bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community-based health professionals in face of crisis – a practice example from Bremen, Germany
Authors: Gansefort D , Altgeld T , Tempel N , Wächter M , Sterner J , Lettau I , Focke L 
Published: October 2022

Abstract

At the end of 2020, a district-based analysis of Covid-19-infection rates in Bremen uncovered differences between socially deprived and “better off” areas. The first analysis conducted on a district level in Germany revealed a social gradient in the Covid-19-affectedness with deprived areas having above-average incidences. These areas are characterized by poor living conditions, high migrant population, low education and health literacy levels, language barriers and precarious job situations. Bremen's Health Senator acted on this challenge early on, initiated and financed the deployment of community-based health professionals (CHP) in disadvantaged areas to tackle the rising Covid-19-rates while reducing social inequalities and promoting health literacy. The CHPs’ work is coordinated by the Association for Health & Academy for Social Medicine Lower-Saxony. The 14 CHP are multilingual, with a background in health professions, social work and public health. They cooperate with local partners in 18 disadvantaged districts in Bremen and Bremerhaven. In 2021, work focused on outreach work, low-threshold provision of multilingual information (e.g., on regulations, vaccination) and the support of local vaccination campaigns. Bremen currently has the highest vaccination coverage in Germany (87,5% of population with primary series, national average: 76,2%; 07/2022).
Since 2022, CHPs’ work has shifted to health promotion activities aimed at mitigating the effects of the pandemic, e.g., physical inactivity, mental stress. Bremen was the first German city to pilot a large-scale implementation of CHP in socially disadvantaged areas. Due to their continuous presence, CHP quickly became people of trust and are integrated into local structures. Their work has received huge attention both in professional contexts and public media. The low-threshold outreach-work and close cooperation with local partners has high potential to address other health challenges in disadvantaged communities.

Key messages
Implementation of Case Management in emergency departments: the view of the involved staff
Authors: Schmutz E , Graells M , Moullin J , Kasztura M , Chastonay O , Allen M Canepa , Hugli O , Daeppen JB , Grazioli V , Bodenmann P 
Published: October 2022

Abstract

Introduction
Frequent users of emergency departments (FUED; ≥ 5 ED visits in the previous 12 months) often present with somatic, psychological and substance use problems. Providing a Case Management (CM) intervention may reduce their number ED visits and improve their quality of life. However, there is limited knowledge about the implementation process of CM.

Methods
This study aimed to introduce CM into the EDs in the French-speaking part of Switzerland and to identify the facilitators, barriers and needs encountered in this process. Semi-structured interviews were conducted with ED involved staff. An inductive content analysis was conducted.

Results
Among 13 invited hospitals, 8 implemented CM (62%); 23 ED staff were sampled from all participating ED: 17 nurses (74%), 5 physicians (22%) and 1 healthcare manager (4%). The average age was 48,48 years (SD = 8,64) and 74% were female. Four main facilitators emerged from the analysis: 1) Direct hierarchy support and flexibility (e.g. time management, supplemental paid hours); 2) Exchange with colleagues (e.g. debriefing, support); 3) Supervision by the research team (training and toolkit consisting of a binder and USB stick containing the study presentation and implementation procedures); and 4) Motivation (pleasure to work on an innovative project, benefit for patients and caregivers). Lack of resources was an unanimously mentioned barrier (e. g., time to identify and contact FUED medical and social support). Finally, participants identified the following needs to enable CM implementation: official and protected time for the project, a dedicated room for CM, at least two team members involved in the project since its initiation with complementary skills (e.g.: somatic, psychiatric and social).

Conclusions
Our study suggests that successful CM implementation is a complex process that, in addition to motivated ED staff, requires significant dedicated resources, such as protected time and a devoted support team.

Key messages
Improving population health in Germany – lessons of a pilot study to assess health system performance
Authors: Achstetter K , Blümel M , Hengel P , Schwarzbach V , Busse R 
Published: October 2022

Abstract

Background
Improving the population health, both its level and equity, is a major goal of health systems. Health System Performance Assessment (HSPA) is a tool to evaluate the performance of different health system dimensions, e.g., population health, access, efficiency. For the first time, a systematic HSPA was piloted for Germany including the dimension population health.

Methods
The conceptual framework for the German HSPA pilot has been developed in a previous feasibility study. The selection of indicators was based on established indicators used in other HSPA initiatives. Another inclusion criterium was data availability. The ten indicators to measure population health cover e.g., maternal and neonatal health, amenable mortality, infectious diseases, and cancer screening. The indicators are evaluated in terms of their trend over time (2000-2020), in international comparison (e.g., Austria, Denmark, France), and by various equity criteria (e.g., age, gender, region).

