connect all partners in a time efficient manner.

Key messages
• Multidisciplinary networking can support a patient-oriented health services research environment.
• However, for the regional network to be efficient a goal-oriented coordination and time-balanced communication is key.
Provision of COVID-19 treatments to non-hospitalised patients in Northern Ireland: an evaluation
Authors: Patterson L , McGuinness S , Bradley D T , Corrigan D 
Published: October 2023

Abstract

Background
The first UK interim clinical commissioning policy for the treatment of non-hospitalised patients with COVID-19 was published in December 2021. A service was established in Northern Ireland, with implementation and developments overseen by a multi-agency group. We investigated the reach, uptake and equity of the programme to understand performance and offer recommendations for improvement.

Description of the problem
Data were extracted for 16 December 2021 to 16 December 2022. The objectives were to: 1) describe referrals over time using weekly aggregate returns sourced from the commissioning agency for all of NI and; 2) for a subset of providers, to describe treatment acceptance and those treated by age group, sex, deprivation quintile and all-cause mortality using anonymised, linked administrative data. Treatment acceptance was analysed using logistic regression.

Results
Overall, 16,454 patients were referred of whom 9,536 (58%) were eligible for treatment. Of these, 5,849 (61.3%) accepted, 1,215 (12.7%) declined, 1,140 (12%) were already an inpatient and the remainder unknown (1,332; 14%). Using the subset, treatment acceptance was associated with increasing age (likelihood ratio test (LRT) P = 0.02) but not deprivation (LRT P = 0.83). Of those treated (3,645 people) the majority were aged 18-64 years (68%) and were female (59%). Just 8% lived in the ‘most deprived’ quintile, compared to 20% in all others. The 28-day all-cause mortality for those recommended treatment was &lt;1%.

Lessons
This was a rapidly established service which has treated 5,849 people. Acceptance of treatment increased with age but was not affected by deprivation. However, a higher percentage of those treated were from least deprived areas. Recommendations include monitoring equitability of access and a greater focus on those eligible for treatment but who decline, both highlighting the importance of engaging and empowering service users to make an informed choice around COVID-19 treatment.

Key messages
• Almost 6,000 people in the community have received a COVID-19 treatment since the inception of the service in Northern Ireland.
• Equitability of access should continue to be monitored.
Bridging public health and primary care in an Italian Urban Area. Lessons learnt from pandemic
Authors: Frisicale E M , Barbara A , Borghini A , Carini E , Grossi A , Tanese A , Goletti M , Parente P 
Published: October 2023

Abstract

COVID-19 pandemic represented a disruptive event for all sectors, especially the healthcare one. It revealed weakness of healthcare systems, often organised in silos, and called for a great coordination among several stakeholders. Different healthcare organizational solutions were implemented in order to address this extraordinary situation. This study investigates the impact of an organizational innovation, District Operation Centres (DOCs), of a Local Health Authority (LHA) in Rome aimed at responding overall to primary care and public health (PH) needs during the first phases of pandemic. In the DOCs health districts professionals supported general physicians (GPs) and family paediatricians (FPs), acting as a bridge with the PH Department, in order to better manage COVID-19 patients and close contacts. To understand the utility and the areas of support to GPs and FPs a survey (21 open questions or on a Likert scale), realised according the Delphi method, was admnistered to them. The sample was calculated using Epi Info, randomization was performed through Excel. A descriptive analysis of the sample and of the answers was carried out. When appropriate, statistical tests were used to understand differences among districts. 215 doctors were interviewed between Dec 2020 and Jan 2021. More than 50% declared to have found DOCs useful, above all for guiding to legislation and to activate medical equipes to deliver swabs at home. The support was evaluated not good regarding COVID-19 cases/contacts and cluster(s) management. Further needs as support in frail patients’ management, involvement of specialists, delivery of telemedicine, more involvement of GPs/FPs in district activities were identified. DOCs were an attempt to support GPs/FPs in improving care to COVID-19 patients/contacts. To provide this new service in the pandemic emergency denotes great leadership in the LHA to yield collaboration among several stakeholeders and vision about patient-centered healthcare.

