bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaccination campaign implementation in Madagascar: a Dynamic Sustainability Framework approach
Authors: Pavoncello V , Kislaya I , Andrianarimanana D K , Marchese V , Tsiky Zafinimampera A O , Totofotsy O , Randriamanantany Z A , Rakotoarivelo R A , Puradiredja D I , Fusco D
Published: October 2024

Background

The COVID-19 pandemic has highlighted the need for equitable and timely access to vaccination. Limited evidence is available on how to implement vaccination campaigns (VCs) that are sustainable and responsive to changes in real-world health policy and practice contexts. We present lessons learned from the implementation of a COVID-19 VC in the Boeny region of Madagascar.

Methods

Informed by the Dynamic Sustainability Framework, VC implementation was continuously reviewed during multisectoral stakeholder feedback rounds, key informant interviews, and problem-solving meetings to identify and put key adaptations throughout the campaign process into practice. Outcome indicators include pre- and post-VC vaccine hesitancy and trends in vaccine doses deployed were analyzed using generalized linear models.

Results

Key adaptations of the implementation strategy included community-led awareness-raising and outreach activities also in remote areas, strengthening VC through the training of 340 staff, and addressing gaps identified in the cold chain, waste management, vaccine transportation, and IT equipment. Overall, 24888 COVID-19 vaccines were administered in six months. Changes in campaign strategy increased the number of doses administered by 8% (RR = 1.08; CI 95%: 1.01; 1.15) per week. No changes in vaccine hesitancy post-VC were observed in an unvaccinated population(Δ = 0.02, CI 95%: -0.04; 0.08).

Conclusions

Collaborative and dynamic multi-sectoral VC strategies that combine healthcare-based approaches with pro-active outreach and community-led awareness-raising activities are essential in increasing vaccine uptake in limited-resource settings. Our findings show that despite boosting vaccination coverage, such initiatives may not have an impact on COVID-19 vaccine hesitancy at the community level

Key messages

• Multisectoral stakeholder collaboration and engagement are key to successful vaccination campaign implementation.

• A Dynamic Sustainability Framework approach can be effective in ensuring a continuous fit between campaign and its setting.
The Icehearts Europe Implementation Guide to promote a mentoring programme for youth mental health
Authors: Valli M , Luzi I , Gigantesco A , Del Re D , Cascavilla I , Faella P , Iannaccone A , Ponchon C , Conti D , Capelli G
Published: October 2024

Issue/problem

In Europe, 9 million young people (10-19) suffer from mental disorders and 70% of children and adolescents with mental health problems do not receive appropriate interventions at a sufficiently early age. Moreover, during the Covid-19 pandemic a high prevalence of depressive symptoms, anxiety and sleep disorders was observed in the population aged 4-19 years. The Icehearts Europe project (funding: EU4Health 2022 Programme) aims to disseminate at EU level a long-term programme for supporting health and wellbeing of disadvantaged children and adolescents. It is inspired by the Finnish best practice Icehearts, a 12-year long mentoring programme. Five pilot countries (Italy, Denmark, Spain, Slovenia, Estonia) will test the model to raise European awareness of how it works and to get more countries and organisations involved.

Description of the problem

Icehearts Europe is a preventive mentoring programme based on team sports, recreation and school support activities, with a child-centred community approach. To facilitate its implementation, a practical guide has been developed for grassroots sport and social promotion organisations to help them implement the model in their own contexts. The guide is the result of both a multisectoral cooperation between grassroots sport, health, universities, NGOs, and qualitative study activities (bibliographic research, study visit, group work, analysis of the situation and needs of local contexts).

Results

From February 2024 the Icehearts Europe Implementation Guide is available in six languages at https://www.icehearts.eu/resources. It is now being adapted by the Icehearts Europe partners into an online training programme for managers.

Lessons

The guide has incorporated lessons learnt from the Finnish model, considered as an evidence-based approach. It contains several operational tools to implement Icehearts Europe and can be adopted using different approaches: there is no one-size-fits-all solution.

