bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Local interventions within JADECARE – Key learnings from two Next Adopters
Authors: Papa R , Dolecek Z
Published: October 2022

In this third presentation, the NA representatives Roberta Papa (Regional Health Agency Marche Region, Italy) and Zdislav Dolecek (University Hospital Olomouc, Czech Republic), will present the Local interventions and action plans they developed during the pre-implementation phase, pre-final results of their implementation phase and preliminary lessons learned from the implementation.
The school environment-related predictors of fights and bullying among School-Age Children in Serbia
Authors: Šantrić Milićević M , Stankovic S , Nikolić D , Bjelica N , Babić U , Rakić Lj , Todorović J , Terzić-Šupić Z
Published: October 2022

Background

The health and development of school-age children is a contemporary topic of various health policies and programs, which has become even more of a focus in critical situations such as the COVID-19 pandemic. The study aims to assess the prevalence of school-age children's participation in fights and bullying in Serbia, and to examine the relevance of students’ socio-demographic characteristics and perceptions of school and relations with other students and professors for participation in fights and bullying.

Methods

A secondary analysis of the original data of the 2017 HBSC study is performed on 3267 students in a nationally representative sample of primary and high schools in Serbia. Predictors of taking part in fights and taking part in bullying were examined by using univariate and multivariate logistic regression.

Results

The main results show that 50.8% of boys and 17.1% of girls have taken part in fights, while 17.7% boys and 10.4% of girls have taken part in bullying. Students who felt a large and very large burden of school obligations were 1.43 times more likely to participate in bullying at least once, while they were 1.38 and 2.12 times more likely to participate in multiple fights and 4.04, 1.24, and 2.78 times more likely to participate multiple times in bullying. Fights among school-age children are significantly positively associated with living with relatives/legal guardians and poor quality of life.

Conclusions

The prevalence of participating in at least one fight/bullying is higher than in multiple fights/bullying. These associations suggest a necessity to enhance the monitoring and control of peer behavior among school-age children. The findings of the study imply key enablers of protection, such as building relationships based on team spirit and work, friendly behavior, empathy, and help, which should be included in the value system of school and family activities in programs to combat fights and bullying in school-age children.

Key messages

• In Serbia, every second boy and every fifth girl participated in fights, while less than every fifth boy and every tenth girl participated in bullying.

• Study results can inform school and healthcare actors’ efforts to improve school-age children’s development and health capacity for life.
Implementation of resilience training programmes in children and adolescents: value and barriers
Authors: Pacillo C , Malorni W , Moscato U , Sisti LG
Published: October 2022

Background

Emotional distress increasingly represents a major burden in children and adolescents (C&A), especially in conflict zones where its prevalence is estimated to reach 70%. Resilience training programmes (RTPs) are interventions that seek to enhance resilience in individuals or groups pursuing mental distress prevention. Literature suggests RTPs be particularly effective in C&A; however, their effectiveness and value for public health are still unclear.

Methods

A scoping review was performed in order to summarize evidence regarding the implementation and effectiveness of RTPs in children and adolescents. A search string has been built according to the PICO model and launched on PubMed, PsycInfo, Academia databases. Additional references were identified by a hand-search in Google Scholar. Studies included were narratively summarized according to topics that emerged.

Results

18 articles were finally included in the review. Main issues were 1) RTPs seem to be more effective in adolescents rather than in children; 2) COVID-19 pandemic has raised the attention towards RTPs in C&A; 3) beyond conflict zones their implementation is increasingly recognized in supporting C&A management of daily stressors and traumas also in C&A with disabilities; 4) school is identified as the key setting for RTPs; 5) the high heterogeneity in RTPs approaches, contexts and study samples limits a conclusive effectiveness assessment.

Conclusions

Our findings highlighted how RTPs are increasingly recognized as a tool to improve C&A cognitive and behavioral functioning and resilience to external stressors, getting greater interest in the COVID-19 pandemic. Despite relevant theoretical support and promising study results, RTPs still lack strong evidence supporting their embracement by policymakers and effective implementation in public health policy. In order to not miss this chance, more efforts are needed in strengthening RTPs conceptualization and cost-effectiveness studies.

Key messages

• RTPs are a promising tool to enhance the resilience of children and adolescents gaining increasing interest due to the COVID-19 pandemic.

