bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital and Home Healthcare Survey among Nigerians: Assessing Awareness, Preferences, and Willingness to Pay for an Integrated Healthcare Ecosystem to achieve Universal Health Coverage
Authors: Ahmad Jameel Ismail , Jibril Murtala , Ahmad Barroon Isma’eel , Suleiman Abdurrahman , Inuwa Nasir Sani , Ali Abdullahi Garba , Ismail Salihu Ibrahim 
Published: May 2023

Introduction: The COVID-19 pandemic highlighted the need for evolving an integrated healthcare ecosystem that will connect patients to digital and home healthcare to achieve universal health coverage. The survey aims to assess perceptions and preferences about digital and home healthcare services and develop an integrated healthcare ecosystem.
Methods: A survey of 254 Nigerians was conducted to assess their awareness, preferences, and willingness to pay for digital and home healthcare services using electronic questionnaires, and the data were analysed using SPSS 16.0.
Results: Males constituted 70.9%, and 61.4% were aged ≤35 years. Two-third were clients, and a third were healthcare providers. Although about 71% patronized public hospitals, there was poor satisfaction (31.7%) than those attending private hospitals that were more satisfied. The male gender, private hospital utilization, and age of ≤35 years were associated with the satisfaction with OR 1.19 (95% CI 0.69-2.05), OR 1.22 (95% CI 0.73-2.04), and OR 2.41 (95% CI 1.38-4.20) respectively. Thirty minutes was the acceptable delay in receiving care by most respondents. Only 39.4% were aware of digital health, and 52.8% were aware of home healthcare. Male gender was associated with DH awareness, while being a healthcare provider was associated with both DH and home healthcare awareness. The respondents' median amount was willing to pay for DH and HH respondents is $1.64 - $6.56 and $3.28 – $6.56, respectively.
Conclusion: In response to the survey result, we designed an integrated hospital, digital, and home healthcare project named eDokta, to leapfrog the attainment of universal health coverage in Nigeria.
Time for action towards a sustainable future: a policy brief for “Green Supermarkets”
Authors: Alaze Anita Franziska , Coomans Saskia Karina , Dimitsaki Persefoni , Mol Maud Alline , Smith-Cornwall Matilda 
Published: May 2023

Context: Climate change is considered to be the greatest threat to global public health. It affects our food and water sources, the air we breathe and the weather we experience. Climate change is equally harmful to supermarkets: 95% of the current food supply is at risk from climate change. As fewer products become available, costs will increase not only for consumers but also for purchasers. The European Green Deal functions as a secure foundation to create a business that is focused on the protection of the environment. The aim of this policy brief is to guide industry leaders on how to transform supermarkets to function in a more sustainable way and mitigate negative environmental impacts.
Policy Options: Three policy options are presented for discussion: reduction of food waste, reduce energy efficiency, reduce plastic packaging. Supermarkets are a major factor in climate change contributing to food waste, high energy use and plastic pollution, each with negative effects. We see an urgent need and opportunity for supermarket chains to act. These policy options are presented in conjunction to allow for maximum effect of action.
Recommendations: Supermarkets should reduce fossil fuel use in transport, storage, and delivery, incorporating sustainable design into practice. Landfill and food waste should be minimised by an improved supply chain management. Harmful packaging should be diminished or replaced by alternative materials providing customers with more sustainable options.
Reproductive health of medical students: exploring knowledge, experiences, and behaviors
Authors: Djuric Petar , Stevanovic Aleksandar , Rajovic Nina , Todorovic Jovana , Laaser Ulrich 
Published: May 2023

Introduction: Sexually transmitted infections (STIs) along with unintended pregnancies, gender-based violence, and gender inequality represent a serious risk to reproductive health in adolescent age. Comprehensive Sexual Education (CSE) plays a central role among public health interventions designed to prepare young people for these challenges. The aim of our research was to examine knowledge, experience, and behaviors regarding reproductive and sexual health among the population of medical students, as well as the possible connection between reproductive health, information, and study success.
Material and methods: A total of 186 second-year and 214 fifth-year medical students were included in the study as a convenient sample taken by random selection. We used a questionnaire of the World Health Organization designed for adolescent sexual and reproductive health. Data were analyzed with the IMB SPSS 25 software.
Results: For the second-year students, primary source of information about sex are conversations with their family and friends (37.6%), while for the fifth-year students it is the faculty curriculum (34.7%). Students with personal experience of STIs showed higher average level of knowledge about STIs and reproductive health (p=0.011). Significant positive correlation between the average grade and the level of knowledge about reproductive health was found (r=0.150; p=0.03).
Conclusion: This study has shown the diverse sexual life of young medical students in Serbia, combined with risky habits and attitudes, also similarly represented in the world. Further research is needed in order to formulate public health policies adjusted to the needs of the Serbian youth.
Correlates of level of satisfaction among primary health care workers in Albania
Authors: Naum Alvi , Toçi Ervin , Toçi Dorina , Burazeri Genc Burazeri , Kessel Robin van , Czabanowska Katarzyna 
Published: May 2023

