bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Intervention Mapping to develop an intervention to promote healthy child weight development
Authors: Bonnesen CT , Carlsson RR , Brautsch LAS , Kierkegaard L 
Published: October 2022

Abstract

Background
Clear documentation of the understanding of the problem, development process, and content of interventions is essential to understand why interventions succeed or fail. Transparent reporting will enable future researchers to build on previous evidence and replicate or adapt interventions for new contexts. This paper describes the theory- and evidence-based systematic development of the Bloom Trial - a home-based intervention to promote healthy weight development among infants and children in Denmark.

Methods
Development of the intervention is guided by the six-step planning tool the Intervention Mapping protocol. Step 1: Needs assessment including identification of risk factors in infancy and existing interventions, interviews with parents, and an organizational capacity assessment. Step 2: Development of program theory and matrices. Step 3: Selection of theoretical methods and practical applications for modifying personal and environmental determinants. Step 4: Development of intervention tools. Step 5: Planning of program adoption, implementation, and sustainability. Step 6: Generation of an evaluation plan.

Results
The Bloom intervention is universal but with a strong focus on families with low socio-economic position and non-Danish ethnic background. It is aimed at first-time parents and addresses early risk factors for child overweight such as parental skills and healthy habits related to food and meals, movement, screen time and sleep, and introduce a new theme: sense of security in the family. It will be integrated in existing services delivered by community health nurses supplemented with extra elements such as telephone consultations, family groups and a video library.

Conclusions
The transparency of the developmental process and theoretical, empirical, and contextual foundation of the Bloom Trial may enable future studies to build on our findings and accumulate knowledge to promote healthy weight development among infants and children.

Key messages
A training ground Lay out improves rehabilitation after trauma surgery: A Fast Track Policy
Authors: Balato G , Palladino R , Montella E , Diana L , Coviello A , Festa E , Iervolino A , Rubba F , Mariconda M , Triassi M 
Published: October 2022

Abstract

Fracture patients are frail and have high mortality. We investigated whether introducing a fast-track strategy during post-surgery care and including early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness. A training ground was built inside the inpatient area dedicated to trauma settings. Usual postoperative care consists of immobilization during the first day, but patients may start rehabilitation earlier, 24 hours after the surgical procedure, with a fast-track strategy. In general, gait speed, step length, and self-assessment in terms of mobility improve significantly in the first six postoperative weeks in fracture patients. As delayed postoperative mobility during hospitalization was observed, the established training ground may help with this concern. The expert physiotherapist may contribute to ameliorating the indicators showing great potential in postoperative rehabilitation regardless of fracture pattern. The primary outcome was postoperative physical functioning. Secondary outcomes included the patient’s assessment of therapeutic effect (overall improvement), perceived pain intensity, health services utilization, treatment side effects, and adverse events. Data were analyzed by univariate analysis and binary logistic regression showing a reduction of LOS of almost three days. Further, the optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Adding to the schedule, some PROMPTS (Patient-reported outcome measures) could further integrate the patient empowerment perspective into the quality set of values. For this reason, ‘fast track’ may define a crucial policy able to guarantee rapid rehabilitation, becoming a key factor to achieving a good clinical effect. Fast-track rehabilitation facilitates a shortened hospital stay and cost-saving and can be used to optimize the patient’s condition before admission to a rehabilitation facility

Key messages
• Early rehabilitation protocols may shorten the length of hospital stay (LOS) while improving the overall clinical effectiveness.
• Human factors and patients empowerments may help.
Evaluation of primary health care system in Yangon Region, Myanmar: a mixed-method approach
Authors: Moon J , Kang SJ , Noh JW 
Published: October 2022

Abstract

Background
Many low- and middle-income countries and international organizations have invested resources to strengthen primary health care services. Despite efforts from the Ministry of Health on primary health care, barriers to accessing health care services and health inequality in Myanmar still exist. This study aimed to identify the challenges and unmet needs in the current primary health care services by assessing the experiences and perceptions of healthcare workers and local leaders in three townships (Htantabin, Hmawbi, and Taikkyi) in Yangon, Myanmar.

