Local Health Services Research Articles

Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service

BackgroundReducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting...

Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban Ontario.

Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites. We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs. Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers. The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Real-world evaluation of a lipid transformation project in primary care settings

Abstract Background The National Health Service England Long-Term Plan (2019) highlights the need to optimise lipid management to reduce cardiovascular disease (CVD) risk. A collaborative project was funded between a local health service and an industry partner to review current practice and improve outcomes in a UK region through introduction of lipid management pathways, primary care education and patient-focused reviews to optimise lipid-lowering therapies among high-risk patient groups. Purpose The project aimed to increase prescribing of CVD risk reduction therapies such as high-intensity statins (HIST), escalation of therapy to achieve lipid-lowering treatment targets, to improve clinician knowledge and confidence in lipid management and provide benefits for local populations in reducing CVD risk. Methods Systematic patient searches across six Primary Care Networks (PCNs) prioritised high-risk patients for review. Community of Practice sessions were held to facilitate shared learning and problem-solving. A pragmatic, real-world evaluation was conducted to explore the impact of the new pathways and tools on prescribing outcomes and optimisation of lipid-lowering therapies. To examine the changes in HIST prescriptions, a statistical analysis of open-source prescribing data was undertaken between baseline (December 2021) and follow-up (December 2022) on over 39,000 eligible patient records. Qualitative interviews with clinicians from all participating PCNs and a thematic analysis of emerging themes was conducted in 2023. Results A paired sample t-test demonstrated a significant increase in the percentage of HIST prescribed, of the total number of statins prescribed, across the six PCNs between baseline and follow-up t(5) = -3.38, p = 0.01. Table 1 illustrates the changes at individual PCN level. Four of the six PCNs reached the National Institute for Health and Care Excellence minimum threshold of 65% target for HIST prescribing in statin prescriptions and three of these PCNs exceeded the optimal target of 75% HIST. An additional 600 patients were prescribed Ezetimibe (as therapy escalation or for statin intolerance). Through qualitative data, clinicians reported development of new skills and knowledge, leading to increased confidence in optimising lipid management with medication and lifestyle interventions. Conclusion The lipid transformation project demonstrated significant improvements in prescribing of lipid-lowering therapies and improved clinician competence in lipid management pathways and guidance. This has enabled sustainable improvements in lipid management and cardiovascular disease reduction in local populations.

Cross-sectoral interventions to promote health-supportive urban environments

Abstract Background As dealing with the complexity of urban living conditions becomes more and more evident and urgent, it is fundamental to promote cross-sectoral interventions that allow cities to become more inclusive and supportive of health. The Emilia-Romagna region, Italy, has promoted a participatory initiative to structurally integrate health into urban planning tools, identifying a framework of tailored urban indicators linked to locally perceived population health issues. Methods Through internal discussion and systematic literature research, a set of urban planners, epidemiologists, and public health experts from regional offices, local health services, universities, and environmental protection agencies identified the urban and health dimensions most suitable for embedding population health into city planning. The result was summarised in a preliminary working paper, which included a matrix of associations between urban features and health dimensions framed according to the DPSEEA framework. Its applicability was then tested in a participatory process (March-May 2024) involving urban planners and public health departments of 7 different sized municipalities. Results A group of epidemiologists identified local-level computable indicators for the health dimensions already included in the matrix or added at request. Each municipality focused on specific topics based on local priorities: 3 groups assessing their already-approved urban plans and looking for computable urban indicators; the others integrating their under-construction plans with local health indicators. Conclusions The need for professional contamination and cross-sectoral interventions is significant. Epidemiological support is pivotal in integrating different professional languages and reading health data. The outputs of this experience will contribute to a technical document outlining how to incorporate health promotion into urban planning tools and practice while actively considering the local context. Key messages • Although the development of a common vocabulary can be difficult, multidisciplinary collaboration is essential in promoting a model for integrating health promotion into urban planning. • Local municipalities’ involvement in the experimentation can improve the model’s applicability by taking into account territorial specificities.