Results
Overall, Germany's health system performs moderately regarding population health, especially when compared to selected European countries. While Germany performs very well in terms of incidence rates of infectious diseases, amenable mortality is an area with need for improvements. However, trends over time show improvements of the population health in Germany.

Conclusions
Measuring population health in Germany using ten predefined indicators reveals areas for improvement. Furthermore, subgroup analyses indicate inequities. These results should be considered in further efforts aiming at the improvement of population health in Germany.

Key messages
Introducing Community Houses in Italy: a scoping review of the international literature
Authors: Cerri A , Arcaro P , Veneziano E , Panà A , Mete R , Maurici M , De Vito C , Damiani G 
Published: October 2022

Abstract

Background
The SARS-CoV-2 pandemic put under pressure all the world's health systems, to the point that it was a severe threat to their stability. At the same time, this scenario confirmed the importance of primary health care to guarantee effective care for patients who suffer from complex and chronic diseases. From these considerations and in the light of the funding provided by the European Union for enhancing the health care system in Italy, our working group has decided to analyse various organisational models of Primary Health Care founded around the world to set up innovative Primary care community Centers in Italy, called Community Houses.

Methods
A scoping review of the international literature was conducted on Pubmed, searching for primary care models based on integration and co-location of services. Each organisational model was then evaluated using different levels of multidimensional integration inspired by the taxonomy work of P. P. Valentijn, such as clinical, professional, organisational, system, functional and normative integration levels.

Results
The search produced 2053 results, initially screened by title and abstract and, subsequently, by full-text, finally obtaining 116 articles. When a model is characterised by integrating services with external stakeholders, it also presents more integration levels than the others. In particular, these models are, on average, about 20% more likely to have an organisational, functional and normative integration in the model. Moreover, by stratifying for population complexity, we can find an increase in integration levels for populations suffering from chronic diseases with a higher degree of complexity, such as diabetes or cancer.

Conclusions
From these preliminary results, we can conclude that it is necessary to prefer primary care models with more integration levels to deliver better healthcare for people with complex or chronic diseases, improving the performance of the Health Care System, especially in Italy.

Key messages
Evaluating the pandemic’s impact on surgical site infections after abdominal surgery in Italy
Authors: Elhadidy HSMA , Paladini G , Ugliono E , Cornio AR , Bordino V , Vicentini C , Zotti CM 
Published: October 2022

Abstract

Background
The COVID-19 pandemic led to important disruptions in surgical activity. The aim of this study was to evaluate the impact of COVID-19 on abdominal surgery outcomes in the region of Piedmont, in northern Italy.

Methods
Data were gathered from 42 hospitals participating in the regional surveillance network from 2018 to 2020. SSI, overall mortality and case fatality rates (CFR) were calculated, comparing 2020 to mean 2018-19 data. Chi-squared tests were used to assess both the differences among the proportion of urgent and oncological procedures (based on ICD-9-CM codes) and rates between the two periods. Subgroup analyses on 2020 data were carried out comparing urgent vs. elective and oncological vs. non-oncological procedures using chi-squared tests. Analyses were performed using SPSS v. 28.0.1.0.

Results
5407 procedures were recorded in 2018-19; 310 SSIs and 120 deaths were observed. The mean proportions of urgent and oncological operations were, respectively, 21.90% and 43.24%. In 2020, 1057 procedures were recorded, along with 44 SSIs and 29 deaths. 34.44% of procedures were urgent and 39.74% oncological. The mean 2018-2019 SSI rate was 5.73%, with an overall mortality of 2.22% and a CFR of 7.42%. The SSI rate in 2020 was 4.16%, with an overall mortality of 2.74% and a CFR of 9.09%. The proportion of urgent procedures significantly differed between the two periods (p &lt; 0.001), as did the proportion of oncological procedures and SSI rates (both p = 0.05). Considering 2020, significant differences were found comparing overall mortality between urgent vs. elective procedures (4.95% vs. 1.59%, p = 0.002) and comparing SSI rates between oncological vs. non-oncological patients (3.57% vs. 2.20%, p = 0.02).

Conclusions
During the pandemic, patients undergoing surgical procedures significantly differed, reflecting public health decisions. Even though these differences did not reach statistical significance, overall mortality and CFR increased in 2020.

Key messages
Attitudes towards vaccination are associated with vaccination behaviour among university students
Authors: Trümmler J , Heumann E , Helmer SM , Stock C , Busse H , Heinrichs K , Negash S , Horn J , Niephaus Y , Pischke CR 
Published: October 2022

Abstract

Introduction
Vaccination behaviour is influenced by various determinants. Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of complications compared to the general population in Germany. However, little is known about other COVID-19-related determinants for the population of German university students. This study aimed to investigate determinants of vaccination behaviour among German university students.