Aim: The aim of this study was to explore the level of satisfaction of primary health care staff in Albania and the factors associated with it.
Methods: A cross-sectional study was conducted in Tirana city, the Albanian capital, from 11 November 2020 until 25 November 2020. Among all health centers (HCs) and health centers of specialties (HCSs) of Tirana Municipality, there were selected randomly a HC in rural areas, a HC in urban areas and one HCS. All the staff (doctors and nurses) being present at the time of data collection was interviewed, using an international standardized tool (the Dartmouth-Hitchcock Medical Center instrument) assessing the satisfaction with various elements of the work in PHC, validated in Albanian. A total of 102 PHC staff were included in the study. Binary logistic regression was used to assess the association of staff satisfaction with independent factors.
Results: The aspects of work most appreciated by PHC staff (% satisfied or very satisfied) were: respectful treatment by colleagues (78.2%), staff morale and their positive attitude towards work (73.2%). The most disliked aspects of work by PHC staff (% dissatisfied or very dissatisfied) were: current salary (60.8%), stress at work (38.3%), physical and medical infrastructure in the institution (27%). Staff in rural HCs, older staff, females and nurses and family doctors are more likely to be satisfied compared to their respective colleagues.
Conclusion: Our findings suggest various factors associated with the satisfaction of PHC staff in Albania. These findings could be guiding future efforts aiming to improve the work conditions of the professionals working in primary health care in Albania.
Advancing the diversity and inclusion agenda in healthcare organizations: The case of German university hospitals
Authors: Gobianidze Mariam , Hammond Jordan , Jürgens Kira , Reisser Katharina , Kalaitzi Valia 
Published: May 2023

Introduction: Diversity and inclusion (D&I) challenges in the hospital workforce continue to pose threats to an inclusive work environment. Acknowledging the benefits of a diverse and inclusive healthcare workforce, the Association of German University Hospitals signed the German Diversity Charter to encourage its member hospitals to apply policies to cultivate such a workplace. This policy brief explores the implementation of D&I policies aligned with the Charter in six university hospitals in Germany, aiming to identify the policy gaps and provide recommendations for improvement.
Policy Options: The Charter´s commitments include a shared organizational vision of D&I as a source of great potential and the significant support of the senior management. It also includes D&I in employment processes, open communication about policies, and active employee engagement. Overall, a comprehensive D&I strategy has been shown to be vital for sustainable change. However, not all the hospitals have signed it, nor do all fully adhere to its policies. Therefore, recommendations are provided for the Association to support their constituents in working toward comprehensive D&I policies.
Recommendations: Most importantly, the Association should further promote D&I awareness, enhance the support to the hospitals to improve D&I activities, and lead and monitor the implementation and outcomes of the adopted D&I strategies and policies. The comprehensive approach includes transparency; measurement and evaluation to assess the successes and failures of the strategies; the commitment by senior management to D&I efforts; and bottom-up involvement for employees to share their concerns and get involved.
Increasing fruit and vegetable consumption in Ireland
Authors: Tamminen Alisa C. M. , Duport Gaetan , Serrano Rocío Atienza , Babich Suzanne M. 
Published: May 2023

Context: Following recommended dietary guidelines, Ireland has since 2010 implemented a 0% Value Added Tax (VAT) on fruits and vegetables to increase consumption. Eleven years after policy implementation, the Irish still do not meet recommended intake for fruit and vegetable consumption, consuming 3.9 portions a day compared to 7 daily portions recommended.
Policy Options: Four alternatives for improvement were assessed and compared: 1) retain the status quo of reduced VAT for healthy foods, 2) VAT only for locally produced fruits and vegetables, 3) increased VAT for salty and sweet foods with a subsidy for fruits and vegetables, and 4) an education-based policy. Four evaluation criteria were applied for the comparison: economic feasibility, effectiveness, political feasibility, and equity.
Recommendations: The status quo remains the best option for Ireland. However, further assessment of this 0% VAT policy on fruits and vegetables is warranted, pending the availability of additional data to enable an in-depth understanding of policy implementation.
Piloting an advanced methodology to analyse health care policy networks: The example of Belgrade, Serbia
Authors: Wenzel Helmut , Bjegovic-Mikanovic Vesna , Laaser Ulrich 
Published: May 2023