Methods
The study was conducted among healthcare professionals and community leaders in three townships. By adopting a mixed-method approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (15 group discussions) were conducted online for qualitative data.

Results
As a result of the survey regarding six domains; hygiene, primary medical care, maternal and child health, infectious diseases, non-communicable diseases, and leadership, enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5), while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28 out of 5) and the impact of the intervention (4.7). The focus group discussions revealed that while specific infrastructures and equipment necessary for the category were addressed, the need for financial support has been the recurrent theme throughout the discussions.

Conclusions
Utilizing the World Health Organization’s six-building block framework, our findings suggest that a long-term targeted financial investment in the primary health care system is critical in Myanmar by increasing health care expenditure per capita. At the same time, related barriers and facilitators should be considered to optimize the effectiveness of prioritized interventions.

Key messages
• Health care providers and local leaders perceived the management and leadership capacity as the lowest current achievement.
• A long-term targeted financial investment in the primary health care system is critical in Myanmar.
Attitudes of children and adolescents towards healthy lifestyle issues
Authors: Antia N , Tabidze D , Gabunia L , Zarnadze I , Khetsuraini Sh , Gamkrelidze N , Sulashvili N 
Published: October 2022

Abstract

Background
Health education for promoting healthy lifestyle from early ages is considered to be important. However, this issue has not been thoroughly examined in Georgia. The research, undertaken on adolescents, aimed to analyse adolescents’ lifestyle, awareness and attitudes towards healthy lifestyle.

Methods
The study applied a mixed methods design and included both, qualitative and quantitative research methods. 145 students aged 17 to 23 years participated in the research. In order to evaluate the adolescent’s perceptions and attitudes, qualitative individual interviews with university students were conducted. For the quantitative method, a self-administered questionnaire assessing the level of adolescents’ awareness and attitudes towards healthy lifestyle was developed.

Results
This section presents preliminary findings of the study. We found that more than 67% of adolescents were aware on the importance of healthy lifestyle. However, most of the participants did not transfer their knowledge into practice. The participants found it challenging to maintain healthy eating habits due to increased costs of healthy, organic food. The study also confirmed the need for integrated work of public, governmental, and non-governmental organizations to initiate and implement health promotion programs for children and adolescents.

Conclusions
Overall, the study found that even though adolescents are aware about the importance of the healthy lifestyle, it is challenging for them to maintain it. In order to change adolescents’ attitudes towards unhealthy behaviour, it is necessary to carry out targeted interventions.

Key messages
• Health education is a necessary component for healthy lifestyle.
• Healthy lifestyle requires careful study of the issue and making evidence-based conclusions.
Health system efficiency in Germany: results of a pilot study to assess health system performance
Authors: Hengel P , Achstetter K , Blümel M , Schwarzbach V , Busse R 
Published: October 2022

Abstract

Background
Improved efficiency is one overall goal in WHO’s Health Systems Framework. Efficiency is an important dimension of health system performance assessment (HSPA). HSPA is used as a tool to monitor and evaluate the performance of health systems and to support evidence-based policymaking. In the pilot study for a first German HSPA, efficiency was assessed as one dimension.

Methods
Indicators were selected based on a systematic search of established instruments in national and international HSPA initiatives. Criteria for the inclusion of indicators were data availability and international comparability. Where possible, indicators were evaluated in terms of their development over time (2000-2020), in comparison to eight European countries (e.g., Austria, Denmark, France), and regarding equity aspects (e.g., age, gender, region).

Results
Eight indicators to assess the efficiency of the German health system were identified and analysed accordingly. They cover the pharmaceutical sector, outpatient and inpatient care, and system-wide efficiency. Trend analyses were possible for all indicators, and most were also suitable for international comparisons. Overall, results of the chosen indicators indicate a moderate health system efficiency. The volume of generics as share of all pharmaceuticals, e.g., was 83% in Germany in 2019 (country average: 54%) and has been steadily increasing since 2000. In contrast, expenses for pharmaceuticals overall rose from 1.4% of GDP in 2004 to 1.7% in 2019, whereas it declined from 1.3% to 1.1% on average in the other countries.