Key messages

• Developed as a support to the Icehearts Europe piloting partners and as a basis for a fully-fledged online training programme for future Icehearts Europe managers.

• To facilitate the implementation of early interventions to promote health and wellbeing of children and adolescents and enable them to cope with disadvantaged conditions.
Trends in overall and abdominal obesity among Korean adults, 2007-2022: an Age-period-cohort analysis
Authors: Jeong D , Jo G , Oh H
Published: October 2024

Overall and abdominal obesity, often defined as having high body mass index (BMI) and waist circumference (WC), are associated with an increased risk of chronic disease. A comprehensive understanding of trends and contributing factors is necessary to reduce the disease burdens. This study investigated the nationwide trends and independent effects of age, period, and birth cohort on BMI and WC in Korean adults. We conducted hierarchical age-period-cohort (cross-classified random-effects models) analyses using measured BMI and WC data from 85,292 Korean adults (aged ≥19) in the Korea National Health and Nutrition Examination Survey 2007-2022. We also examined whether the age, period, and cohort effects varied by socioeconomic subgroups. In 2007-2022, the age-standardized mean BMI (23.6 to 24.2 kg/m2) and WC (81.7 to 83.5 cm) increased in the overall population. An upward trend was evident among men, while only a slight change was observed in women. The mean BMI was highest at age 47 (25.1 kg/m2) in men and age 60 (24.2 kg/m2) in women and it decreased at older ages. Controlling for age and period effects, mean BMI was lowest among the birth cohorts of 1960-1964 (24.15 kg/m2), with the highest mean BMI observed among the birth cohorts of 1919-1939 (24.97 kg/m2) and 1990-2003 (24.99 kg/m2). The mean WC was highest at age 55 (88.0 cm) in men and age 79 (83.4 cm) in women. Similar U-shaped birth cohort effect was observed with WC, with the lowest mean observed among the birth cohorts of 1960-1964 [82.92 (0.30)]. At most age, period, and birth cohorts, mean BMI and WC were consistently higher among adults at lower income and education. The overall period effect was consistently found in all socioeconomic subgroups, but the gap in BMI between income and education subgroups widened over time. Our findings suggest that BMI and WC slightly increased in overall Korean adults in 2007-2022, with some inequalities among age, sex, birth cohort, and socioeconomic subgroups.

Key messages

• The obesity indices increased from 2007 to 2022, but the cohort effect on BMI and WC showed a U-shaped pattern with the lowest mean among birth cohorts of 1960-1964.

• The obesity prevalence is varied by socioeconomic status, suggesting that more intense interventions may be needed to target the susceptible groups.
Impact of primary course COVID-19 vaccination on hospitalizations in Belgium, a Bayesian approach
Authors: Vermeiren E , Braeye T , Stouten V , Nasiadka L , Billuart M , Van Evercooren I , van Loenhout JAF
Published: October 2024

Background

The Belgian COVID-19 primary course vaccine rollout was prioritized for individuals aged 18-64 years with underlying health conditions (increased risk of severe COVID-19), over their peers of the same age. This led to a 32-day earlier vaccination of prioritized individuals. In this research, we assessed the impact of vaccine rollout prioritization on hospitalizations for COVID-19 in Belgium between April 1st 2021 and June 30th 2021.

Methods

The sample consisted of the Belgian population aged 18-64 years. Individuals were classified by their priority status according to underlying health conditions and by vaccination status, creating weekly changing cohorts. The hospitalization probability was estimated by cohort using a national COVID-19 hospital surveillance. Two counterfactual scenarios were considered: (1) a no vaccination scenario and (2) a scenario in which the vaccine administration occurred at random in both cohorts (a vaccine rollout without prioritization). We used a Bayesian model to jointly estimate cohort-specific hospitalization probability and scenario outcomes.