Aim: Political decisions usually emerge from the competing interests of politicians, voters, and special interest groups. We investigated the applicability of an advanced methodological concept to determine whether certain institutional positions in a cooperating network have influence on the decision-making procedures. To that end, we made use of the institutional network of relevant health care and health governance institutions, concentrated in Belgrade, Serbia.
Methods: We used a Principal Component Analysis (PCA) based on a combination of measures for centrality in order to evaluate the positions of 25 players in Belgrade‟s institutional network. Their directed links were determined by a simulated position approach employing the authors‟ long-term involvement. Software packages used consisted of Visone 2.9, UCINET 6, and KeyPlayer 1.44.
Results: In our analysis, the network density score in Belgrade was 71%. The PCA revealed two dimensions: control and attractiveness. The Ministry of Health exerted the highest level of control but displayed a low attractiveness in terms of receiving links from important players. The National Health Insurance Fund had less control capacity but a high attractiveness. The National Institute of Public Health‟s position was characterized by a low control capacity and high attractiveness, whereas the National Drug Agency, the National Health Council, and Non-Governmental Organisations were no prominent players.
Conclusions: The advanced methodologies used here to analyse the health care policy network in Belgrade provided consistent results indicating that the intended decentralization of the health care network in Belgrade may be incomplete, still with low participation of civil society representatives. With the present study we set the stage for a broad-range survey based data collection applying the methodology piloted in Belgrade.
Pharmaceutical expenditure changes in Serbia and Greece during the global economic recession
Authors: B. Jakovljevic Mihajlo , Souliotis Kyriakos 
Published: May 2023

Aim: Clarity on health expenditures is essential for the timely identification of risks that jeopardize the democratic provision of health services and the credibility of health insurance systems. Furthermore, observing health outcomes with geographical scope is essential for making multilateral associations. This study aimed at conveying information on the variability of important economic parameters of the health sector of Serbia and Greece from 2007 to 2012, when the most serious financial crisis in the post-war economic history hit the global economy.
Methods: Exchange rates, purchase-power-parities (PPP) and price indices were used for the bilateral review of health and pharmaceutical expenditure dynamics during 2007-2012. Prescription and dispensing changes were also studied taking into account the anatomical therapeutic chemical (ATC) structure of drugs consumed.
Results: Greece was forced to cut down its total health care and pharmaceutical expenditure and mainly its out-of-pocket payments were more seriously affected by the recession. Surprisingly, emerging market of Serbia, although severely damaged by global recession, succeeded to maintain 19% growth of its per capita health expenditure and even 25% increase of its per capita spending on pharmaceuticals. Innovative pharmaceuticals showed an upward trend in both countries.
Conclusions: These two countries might serve as an example of two distinct pathways of mature and emerging health care markets during financial constraints caused by global recession. Our findings show that producing disease-based feedback, in the long run, may empower the assessment of the return on investment on medical technology and healthcare systems’ cost-effectiveness.
Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic aneurisms in Albanian patients
Authors: Laci Ilirian , Spahiu Alketa 
Published: May 2023

Aim: The aim of our study was to assess the concurrent validity of radiography and ultrasound examination among patients diagnosed with aortic aneurisms in Albania, a transitional country in South Eastern Europe.
Methods: This study included 75 consecutive patients diagnosed with aortic aneurisms (thoracic and/or abdominal) admitted at the University Hospital Centre “Mother Teresa” in Tirana during 2012-2014 (56 men and 19 women). For each patient, computerized tomography (CT) scan with contrast was used to confirm the diagnosis of aortic aneurisms. In addition to the CT scan (“gold standard” for the diagnosis of aneurisms), in 37 patients, radiography and ultrasound examination were simultaneously performed in order to assess the validity of these techniques. Furthermore, demographic data and other relevant clinical information were collected for each study participant.
Results: In 18 patients with thoracic aneurisms pertinent to ascendant aorta where radiography and ultrasound were simultaneously performed, ultrasound was able to diagnose 5 (27.8%) cases which were not detected through radiography (P=0.038). Conversely, in 16 patients with abdominal aneurisms where radiography and ultrasound were simultaneously performed, ultrasound was able to diagnose 4 (25.0%) cases which were not detected through radiography (P=0.034). The remaining three patients diagnosed with thoracic-abdominal aneurisms were not detected either by ultrasound examination or radiography.
Conclusions: In this sample of Albanian patients diagnosed with aortic aneurisms (N=75), overall, 9 (24.3%) subjects were detected through ultrasound examination but not radiography (P<0.001). Findings from this study provide valuable clues about the concurrent validity and predictive value of these two key examinations for the diagnosis of aortic aneurisms.
Global health in foreign policy in South Africa – Evidence from state actors
Authors: Modisenyane Moeketsi , Senkubuge Flavia , Hendricks Stephen JH 
Published: May 2023