Conclusions
Within this first pilot study, a systematic and comparative German HSPA measuring the efficiency of the German health system using eight predefined indicators was proven to be feasible. The results give insights into efficiency measurements across different sectors, e.g., pharmaceuticals, identify developments of efficiency over time, and can support evidence-based policymaking.

Key messages
• In the pilot study for a first German HSPA, efficiency was evaluated using eight indicators covering pharmaceuticals, outpatient and inpatient care, and system-wide efficiency.
• Based on the available data, which allowed trend analyses for all indicators and comparisons to eight European countries for most indicators, Germany’s health system efficiency can still be improved.
The European pharmacy market: the density and its influencing factors
Authors: Schwaabe S 
Published: October 2022

Abstract

Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government’s goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. The research question is: upon which conditions depends the variance in the density of community pharmacies in Europe? So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. I focus on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. The results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of my analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies.

Key messages
• Regulated pharmacy markets, with a ban on mail-order of prescription drugs and third-party-ownership have a positive effect on pharmacies density.
• The results of my analysis provide the government with measures to improve professional nationwide health care coverage for the population through pharmacies.
Need for a competency-based approach for the Public Health Workforce training: the ISS proposal
Authors: Mazaccara A , Privitera G , Di Pucchio A , Barbina D , Bertinato L , Mistretta A , Simonelli M , Caminada S , Arzilli G , Brusaferro S 
Published: October 2022

Abstract

Issue
The COVID-19 pandemic acted as a catalyst for a reconsidering health care professional workforce (HCPW) competency needed to face future public health challenges, in line with the recent WHO “Global Competency and Outcomes Framework for UHC” document. In this context, in the Italian G20 Presidency framework, the Italian National Institute of Health (ISS), launched a program named “Laboratorium” - recognised in the G20 Declarations of Ministers of Health and Leaders - aimed to the development of training tools suitable for distance learning in whatever context they are placed.

Description of the problem
Common competencies and needs of the HCPW have to be fulfilled through cross-sectional and multilevel training, to overcome the current emergency and be able to face future challenges. The aim is to provide a modular educational approach that is finalized to actively involve the participant: health professionals step in their training pathway according to their knowledge gaps, identify their specific learning objectives and, through a problem-based learning approach, acquire the proper skills for their function and tasks.

Results
We propose a two-tiered approach to training: the development of competence based courses oriented to active learning. A pilot course on Epidemic Intelligence design according to this model is ready to be released. At the same time, a repository of everything available on the web systematically selected from authorised sources by a scientific committee was created to support the training objective. It is characterised by a detailed multilevel tagging that allows an effective modularisation to reach only the content useful for its user.

Lessons
Accessibility to health-related training materials is a required necessity at every level of HCPW. Profiles within healthcare are increasingly heterogeneous and there is a need to focus on disseminating tools that can provide knowledge to address different healthcare scenarios and common purposes.

Key messages
• Future public health challenges underline a need for a competencies-based learning approach in Healthcare Workforce training.
• Italian National Institute of Health propose two methods within the ‘Laboratorium’ project to enable this type of learning: specifically designed courses and a structured document repository.
Ukrainian refugee crisis: the experience of the Roman Local Health Authority “ASL Roma 1”
Authors: Melnyk A , Barone LC , Messina S , Grossi A , Kohut M , Cascini F , Damiani G , Parente P , Goletti M 
Published: October 2022

Abstract

Problem
On February 24th, 2022, Ukraine was invaded by Russian forces, forcing many Ukrainians to flee from their homes as refugees. More than 55,000 Ukrainians have since arrived on Italian territory. In response to the humanitarian crisis, the Roman Local Health Authority “ASL Roma 1” provided socio-sanitary assistance through first reception centers to more than 7700 refugees, prioritizing people with high social vulnerability. Ukraine’s vaccine hesitancy and different epidemiological landscape represented a major hurdle to be overcome.

Practice
ASL Roma 1’s practice served to ensure infectious diseases prevention and control, as well as continuity of care for non-communicable diseases and mental health issues. It consisted of repurposing resources, such as COVID-19 Hubs and their personnel, stipulating Public-Private Partnerships and collaborations with the local Ukrainian community, massive training, creating a centralized multidisciplinary team (with Ukrainian members) and a dedicated database/IT system.

