bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of health care 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
Health System Performance Assessment (HSPA) is used as a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a systematic HSPA was piloted for Germany. The conceptual framework includes different dimensions, e.g., access, population health, efficiency, and quality of care. In the following, Germany’s performance is analysed in terms of quality of care.

Methods
Indicators to assess the dimension of quality of care were selected based on a systematic search of established instruments in national and international HSPA initiatives. Other criteria for the inclusion of indicators were data availability and international comparability. The indicators were evaluated in terms of their time trend (2000-2020) and in international comparison (e.g., Austria, Denmark, France).

Results
Overall, 17 indicators were selected to assess quality of care, of which two could not be analysed due to missing data. Indicators include, e.g., emergency readmissions after hospital stays, patient-reported medical errors, coercive measures in psychiatric wards, and in-hospital mortality. Trend analyses were possible for 14 indicators and most of them showed positive developments. In country comparisons, which were feasible for seven indicators, Germany mostly ranked below average. In-hospital mortality for acute myocardial infarction, e.g., was 8% in 2019 in Germany (other countries: 4%-7%) and has been stable since 2014. For stroke, Germany performs better and ranks three of five (6%; range: 5%-9%) in 2019.

Conclusions
Measuring quality of care for a systematic and comparative German HSPA was proven to be feasible. However, some indicators could not be mapped so far due to lack of data. The results give insights into quality measurements across different sectors and can support evidence-based policymaking.

Key messages
• In the first health system performance assessment (HSPA) for Germany, quality of care was evaluated over time (2000-2020) and compared to eight European countries using 17 indicators.
• Measurement of quality was feasible, but data availability should be strengthened in the future as country comparisons were possible for only half the indicators and two could not be analysed at all.
Informal caregivers’ profile needs: where do we stand?
Authors: Henriques A , Sousa Loura D , Nogueira P , Costa A 
Published: October 2022

Abstract

Background
Non-communicable diseases’ increase and demographic ageing require a solution to manage long-term care (1), where informal caregivers are key actors (2). Optimization in policies designed to support their caregiving role is needed. Portugal is an aged country with high prevalence of family that take care of dependent relatives. ‘Informal caregivers’ profile in Lisbon County: a health community approach’ is a nurse-led research project designed to meet these challenges with the main aim: to develop a profile on informal caregivers in Lisbon county.

Methods
Reporting the descriptive phase, a survey containing health/social questions was submitted to a non-probabilistic representative sample of careers, aged 18 years old or above in about 300 caregiver’s caring dependent persons resident in Lisbon, in 2021. Univariate descriptive analysis was performed.

Results
Married and retired women’ caring for a parent were the most typical informal caregiver profile (n = 13, 4%). The majority do not have support from social services (n = 209, 61%). Two thirds live with the cared-for person (n = 219, 64%). Almost half (n = 150, 44%) have a university degree and only few planned the transition to a caregiver role (n = 13, 4%). No more than 10% had access to support programs (n = 71, 20%).

Conclusions
Caregivers’ unmet needs can complexify societal mechanisms relying on their work. Addressing these needs will be key to develop a strategy focused on supporting informal caregivers’ priorities.
References
1. Zigante, V. (2018). Informal care in Europe: exploring formalisation, availability and quality. Publications Office of the European Union. https://doi.org/10.2767/78836.
2. Crisp, N. (Coord.) (2014). Um futuro para a saúde - todos temos um papel a desempenhar. Fundação Calouste Gulbenkian. https://www.gulbenkian.pt

Key messages
• Caregivers profile needs will be key support a strategy on informal caregivers’ priorities.
• No more than 10% of informal caregivers in a relevant European County had access to support programs.
Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK
Authors: Blake H , Carlisle S , Fothergill L , Hassard J , Favier A , Corner J , Ball JK , Denning C 
Published: October 2022

Abstract

Background
Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite.

Methods
Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152; focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework.

