bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing health equity within the implementation of health system reforms: A scoping review
Authors: Bouckley T , Peiris D , Nambiar D , Mishra S , Sood T , Schierhout G 
Published: October 2023

Abstract

Background
Health equity is a commonly asserted goal of health systems. However, there is limited understanding on appropriate equity-promoting strategies within system reform initiatives. To address this knowledge gap, we conducted a scoping review to (1) identify and characterise strategies that promote health equity during the implementation of health reform initiatives; and (2) reflect on implications for reform implementation and research.

Methods
Using scoping review methodology, we systematically searched peer-reviewed literature from 2013-2022. A comprehensive search strategy captured literature inclusive of four domains: (1) health equity; (2) implementation; (3) health system; and (4) reform, policy, or theories. Thematic analysis was conducted, and findings reported according to the PRISMA checklist.

Results
Of 10,999 identified articles after duplicates were removed, 69 articles met the inclusion criteria. A vast number of health equity promoting themes derived from individual strategies was identified, with a median of 10 strategies (interquartile range 7, 15) per article. Two a priori conditions were observed: (1) the need for health equity promoting strategies to be made explicit, and (2) the need for alignment and complementarity of strategies at community, regional, state, and national health system levels. Themes identified, such as accountability, leadership commitment, shared power, adaptability, and trust, present opportunities to support strategy selection and alignment across health system levels. Underpinning strategies were present across a range of governance domains, although emphasis varied by health system level.

Conclusions
The review recognises that different strategies may be applicable in different contexts; however, it may help to be explicit toward health equity strategies and align across health system levels. In future, reform implementation reporting should be made more consistent to promote a shared language.

Key messages
• A comprehensive review identified two a priori conditions to support equity promoting strategies within reform implementation; being explicit towards equity, and alignment across system levels.
• Our research identified health equity-promoting strategies within health reform implementation. Common across system levels included accountability, leadership commitment, shared power and monitoring.
European Hub for Planetary Health – Policy Engagement Working Group vision mission and priorities
Authors: de Heer P , Queralt Bassa A , Voss M , Jevtic M , Rochfortt A , Hämäläinen R M 
Published: October 2023

Abstract
In September 2022, the European Hub for Planetary Health (EHPH) was established with the aim of coordinating a movement to promote leadership across multidisciplinary communities in Europe towards a synergistic approach to planetary health. www.planetaryhealth.eu The vision of the Policy Engagement Working Group (PEWG) of the EHPH is that Planetary Health should be the central mindset of everyday life for all people, for the purpose of safeguarding a liveable planet for future generations. It is necessary to apply scientific insights to promote Planetary Health-based policies whilst being mindful of the social and economic pressures on populations to ensure that such policies are actionable. The mission of the Policy Engagement Working Group is to build bridges between researchers and policy makers in Europe (on local, regional, national, and EU levels), to promote Planetary Health as a central line of thought for policy making. The PEWG aims to be an interface between views and insights of the members of the Planetary Health European Hub and governments, academia, and other relevant actors in European policy, to move the evidence-base for Planetary Health higher on the political agenda so it is integrated into policies, strategies, and policy agendas. We want to support enhanced policy coherence and vertical coordination in support of Planetary Health and sustainability at international, national, regional, and local levels. The priorities of the Policy Engagement Working Group include knowledge translation; awareness raising by dissemination of information and signposting to reliable sources that can be for the benefit of policy makers and the public on the concept of Planetary Health; policy dissemination and analysis; policy advice and advocacy to European health services and governments; capacity building and development of operational methodologies for national, regional and local Planetary Health Operations.
Stakeholders’ perceptions of factors influencing uptake, delivery, and commissioning of health checks
Authors: Sommer I , Harlfinger J , Toromanova A , Dobrescu A , Affengruber L , Klerings I , Griebler U , Kien C 
Published: October 2023

Abstract

Background
General health checks are offered through national programs and commercial providers in many healthcare systems. Despite their popularity, it has been argued that health checks have little or no impact on population morbidity and mortality. The aim of the qualitative evidence synthesis was to identify factors that influence the uptake, delivery, and commissioning of general health checks from the perspective of stakeholders.

Methods
We searched Medline and CINAHL for relevant studies up to 20 January 2022. We dually selected abstracts and fulltexts according to predefined criteria and sampled studies using a maximum variation. We developed a logical model representing individual, intervention, and contextual factors which guided data extraction and synthesis.

