bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction of medical assistants in France: an innovative approach to healthcare access?
Authors: Guyonvarch O , Bourgueil Y , Dugué F 
Published: October 2022

Abstract

Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care. Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas. Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices. How does French model of MAs impact quality and productivity in GPs’ practices and articulate with other policies? We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs’ work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews). MA was defined as a function centered on physicians’ needs, accessible both to administrative staff and nursing professions. MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management. Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise. In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity. However, for most GPs, it primarily helped them to maintain high workload without burning out. Although MAs with clinical background seem better suited for patients’ needs, recent figures have shown that more than half of MAs employed are former secretaries. If in-person secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals. Other aspects than productivity must be taken into account in a support policy.

Key messages
• Regardless of productivity objectives to attain, hiring MAs can relieve physicians’ workload and stress, preventing them from burning out and guarantee access to care in deprived areas.
• MA’s clinical profile could have a stronger impact on public health issues such as chronic disease care management.
Measuring the performance of health systems in Latin America
Authors: Flores S , San Sebastian M , De Alva P 
Published: October 2022

Abstract

Background
Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years.

Methods
Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs.

Results
Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen.

Conclusions
The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making.

Key messages
• Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years.
• Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.
The development of a regional network for health care research in Hamburg, Germany
Authors: Lindemann C , Busch S , Bott T , Meusch A , Loewe B , Scherer M , von dem Knesebeck O , Haerter M 
Published: October 2022

Abstract

Background
At the University Medical Center Hamburg-Eppendorf (UKE), health care research has been established as one of five research priorities recommended by the Research Council with the founding of the Center for Health Care Research (CHCR) in 2006. The CHCR was involved in numerous research projects with the focus on strengthening regional networking. Despite the numerous initiatives, there is still potential for improvement with regard to a systematic and sustainable exchange in the region of Hamburg, Germany.

Methods
These requirements led to the initiation of the ‘Hamburg Network Health Services Research (HAM-NET)'. The mission of HAM-NET is to build an open forum for all relevant institutions, to concentrate their interests and needs in health services research and to promote and conduct innovative, efficient, needs-based and patient-centred health services research projects in the metropolitan area of Hamburg. Three main tasks were appointed: 1) linking health care research to relevant regional institutions, 2) promoting research activities and new fields of research and 3) using methodological expertise to promote young scientists.

Results
By today 40 institutions from all sectors of health care joined HAM-NET. The regularly general meetings offer exchange and advice. Internal communication is promoted by mailing lists and newsletters. Also, HAM-NET presents itself with a website, logo and by organizing recurring events and participating in international and national congresses and networks. Within two funding phases a total of four overarching research projects were developed and implemented. Furthermore, a person with lived experience committee was established.

Conclusions
For the further development of health care research as one the core disciplines of public health a regional network with an efficient infrastructure is needed. HAM-NET promotes this with the implementation of an innovative, efficient and patient-oriented network.

Key messages
• Regional networks help to integrate multiple public health initiatives and community stakeholders.
• Public health networks can be established on multidisciplinary cooperations in different out- and inpatient sector levels.
Positive Health and palliative care: an exploration among nurses
Authors: De Bot C , Dierx J , Echteld M 
Published: October 2022

Abstract

Background
The current WHO definition of health seems to no longer meet the changes in the current Dutch health system. An alternative approach which puts emphasis on health, not disease, is Positive Health (Huber et al, 2011). This focus shifts the emphasis on improving resilience and well-being rather than the perspective on what is lacking in health.In this study, the attitudes towards the concept of Positive Health of palliative care nurses are examined.

Methods
A mixed-methods approach design was used for this study. This involved the collection of both quantitative and qualitative data. Among the nurses, 134 questionnaires were administered. SPSS was used to analyze these results. For this study, six interviews were conducted and analyzed through thematic coding.

Results
The quantitative analysis shows that the respondents are look positively about the Positive health description. Nurses find it important that it emphasizes that someone is more than his illness. In addition, the emphasis is on personal control. However, the question is also raised whether every patient can handle this. Nurses find the most important dimension ‘quality of life'. This is followed by the dimension ‘mental well-being’ and ‘spiritual existential'. The dimension ‘daily functioning’ is found to be the least important. The qualitative analysis also shows that the concept of Positive Health is viewed positively. The concept is considered positive, because it covers several areas of health. However, it was also indicated that the concept is still too broad. However, all respondents found that the concept can be applied in practice.

