bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of hospital/ICU characteristics with HAIs: findings from the SPIN-UTI project
Authors: Barchitta M , Maugeri A , Favara G , Magnano San Lio R , La Mastra C , La Rosa MC , Campisi E , Mura I , Agodi A ,   SPIN-UTI network
Published: October 2022

Abstract

Background
Preventing the spread of healthcare-associated infections (HAIs) in Intensive Care Units (ICUs) constitutes a priority for Public Health. In a country with decentralized healthcare system, the comparison between and within regions might represent a useful approach to identify what hospital and ICU indicators are associated with HAIs.

Methods
Using data from the SPIN-UTI (”Sorveglianza attiva Prospettica delle Infezioni Nosocomiali nelle Unità di Terapia Intensiva”) network, the present analyses aimed to identify the main hospital and ICU indicators associated with HAI incidence at national level, and to stratify the analyses between Italian regions.

Results
No associations between hospital/ICU characteristics and HAIs were evident at national level. However, ICUs in Southern Italy showed the highest incidence density of HAIs if compared with those in Central and Northern Italy (p &lt; 0.001). Stratified analyses found a positive association of incidence density of HAIs and total days in ICU in Northern Italy (β = 0.3; SE = 0.1; p = 0.002); a positive associations with ICU size (β = 1.8; SE = 0.7; p = 0.020), total days in hospital (β = 0.06; SE = 0.02; p = 0.037) and total days in ICU (β = 0.5; SE = 0.1; p = 0.006) in Center Italy; a positive association with hospital size in Southern Italy (β = 20.3; SE = 9.4; p = 0.033).

Conclusions
Although our study confirms that HAIs still represent an important issue in Italian ICUs, there is some variation between regions from Northern, Central and Southern Italy. In general, we found that HAI incidence increased with increasing number of beds in hospital and in ICU, as well as with the the increasing number of patient-days. However, further research is necessary to better understand if additional hospital and ICU characteristics could motivate the observed regional differences.

Key messages
• There is a large regional variation in the incidence of HAIs in Italian ICUs and hospitals.
• This difference that could be motivated by specific hospital and ICU characteristics.
Factors influencing general practitioners’ decisions in migrant patients with mental health disorder
Authors: Duveau C , Wets C , Delaruelle K , Demoulin S , Dauvrin M , Lepièce B , Ceuterick M , De Maesschalck S , Bracke P , Lorant V 
Published: October 2022

Abstract

Background
Patients with a migration background (MB) have more mental health disorders than those without migration background. Yet, those patients are still underrepresented in mental healthcare services and have more unmet medical needs. Although providers’ bias has been well studied, up to date, little is still known about the factors explaining those biases. We assessed the effect of general practitioners’ (GPs') individual and organizational factors on their decision-making regarding diagnosis, treatment and referral recommendations for patient with MB with symptoms of major depression.

Methods
An experimental study staged a video-vignette of a depressed patient with or without MB. GPs had to make decision about diagnosis, treatment and referral. We then assessed the influence of several factors on their decisions such as age, ethnicity, workload and patient confidence. ANOVA and MANOVA were used for analyses.

Results
Overall, we found more unfavourable decisions in GPs diagnosis and treatment recommendations regarding the patient with a MB (F = 3.56, p &lt; 0.001). In addition, they considered the symptoms of the patient with a MB as less severe (F = 7.68, p &lt; 0.01) and would prescribe less often a medical treatment to these patients (F = 4.09, p &lt; 0.05). Nevertheless, few factors explained these differences, except the age, the workload and the patient trustworthiness.

Conclusions
This paper highlighted GPs biases based on apparent migration background of a patient with major depression that perpetuates ethnic inequalities in mental health care. Further research into the origins of discrimination in primary mental health care are needed to explain how and when those discriminations arise.

Key messages
• This paper shed light on pervasive unintentional discrimination still persist in mental health care among migrants in Europe.
• These findings may help us to further understand the role of general practitioner behaviour in primary mental health care discrimination.
How do countries plan, purchase and use imaging technologies to prevent over-purchase and overuse?
Authors: Waitzberg R 
Published: October 2022

Abstract

Background
The adoption of new and expensive technologies is one of the main causes of the growing expenditure on health. Regulators are concerned that health care providers purchase (and use) imaging technologies in quantities that exceed the need, increasing expenditure with little value. We review how countries regulate the purchase and use of imaging technologies.