• More studies are needed to provide a strong evidence base that supports their acknowledgment by policymakers and their implementation in public health policies.
8.O. Workshop: New challenges for suicide prevention in the context of Covid-19
Authors:   Organised by: EUPHA-PMH,   Chair persons: Johan Bilsen (EUPHA-PMH), Jutta Lindert (EUPHA-PMH)
Published: October 2022

The recent COVID-19 pandemic confronted many societies with profound public health challenges. Although primarily a ‘somatic’ health concern, it becomes clear that Covid-19 and its aftermath also proved to have a substantial impact on mental health and wellbeing of the population in general and on vulnerable subgroups, such as young people and the elderly, in particular. An important public mental health concern in this context is the possible adverse influence of this pandemic on suicidality. Recent studies show that during the outbreak of the coronavirus disease the suicide mortality did not rise, rather on the contrary. However, the impact of the increased number of people with mental distress related to Covid-19 on suicidal ideation as well as the long-term impact on suicide rates is unclear. Also the long-term impact of the Covid-19 restriction measures greatly hindering adequate mental healthcare services and suicide prevention initiatives is uncertain. This workshop will focus on suicidality trends since the pandemic onset in different countries, suicide figures, experiences in the field of suicide prevention and on attitudes towards seeking help. Ann John from UK will talk about suicide trends during Covid-19 pandemic and will present suicide data of 35 countries collected by the international Covid-19 Suicide Prevention Research Collaboration. Fabrice Jollant will present data about the impact of Covid-19 pandemic on suicide attempts in France, and will discuss in this context the new national suicide prevention strategy. John Cachia will show the importance of a broad mental public health approach to suicide prevention in Malta. And finally, Saska Roskar from Slovenia will show how prevention of suicidality in individuals working themselves in the field of mental health can be hindered by self-stigma.

Key messages

• We must remain vigilant about the possible long-term mental health impact (including suicidal behavior) of the Covid-19 pandemic.

• Pandemics like Covid-19 highlight certain weaknesses in suicide prevention strategies.
Public health and social measures during health emergencies such as the COVID-19 pandemic: an initial logic model to conceptualise and classify measures
Authors: Rehfuess E , Burns J , Ludolph R , Movsisyan A , Pfadenhauer L , Strahwald B
Published: October 2022

Issue/problem

In the context of the COVID-19 pandemic, public health and social measures (PHSM) are being implemented worldwide, but in very different ways. This is also due to a lacking common understanding of PHSM so far. As a result, there are limited insights regarding their components, implementation and effectiveness as well as impacts beyond health of PHSM.

Description of the problem

The project contributes to the WHO PHSM initiative. A logic model is being developed that offers a shared language and understanding of how PHSM are intended to achieve transmission-related outcomes, but also that non-intended consequences need to be considered. The overall approach is informed by a system-based logic model template and a staged approach to logic modeling. The development process is making use of (i) existing COVID PHSM taxonomies and related literature, (ii) existing theoretical frameworks related to complex interventions in complex systems, (iii) consultations with WHO staff and the according PHSM steering group, and (v) iterative brainstorming within the working group.

Results

The initial logic model is rooted in a complexity perspective which recognises that (i) all measures have both intended and unintended consequences for health and society and (ii) all elements within the logic model are interconnected and interact with each other. All PHSM operate through two basic mechanisms: reducing contacts and making contacts safer. Taken together, these two mechanisms work to reduce transmission-relevant contacts. Any specific PHSM is defined by a combination of the measure itself, the population and/or setting targeted and the mode of enactment. The central hub of the logic model connects and integrates all elements. The initial logic model was applied to school and travel measures as examples.

Main messages

The PHSM logic model is a conceptual basis to facilitate research on PHSM, monitoring and evaluation of PHSM, and evidence-informed decision-making.
Implementing public health and social measures: an integral part of the health emergency management cycle
Authors: Addo J , Cocciolone D , Gapp C , Latta A , Lindmark S , Owen L , Sane J , Perehinets I , Schmidt T , Wippel C
Published: October 2022

Public health and social measures (PHSM) have been utilized as a tool to reduce the infection rates and disease burden throughout the COVID-19 pandemic and continue to play an important role even with vaccination campaigns well underway in preventing severe disease. In order to systematically track, analyze and report qualitative and quantitative data o PHSM implementation across the European Region and assist countries in the COVID-19 response, the COVID-19 Incident Management Support team at the WHO Regional Office for Europe developed PHSM Severity Index and PHSM Dashboard. The PHSM Severity Index captures the types, severity and timing of PHSMs implemented by a country across six main indicators. By providing standardized data on PHSM implementation, the PHSM Severity Index can support and inform the development of policy at country and regional levels. PHSM data, severity methodology and policy tools developed throughout the COVID-19 pandemic should be adapted to provide a foundation for preparedness for future large-scale health emergencies. In addition, discerning the epidemiological impact of specific PHSM and their combinations currently is a priority for policy-makers and can guide countries’ transition strategies. Analysing the impact of PHSM on COVID-19 transmission is of critical importance, especially as variants of concern bring new waves of COVID-19 cases and may challenge countries’ vaccination and response strategies. Reference PHSM in Response to COVID-19 (who.int)
COVID-19 incidence on Emergency Departments accesses. Health need and fear of infection, what wins?
Authors: Quercioli C , Bosco R , Bova G , Mandò M , Dei S , Gusinu R , Messina G
Published: October 2022

Introduction

The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law.