Results

Out of the sample of 5,448,534 individuals, 22.65 % was prioritized. By May 1st, vaccination coverage was 18% and 2% within the prioritized and the non-prioritized cohort. In scenario 2, coverage within the prioritized was 6% by May 1st. There were 6968 hospitalizations reported through the hospital survey. Our initial scenario-outcomes indicated a reduction in hospitalizations of 3203 (95%CI[2548;3858]) and 919 (95%CI[406;1433]) by the vaccination prioritization, compared to scenarios 1 and 2, respectively.

Conclusions

This research provides insights in the impact of vaccination in a pandemic context in Belgium. We report a significant reduction in simulated COVID-19 hospitalization by vaccine prioritization compared to at random vaccination and no vaccination at all. Currently, we are investigating the effect of age-dependent vaccination next to at random vaccination.

Key messages

• The prioritised vaccination campaign in Belgium led to a significant reduction in hospitalizations.

• Prioritisation based on underlying health conditions is an important public health measure.
Is the medical curriculum failing patients with obesity? - A public health concern
Authors: Sant D
Published: October 2024

Introduction

Despite the global surge in obesity, it often receives insufficient attention in medical curricula, potentially impacting its management. This study aims to assess the preparedness of medical students in managing obesity.

Methods

A cross-sectional survey was conducted by disseminating a mixed-methods anonymous questionnaire to medical students studying at the University in Malta. A sample size of 117 participants was determined a-priori. Descriptive statistics and chi square testing were conducted. and coupled with thematic two-stage coding analysis of qualitative data.

Results

189 participants were recruited. The majority expressed dissatisfaction with the teaching of obesity and its management during the MD course (pre-clinical = 90%; clinical = 74.4%, p = 0.006). Clinical students expressed dissatisfaction regarding the adequacy of their pre-clinical education (82.65%) and clinical attachments (70.40%), in equipping them with the theoretical knowledge and foundational skills necessary for managing patients with obesity. No significant difference between clinical and pre-clinical students’ knowledge was noted except concerning diagnostic criteria (preclinical: 63.33% versus clinical: 89.90 %; p < 0.001). Thematic analysis highlighted the importance of curricular obesity teaching, need for a holistic approach towards obesity, and hesitancy in treating patients with obesity.

Conclusions

The gap between medical students’ perceived readiness and the growing obesity epidemic is a public health concern. Without proper training, future doctors may struggle to manage obesity, posing risks to health outcomes and healthcare systems. Urgent curricular reforms are necessary to prioritize obesity education and ensure physicians are equipped to address obesity, to meet national needs. This requires collaboration among stakeholders, especially post-COVID-19, to align medical education with public health needs while addressing the severity of the obesity epidemic in Europe.

Key messages

• A gap between students’ attitudes and their understanding of obesity education was identified in this study, indicating a need for curriculum reform.

• This presents a critical public health issue, as it leaves the new generation of doctors ill-equipped to address the growing obesity epidemic across European countries.
Strengthening youth mental health capacities in Albania: Training primary healthcare professionals
Authors: Qirjako G , Qosja A , Çumashi R , Meksi A , Hala R , Zikaj L , Qirjako S , Tollozhina E , Pilika A , Tomini E
Published: October 2024

Background

Addressing mental health issues among children and adolescents globally is crucial, necessitating interventions at the primary healthcare (PHC) level. The training programme in Albania equipped PHC professionals with skills for early identification, support, and referral for youth mental health issues. Given the global prevalence of such challenges, our intervention serves as a valuable model for enhancing mental health services in communities.

Objectives

The training aimed to develop the capacities of Albanian PHC professionals in improving mental health and psychosocial wellbeing among youth. Through innovative training sessions using participatory action methods, it was sought to answer key questions: How can Albanian PHC professionals better identify and support youth mental health issues? What innovative approaches can enhance mental health training for Albanian healthcare personnel? How can community engagement be strengthened to support youth mental health initiatives in Albania?