Co-planning as a public health tool: the Milan Health Protection Agencies’s Local Gambling Plan

Abstract Issue/problem Gambling represents a public health, social, and economic problem. Lombardy Region, according with national and regional law, has approved the Regional Plan for the prevention and contrast of Pathological Gambling. The Health Protection Agencies (HPA) of the Metropolitan City of Milan, as the other HPAs, implemented the Local Gambling Plan, based on a context analysis and in synergy with all the actors involved. Description of the problem Since 2019, the Milan HPA’s Local Gambling Plan has been implemented through collaboration with non-profit entities (TSEs), which are involved via public tendering. The implementation of the new Italian ‘Code of the Third Sector’ changed the TSEs engagement modalities. For this reason, a complex co-planning process has been initiated in order to increase the level of active citizenship and to enhance public health, in line with horizontal subsidiarity principle. Results The Co-planning procedure promoted the integration among local health services, non-profit entities and municipalities with the aim of gambling prevention and contrast, ensuring the continuity of prevention programs and the involvement of local stakeholders in addressing a public health issue. During the co-planning, 9 working groups were established to define objectives, project actions, monitoring and evaluation methods, ensuring the common interest of all actors involved. Lessons For the health and social system, the co-planning procedure becomes an opportunity to translate what is foreseen by the regulations into local actions. It allow the active participation of local stakeholders involved into the co-construction and achievement of public health objectives and the promotion of communities’ empowerment. Key messages • Co-planning is both a process and a tool for local welfare. • Co-planning involved multiple actors, among which the public institution that ensures satisfaction of health needs through governance actions.

Assaults against pandemic heroes: an observational study in the Metropolitan City of Genoa in Italy

Abstract Background Escalating violence against healthcare workers is a significant public health issue that undermines care quality and workers’ health. This descriptive study aims to examine trends in aggression across different pandemic phases. Methods The study analysed reported violence among healthcare workers from 2018 to 2023 within a Local Health Authority in Genoa, Italy. Variables of interest included the severity of aggression, the professionals affected, and the locations of incidents. Data was analysed using appropriate statistical methods, including multinomial logistic regression, to assess relationships across pandemic phases. Results Reported aggressions rose from 48 incidents in 2018 to 103 in 2023, totaling 463. Pre-pandemic physical violence was at 39%, dropping to 27% during and after the pandemic (χ²=7.4, df = 2, p < 0.025). Nurses experienced the highest violence rates, with an average of 72% pre-pandemic and 74% post-pandemic, reducing to 51% during the pandemic if compared with doctors (Coef -0.80; 95%CI -1.45|-0.15). Over half of incidents occurred in Emergency and Psychiatric Services, from 77% before to 51% after pandemic. Conversely, violence in Local Services rose from 7% before to 24% during and 28% after pandemic (χ²=56.9, df = 6, p < 0.000). If compared to Hospitals, violence in Local Services increased during (Coef 1.44; 95%CI 0.40|2.48) and post-pandemic (Coef 1.001; 95%CI 0.13|1.87), and in Psychiatric Services decreased post-pandemic (Coef -0.98; 95%CI -1.67|-0.29). Conclusions Violence against healthcare workers shifted during and post-pandemic, mirroring the decentralisation of healthcare due to pandemic. The urgent development and implementation of effective violence prevention strategies are imperative. These should include training, psychological support, security enhancements, and a strong organisational culture that prioritises safety and respect. Protecting healthcare workers is crucial for their well-being and to ensure high healthcare quality. Key messages • Escalating violence undermines care quality and healthcare worker well-being. Effective prevention strategies are essential, including training, support, and an organisation that prioritises safety. • Nurses are the main victims of violence. Violence is higher in Emergency Departments, but incidents are increasing in Local Health Services, due to organisational changes during and post-pandemic.