Aim

To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January - 31 December 2020.

Material and methods

The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code.

Results

A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p < 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p < 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154).

Conclusions

ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious.

Key messages

• The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department.

• The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.
Characterizing post-covid conditions in a Turkish cohort: A prospective study
Authors: Emecen AN , Turunc O , Sivye N , Suner AF , Basoglu Sensoy E , Keskin S , Unal B
Published: October 2022

Background

Investigating the people who suffer from post-COVID health conditions is necessary to accommodate the demand for accessing healthcare. This study aims to describe post-COVID health conditions within six months after diagnosis.

Methods

This study was conducted at Dokuz Eylul University Hospital, a tertiary care hospital in Ä°zmir-Turkey. Participants aged ≥18 years who were diagnosed as SARS-CoV-2 RNA positive in the hospital from November 1st, 2020 to May 31st were interviewed by phone at one, three and six months after diagnosis. Symptom frequencies were stratified by demographic and clinical characteristics. The dependent variable was having post-COVID condition according to World Health Organization's definition. We estimated logistic regression models to identify associated factors for post-COVID condition in the patients who had symptoms at baseline.

Results

A total of 5083 people completed the third month's interview. The prevalence of post-COVID condition was 21.8% (n = 1108). Tiredness/fatigue (10.2%), muscle or body aches (7.3%) and dyspnea/difficulty breathing (4.8%) were the most common symptoms. Older age (65-74 aged groups versus 18-24 aged group, odds ratio-OR:1.57, 95% confidence interval: 1.10-2.25), female gender (OR: 1.97, 1.71-2.28), bad economic status (OR: 1.44, 1.13-1.84), having more health conditions (≥3 conditions, OR: 1.82, 1.28-2.55), having more symptoms (>5 symptoms, OR: 2.59, 2.20-3.07) and hospitalization (intensive care unit, OR: 1.98, 1.13-3.37) were found to be associated with reporting of post-COVID condition.

Conclusions

This study identifies the prevalence and risk factors for post-COVID conditions in a large cohort of patients. The results of the study would guide the healthcare organizations in the planning of post-COVID management strategies.

Key messages

• The prevalence of post-COVID conditions was 21.8%. Older age, female gender, having more health conditions, disease severity in the acute phase and bad economic status were risk factors.

• Clinical management strategies and country-specific healthcare planning should be devised for the post-COVID condition burden.
WICID 2.0: Integrating evidence and ethics in decisionmaking and guideline development on SARS-CoV-2
Authors: Arnold L , Bimczok S , Lehner J , Stratil J
Published: October 2022

Evidence-informed decision-making (EIDM) requires the balancing of numerous and often conflicting factors. During the SARS-CoV-2 pandemic, sound and fair EIDM procedures were challenged by time constraints and limited evidence. Beneficial effects had to be weight against public health impacts beyond COVID-19, broad societal consequences, or individual liberties. Evidence-to-decision (EtD) frameworks are neither able nor intended to replace stakeholder participation, but can serve as a tool to ensure the relevance and completeness of criteria to be considered for EIDM in public health and guideline development. Employing ‘best-fit’ framework synthesis, we used the WHO-INTEGRATE framework as a starting point to develop the WHO-INTEGRATE COVID-19 framework version 1.0. WICID 1.0 is based on a content analysis of comprehensive strategy documents to guide policy makers in implementing new or decrease existing measures to protect against COVID-19 in Germany. WICID 1.0 was validated by coding the framework against an updated set of the key strategy documents, and key strategy documents addressing non-pharmacological measures in long-term care facilities. In total, 12 key strategy documents were analysed to develop WICID 1.0, and 18 + 23 documents were analyzed for its refinement towards WICID 2.0. The revised framework consists of 11 + 1 criteria and includes implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. Validation found high consistency with minor revisions between WICID 1.0 and 2.0. WICID can be a tool to support researchers, practitioners, and policy makers to systematically integrate evidence and ethics and to balance of health, societal and other considerations when reflecting on PH interventions targeting COVID-19.

Key messages

• Due to the rapidly developing pandemic, decision-making process often did not include the views of all affected stakeholders and did not adequately include all criteria and considerations of relevance.