Results
A total of 110 studies met the inclusion criteria, and we selected 37 as sample. Individual factors identified were awareness of the existence of general health checks, personal risk perception, social factors, patient-doctor relationship, financial and time resources, experience during examination and fears regarding outcomes, feedback on health status as impetus for lifestyle changes. Intervention factors included information and invitation systems, discussions about the components and impact of general health checks, modalities of follow-up care, staff qualifications, framework conditions, logistical aspects, and setting. The contextual factors included cultural differences in the perception of disease and prevention, effects of general health checks on morbidity, mortality and social inequality, accessibility, and political climate.

Conclusions
The results show a variety of perceptions regarding factors that influence the uptake, delivery, and commissioning of general health checks. They shed light on the debate about general health checks as a preventive measure in the health care system and highlight the limitations of the evidence regarding effectiveness.

Key messages
• Clients, providers and commissioners may define the “effectiveness” of general health checks not merely on the grounds of population-wide morbidity and mortality reduction.
• Clients, providers and commissioners might seek in general health checks the fulfillment of individual needs that are context dependent.
Experiences with a patient-oriented navigation program in Germany from the navigators' perspectives
Authors: Fuegemann H , Goedde K , Goerling U , Rieckmann N , Holmberg C 
Published: October 2023

Abstract

Background
The German healthcare system has a distinct separation of outpatient and inpatient care, with no coordination along a patient's care trajectory between these sectors. Additionally, support offers are often unknown by patients and providers. To address these barriers, we developed a patient-oriented navigation program for people with chronic conditions in Germany, which mainly focus on the patients' individual needs.

Methods
In a mixed methods study our navigation program for people with lung cancer and stroke is being evaluated in the German healthcare context. Patient navigators support study participants in their individual healthcare organization and coordination for 13 months. Qualitative interviews are conducted regularly with the navigators to capture their experiences with the navigation program.

Results
In our study, three navigators support a total of 122 study participants. Their activities include emotional support, help with bureaucratic matters, organizing outpatient care and gathering specialized information. There is a high overlap in navigation tasks between the two groups of patients. Interviews show that the navigators perceive their work as meaningful and find the exchange within the team and the offer of supervision very important.

Conclusions
For navigation of chronic conditions that require complex care, such as lung cancer and stroke, it appears important to ensure that patients' emotional, social and coordination needs are met in a way that suits their individual wishes. The experiences of the navigators as providers of the navigation intervention can be used for a practice-oriented optimization of the navigation program.

Key messages
• Navigation tasks overlap to a large extent in both groups of patients despite the differences in disease trajectories.
• We suggest that a patient-oriented navigation program focusing on social and coordination needs does not have to be disease-specific but can cover general needs of people with complex care situations.
Development of a low-cost, at-home device for early detection of chronic kidney disease
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

Chronic kidney disease (CKD) is classified according to patient's kidney state and functionality. Stage 1 represents the initial renal damage, maintaining normal function, while Stage 5 indicates end-stage of CKD, marked by renal insufficiency and the need for dialysis or transplant. Patients in the early stages of CKD may be asymptomatic, but may experience symptoms as fatigue, weakness, and a general feeling of unwellness as the disease progresses, making diagnosis accessibility an essential aim of the health system. A low-cost and home-based device accompanied by a mobile app were developed as an early indicator of CKD, using colorimetry to determine the creatinine levels and chromogens in urine deposited in the device, designed using a solution of picric acid, sodium lauryl sulphate, borate solution, and sodium hydroxide. A range of chromogens was assigned to creatinine concentrations, calibrated by analysing diluted creatinine samples in triplicate, taking 1.2 ml of the sample and adding defined amounts of alkaline picrate according to the calibration curve. The absorbances were recorded at 45, 60, and 180 seconds for each of the creatinine samples combined with alkaline picrate in the creatinine analysis. Finally, the curves corresponding to each time were compared, providing a final absorbance to each creatinine level by subtracting the blank curves’ values. The chromogen is obtained according to the patient's health status, and compared in a database in the application, displaying the possible health status of the kidneys, without providing a diagnosis, but rather an early alert of the kidneys state and approximate glomerular filtration rate. The device has the potential to offer an early diagnosis accessible to all population with a history or risk of CKD. Early detection of CKD may improve patient health through frequent medical appointments, medication, dietary restrictions, and lifestyle changes.