Results

Following the programme, 525 healthcare professionals in Albania received training, showing improved knowledge and skills in youth mental health support. They emphasized the importance of community engagement, standardized documentation, and specialized mental health services. Preliminary results indicate increased awareness and readiness among Albanian PHC professionals to address youth mental health needs.

Conclusions

The programme underscores the significance of equipping Albanian PHC professionals with comprehensive skills to tackle youth mental health challenges. Lessons learned have broader implications for strengthening mental health services globally, emphasizing collaboration, standardized protocols, and targeted interventions.

Key messages

• Strengthening PHC capacity in Albania improves early identification and support for youth mental health, enhancing overall wellbeing.

• Tailored training and community engagement are vital for effective mental health interventions at the grassroots level in Albania.
A matter of measurement? Segregation and all-cause mortality in Sweden’s three metropolitan regions
Authors: Cederstrom A , Dunlavy A
Published: October 2024

Background

Residential segregation can be operationalized and measured in many ways, along distinct dimensions. There are multiple mechanisms through which segregation and health mutually affect each other. Consequently, contextual health effects of segregation may vary depending on how segregation is measured.

Methods

We used longitudinal Swedish register data to compare associations between local measures of residential segregation (migrant density, migrant isolation, and the mutual information index) and all-cause mortality among the adult migrant and native-born populations in Sweden’s three largest metropolitan regions between 2004-2016.

Results

Among migrants, modest positive mortality gradients were observed across measures of migrant density and isolation, where a higher level of segregation was associated with higher risks of all-cause mortality (Q5 RR ranged from 1.08-1.20 across cities and measures). However, these effects were largely attenuated by individual-level socioeconomic factors, and reversed when further controlling for neighborhood economic deprivation (Q5 RR ranged from 0.74-0.87). Among the native-born, a positive gradient for mortality was found (Q5 RR ranged from 1.31-1.45), although this was reduced when accounting for neighborhood deprivation (Q5 RR ranged from 1.01 -1.11). For both migrants and the native-born, the mutual information index showed no clear association with mortality, although a mortality advantage is observed for migrants in the most segregated areas after individual and neighborhood level adjustments (Q5 RR ranged from 0.73-0.86).

Conclusions

Our findings show that the manner in which residential segregation is conceptualized and operationalized alters associations with health. However, individual and other contextual level confounders are important determinants which influences the patterns. Much of the negative health effects of residential segregation can be perceived through the lack of economic opportunities.

Key messages

• Associations between segregation and all-cause mortality depends on how segregation is conceptualized and measured.

• The mortality disadvantage observed in local areas with high migrant density may be attributed to the lack of economic opportunities in the neighborhood.
Harassment of interns, medical interns and residents: consequences and complaints
Authors: Villegas-Dominguez J , Teczon Castellanos C O , Suárez Hernández N , Andrade Martinez M , Ruiz Garcia F , Viñas Dozal J C , Duarte Cruz V , Sosa Gonzalez Y R , Hernandez Rico M
Published: October 2024

Introduction

Workplace harassment manifests in various forms for healthcare students, potentially leading to modifications in their lives and academic activities.

Objectives

To describe the type of harassment experienced by interns, medical interns, and residents, and its consequences.

Methods

A cross-sectional and prospective study was conducted, including medical interns, social service interns, and residents from Veracruz who reported experiencing harassment in their assigned areas during their last academic year. Direct and virtual invitations were sent through various electronic means.