Conclusions
This study shows that palliative care nurses have a positive attitude towards Positive Health. Nurses consider the all the dimensions important and also embed the aspects of it in their daily practice. However, the implementation of new concept should be explored.

Key messages
• Palliative care nurses have a positive attitude towards Positive Health.
• The implementation of Positive Health in palliative care should be explored.
Parents’ evaluations on the service delivery and communicatıon skills of the pediatric dentists
Authors: Karamüftüoğlu N , Uğraş Dikmen A , Atabek D , Korkmaz Öner FS , Özkan S 
Published: October 2022

Abstract

Aim
In the study,it was aimed that parents who need oral health services for their children for any reason should evaluate pediatric dentists in terms of service provision and communication skills.

Methods
The study was conducted with 123 parents who applied to a private oral health clinic in Ankara between 20/06/2021-20/07/2021.For parents,10 descriptive and 20 face-to-face questionnaires questioning service delivery and communication skills on a 5-point Likert scale were applied.

Results
The mean age of the participants was 40.9±5.9 years.Only 34.1%(n = 42) of the parents who needed oral health services for their children directly applied to the pediatric dentist,while the others 65.9%(n = 81) applied to dentists who were not pediatric dentistry specialists.The mean score of evaluation of parents’ pediatric dentists in terms of service delivery and communication skills is 4.16±0.44.When pediatric dentists were evaluated in terms of service delivery and communication skills.74.8%(n = 92) made the explanations in a way that they could easily understand,67.8%(n = 82) did not speak fast enough to prevent them from understanding the words,66.9%(n = 79) stated that they created an environment that respects privacy and 72.6%(n = 85) stated that they allocated enough time as “always”.

Conclusions
As a result, it has been determined that the frequency of parents applying to physicians who are not pediatric dentists for their children’s oral health problems is high. However,the parents who applied to the pediatric dentist found the pediatric dentist to be more competent in terms of service delivery and communication skills.It is necessary to increase the awareness of the parents about the pediatric dentistry expertise.

Key messages
• Parental evaluations of pediatric dentists regarding service delivery and communication skills are important.
• Oral health literacy of parents should be developed.
LärMiljö (Learning Environment) - study protocol: movement, outdoor learning and well-being in school
Authors: Simonsen N , Wackström N , Ray J 
Published: October 2022

Abstract

Background
Outdoor education (OE) is a teaching method aiming to promote children’s learning, physical activity (PA) and wellbeing. OE in green areas may further increase positive effects. There is little knowledge on use of OE and its possible effects in a Finnish context. Also, there is a need to evaluate OE from a teacher perspective. The aim of the LärMiljö-study is to: a) survey the use of OE in Swedish-language primary schools and investigate factors related to its use; b) investigate the associations between OE and PA, wellbeing, nature relations and learning among children aged 9-13 years, considering other related factors.

Methods
The self-determination theory (SDT) is used as theoretical framework. Data is collected via electronic surveys in Swedish-language primary schools, including: a) national surveys among principals and teachers; b) surveys among children and guardians. Children’s PA is measured for a 7-day period via accelerometers and a diary is kept. Teachers keep a class diary on OE provided. Academic tests are performed. Data will be analyzed using quantitative methods.

Results
This abstract describes the study protocol. The investigation of associations between OE and outcomes among children is mainly done by comparing classes that regularly use OE with classes that do not. Main outcomes are PA, psychosocial wellbeing, academic performance and nature connectedness; secondary outcomes are school motivation, social relations and sleep. Teachers’ experience and use of OE is explored, as is perceived effects of and barriers to OE use. Based on SDT, associations between OE and need satisfaction at work, competence, motivation and work engagement are studied.

Conclusions
The study represents a unique opportunity to explore OE use in primary schools, its effects among children and teachers, and what the supporting and hindering factors for its use are. The study contributes knowledge that can be used to promote learning and wellbeing in school.