• The WICID Framework can serve as a tool to support decision-makers in accounting for relevant considerations and criteria, even when not all stakeholders could be included.
The Southern European Atlantic Diet and depression incidence: a multicohort study
Authors: Carballo-Casla A , Stefler D , Ortolá R , Chen Y , Kubinova R , Pajak A , Malyutina S , Rodríguez-Artalejo F , Brunner EJ , Bobak M
Published: October 2022

Background

The Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and North-Western Spain, but it may resemble that of other European countries. Higher adherence to SEAD has been associated with lower risk for myocardial infarction and all-cause mortality, but its relationship with mental health is uncertain. We examined the association between SEAD and depression incidence in Southern, Central, and Eastern Europe.

Methods

We used data from participants ≥45 years from the Seniors-ENRICA-2 and HAPIEE cohorts, who were followed for a median time of 3.6 years. SEAD comprised fresh fish, cod, red meat and pork products, dairy, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine. Depressive symptoms were assessed with the GDS 10 and the CES-D 10 (participants with scores ≥4 were considered depression cases). Statistical analyses were performed among the 14675 participants who were depression-free at baseline.

Results

Higher adherence to SEAD was preliminarily associated with lower depression incidence in the pooled sample (fully adjusted odds ratio [95% confidence interval] per 1-SD increment in the SEAD = 0.93 [0.89,0.98]). Results were consistent in Spain (odds ratio [95% confidence interval] 0.86 [0.68,1.08]), Czechia (0.92 [0.82,1.04]), Poland (0.94 [0.88,1.01]), and Russia (0.93 [0.87,1.00]). The association of SEAD with depression in the pooled sample was similar to that found for the Alternate Healthy Eating Index (odds ratio [95% confidence interval] per 1-SD increment = 0.94 [0.89,0.99]) and the Mediterranean Dietary Score (0.94 [0.90,0.98]).

Conclusions

Adherence to SEAD was preliminarily associated with lower depression incidence in Spain, Czechia, Poland, and Russia. These findings may support the development of mental health guidelines for Southern European Atlantic populations based on their traditional diet, and for Central and Eastern European countries based on the food components of SEAD.

Key messages

• Adherence to the Southern European Atlantic Diet (traditional diet of Northern Portugal and North-Western Spain) was associated with lower depression incidence in Spain, Czechia, Poland, and Russia.

• Mental health guidelines for Southern European Atlantic populations may reference their traditional diet, while those for Central and Eastern Europe could benefit from including its food components.
Healthcare use among cancer survivors during the COVID-19 pandemic
Authors: Pimentel AS , Costa AR
Published: October 2022

Background

The COVID-19 pandemic and the restrictive measures applied to prevent and control this disease have led to a substantial shift in healthcare systems, with a redefinition of priorities and essential care, causing a serious impact in the oncological care. Therefore, we aimed to estimate the association of a previous cancer diagnosis on healthcare use during the COVID-19 pandemic among European and Israelis cancer survivors (CS).

Methods

This cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. All CS (n = 6,490) were country-, sex-, age- and education-matched (1:2) to non-cancer individuals (NC). Odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.

Results

Overall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI:1.19-1.41), than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI:1.39-2.30). Likewise, CS reported the occurrence of postponements more often (OR = 1.54, 95%CI:1.44-1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI:1.63-2.36), who reported higher economic difficulties (OR = 1.73, 95%CI:1.50-2.00) and those with no multimorbidity (OR = 1.85, 95%CI:1.62-2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI:1.26-1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI:1.47-5.01).

Conclusions

CS were more likely to forgo medical treatment and to report healthcare postponements and to be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.

Key messages

• During the COVID-19 pandemic, a previous cancer diagnosis was associated with a more frequent report of appointment cancellations, postponements or denials.

• The first months of the COVID-19 pandemic led to changes in healthcare provided to cancer survivors, which may have a deleterious impact in their care and prognosis.
Policies out of sync – are healthy ageing agendas fit for the future?
Authors: Mavrodaris A , Lafortune L , Brayne C
Published: October 2022

Background

In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems. This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and resilient communities, and ensure sustainable consumption. The overarching connections between global ageing and sustainability are clear: a focus on sustainable healthy ageing is fundamental to a healthy planet. Our responses to date have however largely been disconnected. To progress this dual agenda, our work aims to i) assess whether current national/international strategies addressing healthy ageing include a strategic focus on sustainability; ii) present the evidence for such alignments; and iii) develop a framework of sustainable actions and aligned policy.

Methods

A mixed-methods approach using content and applied thematic analysis was utilised to examine strategy documents, and develop an analytical framework derived from relevant theory to guide quantitative and qualitative analysis of the resultant data. Evidence themes were developed iteratively during analytical phases. Findings informed the development of the framework.