Results

58 students were included, with 39 (67.2%) being women. 50% reported experiencing psychological abuse, and 65.5% reported experiencing sexual harassment. The most severe sexual harassment incidents included sexual assault with physical force (1.7%) and three instances of non-consensual sexual relations (5.2%), while the most common were sexual jokes/comments (72.4%). Following harassment experiences, 25% of participants reported feeling anxious, 22% stressed, and 17% angry. Students who perceived psychological abuse reported anger (69%), stress (58.6%), and anxiety (58.6%) as the most frequent consequences, while those reporting sexual abuse indicated anger (73.7%), shame (68.4%), and anxiety as primary consequences. The most frequently identified harassers were attending physicians (56.9%), senior students (34.5%), and non-medical personnel (34.5%). Students filed complaints with hospital authorities (6.9%), university authorities (6.9%), and external agencies (5.2%). The individual who experienced sexual assault with physical force did not file any complaint, while only one person reported non-consensual sexual relations to hospital authorities.

Conclusions

It is crucial to establish safe spaces for students within the hospital environment to promote their overall well-being and academic success, as well as to encourage a culture of reporting.

Key messages

• Highlighting the need for intervention within the work teams where our students are placed, promoting a violence-free environment.

• Annexing a therapist as part of the work team could favor the well-being of students, since mental health is one of the main points affected within a violent environment.
Ready to act? Factors associated with nurses’ desire to work in Primary Health Care in Italy
Authors: Renzi E , Panattoni N , Di Simone E , Peltrini M , Baccolini V , Migliara G , Marzuillo C , De Vito C , Villari P , Massimi A
Published: October 2024

Background

The rapid increase in demand for primary healthcare (PHC) services after the pandemic requires reconsidering nursing staff planning and availability. The objectives of the study were to i) identify knowledge, attitudes, practices and work expectations of future nurses in primary care; ii) estimate the prevalence of nursing students who desire to be employed in PHC and Family and Community Health Nursing (FCHN) services after graduation.

Methods

A cross-sectional study is being conducted on a sample of nursing students enrolled in universities in the Lazio Region. A structured instrument was built based on the literature and national regulations and validated (Cronbach’s alpha=0.81).

Results

In this first phase, 163 nursing students were enrolled. The majority of the sample was female (N = 125, 76.7%), with a mean age of 22 (SD ± 5) years and were enrolled in the last year of degree program (N = 85, 52.1%). A total of 49 students (30%) reported adequate knowledge of PHC service reorganization policies and nursing practice in this setting. While 74% (N = 122) of the sample intended to undertake a PHC curricular internship during their degree program, only seven students (4%) participated in one. 52 individuals (30%) expressed their intention to be employed in PHCs after graduation, and 29 (17.8%) indicated their desire to work as FCHN practitioners. The main factors contributing to the undesirability of employment in PHC reported by students were: i) preferring the hospital settings (N = 53, 48%); ii) not having adequate skills to be employed in the PHC (N = 21, 19%); and iii) believing that the PHC does not offer attractive services for nursing practice (N = 14, 13%).

Conclusions

A multivariable analysis will be conducted to identify predictors of nursing students’ desire to work in PHCs after graduation. Preliminary results of the study showed that only one-third of nursing students indicated a desire to work in PHCs.

Key messages

• Only one-third of nursing students express a desire to work in PHC and in Family and Community Health Nursing (FCHN) services post-graduation.

• Collaboration between the PHC workforce, academics, stakeholders, and policymakers is needed to create tailored initiatives that increase the attractiveness of PHC.
Enhancing Interprofessional Skills with SKY Campus: A Pilot Study on Mental Well-being at UCD
Authors: Kumawat J , Conyard K , Wall P , Codd M
Published: October 2024

Background

Public health professionals and students face increasing mental health challenges. Sudarshan Kriya Yoga (SKY), known for its mental health benefits such as stress reduction and improved emotional regulation, offers a promising strategy for enhancing well-being in public health education.

Objectives

To evaluate the immediate effects of a three-day participatory SKY workshop on mental well-being of Master of Public Health students at University College Dublin, Ireland.