Developing a set of core items for assessing preparedness in Italy: a Delphi approach

Abstract Background Effective pandemic management relies on preparedness and several tools are available for evaluation. However, due to differences in regional healthcare organization and structures, these may not accurately evaluate Italy’s capacities. This study, part of a project funded by the Italian Ministry of Health, report on the development of an assessment tool capable of evaluating the preparedness to confront pandemics at the regional level based on the actions outlined by the Italian influenza pandemic plan. Methods A desk research was carried out for preparedness evaluation tools, consulting Public Health Agencies, and Google Scholar and Search. Tools evaluation items were extracted, associated with the Italian plan, and screened for relevance and data availability. Selected items were then subjected to a two-round Delphi procedure involving 18 stakeholders from academia, local health services, and national agencies. The agreement was assessed using a 10-point Likert scale, and defined as a mean score ≥8, and consensus as a score standard deviation (SD) ≤1.5. Items with mean score ≥ 8 and SD > 1.5 after the first round were sent to the second round. Results A total of 6 tools were included in the study, from which 303 evaluation items matched the actions of the plan. After the screening phase, 122 indicators were deemed relevant and potentially available and sent to the Delphi procedure. Eighteen (14.8%) items reached both agreement and consensus in the first round, while another fifteen (12.3%) after the second. The 33 items covered all the domains of the national plan, especially Research and Development (21.1%) and Clinical Governance (15.2%). Conclusions The development of a set of core items that are agile, relevant, and readily available was facilitated by the involvement of stakeholders from different sectors. Moreover, adherence to the Italian pandemic plan should ensure that these items are deeply integrated into the unique context of the Italian regions. Key messages • The Delphi process identified a narrow number of evaluation items with great consensus. • Consensus was searched involving stakeholders from central authorities, local units, and academia.

The New Healthcare: AI-Driven Population Stratification, Proactive Medicine, and Predictive Analysis

Abstract Background The Covid-19 pandemic has highlighted structural and functional weakness of local health services. Italy carried out its reorganization with DM 77/2022, financed by Mission 6 PNRR of the CE. The model adopted aims to move from a reactive to proactive medicine, to be implemented close to the places where citizens live. The priority objective is to know data on the progress of chronic pathologies and non self-sufficiency using advanced digitalization tools. Methods 14 types of administrative data from 2022 to 2023, concerning 180000 (ISTAT data) people in the Lecce Social Health District (DSS Lecce), were analyzed with AI (Chat GPT). Results Thanks to algorithms, 6 categories of clinical complexity were identified. The analysis showed that the population assisted is 198696, for temporary presences, with the most represented age group being 50-55 years. Births decreased by 36% in 10 years (from 1681 to 1076), with 2197 deaths in 2023. 42,38% of the population (average age 38,58 years) did not use healthcare resources, while 57,62% (average age 54,19 years) required them. 48646 patients have cardiovascular disease, but only 10% with heart failure were actively monitored. 25047 have metabolic disease, 11195 are diabetics, 5929 have chronic respiratory diseases, 8167 chronic neurological diseases and 907 are cancer patients. Increasing age leads to polymorbidity and show signs of social, economic and health fragility. Conclusions the strategic objective of the Lecce DSS was management of chronicity according to specific care pathways, PDTA. Create healthcare teams capable of being case managers depending on the level of complexity (family doctors, nurses, etc). With the 2024 data there will be 3 consecutive years of analysis which will allow the development of predictive systems to identify population clusters at risk of increasing complexity and in need of proactive medical interventions, use of telemedicine with the support of a Territorial Operations Center. Key messages • AI-driven stratification supports personalized health plans to improve healthcare delivery, patient outcomes, and optimize resource allocation. • A new model of Population Health Management supported by Artificial Intelligence.

Mental health and resilience in young people on Saint Helena Island.

This study explored the mental health needs and strengths of young people (aged 11-18 years) living on the remote island of Saint Helena (SH). 24 young people and their carers completed standardised inventories assessing mental health and resilience, of whom 15 of the young people and their carers participated in semi-structured interviews enquiring into mental health awareness, contributing factors to young people's mental health and resilience, as well as experience with local mental health services. Descriptive data were reported based on the quantitative measures and thematic analysis was applied to the interview transcripts. A number of young people were found to meet criteria for mental health problems while they showed high levels of resilience. The themes derived from young people's interviews were broadly centred around mental health boosters, including personal successes, social interactions, engagement in pleasurable activities and use of anxiety management strategies; and around limitations of living in SH in terms of limited resources and difficulty in maintaining trust in the community. From the carers, the themes revolved around awareness of mental health needs and strengths in young people, perceived barriers to access support mainly due to apprehensions around stigma and anonymity. Recommendations for improvement of mental health provision are made.