Results
Uptake was high (n = 464 students opted-in; 98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

Conclusions
This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings.

Key messages
• Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing.
• This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.
Modeling and analysis of psychological mechanism for preventive behaviors against the COVID-19
Authors: Fukukawa Y , Kurita S 
Published: October 2022

Abstract

Background
The COVID-19 pandemic has dramatically changed human life style. People all over the world are still on the way to establish “New Normal”. The purpose of this study was to construct a cognitive model that predicts preventive behaviors against the infectious disease.

Methods
A total of 3,000 Japanese respondents aged from 18 to 86 years participated in a web survey in January 2021. The data of 2,913 respondents (1,633 males and 1,280 females) were eligible for analysis. The following information regarding cognitive characteristics was assessed: 1) Cognitive reflection ability (Frederick, 2005), 2) Experiential thinking style (Pacini & Epstein, 1999), 3) Germ aversion (Duncan et al., 2009). In addition to those characteristics, the participants were asked to answer 6 items to rate their preventive behaviors against the COVID-19, such as keeping social distance and wearing a mask. A structural equation modeling technique was used to test the causal relationships among the measures. We hypothesized that experiential thinking style and germ aversion would mediate the causal link between cognitive reflection ability and preventive behaviors.

Results
Correlation analyses indicated that cognitive reflection ability was negatively associated with experiential thinking style, whereas experiential thinking style was negatively associated with germ aversion. Furthermore, the higher germ aversion was, the more the participants enforced the covid-19 preventive behaviors. Parameter estimation of the causal model using the measures by the bootstrap method indicated that the model acceptably fit the data with CFI of 0.997, TLI of 0.996, and RMSEA of 0.008 (95% CI = 0.004:0.011).

Conclusions
The findings of the study suggest that there is a cognitive psychological process that induces preventive behaviors against the COVID-19. The results should be useful to improve public health interventions for future pandemics.

Key messages
• A web survey was conducted for 3,000 Japanese adults to construct a cognitive model that predicts preventive behaviors against the COVID-19.
• The structural equation modeling indicated that the participants’ experiential thinking style and germ aversion mediated the causal link between cognitive reflection ability and preventive behaviors.
A time-varying SIRD model for dynamic vaccination strategies against COVID-19
Authors: Cartocci A , Lucarelli V , Messina G , Nante N , Cevenini G , Barbini P 
Published: October 2022

Abstract

Introduction
The COVID-19 pandemic has demonstrated how the optimal allocation of the limited doses of vaccine available represents one of the main useful measures to mitigate the transmission of the infection and reduce the mortality associated with it, especially at an early stage of the pandemic. The use of a compartmental model allows us to understand which population groups to vaccinate and to what extent to act depending on the type of health or social objective to be achieved.

Methods
A time-varying susceptible-infected-recovered-deceased (SIRD) compartmental model, stratified into ten age groups, was developed on Italian data. Simulations were performed every 15 days from December 2020 to April 2021. An optimal vaccination strategy was achieved by minimizing deaths or infected, considering the total vaccine doses available.

Results
We showed how the effects of a vaccination campaign can be planned in a way that maximizes lives saved and/or minimizes infections. Regarding the minimization of deaths, the model prioritizes the elderly (&gt;80 years) and then those between 60 and 80 years, in all simulations. Regarding the cost function of new infections, the first simulation assigns all available doses to those over 90 years of age. In the later simulations, the doses are assigned mainly to the 20-29-year-old and the 89+ year old.

Conclusions
Optimal allocation of available vaccine doses is useful in mitigating transmission of infection and reducing mortality. Application of the mathematical model can be useful at the beginning of an epidemic caused by a new pathogen, when data are scarce, and it is therefore necessary to introduce a standardized approach. This kind of simulation is useful to understand whether the implemented vaccination strategy needs to be recalibrated, too.