Methods
The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities at the end of 2021 via an online survey (n = 7.267). Multiple logistic regressions were calculated to examine associations of vaccination behaviour (not vaccinated vs. fully vaccinated) and attitudes towards vaccination (5Cs: confidence in the safety of the vaccine, complacency - not perceiving diseases as high risk, constraints - structural and psychological barriers, calculation - engagement in information seeking, collective responsibility - willingness to protect others), health literacy in a pandemic (CHL-P), and additional determinants.

Results
All 5Cs were associated with the vaccination status ‘fully vaccinated’, except for complacency. Regarding CHL-P, we found that students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had a higher odds for being vaccinated (OR = 3.02; 95% CI: 2.26-4.04). Regarding additional determinants, the analysis revealed that students who had been previously infected had in all regressions a lower odds for being vaccinated compared to students with no previous infection.

Conclusions
Due to the strong association of the attitudes towards vaccination and vaccination behaviour among university students, we recommend that the different components of the 5Cs should be considered in future COVID-19 vaccination campaigns in the university context.

Key messages
The timeliness of COVID-19 testing and tracing in eight public health regions in the Netherlands
Authors: Bosdriesz JR , den Boogert EM , Dukers-Muijrers NHTM , Götz HM , Goverse IE , Leenstra T , Raven SFH , van Dijken SKS , Wevers K , Matser AA 
Published: October 2022

Abstract

Background
Testing and Contact Tracing (TCT) was a core strategy in the fight against the spread of SARS-CoV-2. However, little is known about the real-world effectiveness of TCT for COVID-19. Because time is an important conditional factor, we aim to study timeliness of TCT in the Netherlands, and its determinants.

Methods
We used routine COVID-19 TCT registry data from all individuals who tested positive for SARS-CoV-2 at 8 Dutch regional public health services from 1-6-2020 to 28-2-2021 (N = 338,066). We calculated median time intervals of TCT stages. Factors associated with the time between test result and completion of TCT, categorised as ≤ 3 days and &gt;3 days, were assessed using logistic regression adjusting for region, testing site, and laboratory. Potential determinants were: gender, age, country of birth, number of close contacts, working in health-care or education, TCT manpower, and the Oxford Covid-19 Government Response Tracker (OxCGRT).

Results
The median time from symptom onset to TCT completion was 6 days (IQR:3-10). Median times between TCT stages were 1 day (IQR:0-3) for symptom onset to test request, 1 day, (IQR:0-1) for test request to sample collection, 1 day, (IQR:1-1) for sample collection to test result, and 2 days (IQR:1-5) for test result to TCT completion. In 31.7% of tests, time between test result and TCT completion was &gt;3 days. This delay was associated with being older (65+), whereas being younger (0-14), a higher OxCGRT, scaling down TCT, and a higher number of TCT employees were associated with a shorter interval.

Conclusions
Over fifty percent of interval times from symptom onset to TCT completion exceeded the median SARS-CoV-2 incubation period of 5 days. There seems to be little room for improvement on the side of the index case, but there are some implications for logistics such as increasing TCT manpower, and better integration of digital systems.

Key messages
Increasing role of Public Health Rapid Response Teams in infectious disease outbreaks
Authors: Tweed S , Stewart DE , Hornsey E , Graham W 
Published: October 2022

Abstract

Background
Following the Ebola crisis (2013-2016), the WHO, Global Health Security Agenda and other international actors advocated for the development of Public Health Rapid Response Teams (RRTs) to strengthen outbreak response. Despite significant investment, evidence on the uptake, composition and effectiveness of such teams remains lacking.

Methods
Qualitative review of published and grey literature including from governmental and multilateral agencies, with semi-structured interviews of key informants. Thematic content analysis was completed and evidence synthesised to inform future policy recommendations.

Results
RRTs have been adopted globally providing surge capacity in outbreak settings. RRTs typically include microbiologists and field epidemiologists but can be more efficacious when broadly multidisciplinary with the inclusion of social scientists, risk communicators and infection prevention and control professionals. The organisation of RRTs must be responsive to district and national contexts so existing systems are not undermined, with regional collaboration beneficial where skill gaps exist. Literature and interviewees agreed that RRTs should not be uniformly defined by narrow technical capabilities, but rather regional standards and evaluation of deployments used to assess operational readiness.

Conclusions
Public Health RRTs should be multiprofessional in nature and evaluated against regional standards to be effective. Future research should seek to assess the experience of countries before and after RRT implementation including detailed economic assessment.

Key messages
Geospatial characteristics of medical workforce and infrastructure to combat COVID-19 in Kazakhstan
Authors: Glushkova N , Semenova Y , Jobalayeva B , Davletov K , Sarría-Santamera A 
Published: October 2022

Abstract

Background
After cessation of initial quarantine in Kazakhstan, the COVID-19 outbreak peaked in July 2020, imposing dramatic stress on the country's healthcare system. This study was focused on calculation of updated epidemiological characteristics, on evaluation of available medical workforce and infrastructure and the impact of workforce density on infected and dead individuals via ArcGIS platform.