Growing the peer workforce in rural mental health and social and emotional well-being services: A scoping review of the literature.

Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings. Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature. A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search. A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'. While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services. The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

Providing accessible health information for people with disability in a public health crisis: A qualitative study of the experiences of Australian accessible information provider organizations during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, people with disability had a right and an acute need to access accessible COVID-19 information, in formats such as sign language, Braille, large print and Easy Read/English. Yet such information was not always provided and many people with disability were without sufficient accessible information. ObjectiveThis paper explores the experiences of Australian accessible information provider organizations of producing accessible information during the pandemic. The intent is to understand why insufficient accessible information reached people with disability. MethodsIn-depth interviews were conducted with 17 accessible information provider organizations and one other stakeholder in Australia, and thematically analyzed. ResultsThe findings show that accessible information provider organizations felt an immense depth and breadth of responsibility for providing accessible information to people with disability during the pandemic. However, they were hampered by constantly changing information; workforce challenges; and a lack of financial, logistic and partnership assistance. Other notable difficulties included having no source of clear/accurate information to translate to accessible formats and not having medical/health expertise themselves. ConclusionThe findings have implications for better preparation for accessible information access in future public health crises. There should be greater funding and logistic support for accessible information provider organizations. Provision of clear/accurate information and subject matter checks of accessible products would be helpful. Responsibility for this should be scoped into existing outreach, education and communications roles – for example, in local health services, general practice clinics and government health departments.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study.

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

Cycling and Pedestrian Injuries in the Region of Peel, Ontario; An application of linked administrative health data to enhance local road safety and health service delivery, through an Applied Health Research Question (AHRQ)

ObjectivesAn Applied Health Research Question request from Peel Public Health was investigated, to provide a comprehensive overview of injury patterns and healthcare utilization, among cyclists and pedestrians in the Peel Region of Ontario. ApproachEmergency department visits and hospitalizations across the Peel region were analyzed from 2018 to 2022, and categorized by collision type (pedestrian, cyclist motor vehicle collision (MVC), and cyclist non-MVC). Data was segmented quarterly and annually, and further stratified by residence status, sex, and age, by linking individuals to other administrative health databases. Additionally, 30-day mortality outcomes were evaluated. To contextualize incidence rates with population demographics, Public Health Data Zone and Census Subdivision data were also utilized. ResultsFor ambulatory visits, a substantial majority of Peel residents received treatment within the region, evidenced by 4,483 cyclist visits (55%) and 1,338 pedestrian visits (50%). However, a noteworthy portion of Peel residents — 188 cyclists (45%) and 182 pedestrians (46%) — received treatment outside the region. Hospitalization patterns echoed these visits. Overall, non-MVCs accounted for a large proportion of cycling incidents, particularly among females, stressing the need for targeted safety measures. Still, survival rates post-incident were notable, with a 100% survival rate for cyclists after ambulatory visits. Pedestrian survival rates were similarly high. ConclusionThis study provided valuable insights into patterns of pedestrian and cyclist injuries among Peel residents, revealing considerable cross-regional healthcare utilization. ImplicationsFindings will be utilized by the Region of Peel and partner organizations, to enhance local road safety initiatives and service delivery for vulnerable road users.

The microbial etiology and resistance patterns of cosmetic tourism-related infections in Ireland.