Key messages
• Time-varying compartmentalised models can be used both to continuously inform decision-makers about changes in epidemic traits and to simulate the effects of targeted pandemic containment strategies.
• The application of compartmental models can be very useful at the onset of an epidemic to more successfully contain it and structure the health, political, and economic plan.
Isostrain among tourism employees in Tunisia during COVID-19 pandemic
Authors: Maatouk A , Ben Fredj S , Zammit N , Ghammem R , Maatoug J , Boujebha S , Guesmi N , Zendah B , Ghannem H , Hadj Mabrouk K 
Published: October 2022

Abstract

Background
Psychological and social factors related to work activity can improve or deteriorate the physical and mental health of employees. Since the COVID-19 pandemic, the psychological well-being of workers has been strongly affected. Particularly, jobs with isostrain characterized by high work demands and low work control, coupled with low social support, place employees at highest risk for poor mental health. We aimed to assess the factors associated with isostrain among employees in the tourism sector in Sousse.

Methods
A cross-sectional study was conducted between September and November 2020 among tourism workers belonging to 12 hotels and restaurants in Sousse, Tunisia, using a self-administered questionnaire. ‘Isostrain’ was assessed using the Karasek questionnaire. ‘Isostrain’ is a situation where there is a combination of ‘jobstrain’ (‘tension at work') and low social support (score below the median of the group). SPSS 20 software was used to analyze the data.

Results
A total of 226 workers were included. The mean age was 38.2 ± 9.6 years. The sex ratio was 2.7. The majority of employees (64.8%) were working at workplace during COVID-19 lockdown. The prevalence of isostrain was 5.4%. Isostrain was reported by 5.7% of women (p = 1). All workers older than 50 years did not have isostrain (p = 0.6). Moreover, isostrain was found among 6.6% of workers with less than 5 years of work experience (p = 0.4), 4.8% of married employees (p = 0.7), and 7.6% of employees with a university education (p = 0.53).

Conclusions
Isostrain can affect employees in the tourism sector. Social support should be promoted among workers to ensure good mental health.

Key messages
• Prevalence of isostrain in tourism sector of Sousse during COVID-19 pandemic is quite high.
• Preventive strategies of mental health should be promoted at workplace in Tunisia.
How to handle occupational well-being of critical care workers. A lesson from the pandemic
Authors: Magnavita N , Soave PM , Antonelli M 
Published: October 2022

Abstract

Background
The PSIC study (Prospective Study of Intensivists and COVID-19) monitored the intensivists working in one of the two COVID-19 hub hospitals in Central Italy over 2 years from April 2020. This study showed how mental health varies in relation to the stressors posed by the different pandemic phases.

Methods
In 4 surveys corresponding to the 4 pandemic waves, the intensivists were invited to indicate changes in work activity and measure their state of mental health using standardized questionnaires administered via SurveyMonkey.

Results
During the pandemic there was a change in occupational stressors that led to insomnia, anxiety, depression, burnout, job dissatisfaction, unhappiness and intention to quit. The predominant stressors in the first wave were fear of unprotected exposure, distrust of safety measures, and compassion fatigue from having to inform relatives of the adverse outcome of treatment. In the second and third waves the workload, the monotony due to always following only one type of patient, the isolation, and the lack of time to meditate were the more relevant factors. The fourth wave added the stress deriving from interacting with anti-vax patients

Conclusions
Specific prevention strategies have been developed and applied for each of the stress factors identified. Excessive workload and lack of time for meditation originated from lack of staff were remedied with extraordinary temporary hires. The management of compassion fatigue and relations with anti-vax people were addressed with specific policies and training. The monotony and isolation in COVID-19 wards can only be resolved through employee turnover in ordinary departments. Organizational and financial efforts are necessary to protect the health of intensivists during a pandemic.