Methods
The national and local incidence rate (IR), mortality (M) and case-fatality rates (CFR) were calculated along with the population-weighted densities of beds, physicians, general practitioners, resuscitators, nurses and healthcare budget. Associations between the density of different health workers, infected and dead individuals were investigated using Poisson regression. Finally, we constructed vector maps of country regions clustered by IR and CFR to depict the density of beds and those health workers that were significantly associated with infection and death rates.

Results
There is much heterogeneity between the country regions in terms of CFR (range from 0.28 to 2.57) and IR (range from 1.62 to 12.04), while density of beds was characterized by a relatively greater stability (range from 3.47 to 6.66) and so did density of physicians (range from 0.79 to 2.76) and density of nurses (range from 5.73 to 8.26). Densities of beds, physicians, general practitioners, resuscitators, and nurses have been linked significantly with infection and death rates.

Conclusions
As COVID-19 epidemic is still far from ending, findings of this study could be of interest for policy makers to formulate an appropriate action plan in the view of possible repeated outbreaks.

Key messages
Health equity of displaced Syrians in Lebanon
Authors: Khalifeh R , D'Hoore W , Dauvrin M , Saliba C 
Published: October 2022

Abstract
Lebanese government data indicates that the country hosts 1.5 million displaced Syrians (DS). Providing care for DS is a challenge, especially when barriers and discrimination issues arise in accessing the Lebanese health system. This study therefore aimed to understand the causes of biases, their mechanisms, their forms and their consequences on access and quality of care for DS in Lebanon. A qualitative study using in-depth semi-structured interviews was utilized. In 2021, 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16). Six group interviews were conducted with DS (n = 22) in different Lebanese healthcare facilities. The recruitment of participants was based on reasoned and targeted sampling. The interviews were recorded and transcribed for later narrative content analysis. Thematic analysis was performed to identify common themes in participants’ experiences of DS in accessing Lebanese healthcare. The results showed a barrier of access to care related to transportation and financial issues. Discrimination emerged as an underlying mechanism that drives health inequity. Several factors contributed to the presence of biases in the Lebanese healthcare system. Healthcare services provided to the Syrian population may not be the best due to inequity to access the health system attributable to the discriminatory behavior of healthcare providers. The underlying causes of discrimination are due to the fragility of the Lebanese healthcare system facing a humanitarian crisis with a collapsed infrastructure torn by previous wars and current socio-political and financial problems. Global initiatives can provide the help needed for the equitable provision of health services by providing the resources necessary to address this problem. The findings of this study highlight the changes that should be performed at the micro (cultural skills) and macro (equitable distribution of resources) levels to grant quality of healthcare services for DS.

Key messages
Evaluation of interventions for essential newborn care practices at home-based delivery in India
Authors: Moon J , Usmanova G , van der Schans J , Noh JW , Biesma R 
Published: October 2022

Abstract

India has the largest share of neonatal mortality, accounting for 21.7 per 1,000 in 2019, while the global goal is at least 12 per 1,000 by 2030. More than 20% of deliveries still occur at home in India for various reasons. Several national interventions were designed to ensure essential practices even at home by engaging skilled birth attendants (SBAs), antenatal care (ANC), and community health workers (CHWs). This study evaluates the effectiveness of these interventions on essential newborn care practices (EP); clean cord care, thermal care, and breastfeeding. Using data from the 2015-2016 India Demographic and Health Survey (n = 9,273), this study employs structural equation modeling to confirm the relationship between SBA, ANC, CHWs` counseling, and EP, including indirect effects of ANC and CHWs and moderating effects of women's empowerment. The results show that SBA and ANC have significant direct effects (standardised coefficient=0.105 and 0.056, respectively) on EP, and ANC and CHWs have significant indirect effects (0.015 and 0.004) in the well-fitted model (CFI=0.938, TLI=0.920, RMSEA (upper 90% CI)=0.028 (0.029), SRMR=0.044). The empowerment-related factors which had a significant positive moderating effect on the paths from SBA to EP and from ANC to EP are decision-making power (0.007, 0.003), allowed mobility (0.002, 0.001), and education (0.009, 0.004). More than 90% of EP variance is not associated with the factors in this model (standardised coefficient=0.958). SBA demonstrated the most considerable effectiveness for EP, while ANCs and CHW indirectly impacted EP. Improving women's empowerment can be an effective strategy to enhance EP. Previous literature said that the other factors explaining EP could be quality of care, other interventions for a safe birth, and cultural characteristics. Policymakers are recommended to consider comprehensive factors to address barriers to safe home birth and design CHW's intervention to persuade SBA.

Key messages