Results

We identified and analysed 36 strategies published from 2000 to 2021 containing over 600 wide-ranging policies. No strategies and only a minority of policies included a strategic sustainability focus. A larger subset made reference to links between ageing and sustainability or environmental elements yet these were largely theoretical and not carried through in the key strategic approaches or resulting polices.

Conclusions

This work provides valuable insights into strategic approaches to foster sustainable healthy ageing and identifies levers for greater alignment and sustainable action. The recently declared 2021-30 UN Decade of Healthy Ageing provides an ideal platform for action.

Key messages

• While the evidence for strong alignment is unequivocal, global healthy ageing and sustainability agendas are largely disconnected.

• By strengthening the links between healthy ageing and sustainability agendas, stakeholders across sectors can reinforce and design approaches that meet human needs while protecting our planet.
Identifying cross-sectoral cooperation for urban health
Authors: Matinheikki K , Liinamo A
Published: October 2022

Empirical evidence for collaborative health promotion practices is still limited. The Cross-Sectoral Cooperation Self-Assessment Tool (CroCo SA) presented here provides a tool for cities to assess their current commitment to promote urban health and well-being across sectors. The SA tool was validated by co-operating with 9 pilot cities and seven countries in the framework of the Healthy Boost project funded by Interreg Baltic Sea Region (2019-2022). Addressing the current complexity, interdependence and emerging challenges of health promotion requires cross-sectoral cooperation and tools to assess cross-sectoral processes and make their impact visible. A digitized CroCo SA tool was developed and validated. An SA evaluation matrix was created, including 162 cells of options for reflective and guiding responses according to 6 scale x 27 items used in the SA tool. After submission of the electronic form, respondents can view anonymized results in a digital form on the Healthy Boost platform. The feedback report summarizes the results for respondents and provides, both numerical and descriptive, verbal feedback on the state of the assessed city's capacity for cross-sectoral cooperation, based on each assessment. The steps the respondents could take in their respective cities to improve cross-sectoral cooperation are outlined. Recommendations are based on the evidence found to be the prerequisites for effective cross-sectoral work for health promotion. SA can be conducted in many languages offered by the Google translation programme. Guiding feedback of CroCo SA defines areas for improvement in strategies and actions, allowing respondents also to do benchmarking and learn from other cities and countries. Self-assessment itself is a learning process.

Key messages

• The CroCo SA tool offers a method for gathering information about the state of cross-sectoral cooperation for urban health promotion.

• By identifying strengths and weaknesses in cooperation, the city can build capacity for cross-sectoral cooperation.
Alternative routes to HiAP implementation
Authors: Bekker M
Published: October 2022

From a public health political science perspective there are alternative routes to HiAP. Besides the ‘classic’ HiAP approach seeking government internal departmental alignments, facilitating and rewarding bottom up social initiatives by communities, or marketed health innovations by commercial health-related consultancies and enterprises, and regional (socio-) economic innovation networks that after a developmental stage can start to pressure multi-level governments for action. A final route lies along the litigation path (Think of climate agreements and governments being held accountable by the judiciary to comply with agreed emissions reductions etc.)
Impact of sepses caused by three Multi-Drug Resistant bacteria in a tertiary hospital in 2018-2020
Authors: Garlasco J , Beqiraj I , Bolla C , Marino EMI , Zanelli C , Rocchetti A , Gianino MM
Published: October 2022

Background

Healthcare-associated infections represent a major health issue, particularly if caused by multi-drug resistant (MDR) microorganisms, with additional hospitalisation days and relevant costs besides illness and deaths. This study aimed at evaluating the economic impact of healthcare-related sepses caused by three MDR Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital.

Methods

An observational, retrospective-cohort analysis was based on data related to patients admitted to the “SS. Antonio e Biagio e Cesare Arrigo” Hospital in Alessandria (Italy) between 2018 and 2020. Starting from the microbiology laboratory database, the set of patients developing sepses from the examined species was selected, by also checking that the relevant antibiogram provided evidence of resistance to ≥ 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients’ medical records and from the hospital's computer-based application.

Results

In years 2018-2020, 174 patients developed septic infections from the examined species, the majority of which (88, i.e. 50.6%) in 2020 only. Altogether, these cases were responsible for 3,295 additional hospitalisation days (median 14 days, mean 19 days), with 901 imaging and 7,365 laboratory exams being reasonably ascribable to the septic episodes. Sepsis-related costs could be estimated in around 3 million Euros, about 85% of which (≈2.5 million Euros) were due to the actual cost of extra hospital stay. Specific antimicrobial therapy accounted for around 11.2% of the total (≈336,000 €).