Aim: There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interests’ South African policy actors pursue to advance global health and the processes that lead to such integration.
Methods: The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis.
Results: A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate ‘free movement of people, goods and services’. Majority (79.0%, n= 29) agreed that ‘development and equality’ are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that ‘moral and human rights’ are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance ‘Africa regionalism and south-south cooperation’ and 85.7% (n=30) strongly argued for a ‘whole-government approach’ in addressing global health challenges. ‘HIV/AIDS’ and ‘access to medicines agenda’ were the main policy issues advanced. The main domestic factors shaping South Africa’s involvement in global health were its ‘political leadership’ and ‘capacity of negotiators’.
Conclusion: It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential entry point for engagement in global health diplomacy.
Ethnic differences in smoking behaviour: The situation of Roma in Eastern Europe
Authors: Duval Laetitia , Wolff François-Charles , McKee Martin , Roberts Bayard 
Published: May 2023

Aim: To investigate ethnic differences in smoking between Roma and non-Roma and their determinants, including how discrimination faced by Roma may influence smoking decisions.
Methods: We analysed data from the Roma Regional Survey 2011 implemented in twelve countries of Central and South-East Europe with random samples of approximately 750 households in Roma settlements and 350 households in nearby non-Roma communities in each country. The overall sample comprises 11,373 individuals (8,234 Roma) with a proportion of women of 57% and an average age of 36 years. Statistical methods include marginal effects from Probit and zero-truncated negative binomial estimates to explain cigarette consumption.
Results: We found that Roma have a higher probability of smoking and are heavier smokers compared to otherwise comparable non-Roma. These differences in smoking behaviour cannot purely be explained by the lower socio-economic situation of Roma since the ethnic gap remains substantial once individual characteristics are controlled for. The probability of smoking is positively correlated with the degree of ethnic discrimination experienced by Roma, especially when it is related to private or public health services.
Conclusions: By providing evidence on smoking behaviour between Roma and non-Roma in a large number of countries, our findings support the need to understand smoking behaviour of Roma from a comparative perspective, and may ultimately contribute to more effective anti-smoking messages for Roma. However, if the health disadvantage faced by Roma is to be addressed adequately, this group must be involved more effectively in the policy and public health process.
Benefits of Implementation of Insulin Pump in People with Type 1 Diabetes: 10 Case Reports
Authors: Nováková Noemi , Nezval Martin , Anna Robenková Marie 
Published: May 2023

Ten people with type 1 diabetes (T1D), aged 28 to 57 years, with a duration of diabetes from 8 months to 47 years, attending an urban diabetes center, were retrospectively observed to assess the effects of intensive insulin treatment using continuous subcutaneous insulin infusion (insulin pump) for a period ranging from 2 months to 30 years, controlled either by glucometer-strips systems or using sensors for continuous glucose monitoring (CGM). Retinopathy, neuropathy, and nephropathy were present in some of them. An assessment of changes in HbA1c, body mass, insulin requirements per day (INS/d), blood pressure, lipoproteins, and estimated glomerular filtration rate (eGFR) was used to determine treatment efficiency. In conclusion, a combination of adequate education, long-term therapy with an insulin pump, and early implementation of CGM appear to be the optimal approach to T1D management, resulting in improved diabetes control and/or enhanced quality of life for the users.
‘The Writing of the Empire’: Economies of Writing and ‘Otherness’ in Henri Fauconnier’s Malaisie
Authors: Surin Kenneth 
Published: May 2023

The development of colonial and postcolonial literatures usually follows a tripartite periodization: (1) a phase during which works are produced by ‘representatives’ of the colonial order, those able to represent this order by virtue of being white and European; (2) a succeeding phase in which texts are produced under the auspices of the colonial order by culturally incorporated natives who are bound by the hegemonies of this order as a condition of undertaking literary production; (3) this phase is then overtaken by one existing after the Second World War—here independent postcolonial literatures arise in which the cosmography of Western superiority is supplanted. However, there are texts produced in phase (1) that do not possess the allegedly typical features of the works belong to it. My claim resides in the possibility that such periodizations do account for a kind of ‘Western’ text in which the author risks being changed, as he/she submits her/himself to worlds of possibility displacing authorized notions of ‘being Western’, etc. Using de Certeau and Edward Said, I provide a reading of Henri Fauconnier’s Prix Goncourt-winning 1930 francophone novel Malaisie that develops the concept of a ‘paracoloniality’, where I show what tends to be overlooked in most discussions of colonial and postcolonial literatures.