Key messages
• Outdoor education in primary school may promote schoolchildren’s learning, physical activity, wellbeing and nature relation, but more knowledge is needed, including the perspective of teachers.
• The LärMiljö-study will broaden the understanding of the potential effects of OE in primary education and school health promotion, and on factors supporting and hindering its use.
A health promotion intervention for vulnerable schools (BeE-school): a cluster-randomized trial
Authors: Rosário R , Pereira B , Novais P , Antunes H , Silva MJ , Augusto C 
Published: October 2022

Abstract

Background
Noncommunicable diseases (NCDs) share key determinants like unhealthy diet, unhealthy 24h- movement behaviour (sleep, sedentary behaviour and physical activity), leading to other risks including overweight, obesity and raised blood pressure. Although the manifest of the NCDs in childhood is rare, risk behaviours, obesity, and raised blood pressure that accelerates their development begin during childhood. The current study aims to analyze the effectiveness of the intervention program based on the promotion of health literacy and lifestyles, on children’s health literacy, lifestyles (e.g. dietary intake, 24hmovement behaviour) and overweight and obesity.

Methods
478 children (6 schools) aged 6-12years old will participate in this cluster-randomized trial, having schools as the unit of randomization, assigned into intervention (239-3schools) and the control arm (239-3schools). This project is currently performing social listening (online and offline) and stakeholders’ involvement. Data collection includes sociodemographics, health literacy and infodemic resilience, dietary intake and children’s 24-h movement behaviour (e.g. accelerometry), anthropometry (e.g. weight, height and waist circumference) and blood pressure. It will occur at baseline and after the intervention (follow-up, 6 months after the beginning of the intervention).

Results
Expected outputs and outcomes include the 1-creation of a model for characterizing NCDs and health topics based on artificial intelligence techniques (e.g. deep learning, social network analysis methods).2- improved health literacy and infodemic resilience of children, families and teachers.3- enhanced children’s lifestyles. 4- reduce NCDs’ physical risk factors (e.g. overweight, raised blood pressure).

Conclusions
A feasible intervention program for school-aged children with vulnerabilities enhances tailored policies about health promotion and NCDs’ prevention, respecting the contextś singularities.

Key messages
• Health promotion and NCDs prevention are crucial for the well-being of our societies.
• Feasible intervention programs advocates for evidence-based policies that respect local singularities.
Codevelopment and evaluation of a multicomponent intervention to improve HPV vaccination in France
Authors: Bocquier A , Bonnay S , Bruel S , Chevreul K , Gagneux-Brunon A , Gauchet A , Giraudeau B , Le Duc-Banaszuc AS , Mueller JE , Thilly N 
Published: October 2022

Abstract

Background
HPV vaccine coverage (VC) in France has always been lower than in most high-income countries. The French authorities launched in 2018 the PrevHPV national research program aimed at codeveloping with stakeholders and evaluating the impact of a multicomponent intervention to improve HPV VC among French adolescents.

Methods
We identified three components to address main barriers to HPV vaccination in France: adolescents’ and parents’ education and motivation (component 1); general practitioners (GPs)’ training (component 2); and access to vaccination at school (component 3). We developed the intervention using the UK Medical Research Council framework for developing complex interventions as a guide. We used (i) findings from published evidence; (ii) primary data on knowledge, attitudes, behavior and preferences collected through a mixed methods approach (quantitative/qualitative studies, discrete choice experiment); (iii) the advice of stakeholders (e.g., adolescents, parents, school nurses, GPs) involved in working groups. We will evaluate the effectiveness, efficiency and implementation of the components (applied alone or in combination) through a pragmatic cluster randomized controlled trial. The primary endpoint is the HPV VC (≥ 1 dose) among adolescents aged 11-14 years, 2 months after the end of the intervention, at the municipality level.

Results
Primary data highlighted the need to improve adolescents, parents and school staff knowledge on HPV and to help GPs communicate with patients on this topic. They provided guidance on the most effective communication contents. For each component, we codeveloped tools with a participatory approach (e.g., eHealth tools for adolescents, a decision aid tool for GPs). The trial will end in June 2022; 90 middle schools (i.e., about 40,000 adolescents) and 46 GPs accepted to participate.

Conclusions
Should the intervention prove effective, results from the implementation evaluation will help us refine it before scaling it up.