Key messages
• Although several limits like need of more integration, DOCs represent an experience aimed at overcoming duality between primary care and public health systems and the fragmentation of the system.
• DOCs could be considered an organizational innovation to make the system more resilient and patient-centered.
Complex social factors in pregnancy - a Scottish health needs assessment
Authors: Harpur A , Goodfellow A , Garbe F , Wilson S 
Published: October 2023

Abstract

Issue
Health inequalities begin prior to conception. In the UK, babies born to women living in the most deprived areas are twice as likely to be stillborn compared to babies from the least deprived areas. Maternity services have a vital role in tackling health inequalities during the antenatal period but are not always equipped to optimally achieve this.

Description
A health needs assessment (HNA) of pregnant women experiencing complex social factors (CSFs) was undertaken in NHS Lothian. The objectives were to describe the epidemiology of CSF in pregnancy, identify the needs arising from these, map the services available, and understand the experiences of staff and pregnant women. The HNA reviewed data from &gt;42,000 maternity records between 2016-2020, engaged with midwives through focus groups and questionnaires, and undertook focus groups with women who had recently used antenatal services.

Results
Between 2016-2020, socio-economic deprivation was the most common CSF at booking (17%), followed by domestic abuse (4%), living in temporary accommodation (4%) and teenage pregnancy (4%). Other CSFs included problem substance use, difficulty reading/speaking English and involvement in the justice system. Midwives highlighted that CSFs could affect anyone at anytime, were often multiple and overlapping, and required additional time and partnership working to support. Whilst excellent models of care existed, there was geographical inequity in the quantity and quality of support available. Conversations with women emphasised the importance of continuity of care and described how a single point of contact through a trusted practitioner helped them access the range of services required.

Lessons
The HNA made 15 recommendations on how maternity services could better support CSFs. These related to developing better data systems to understand CSFs, increasing staff support, designing flexible care models, and strengthening multi-agency working.

Key messages
• The HNA has raised awareness of the range of CSFs encountered by pregnant women and their links to short- and long-term health inequalities for women and their babies.
• The HNA is being used by maternity services to improve CSF support by using routine health data, allocating resources in a way that is proportionate to need and strengthening multi-agency working.
Perceived and functional parental health literacy and vaccine hesitancy among Cypriot parents
Authors: Menikou J , Middleton N , Papastavrou E , Nicolaou C 
Published: October 2023

Abstract

Background
Assessing the association of perceived health literacy (PHL) and functional health literacy (FHL) with childhood vaccination hesitancy (VH) among parents is important in the context of developing targeted responses given that VH is of increasing public health concern.

Methods
A cross-sectional study was conducted with a convenience sample of parents of children, aged 6 months to 15 years old, presenting in pediatric primary care centers across 3 Cypriot cities. Participants responded to the HLS-EU-Q47 and the NVS (Newest Vital Sign), a self-rated and performance-based tool of health literacy (HL), respectively. They also completed a questionnaire tapping on attitudes and practices regarding childhood vaccinations. Parents were classified according to the overall and domain-specific PHL and FHL, and associations with VH were explored.

Results
Amongst 207 parents (82.6% female, 86.0% tertiary education), higher PHL was associated with certain positive attitudes and practices related to childhood vaccination e.g. childhood vaccination according to health science, whereas higher FHL appeared to be associated with certain negative attitudes and practices e.g. more concerns about side effects of vaccines. Lack of accurate information was the only reported vaccination barrier associated with lower PHL (34.28, SD = 7.54 versus 36.51, SD = 7.20 p = 0.04), whereas no vaccination barrier was associated with FHL. No significant associations between PHL and VH were observed. In contrast, higher FHL was associated with VH (p = 0.01) with parents categorized as ‘refusers’ (3.67, SD = 2.64) or ‘hesitant acceptors’ (3.15, SD = 2.74) having higher FHL than parents categorized as ‘delayers’ (2.95, SD = 2.63) or ‘non-hesitant acceptors’ (2.99, SD = 2.42).

Conclusions
Assessing both PHL and FHL led to a more comprehensive understanding on the influence of parental HL towards childhood vaccination which can guide the design and implementation of interventions to address VH among parents.