Methods

A non-randomized, controlled pilot study will involve MPH students at UCD. Participants, aged 18 and above, enrolled in the MPH programme, will provide informed consent to attend a three-day SKY workshop in September 2024. The workshop, delivered by certified trainers, includes three sessions of three hours each. Standardised and validated Patient-Reported Outcome Measures (PROMs) such as the Perceived Stress Scale (PSS-10) and WHO-Five Well-being Index (WHO-5) will be used to assess perceived stress and mental wellbeing at baseline and immediately after the workshop.

Results

Based on previous literature, it is hypothesized that participants will show a significant reduction in perceived stress and improvement in mental wellbeing scores. Data will be analysed using descriptive statistics and Wilcoxon signed-rank tests to evaluate changes in PROM scores.

Conclusions

This pilot study aims to provide preliminary evidence on the effectiveness of SKY in improving mental wellbeing among public health students. Successful outcomes could support integrating SKY into the public health curriculum, promoting its adoption across other institutions, and enhancing the professional skills development of future public health professionals. This component is proposed in the ASPHER core curriculum programme for public health as an important cross curricular subject area

Key messages

• Integrating SKY Campus workshops into public health education enhances interprofessional skills and mental well-being, offering a holistic approach to professional development in global health.

• This study uses standard PROMs to assess the SKY workshop’s impact, aiming for significant improvements in stress and mental well-being to shape global public health curricula.
A prolonged outbreak of tuberculosis associated with an intellectual disability daycentre in Ireland
Authors: McGlacken T , O’Connor K , O’Hare C , O’Connell A , Dwan E , Doyle S
Published: October 2024

One of the factors impeding tuberculosis elimination in low burden countries is its persistence and concentration in vulnerable populations. This is a complex, prolonged Tuberculosis (TB) outbreak in a daycentre for adults with intellectual disability in Ireland. This is a particularly vulnerable population with special considerations for Public Health (PH) management. There are eight cases of active TB, 46 cases of Latent TB Infection (LTBI) and a cumulative total of 116 contacts associated with this outbreak, with diagnosis spanning 15 years. The last three cases were identical on Whole Genome Sequencing. The index case was an Irish-born, Caucasian, social care worker, with smear positive pulmonary TB, who was symptomatic in the facility for three months prior to diagnosis. Case 2 was a household contact of the index case and the other 6 cases were Service Users (SUs) at the facility. At least five of the subsequent seven cases are secondary cases of the index case. Significant to this outbreak was the change in Irish guidance, 2010, relating to the management of contacts of cases. Following the notification of the most recent case, July 2023, the Outbreak Control Team decided a retrospective review be conducted of all SU contacts of the seven cases associated with the facility. The contacts were stratified according to hierarchical risk. A total of six contacts met the criteria for review and offered screening, re-screening or treatment as appropriate. In this outbreak 21.8% of the total contacts and 16.1% of SU contacts completed treatment for LTBI. The significance of this outbreak lies in its duration, infectivity of the index case and particular vulnerabilities of the SUs. There were issues with overcrowding and difficulties in relation to symptom recognition, diagnosis and treatment. The PH team tailored their approach to meet the SU needs, demonstrating the importance of person-centred contact tracing in the disruption of transmission.

Key messages

• A factor impeding tuberculosis elimination in low burden countries is it’s persistence and concentration in vulnerable populations.

• Adapting a patient-centred approach to contact tracing can lead to higher participation rate and the disruption of infection transmission.
The resurgence of pertussis in Central Serbia in the period from June to December 2023
Authors: Grego E , Gospodinovic H , Cabrilo M , Ivanovic M , Ivanovic J , Simic N , Pavlovic L J , Veljkovic M , Jovanovic S , Jovanovic V
Published: October 2024

Background

There was a registered increase in the number of confirmed pertussis cases in Central Serbia between June and December 2023. Among the possible causes of pertussis resurgence are increased awareness of pertussis among healthcare workers, availability of the sensitive RT PCR method in diagnostic, the limited duration of vaccine-induced immunity as well as decline of immunization coverage influenced by the COVID-19 pandemic.