Conclusions

The results of this study pointed out that MDR sepses were responsible for conspicuous costs, largely grounded on the extra length of hospital stays but also due to the use of highly-expensive new-generation antimicrobials. Further research is needed to explore costs of septic episodes in different contexts.

Key messages

• MDR sepses entailed high costs (around 3 million Euros in three years only in a single hospital), due to extra length of hospital stays and use of highly-expensive new-generation antimicrobials.

• In order to provide wider-scale estimates of the economic impact of sepses, further research is needed to explore costs of septic episodes in different sanitary systems and contexts.
Trends in mortality associated with surgical site infections: a cohort study in Italy, 2009-2019
Authors: Paladini G , Elhadidy HSMA , Cornio AR , Bordino V , Vicentini C , Zotti CM
Published: October 2022

Background

Surveillance programs have proven to be effective in reducing surgical site infection (SSI) rates. In 2008 Piedmont joined the Italian national surveillance system. The aim of this study was to evaluate mortality rates and trends associated with SSIs in Piedmont from 2009 to 2019 for the two most frequently performed surgical procedures, hip arthroplasty (HPRO) and colon surgery (COLO).

Methods

Data were collected through the national surveillance system, which includes 42 hospitals in Piedmont who participated in the surveillance program from 2009 to 2019. Procedure-specific SSI rates, overall mortality rates and case fatality rates (CFR) associated with SSIs were calculated, overall and per year. Trends were evaluated using the chi-squared test for trends. Analyses were performed using Epi Info v. 7.2.

Results

A total of 33438 surgical procedures (21645 HPRO, 11793 COLO) were monitored over the study period from the hospitals participating in the network. 1215 SSIs (293 HPRO, 922 COLO) were observed and 617 deaths were registered (222 HPRO, 395 COLO). For HPRO procedures, an overall SSI rate of 1.35% was found, with an overall mortality of 1.03% and a CFR of 3.75%. No significant trend was observed. Considering COLO interventions, an overall SSI rate of 7.82% was found, with an overall mortality of 3.35% and a CFR of 6.94%. There was a statistically significant downward trend in SSI and overall mortality rates (p = 0.046 and 0.005, respectively).

Conclusions

Considering HPRO, it is possible that the lack of significant trends could be due to the already low SSI and overall mortality rates, with the protective effect of surveillance having reached a plateau. Regarding COLO procedures, a significant reduction in SSI and overall mortality rates was observed during the study period. The reduction in mortality could be due to the decrease in SSI rates, however other factors not analysed in our study could have contributed.

Key messages

• This study brings further evidence to the protective effect of surveillance, attributable to an improvement in healthcare quality and patients’ safety.

• A significant decrease in COLO mortality rates was observed, which could be due to the decreasing trend in SSI rates.
Aetiology of influenza-like illnesses in the pre-COVID-19 season 2019-2020: role of coronaviruses
Authors: Amoruso I , Fonzo M , Bertoncello C , Baldo V , Baldovin T
Published: October 2022

Background

Only a proportion of seasonal influenza-like illnesses (ILIs) can de facto be attributed to influenza viruses. This study investigated the aetiology of ILIs to estimate the prevalence of human coronaviruses (CoVs) and to analyse their clinical-epidemiological traits.

Methods

A sample of 613 outpatients (253 adults, 360 children) with ILI in Veneto Region, Italy, was included. ILI was defined according with the EU Decision 2018/945. Sigma-Virocult nasopharyngeal swab were used. Nucleic acids were extracted with the QiaAmp Viral RNA Mini Kit (Qiagen). Molecular detection of respiratory viruses was performed with commercial One-step RT qPCR reagents (Allplex® Respiratory Panels, Seegene). Information on age, sex, symptoms, co-infections and comorbidities was collected.

Results

CoVs were the 3rd most frequent pathogen in adults (7.5%, after influenza and rhinovirus) and the 4th in children (4.7%, after influenza, rhino- and adenovirus). Subtype distribution was similar, with OC43 the most frequent. Probability of CoV involvement was twice in males (AOR=2.16; 95%CI: 1.05-4.39), whereas no association with age was noted. Co-infection with other viruses was frequent in children (65% of cases). CoV symptoms were not peculiar, although respiratory tract involvement was less likely than influenza (AOR=0.13; 95%CI: 0.04-0.41). Among CoV outpatients, 36% had one or more chronic diseases, compared with 5.6% among influenza (p = 0.001).