Methods
Qualitative. We collected data using a questionnaire completed by researchers from 17 high-income countries purposefully selected based on variation of policies. We built and compared case studies.

Results
Eleven of the 17 countries analyzed have clear criteria for planning and purchasing imaging technologies. Countries plan different areas, such as supply of specialist care, hospitals by level and type of services, quantity or type of equipment, as well as expenditure on health services and resource allocation. Most countries combine three mechanisms that manage the purchase or use of imaging technologies: (1) seven countries regulate by requiring certificates of need, licenses, or purchase approvals; others regulate by directly limiting the amounts, types and quality of technologies. (2) All countries use financial tools such as activity-based payment, limited and conditional budgets, and caps on income or volume of services. (3) Nine countries centralize purchase by a government agency. The literature provides inconclusive evidence regarding the impact of these mechanisms on expenditure on health and access to imaging services.

Conclusions
Planning the imaging technologies market with clear criteria is essential to avoid abuse. Most countries combine the three mechanisms (regulation, financial tools, centralized purchase). Financial tools are more common and effective. Countries with single payers implement more regulation than countries with multiple, competing, payers. In the later, regulated competition seems to replace regulation. There is a trend of adopting centralized procurement.

Key messages
• Planning the imaging technology market is a precondition to avoid abuse.
• Regulation, financial tools, and centralized purchase can be combined to manage the use of imaging technologies.
Barriers for using amoxycillin dispersible tablet in pediatric pneumonia treatment in Bangladesh
Authors: Shah M , Ahmed S , Rana S , Mothabbir G , Islam J , Islam S 
Published: October 2022

Abstract

World Health Organization recommends guideline for integrated management of childhood illnesses (IMCI) where Amoxicillin Dispersible Tablet (DT) appears as the first drug of choice for treating childhood pneumonia. The Government of Bangladesh adopted the IMCI strategy in 1998, and scaled it up nationwide by 2014. But, even today, the use of Amoxicillin DT, either in public or private sector, for managing childhood pneumonia is a rare event in Bangladesh. We conducted this exploratory study to understand the existing barriers, both in public and private sector, those have influences on reduced availability of Amoxicillin DT and non-compliance of health service providers to follow IMCI guideline by using Amoxicillin DT for treating a child with pneumonia, in Bangladesh. We conducted desk review of relevant strategy and policy documents, key informant interviews with 19 key individuals from Ministry of Health and national / international NGOs. Collected information were analyzed and interpreted using thematic analysis method. Identified barriers through this study pointed to inadequate policy level focus on IMCI implementation, non-inclusion of Amoxicillin DT in the national essential drug list, single source of Amoxicillin DT producing pharmaceutical in the country coupled with bureaucracy and procurement procedural complexity, lack of training of health service providers and abundant availability of antibiotic over the counter. Study respondents recommended for policy level strengthening of IMCI program, increasing coverage of training for health care provider, including practicing pediatricians both at public and private sectors, facilitating production and procurement procedures and prohibiting antibiotic sell over the counter.

Key messages
• Facilitation of production and procurement procedure coupled with enforcement of law prohibiting antibiotics availability over the counter are urgent needs.
• Policy level support emphasizing full compliance of service providers for quality of implementation of IMCI program in Bangladesh (and similar other settings) is also important.
Food choices characterized by the Nutri-Score nutrient profile and risk of cardiovascular diseases
Authors: Deschasaux-Tanguy M , Huybrechts I , Julia C , Hercberg S , Srour B , Danesh J , Riboli E , Gunter MJ , Touvier M 
Published: October 2022

Abstract

Background
Nutrition is a well-established risk factor for cardiovascular diseases (CVD) that can be leveraged by public health prevention strategies. In addition to dietary guidelines, front-of-pack nutrition labels (FoPNL) can help consumers make healthier food choices. Nutri-Score, a scientifically validated 5-color FopNL based on the nutrient profile FSAm-NPS has been adopted by several European countries but remains optional under current EU labeling regulation, which is to be revised end of 2022. Scientific evidence is therefore needed on the relevance of the Nutri-Score at the European level. Our objective was to study the association between the consumption of food as graded by the FSAm-NPS and CVD risk in a large European population.