Key messages
• Monitoring of critical care workers during the pandemic waves indicated the preventive measures necessary to ensure their mental health and quality of care.
• Protecting healthcare workers is a priority.
Socioeconomic and geographic inequalities in colorectal cancer in Cyprus: An ecological study
Authors: Lamnisos D , Giannakou K 
Published: October 2022

Abstract

Background
Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide. To date, the relationship between regional deprivation and CRC incidence or mortality has not been studied in the population of Cyprus. The aim of this study was to analyse the geographical variation of CRC incidence and mortality and its possible association with socio-economic inequalities in Cyprus for the periods between 2000 and 2015.

Methods
A small area ecological study in Cyprus, with census tracts as units of spatial analysis, for the period between 2000 and 2015. The incidence date, sex, age, post code, primary site, death date in case of death or last contact date in case of alive for all cases of CRC from 2000-2015 were obtained from the Cyprus Ministry of Health. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed values of SIRs, SMRs and Mortality to Incidence ratio (M/I ratio) were estimated using the univariate Bayesian Poisson log-linear spatial model.

Results
There are geographical areas having 15% higher SIR and SMR, with most of those areas located at the east coast of the island. Higher M/I ratio values were found in the rural, remote, and less dense areas of the island while lower rates were observed in the metropolitan areas. An inverted U-shape pattern in CRC incidence and mortality was observed with higher rates in the areas classified in the second quartile of the socio-economic deprivation index and lower rates in rural, remote, and less dense areas. A different pattern emerged in the M/I ratio indicating a stepwise increase across increasing levels of socioeconomic deprivation.

Conclusions
These findings can potentially provide useful information at local and national levels and can inform public health authorities to appropriately allocate resources for geographically targeted prevention and control plans to increase CRC screening.

Key messages
• M/I ratio of CRC was positively associated with regional deprivation since a stepwise increase was found across increasing levels of rural-related socioeconomic deprivation.
• Interventions aimed at reducing the risks of CRC should primarily focus on socially deprived communities in Cyprus.
Co-developing a tailored vaccination intervention with Congolese migrants: a participatory study
Authors: Crawshaw AF , Hickey C , Lutumba LM , Kitoko LM , Nkembi SL , Knights F , Ciftci Y , Vandrevala T , Forster AS , Hargreaves S 
Published: October 2022

Abstract

Background
Disparities in vaccination uptake among migrant populations are well documented. WHO and ECDC have sought renewed focus on participatory research that engages migrants in co-producing tailored initiatives to address vaccination inequities and increase coverage.

Methods
This community-based participatory research study aims to engage Congolese migrants in co-developing a tailored approach to increase vaccine uptake. Phase 1 used poster walls and in-depth interviews with Congolese migrants (n = 32) to explore COVID-19 vaccination beliefs, experiences, and preferred information sources and communication methods, analysed iteratively and thematically in NVivo.

Preliminary results
Institutional distrust has shaped this population’s interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold. We found complex information networks and preference for Francophone, African and social media. Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging. Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective. The population felt coerced by vaccination reminders and mandates, and were resultantly more hesitant to accept COVID-19 vaccination.

Conclusions
The population’s specific characteristics suggest that existing and trusted interpersonal networks and oral communication in first languages should be harnessed to spread credible information and encourage vaccine uptake, and mandate policies are unlikely to be effective. Training local role models to facilitate vaccination dialogues and myth-bust may be effective at changing behaviour. The next phases will gather more information from key stakeholders and engage migrants in workshops to co-design insight-driven, tailored interventions.

Key messages
• Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities.
• Populations with strong interpersonal networks and low trust in public institutions may be receptive to tailored, community-centred dialogue approaches using local messengers and role models.
Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access
Authors: Neale F , Watson M , Hargreaves D , Arora S 
Published: October 2022

Abstract

Background
England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required.

Aim
To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019.

Methods
Retrospective analysis of a de-identified database of integrated care records for 495,357 children.

Results
Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values &lt;0.001 in all cases.

Conclusions
Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care.

Key messages
• Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care.
• Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.