Conclusions

Even before the COVID-19 pandemic, CoVs had a substantial role in ILI aetiology: 1 case of CoV every 3 influenza infections in adults. The higher prevalence of comorbidities among CoV positives compared to influenza indirectly shows the benefits of flu vaccines in individuals at higher risk. Careful surveillance of the viruses responsible for ILI continues to be desirable, including, but not limited to, detecting a possible change in the aetiology of ILI after the administration of SARS-CoV-2 vaccines in the population.

Key messages

• Pre-pandemic virological surveillance of influenza-like illnesses (ILIs) reveals how seasonal coronaviruses were the third most frequent respiratory pathogen in adults.

• Prevalence of comorbidities was significantly higher in patients with a coronavirus-related ILI compared to influenza, supporting the benefits of flu vaccination for high risk groups.
Toward a digital child health booklet
Authors: Dratva J , Stronski S
Published: October 2022

Public health, paediatrics as well as other health professionals share the interest in providing services and improving conditions to ensure life-long health and well-being of children and adolescents. In this interprofessional setting and aim, parents are central partners, as are adolescents when they take over the responsibility of their own health. Ensuring the availability of health data for parents and adolescents at any given time and place is a key factor to empower and improve health management and literacy, providing continuity of health information along the care chain, and analysing health data of healthy and sick children is of high importance. The digital booklet will have a positive impact on sharing of health information among care professionals, thus ensuring continuity of care and limiting redundancy of investigation, and in addition provide data for public health research and monitoring of health and determinants. The Swiss Society of Paediatrics, the ZHAW/Institute of Public Health and the Kollegium of Hausarztmedizin (general practices) founded an association to digitalize the current paper child and adolescent health booklet with the aims:

1. Empower parents as ‘owners’ of health data to take responsibility and have greater autonomy in managing their child's health and illness

2. Provide a digital infrastructure for

– low-threshold and reliable source of advice

– easy update of data/information, digital communication with parents

– sharing of data with professionals and non-professionals involved in care of child.

3. Monitoring of children's health data (parental consent provided)

The speakers with present their collaboration and project, its current status, as well challenges and solutions found.
Which effects had the pandemic in migrants’ health and well-being? A mixed-methods approach
Authors: Gama A , Marques MJ , Pedro AR , Hoffmeister LV , Rodrigues F , Ribeiro JS , Dias S
Published: October 2022

Background

The COVID-19 pandemic affected populations’ health, with a disproportionate impact on those most socially vulnerable such as migrants. The way these populations experienced the pandemic lockdowns and its effects on daily life are yet to be known. This study aimed to understand the effects of the pandemic on health and well-being of migrants in Portugal.

Methods

In a mixed-methods approach, a survey was conducted with a community-based sample of 1126 migrants in the Lisbon Metropolitan Area, assessing sociodemographics, migration-related characteristics and the perceived impact of the pandemic on health. In addition, n = 12 migrants purposively recruited were invited to participate in a photovoice study, sharing photographs about their daily life during the lockdowns. Following semi-structured interviews were conducted. Quantitative data were analysed using multivariable analysis and qualitative data were analysed through content analysis.

Results

A fifth of the participants perceived having worse health condition since the pandemic, which was more likely among women (OR = 1.58, CI95% 1.13-2.20), those >45 years old (OR = 1.78, CI95% 1.02-3.16), with lower education (Basic education: OR = 1.57, CI95% 1.01-2.47) and with lower monthly income (<EUR 650: OR = 1.69, CI95% 1.18-2.44). Two themes emerged from the photovoice: effects of the pandemic lockdowns on daily life (routines, social relations, work) and on health and well-being (eating habits, physical exercise, leisure). Strategies to cope with the adverse effects included social activation and changes in lifestyles.

Conclusions

The pandemic had disproportionate effects on some migrant groups, intensifying social and health inequalities, with consequences for their well-being. Participatory methods can contribute to further understand migrants’ experiences while involving and empowering them for health promotion.

Key messages

• The pandemic had adverse effects on migrants’ health and well-being, disproportionately affecting most socially vulnerable migrant groups.

• Participatory research methods as photovoice are valuable to gain access to individual experiences and perspectives, while involving and empowering participants.
Femicides in Turkey: Analysis of the last two decades’ cases
Authors: Erbaydar NP , Muharremoğlu ZD , Mutlu DA
Published: October 2022

Aim

Femicide is the women's murder by men for misogynistic reasons. This research aims to determine the characteristics of femicides in Turkey.

Methods

In this cross-sectional study, 13 news sites were scanned using keywords related to femicides between 2000-2019, and 1744 cases were included. In the study, the murdered women, the perpetrators’, and the femicides’ characteristics were determined and the percentages, central tendency, and distribution measures were calculated.