Key messages
• While parental HL is associated with childhood VH, a mixed pattern emerged depending on whether HL was operationalized using a perceived or functional measure.
• While health education at clinical and population level are needed to counteract parental VH, the association of parental HL with childhood vaccination attitudes and practices is not straightforward.
Effect of smoking on long-term immunity after hepatitis B vaccine in infancy. A 20-year cohort study
Authors: Fonzo M , Amoruso I , Serpentino M , Miccolis L , Baldovin T , Bertoncello C , Trevisan A 
Published: October 2023

Abstract

The immune response to hepatitis B vaccination has been shown to be associated with a number of different factors, including age, sex, BMI, comorbidities and modifiable determinants, including smoking. However, while there is a strong evidence suggesting that smokers are at higher risk of not responding to the vaccine, the effect of smoking on long-term antibody persistence is not fully understood. Therefore, we aimed to evaluate the effect of smoking habit on long-term immunity (∼20 years) after primary vaccination. Individuals were recruited on the occasion of the occupational health surveillance medical examination at the University of Padova, Italy. Participants had to have received a standard 3-dose schedule in infancy (2-12 months of age) with no subsequent booster dose, and be 18-24 years of age at the enrolment. Information was collected on age, sex, body mass index (BMI), age at first dose and interval between doses. Antibody titres &lt;10IU/l were considered non-protective according to international standards. Given the young age of the participants, current and former smokers were considered together. A single-step logistic regression was performed to assess the effect of smoking on a non-protective antibody titre, adjusting for all variables considered. A total of 2,133 individuals were included, of whom 62.6% were female. The mean age of the participants was 20.28±0.92 years. The risk of a non-protective antibody titre was significantly higher in smokers compared to non-smokers (AOR: 1,287; 95%CI: 1,002-1,652). Smokers have a + 29% risk of having antibody levels below the recommended threshold when assessing long-term immunity, although it should be noted that a titre &lt;10IU/l does not automatically mean lack of protection. Smoking habit not only negatively affects the short-term response to the vaccine in adults, but also the long-term immunity when vaccinated in infancy, making the need for additional immunity enhancement in this subpopulation reasonable.

Key messages
• Smoking has a negative effect on long-term immunity (about 20 years) after hepatitis B vaccination in infancy, not just on short-term responsiveness in adults.
• Smokers have a + 29% higher risk of having a non-protective antibody titre, raising the question of the need for additional immunity enhancement in this subpopulation.
Guidelines for Physical Activity, Sedentary Behavior, and Sleep in Colombian Youth during COVID-19
Authors: Valencia Rivero K , Muñoz Pinzón D , Caviativa Castro Y , Jaramillo Guzmán V , Álvarez Salazar C , Perea Rodríguez R , Sánchez Güette L , Valero Inerarity A , Hernández Garay A , Cruz Quiroga L 
Published: October 2023

Abstract

The Canadian 24-Hour movement guidelines integrate physical activity, sedentary behaviour and sleep habits for children and adolescents. This study aims to assess the compliance of these guidelines in Colombia, as an instrument to design strategies of health promotion in this population. A cross-sectional study in 619 scholars aged 7-17 in Caribbean Colombian region was performed to measure aerobic activity, muscular force and flexibility during 7 days through the ActivityGram questionnaire of the Cooper Institute. The data was gathered in May, 2021, through phone interviewing, and parents and participants signed an informed consent form. The screen time was measured (in hours/day), as well as the times sitting and sleeping, to perform a regression analysis and determine the Pearson coefficient characterizing the correlation between the total time in physical activity and the time in aerobic exercise. A 73.5% of the sample do not comply with the Canadian physical activity guidelines. The mean sleeping time per day is 7.9±1.2 h, being 8.1±1.2 h for 7-13 scholars and 7.5±1.3 h for 14-17 adolescents (p = 0.003). Sedentary behaviour exceeds 2 h per day, being 4.7±1.3 h sitting and 3.2±1.9 h screen time. Aerobic exercise was the most influential in the total time of physical activity (r = 0.82, p = 0.0001). The sample was composed of 51.5% males, and the mean age was 11.5±3.2 years. In this sample, 80.5% were socioeconomically vulnerable, and 55.7% were involved in remote learning activities. The COVID-19 health emergency increased the non-compliance of the physical activity guidelines and the sedentary behaviour in childhood and adolescence. It is mandatory to design health promotion strategies to encourage active life styles during these stages, as they lay the foundations of healthy habits in the future, and this is a shared responsibility between educational institutions, families and policy-making institutions

Key messages
• The ActivityGram test assesses physical activity in children and adolescents.
• Analysis of physical activity and sedentary habits help to design health promotion policies in young people.