Key messages
• Early stages of CKD can go unnoticed by patients and physicians, making early diagnosis a valuable tool.
• At-home health devices can be designed for the early detection of CKD.
Increased temperatures and child health outcomes: a systematic review
Authors: Faurie C 
Published: October 2023

Abstract

Background
Increased ambient temperatures and extreme heat events are well-established risk factors for increased mortality and morbidity. Most studies to-date have focused on the effect of high temperature on adult populations. However, the paediatric population is vulnerable to increased temperatures, due to a combination of physiological and social vulnerabilities characteristic of children. This presentation will present the findings of a systematic review and meta-analysis on increased heat and childhood health risks.

Methods
A literature search was carried out of three scientific databases: Pubmed, Embase, and SCOPUS. The data was pooled and summarised in statistical meta-analysis, and presented as relative risk (RR) scores. Subgroup analyses by disease category, gender, and climate group were carried out. Studies not meeting criteria for statistical meta-analysis were summarised in narrative review.

Results
There is evidence that increased heat increases all-cause mortality in the paediatric population. Increased heat is a risk factor for morbidity throughout the childhood years, from increased rates of preterm birth, to increased adolescent mental health presentations. There is evidence that heat increases the risk of SIDS, respiratory, heat illness, renal disease, mental health, and infectious diseases in children. The majority of studies which quantified the relationship between increased heat and illness do not separate children from adults in statistical analyses.

Conclusions
There is a substantial body of evidence demonstrating that children have higher rates of morbidity and mortality as a result of higher than usual temperatures. Further research is required into the effects of global warming on child health, and more research is needed to establish protective factors. Researchers in environmental health should consider sub-group analyses on children to identify risks particular to this vulnerable population

Key messages
• Children are at increased risks of multiple diseases in hot temperatures or heatwaves.
• More research is needed into the unique impact of climate change on children.
Heat exposure and heat stress in outdoor workers: a review of measures in published studies
Authors: Estephan C , Fakih L , Nuwayhid I , Habib R R 
Published: October 2023

Abstract

Background
Increased ambient air temperatures resulting from climate change led to higher heat levels for outdoor workers. Heat exposure refers to ambient environmental heat exposures; while heat stress also considers the clothing type and the metabolic rate resulting from physical activity. We reviewed the types of heat exposure/stress measures used in published studies.

Methods
A literature review was conducted to identify and examine measures of heat exposure and heat stress in outdoor workers.

Results
The most common indices measuring heat exposure/stress in occupational health include the Wet Bulb Globe Temperature (WBGT), Environmental Stress Index (ESI), Heat Index (HI), Humidex (HD), and Discomfort Index (DI). HI, HD and DI account for ambient air temperature and relative humidity surrounding workers. WBGT accounts for air temperature, radiant temperature, humidity, speed of air movement, and adjusts for clothing and metabolic rate. ESI considers factors like WBGT except for speed of air and does not account for clothing and metabolic rate. Both ESI and WBGT fail to consider the risk of dehydration resulting from excessive sweating in hot work environments. HI, HD and DI measure heat exposure but not heat stress as they do not account for the metabolic rate; also, they do not consider radiation and may underestimate the potential danger of working in excessive heat. These indices are considered simpler to use than WBGT. However, WBGT is more precise and covers environmental factors influencing heat exposure/stress. Questionnaires are also used to assess workers’ perceptions of heat exposure and self-reported health impacts. Their findings, in general, have not been comparable due to the heterogeneity of questions used.

Conclusions
Although WBGT is recommended for accurate measures of heat exposure/stress, its high cost has been a deterrent for workplaces in low-income countries. Projects with low financial resources opt for simpler and cheaper measures of heat.

Key messages
• The use of reliable devices is necessary to measure and monitor heat exposure in outdoor work.
• It is desirable to generate homogenous results for the comparability of study findings in occupational health research.
Health Literacy of a Migrant community in Portugal on environmental health risks
Authors: Machado R , Garcia M , Serra I , Tiago V 
Published: October 2023

Abstract

Background
Social, cultural and environmental factors are crucial for the health of migrants. Health Literacy is a fundamental contribution, giving them greater capacity and making it possible to reduce health inequalities. The aim of this study was to characterize the perception and behavior of a migrant community residing in Portugal, in view of the health risks resulting from the environmental conditions in which they live, and to identify their level of Health Literacy.

Methods
Cross-sectional, descriptive, exploratory study. Data collection was obtained through the application of the “Health Literacy Questionnaire” (Osborne, 2013), complemented with sociodemographic and environmental indicators referring to the physical space and social context of residence. The questionnaires were applied to a sample of the population, coming from Portuguese-speaking African countries, with 101 participants. Data analysis involved measures of descriptive and inferential statistics.