Results

The mean age of the murdered women was 33.2 (SD = ±13.2); 55.5% who were married or cohabitated had at least one child (Mean=2.2±1.4), and 977 children lost their mothers due to femicide. Of the women killed, 19.1% of them filed for divorce, 10.0% of them applied to law enforcement before, and 4.5% were pregnant. Of the perpetrators, 53.1% were husbands/ex-husbands. The mean age of perpetrators was 38.3±13.4 and 10.8% had criminal records. Of the perpetrators, 12.1% had threatened the women before, and 6.2% of them had been detained. Of the femicides, 80.4% were committed in urban areas. According to the news, 34.7% of the perpetrators were in the prosecution and detention process, 25.6% were on trial, 16.2% committed suicide. Of those whose sentences have been finalized, 26.6% of them were given aggravated life imprisonment and 36.3% of them to life imprisonment. Sudden quarrels, desire for divorce, jealousy, and honor/custom were the most cited reasons. Firearms or sharps were the most frequently used weapons.

Conclusions

Women were killed by men who were close to them. Women's desires for separation/divorce or to make their own decisions for their lives posed a threat to traditional masculinity. The fact that one out of every ten perpetrators had a criminal record in femicides showed that violence was a way of life for some men. In addition, the ease of access to firearms led to their frequent use in femicides.

Key messages

• Improve gender equality.

• Access to firearms should prevented.
Redistribution of ill-defined deaths: the Scottish Burden of Disease approach
Authors: Fletcher E , Grant I , Wyper G , McCartney G , Thrower M , Stockton D
Published: October 2022

Burden of disease (BoD) studies are an established method of quantifying health loss across - and within - a population. They aim to combine the impact of living with, and dying from, various health conditions to allow for comparability of conditions in an equitable manner. A key component of this is the calculation of the loss of years of life arising from premature death (Years of Life Lost (YLL)). Most high-income nations have robust death registration systems which ensure that deaths are routinely recorded, the causes are medically certified and the age at death is accurate. However, even in these situations the recording of ill-defined death (IDD) causes remains widespread and to some extent unavoidable, in that it is not always appropriate to undertake extensive investigation to establish an exact cause of death or the cause of death recorded does not map directly to disease groupings used routinely in BoD studies. The Scottish Burden of Disease (SBoD) uses cause of death data from the National Records of Scotland. These patient-level records include one underlying cause of death and up to 10 supplementary causes of death, all coded using ICD classifications. Around 12% of these deaths do not map directly to a BoD cause group and could therefore be considered ill-defined. The SBoD study have developed a 9-step hierarchical methodology for the redistribution of ill-defined deaths, utilising uses a mix of fixed and proportional redistribution and focusses on exploiting the data recorded on the death certificate at both an individual and population level. In this presentation we will describe the methodology used to redistribute ill-defined deaths in the Scottish study - the development, the application and the strengths and weaknesses of our approach. We will also discuss the example of COVID-19 and how competition between the underlying cause of death is likely to impact how we need to approach IDDs in the future.
Primary health care reforms in Poland: ambitions versus reality
Authors: Sagan A , Badora-Musiała K , Domagałaa A , Kowalska-Bobkoa I
Published: October 2022

Poland, like many other former eastern bloc countries, inherited a health system dominated by narrow medical specialties, a large number of hospital beds and relatively weak primary health care (PHC). Since early 1990s, efforts have been made to strengthen the role of PHC, starting with the introduction of specialization training in family medicine. With privatization of PHC practices the standard of PHC care has improved. However, national audits have repeatedly found PHC to still be inadequate, with the key weaknesses including shortages of family medicine specialists, insufficient provision of preventive services, and limited use of diagnostics, which led to inappropriate referrals and long waiting times for specialist consultations. Between mid-2018 and the end of 2021, a new model of PHC organization was piloted in around 40 PHC practices across Poland that met the model's requirements. The pilot, supported by the World Bank, put much emphasis on health promotion and disease prevention by including health educators and dieticians in PHC teams and by introducing periodic check-ups. It also aimed to reduce referrals to specialist care by allowing PHC doctors to order extensive diagnostic and laboratory tests and, if needed, consult with a range of cooperating specialists. It also sought to increase the role of PHC doctors in the management of chronic conditions by introducing disease management programmes (DMPs) for 11 most prevalent conditions. PHC teams were made responsible for coordinating patients’ care pathways, including post-hospital treatment, and a new role of care coordinator was introduced to that end. After the pilot was concluded, all PHC practices were mandated to hire care coordinators. Implementation of other solutions tested in the pilot remains uncertain, mainly due to the lack of financial and human resources, and the dominance of small PHC practices that struggle to meet the ambitious requirements set out in the new model.