Methods
This prospective analysis was conducted on a case-cohort comprising 13,308 participants without CVD risk factors at baseline, among which 5,326 first incident cases of CVD from the EPIC-CVD study (8 European countries). Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox models were computed.

Results
Overall, associations were observed between the consumption of foods with a higher FSAm-NPS score (lower nutritional value) and a higher risk of myocardial infarction (MI; HR1-SD=1.12 [1.05,1.21]; HRQ5/Q1=1.23 [1.00,1.52]). Associations with stroke were not significant. Overall, associations were more particularly observed in men.

Conclusions
In this large European population, a higher risk of MI was observed in individuals consuming on average a diet with higher FSAm-NPS foods (reflecting consumption of foods with a lower nutritional value/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help consumers choose healthier food products.

Key messages
• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with a higher risk of myocardial infarction in the large European EPIC-CVD case-cohort study.
• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help consumers make healthier food choices.
Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands
Authors: van der Noordt M , Proper KI , Loef B , Boot CRL , Kroese FM , de Bruin M , van Oostrom SH 
Published: October 2022

Abstract

Purpose
In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this paper is to study to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic.

Methods
We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,657; number of observations=64,316). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses.

Results
Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale; 95%-CI=0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers.

Conclusions
During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health.

Key messages
• During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands.
• During peak periods of the pandemic, mental health was observed to be poorer in both healthcare workers and non-healthcare workers.
Health workers’ perception vs medically approved COVID-19 infection risk: the risk communication gap
Authors: Kuhlmann E , Behrens GMN , Cossmann A , Homann S , Happle C , Dopfer-Jablonka A 
Published: October 2022

Abstract

Background
This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organisational measures. We aim to explore ‘blind spots’ of pandemic protection and identify mental health needs.

Methods
A German multi-method hospital study at Hannover Medical School serves as an ‘optimal-case’ scenario of a high-income country, well-resourced hospital sector and an organisation with low HCW infection rate serves to explore governance gaps in HCW protection. Document analysis, expert information and survey data (n = 1163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care.

Results
Our study reveals a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed ‘some’ to ‘very strong’ fear of acquiring infection at the workplace. Individual protective behaviour and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived ‘no’ or ‘little’ protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behaviour, but nursing was correlated with higher levels of personal risk estimations and fear of infection.

Conclusions
A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through improved information, risk communication and inclusion of mental health support in pandemic preparedness.

Key messages
• Healthcare workers’ perceptions of COVID-19 infection risks are much higher than medically approved infection risk.
• Pandemic preparedness and protection plans must pay greater attention to information, risk communication and mental health needs.
Opportunities to increase the attractiveness of the German Public Health Service as an employer
Authors: Arnold L , Hommes F , Kellermann L , Fischer F , Jung L , Mohsenpour A , Stratil JM 
Published: October 2022

Abstract

For decades, the public health service in Germany (PHS) experienced shortages of young professionals and challenges in recruiting qualified personnel. To sustainably counteract this challenge, it is necessary to understand the reasons of the perceived low attractiveness of PHS as a potential employer among students and young professionals. Two cross-sectional online surveys were conducted to assess the attitudes of medical, public health, and health science students towards the PHS as a potential employer. Wave 1, conducted from 2019-12 to 2020-04, focused on factors associated with high and with low interest in working for the PHS. Wave 2 was conducted from 2020-06 to 2020-09 to capture changes that may have resulted from the newfound attention of the PHS during the SARS-CoV-2 pandemic. Participants in both waves were asked about opportunities to increase the attractiveness of the PHS, which were analyzed using qualitative content analysis. In total 3040 students participated. Low interest in the PHS was associated with limited knowledge about public health, primary interest in clinical medicine, and a negative image of the public service. The qualitative analysis indicated as major obstacles: low visibility of and low awareness about the PHS, a perception of hierarchical and bureaucratic workplaces, and perceptions of repetitive occupations, among others. The participants suggested: improving awareness about the PHS in the population, including PHS in curriculum, and reducing entry barriers for non-medical students. The results of the largest survey of students on the attractiveness of the ÖGD in Germany provide valuable insights for ongoing reform processes. In addition to approaches to increase external visibility, existing processes and procedures within the ÖGD should be considered.