Methods

The nasopharyngeal samples from clinics and primary care departments were transferred to Institute of Public Health of Serbia. DNA was extracted from each sample using the MagMAX Viral/Pathogen kit. The presence of B. pertussis was determined using two PCR assays, VIASURE Bordetella Real Time PCR Detection Kit and Bosphore B. pertussis/parapertussis Genotyping Kit, Anatolia Geneworks.

Results

RT-PCR confirmed a total of 338 pertussis cases in Institute of Public Health of Serbia during the observed period. Most of confirmed cases were among children 9-14 years old (49,7%) followed by infants younger than 12 months (21,9%). The more severe cases were among the unvaccinated and uncomplete vaccinated infants, 78,4% of which required hospitalization with two deaths in this age group.

Conclusions

Based on the analysis of the obtained results, we can highlight the importance of using sensitive methods in pathogen detection. Rapid diagnosis, laboratory confirmation and notification ensure early public health intervention to minimize the spread of disease. Despite long tradition of mandatory immunization against pertussis in the Republic of Serbia, wanning of vaccine induced immunity poses potential risk for the resurgence of pertussis. For pertussis control, in the future, it will be essential to achieve high immunization coverage as well as to introduce a booster dose of pertussis containing vaccine for children aged 14 and to implement vaccination of pregnant women.

Key messages

• For the better pertussis control vaccination of adolescents and adults, as well as vaccination of pregnant women should be considered in the future vaccination policies.

• Clinicians should consider pertussis in the differential diagnosis of persistent cough illness in people of all ages, even those previously immunized.
From agent-based simulations of disease dynamics to expert support on public health interventions
Authors: Moeckel M
Published: October 2024

Agent-based epidemiological simulators have long been used to predict the dynamics of infectious diseases. They allow to combine compartment approaches with representing contact networks derived from real or synthetic populations. Often, scenario techniques are applied to model the impact of public health interventions. During the COVID-19 pandemics the agent-based simulator COVASIM has been established for modelling the spreading of SARS-CoV-2. It includes four different contact networks related to homes, schools, workplaces and environment. During the pandemic it became obvious that the current simulation techniques were not sufficient to cover important needs in public health administrations and society. While most simulations were based on scenarios predicting expected numbers for the infected, hospitalized or critically ill, these studies could not provide easily strategic options on a variety of equivalent public health interventions, which are all suitable to keep disease dynamics within acceptable bounds, set e.g. by hospital capacity. Knowing about a variety of equivalent options, however, is of crucial importance to enable a fair burden sharing throughout all groups of society. Therefore, we applied machine learning techniques to create an inverse model for epidemiological simulations based on COVASIM. For given transmission rates it outputs a range of quantitative interventions which are equivalently suitable to keep epidemiological dynamics within predefined bounds. Currently, it covers interventions like school and workplace closings and other mobility restrictions. Future work will be directed to include other interventions, like vaccination campaigns, and we will work to make the approach more generalizable for other infectious diseases. The tool may turn out helpful fur public health administrations and stimulate the public debate on the best way a society may take in a pandemic event or other situations where public health action has to be imposed.

Key messages

• Machine Learning allows to invert agent based simulators.

• Instead of disease dynamics simulations a set of equivalent public health interventions consistent with pre-defined constraints can be calculated.
Knowledge, Attitudes and Behaviors of Healthcare Workers Working in Malatya Towards COVID-19 Vaccines
Authors: Boz G , Ozer A
Published: October 2024

Background

The rapid production of vaccines and the introduction of new vaccine technologies have raised concerns among some individuals regarding anti-vaccination, while others have expressed worries about vaccines. Given that healthcare professionals’ recommendations significantly influence people’s vaccination decisions, this study aimed to examine the knowledge, attitudes, and behaviors of healthcare professionals working in family health centers towards COVID-19 vaccines.