Results
Of the data obtained, 77.2% reported having problems with humidity in their homes, with poor behavior in terms of heat (64.4%) and cold (90.1%). 76% reported insect and rodent infestations inside their homes. The presence of stagnant water (43.6%), organic waste (29.8%) and poor electrical networks (26.9%) were the main environmental problems identified. About Health Literacy, “Feeling understood and supported by health professionals’ and “Finding good health information”, registered lower levels, with the remaining ones being generally below the average of the scale. internal consistency ranged between 0.71 and 0.92.

Conclusions
Data analysis showed the precariousness of housing and the inadequacy of support infrastructure, with inherent environmental risks to health. The existence of low levels of Health Literacy was found in most of the domains considered. The results supported and justified the elaboration of a community intervention project with the involvement of local partners.

Key messages
• Knowing the environmental determinants is essential for disease prevention and health promotion.
• Health Literacy is an indispensable vehicle for reducing inequalities in migrant populations.
Tackling climate crisis through systems thinking: PERSIST, a pilot project in an Italian high school
Authors: Zjalic D , Nachira L , Perilli A , Lombardi G S , Cadeddu C 
Published: October 2023

Abstract

Background
The climate crisis is today's most important global health threat. In Europe, the Mediterranean region represents a climate hotspot. Education plays a crucial role in preparing the population for future climate impacts on health: it provides the tools to implement social and individual attitudes for climate change mitigation; it facilitates the development of skills and attitudes for adaptation, and it stimulates critical understanding of climate change.

Objectives
The PERSIST project aimed to improve awareness of the environmental emergency and provide tools to tackle the complex relationships between human activity, climate crisis and health, stimulating pro-environmental behaviours through systems thinking. Three meetings with students from a scientific high school in Rome between March and April 2023 were provided, using systems thinking, group activities and discussions. A pre- and post-intervention questionnaire was administered to measure knowledge, attitudes, and pro-environmental behaviours. The anonymously collected data were processed using descriptive statistics.

Results
Ten classes between 1st and 4th grade took part in the project. The valid responses to the pre- and post-intervention questionnaires were 222 and 211, respectively. The preliminary analysis suggests improvements in knowledge and attitudes and a broad appreciation of the intervention, with 78,1% of students who found the project engaging. There were no changes in the ecological emotions referred by the students.

Conclusions
An interactive approach and the use of complex systems improves students’ knowledge and attitudes towards the climate crisis, without increasing negative ecological emotions. This pilot project can guide similar, repeatable projects in other schools and countries.

Key messages
• Education is fundamental in tackling the health impacts of climate change.
• Training young people on health and climate crisis issues could improve their adaptive capacities.
5 year public health impacts of an urban greenway, Belfast, Northern Ireland: Causal Loop Diagram
Authors: Hunter R , Garcia L , Clewley N , Hafezi M , Hilton J 
Published: October 2023

Abstract

Background
The development of large scale urban green space infrastructure, such as a new urban greenway, provokes a cascade of changes abating a series of public health impacts, in the realms of: health, society, economy and the environment. The relationships between these factors sustain reciprocal and dynamic influence with potential to generate a virtuous cycle. However, such long-term impacts and their inter-relationships are poorly understood.

Methods
We aimed to co-develop a shared understanding of the public health impacts of the Connswater Community Greenway with multi-sectoral stakeholders 5 years post-implementation. Objectives were to (a) build shared understanding of the complex system influencing the public health impact of the Connswater Community Greenway, and (b) identify and explore priorities, opportunities, and actions to improve future impacts. We undertook Group Model Building workshops with people representing relevant stakeholders involved in the development and/or maintenance of the Connswater Community Greenway, and local residents living on or along the greenway.

Results
23 participants were involved in the workshop included local governmental agencies, local residents, advocacy groups, private sector, and researchers. Stakeholders produced a systems map detailing the public health impacts of the Connswater Community Greenway 5 years post-implementation. Key impacts included increased in mental wellbeing, sense of community pride, increased biodiversity, increased economic investment in the local area. Participants identified a range of priority actions that, in their view, could impact and help reshape the system and influence the future impacts of the greenway.

Conclusions
The CLD was reflective of the various stakeholders’ experience, knowledge, perceptions, and views about the factors, and the inter-relationships between these factors, of the public health impact of the Connswater Community Greenway at 5 years post-implementation.

Key messages
• Systems thinking approaches can help identify the public health impacts and plausible causal pathways of green space interventions.
• 5 year impacts of an urban greenway included improvements in the realms of health, wellbeing, the environment, the economy and society.