Results
ASL Roma 1 empowered local Ukrainian communities by providing equipment, medical and administrative staff and socio-sanitary assistance. Ukrainian volunteers helped bridge the cultural gap for essential service provision, such as COVID-19 screening, enrolment in the NHS, health and social orientation, vaccinations and a tailored care pathway. Thus, more than 7700 refugees were assisted, with 1830 COVID-19 vaccinations administered and 170 in critical conditions promptly receiving specialized care.

Lessons
The multidisciplinary and cross-cultural interaction between doctors, nurses, cultural mediators, social workers, and other key actors was essential in ensuring a holistic care pathway. Services catered to Ukrainian refugees need complete integration between primary and centralized care. Flexibility and resilience are fundamental to foster an ecosystem of innovation and optimization of healthcare provision on all levels, from local to supranational.

Key messages
• The multidisciplinary and cross-cultural interaction between all medical and non-medical key actors is essential in ensuring a holistic care pathway and complete social integration of asylum seekers.
• Health system flexibility, resilience and an ecosystem of innovation and optimization of healthcare provision on all levels are fundamental components of preparedness for future refugee crises.
Establishment of the Namibian National Public Health Institute: laboratory systems strengthening
Authors: Thieleke-Matos C , Endjala N , Nepolo E , Winter C , Nowaseb V , Mataranyika M , Ochurus P , Jansen A , Weiss S , Ellerbrok H 
Published: October 2022

Abstract

In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of establishing a Namibia Institute of Public Health (NIPH). A fundamental pillar of an NIPH is a fully operational Public Health laboratory system. Due to the COVID-19 pandemic, the need for strengthening the existing Namibian Laboratory system became eminent. Following the Intra-Action Review (IAR) of the COVID-19 response in Namibia in 2020, three regional diagnostic laboratories, at points of entry, were assessed. The major issues identified were long delays between sampling of both suspected cases and COVID-19 patients and receiving test results due to extended sample transport times to the central laboratory in Windhoek and the overload of the central capacities due to overwhelming numbers of samples during peak times. This led to the establishment of three SARS-CoV-2 PCR diagnostic laboratories through procurement and installation of equipment, provision of consumables/reagents, and on-site training of laboratory technicians with continued virtual technical support. Consequently, an important reduction of the diagnosis turnaround time was achieved. Of great value was the technical support given by the staff at the central laboratory during the trainings allowing for immediate validation of the newly established laboratories and to strengthen the communication between regional laboratories and the central laboratory. The Namibian molecular diagnostic capacities have increased in important regions in Namibia and will provide data to support the health policies of the future NIPH. New diagnostic protocols will be developed to foster the sustainability of the established laboratories and could support the implementation of genomic surveillance capacities. Finally, stronger relationships were built through these joint activities, which will support and the next steps of the establishment of the NIPH.

Key messages
• Supporting and Strengthening the Namibian Public Health Laboratory system.
• Long-term goal of establishing a Namibia Institute of Public Health (NIPH).
Dealing with the unknown: perceptions and fears of SARS-CoV-2 infection among hospital workers
Authors: Utzet M , Villar R , Díaz P , Rodríguez Arjona MP , Ramada JM , Serra C , Benavides FG 
Published: October 2022

Abstract

Introduction
This study aims to explore perceptions, fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives and/or co-workers and non-pharmacological preventive interventions among hospital workers.

Materials and Methods
The research used an explorative qualitative approach. Six focus groups and ten individual interviews across multidisciplinary workers (physicians, nurses, aides, cleaners, maintenance, and security staff) were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding.

Results
Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties.

Conclusions
This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers’ fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, in order to reduce also health inequalities.

Key messages
• Lack of pandemic preparedness increased HCW’ fear of infection, which could be reduced by ensuring the availability and good use of proper PPE, and by clear guidelines on case/contact detection.
• The improvement on non-pharmacological preventive interventions must be underpinned by effective communication channels and/or communication staff, and should reach all workers in the institution.