Key messages
• To counteract the shortage of skilled workers, the PHS must become more attractive to young professionals. This requires both, greater external visibility and modernization of internal structures.
• Successful inclusion of the perspective of young professionals in the current modernization processes introduces opportunities to increase the attractiveness of the PHS in the long-term.
Workplace health promotion programs for employees in long-term care facilities - a systematic review
Authors: Herz M , Gebhard D 
Published: October 2022

Abstract

Background
Employees in long-term care facilities (LTC) are exposed to physically and mentally demanding workloads. Due to the specific working conditions and processes in LTC, recent literature recommends that care setting-specific health promotion is required. The objective was to systematically review the current evidence of workplace health promotion programs among employees in LTC.

Methods
A systematic review was conducted in accordance with the PRISMA 2020 Statement. The literature search was applied in the online databases PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and APA PsycArticles (Jan 2000 - Feb 2022). Studies were included if (1) participants worked in any occupational setting in LTC, (2) personal health and outcomes related to occupational health were measured as primary outcome, and (3) studies were randomized controlled trials. Methodological quality was assessed using the Cochrane risk of bias assessment tool (RoB 2).

Results
The literature search yielded 23.007 articles, resulting in 24 included studies and 21 unique interventions with a total of 6.625 participants at baseline. Most participants were female (85.2% to 100%). Interventions were grouped into person-directed (n = 4), person/work interface-directed (n = 10), work-directed (n = 0), and combined approaches (n = 7). Of these studies, two studies (2/4) using a person-directed approach, four studies (4/10) using a person/work interface-directed approach, and four studies (4/7) using a combined approach demonstrated significant improvements in personal health-related outcomes and occupational health-related outcomes. Methodological quality can be rated as some concerns.

Conclusions
Interventions that incorporate a combination of intervention approaches appear promising for improving health and work-related outcomes among employees in LTC. There is a lack of evidence for only work-directed approaches to health promotion in LTC. High-level quality studies are still needed.

Key messages
• Combined intervention approaches to workplace health promotion in long-term care facility settings appear to be beneficial.
• High-level quality studies on workplace health promotion in long-term care facilities are still needed.
Health system barriers to vaccination among Ukrainian economic migrants in Poland
Authors: Gańczak M , Kalinowski P , Kowalska M 
Published: October 2022

Abstract

Background
Before Russia's aggression, Ukrainians were the largest migrant group in Poland. However, data on health system barriers to vaccination in this vulnerable group were not collected. The study aimed to explore barriers to child MMR/HPV vaccination and related access to Polish healthcare services.

Methods
Between December 2021-January 2022, a qualitative study of Ukrainian migrants (UM) living in Poland, recruited through a snowball sampling method, was conducted as a part of RIVER-EU project. 8 focus groups were held with 49 UM aged 16-44 years, followed by interviews with 12 health care providers (HCP).

Results
UM and HCP experienced communication barriers despite language similarities. HCP reported that since a UM is not willing to register at a GP practice he cannot be reached by the Polish vaccination system. UM experienced challenges in navigating the system and accessing credible information in Ukrainian, no official local health authority vaccination material existed either. UM complained that there are no translated versions of vaccination materials accessible at the PHC facilities and they are not adequately informed about the possible side effects of vaccines; HCP reported the lack of time provided by the system for health promotion. UM were not familiar and rather hesitant regarding self-paid vaccines, such as HPV vaccine. In Poland and Ukraine this topic is not targeted at school curriculum neither by information campaigns. UM reported that HPV vaccine is not of interest for them due to the high cost, however they might consider it for their daughters, if the cost was fully refunded.

Conclusions
The study identified main health system barriers to child vaccination regarding economic UM in Poland, seen from the perspective of migrants and HCP and pinpointed issues for improvement. This can serve as a starting point to confront vaccination related challenges in the context of Ukrainian refugee crisis Poland is currently dealing with.