Cosmetic tourism is an increasingly common phenomenon, both in Ireland and internationally. Complications associated with procedures performed abroad may manifest after the patient has traveled back to their home country with patients often presenting to local health services. Such complications can be infectious in nature requiring either antimicrobial therapy and/or source control in the form of wound debridement or radiologically guided interventional procedures. Patients who had presented to a regional plastic surgery unit between September 2021 and December 2022 with complications related to aesthetic procedures performed outside Ireland were identified in this retrospective-prospective design. Medical records were reviewed to ascertain what procedures were performed, where the procedure had taken place, the nature of complications, and microbial culture and sensitivity results. Thirty patients were identified during the study timeframe, predominantly female (n = 28) with a mean age of 40.27years (SD 10.6). Abdominoplasty was the most common procedure (n = 17), and Turkey was the most frequently cited destination (70%). Wound dehiscence accounted for the majority of complications (n = 18). Wound cultures were obtained in 80% (n = 24) of patients and a causative organism was isolated in 85% (n = 34) of cultures. Eighteen species of bacteria were identified and antimicrobial sensitivities were obtained for 16 of these. Antimicrobial resistance to commonly prescribed empiric antibiotics was noted in several isolates. Post-operative infections related to cosmetic tourism are a growing concern in plastic surgery. The bacterial etiology is varied, and antimicrobial resistance poses significant challenges, highlighting the need for early intervention and wound cultures to guide effective management.

The right care in the right place: a scoping review of digital health education and training for rural healthcare workers

BackgroundDigital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training.ObjectiveTo conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce.Inclusion criteriaSources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas.MethodsWe searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used.ResultsFive articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels.ConclusionsUpskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations.Review registration numberOpen Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX.

S14-1: EUPAP Feasibility Study. Practice transfer of a HEPA prescription model to other nine EU countries. From theory to practice

Abstract Purpose The Swedish Physical Activity on Prescription (PAP-S) method was to be transferred to other European regions through the EUPAP Project, innovative for implementing a reliable method to other nine countries. Implementation practices are strongly context-dependent; therefore, the practice transfer requires a flexible approach. PAP-S results over 20 years have reported success to a variety of populations. It addresses physically inactive individuals and/or with chronic conditions to improve their health by increasing their physical activity (PA) levels. The PAP-S five core components are: individualised patient-centred counselling, evidence-based PA recommendation, written prescription, community support, and follow-up. The goal was to know the context regarding PA prescription and ease the transfer from the Swedish context, specifically to: a) setting relevant PAP-S indicators for planning and monitoring, b) creating guidelines for data collection, c) providing an overview of the situation in each region, and d) assessing for readiness to implement the model. Project description Modified Hybrid e-Delphi process by representative from 10 countries. First, commitment from organisations to assume costs for the implementation. Second, description of variables and procedures for data collection. Data comprised two dimensions (ie, macro level (early diagnosis) and micro level (preparedness for implementation)). Third, data collection. Fourth, data analysis and discussion. Thirty-five experts participated in the EUPAP Feasibility Study. Guidelines for data collection includes indicators on macro level: a) EUPAP-relevant policy documents, b) profiles of prescribers and allied professionals, c) programmes, materials and training on HEPA, d) regulations, e) budget; and micro level: a) stakeholders, b) settings, c) agents, d) end-users. Country-specific results were collected, compared and discussed in relation to the core components of PAP-S (findings are accessible on www.eupap.org). Project partners disseminated the results among region-specific stakeholders. Conclusions Data showed regions with solid background to launch the EUPAP implementation (Flanders, Catalonia, Portugal) and others with less existing materials or weak network (Malta, Romania, Germany). Policy-makers, local health services and communities may better set short- mid- and long-term goals for the PAP-S transfer. Further design on practices and policies may use the Feasibility Study Guidelines for setting specific procedures. Funding Co-funded by the European Union’s Health Programme (2014-2020).

Partnership to Increase Care Access Through Mobile Outreach to Migrant Farm Communities: A Feasibility Study

Abstract: Background: Health care access for migrant farmworkers is limited given the nature of seasonal farm work, including migration patterns, capacity, and availability of local community health services. Consideration of these contextual elements when exploring a community–academic partnership to increase access to care for migrant farmworkers is essential. Objective: Explore the partnerships and processes for integrating nursing faculty and students from a regional public university’s school of nursing into a farmworker health outreach program’s mobile clinic process. Methods: A feasibility study was undertaken using Bowen et al.’s feasibility framework. Results: Integrating faculty and students into the farmworker health outreach program’s mobile clinic process was determined to be feasible. Conclusions: Integrating faculty providers and students into a farmworker outreach program’s mobile health process has several nuances requiring consideration before operationalizing the partnership, including nursing faculty practice (e.g., credentialing, malpractice insurance), student clinical placement processes, the farmworker outreach program’s processes, and farmworker availability.