Key messages
• The PrevHPV study is supported by the French health authorities and conducted by a multidisciplinary consortium to tackle a long-lasting public health concern in France.
• It will add to the small number of studies that compared the effectiveness of various strategies to promote HPV vaccination and will provide key results on cost-effectiveness and implementation.
Attitudes of university students towards mandatory COVID-19 vaccination: a cross-sectional survey
Authors: Sciurti A , Baccolini V , Renzi E , Migliara G , De Vito C , Marzuillo C , Villari P 
Published: October 2022

Abstract

Background
Vaccination is an effective public health measure to control the COVID-19 pandemic. In Italy, vaccination against SARS-CoV-2 was made compulsory by law for some job categories, such as healthcare and education workers. Although students required a valid COVID-19 certificate to access university, they were never subjected to mandatory vaccination. In this context, we investigated their attitudes towards mandating COVID-19 vaccination to be able to access schools and universities.

Methods
We conducted a cross-sectional survey from September 2021 to February 2022. A multivariable logistic regression model was built to identify predictors of positive attitudes towards the outcome. Adjusted odds ratio (aOR) and 95% confidence intervals (CIs) were calculated.

Results
We collected 5287 questionnaires, grouped into three periods (September-October 2021, November-December 2021 and January-February 2022). The highest proportion of students supporting COVID-19 mandatory vaccination (62.5%) was found between November and December 2021. Multivariable analysis showed that November-December and January-February participants had higher odds of having a positive attitude towards the vaccine mandate than September-October respondents (aOR=1.26, 95% CI:1.09-1-48; and aOR=1.22, 95% CI:1.01-1.48). Other positive predictors were age (aOR=1.01, 95% CI:1.01-1.03), higher levels of perceived COVID-19 severity (aOR=1.09, 95% CI:1.05-1.14), concern for the emergency (aOR=1.09, 95% CI:1.05-1.14), getting vaccinated for fear of infecting other people or being infected (aOR=1.08, 95% CI:1.04-1.12; and aOR=1.07, 95% CI:1.03-1.10) and believing that vaccines could end the pandemic (aOR=1.49, 95% CI:1.41-1.56).

Conclusions
Attitudes towards COVID-19 mandatory vaccination changed over time, probably in relation to the pandemic trends. Moreover, feeling involved in the pandemic situation seems to be related with a positive attitude.

Key messages
• Pandemic trends may affect the attitude towards vaccine mandates. Mandating vaccines to access universities could be taken into account in emergency situations to ensure a safer learning environment.
• Involvement in the pandemic situation seems related with a supportive attitude towards vaccine mandates, suggesting that awareness is a key factor to be addressed to implement mandatory vaccination.
The effect of social desirability bias on the measurement of subjective health literacy of children
Authors: Bollweg T , Okan O 
Published: October 2022

Abstract

Background
When measuring children’s health literacy (HL) with self-report questionnaires, there is doubt whether high scores reflect good HL, or if they are caused by social desirability bias, meaning that children present themselves favorably. This study explores how the tendency to answer in a socially desirable way impacts HL scores.

Methods
A cross-sectional study was conducted among fourth-graders in North-Rhine Westphalia, Germany. The study was designed as a representative survey starting in 12/2020, which could not be realized due to pandemic-related constraints. Data collected between 07/21 and 11/21 is included here. Subjective HL was assessed with the HLS-Child-Q15 and a validated 10-item scale (AFS) was used for social desirability bias. Also included in linear regression explaining HL scores are age, sex, country of origin, home language, family affluence (FAS), interest in learning new things about health, the belief that parents are able to answer own questions about health and frequency of conversations with parents about health. Variables were dichotomized where necessary.

Results
n = 364 students are included (49.5% female). Mean age is 9.5 years (SD=.69). In the regression model (F(9, 271)= 6.724, p&lt;.001), which explains 15.5% of variability in HLS-Child-Q15 scores, frequency of communication about health at home (β = .147, p&lt;.01), interest in learning about health (β=.268, p&lt;.001), and the belief that parents are able to answer own questions about health (β =.209, p&lt;.001) are the only significant predictors. Sociodemographic variables and the tendency to answer in a socially desirable way don't have a significant effect on HL.

Conclusions
Our findings suggest that social desirability is not a significant source of bias when measuring children’s HL with the HLS-Child-Q15. Communication about health at home and children’s interest in health seem to be much more important for children’s HL. Further research is necessary to verify these findings.

Key messages
• Social desirability doesn’t seem to be a source of bias when measuring children’s HL with the HLS-Child-Q15.
• Speaking about health at home and children’s interest in health are important predictors of HL.