Applying a Participatory Action Research Approach to Engage an Australian Culturally and Linguistically Diverse Community around Human Papillomavirus Vaccination: Lessons Learned.

Globally, migrant and culturally and linguistically diverse (CALD) communities are known to have inequitable access to HPV vaccination. One participatory research approach used to engage CALD communities around vaccination is participatory action research (PAR), but we know little about the use of PAR to engage priority migrant and CALD communities around school and HPV vaccination. To address this gap, we partnered with our local Multicultural Health Service to understand how the largest CALD group in our region of New South Wales, Australia, engages with their local school and HPV vaccination program. Through a long-standing PAR relationship, we used a participatory research method (World Café) approach to explore the level of awareness and engagement a multi-generational community member had concerning HPV vaccination. We acted by sharing a co-designed information website to answer the community's questions about HPV vaccination. We then evaluated these engagements with surveys, focus groups and online analytic platforms. Last, we reflected with project partners and health service stakeholders on the overall project outcomes and shared our learnings. In our discussion, we shared our lessons learned and contributed to a wider conversation about the benefits, challenges, and practicalities of using PAR to engage a priority CALD community around HPV vaccination.

Riesgo climático en los servicios de Salud Local en Ecuador

This work analyzes the interaction between climate risk, caused by extreme events resulting from the El Niño-Southern Oscillation (ENSO) phenomenon and/or Climate Change, and its impact on local health services in Ecuador. The analysis focuses on Ecuador’s growing vulnerability to the effects of climate change, which exacerbates challenges in the delivery of health services, particularly in the context of severe climate events. The main objective is to analyze the relationship between the number of hectares affected by climate events and the availability and effectiveness of local health services, considering community resilience and health coverage as moderating variables. The methodology uses a linear regression analysis using data from 221 Ecuadorian municipalities, covering variables such as climate risk, health services, community resilience, health coverage, and demographic and socioeconomic factors. The results indicate a significant influence of climate risk on the effectiveness of health services, moderated by community resilience and health coverage. It is observed that areas with greater preparation and health coverage show a better capacity to respond to extreme weather events. Finally, it is important to integrate climate risk management into health services planning, suggesting that greater community resilience and broad health coverage are essential to mitigate the negative impacts of climate change on public health.

Analysis of amputations occurring in the earthquakes centered in Kahramanmaraş: Adıyaman experience.

Amputations are a common surgical procedure resulting from trauma during earthquakes, leading to severe disability. This study aims to investigate surgical outcomes specific to amputations that occurred in Adıyaman after the Kahramanmaraş earthquakes. This descriptive study included amputees who presented to Adıyaman University Training and Research Hospital. Between March 6, 2024 and March 29, 2024, amputees were contacted by phone and asked the questions in the form. Data analyzed included demographic information, number and level of amputated extremities, phantom limb pain, stump infection, extrication time, time to initiation of rehabilitation, number of revision, and whether a prosthesis was fitted. The study reached 75 amputees. The mean age was 37.9 ± 19.2, and the most frequently amputated age group was adults. Stump infection was observed in 40 amputees (53.3%), phantom limb pain in 47 (62.6%),and revision in 29 (38.7%). The median extrication time was 36h and initiation of rehabilitation time was 45 days. It was noted that 35 amputees (62.5%) used prostheses. A statistically significant relationship was found between fasciotomy and stump infection (p = .000). Infection was detected in 65% of those who underwent fasciotomy. Earthquake-related amputations most frequently affected the adult age group and primarily involved lower extremity amputations, such as transfemoral and transtibial amputations. Phantom limb pain, need for revision, and infection are common in earthquake-induced amputations. Delayed fasciotomy increases the risk of stump infection. The data obtained in this study will help plan local health services to coordinate amputation care in disasters.