Methods

Questionnaires for this descriptive cross-sectional study were administered between February and April 2022. The population comprised 408 health workers employed in family health centers in Malatya, with 292 individuals completing the study. The questionnaire included questions about sociodemographic, COVID-19, COVID-19 vaccines and the COVID-19 Fear Scale.

Results

Although 97.3% of the research group reported having received the COVID-19 vaccination, 47.9% expressed concerns about these vaccines. The median score of the COVID-19 Fear Scale was 15 (7.00-35.00). 86.6% of the participants indicated that they recommended COVID-19 vaccines. 16.4% of the participants agreed with the statement ‘there are no studies proving the safety of vaccines,’ and 49% agreed that ‘vaccines pass through clinical trials quickly and are put on the market’. Those who did not recommend COVID-19 vaccines, those who agreed with the statement ‘there are no studies proving the safety of vaccines’ and those who agreed with the statement ‘vaccines pass through clinical trials quickly and are put on the market’ were concerned about COVID-19 vaccines with their level of concern significantly higher (p < 0.05).

Conclusions

Almost all members of the research group had received the COVID-19 vaccine, yet almost half of them expressed concerns about vaccines. Those who do not recommend vaccines, those who believe they are released quickly, and those who have safety concerns are more likely to be concerned.

Key messages

• Identify the reasons for health workers’ concerns about vaccines and provide remedial interventions for concerns that may arise regarding other vaccines.

• It should be ensured that healthcare professionals, who are expected to be role models for society in terms of immunization, possess scientific and up-to-date knowledge on vaccines.
Implementation evaluation of a school-based intervention on HPV vaccination (the PrevHPV study)
Authors: Bocquier A , Simon M , Michel M , Bruel S , Gauchet A , LeDuc-Banaszuk A S , Gagneux-Brunon A , Mueller J E , Giraudeau B , Thilly N
Published: October 2024

Background

HPV vaccine coverage (VC) remains lower than expected in many countries, particularly France. We developed and evaluated the PrevHPV multicomponent intervention to improve HPV VC among French adolescents. We evaluated the implementation of the school-based components of the intervention.

Methods

We carried out a mixed-method study embedded in a cluster randomized controlled trial (July 2021-April 2022; 14/25 French school districts). The cluster was the municipality (n = 91). The school-based components of the intervention were ‘education and motivation’ and ‘at-school vaccination’. Quantitative data were collected through standardized activity reports and self-administered questionnaires; the implementation outcomes were fidelity, dose, reach, acceptability and sustainability. Qualitative data were collected through semistructured group interviews with school staff and analyzed using the Consolidated Framework for Implementation Research.

Results

We found high rates for: fidelity (e.g., 69% of the targeted classes had two educational sessions and 89% of schools invited all pupils for at-school vaccination, as planned); acceptability (e.g., pupils’ participation satisfying in 90% of the sessions, 96% of vaccinated pupils and 78% of school staff satisfied with at-school vaccination); and sustainability (e.g., respectively 91% and 76% of schools considered conducting sessions and vaccination days during the following year). However, the withdrawal of 1/3 of schools before the trial started and difficulties in mobilizing parents negatively impacted dose and reach. Several facilitators and barriers influenced the implementation of the components; they were related to the components’ design, the characteristics of both the external and internal environment of the school, the numerous stakeholders and individuals involved, and the implementation strategies used.

Conclusions

These results can guide policy making on school-based HPV vaccine promotion in France and Europe.

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.

• These findings have practical implications for implementing effective and acceptable school-based interventions in real life to improve HPV vaccine uptake and reduce HPV-associated burdens.
Breastfeeding knowledge, attitudes and practices of HIV-positive women in Africa, a systematic review
Authors: Cuenca-Viñas N , Sánchez-Marqués R , Benito A , Romay-Barja M
Published: October 2024

Background

Breastfeeding (BF) is essential to ensure the health and survival of children, especially in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. The WHO currently recommends, along with antiretroviral treatment, exclusive BF (EBF) for the first six months and mixed BF for the next six months and extending it to 24 months. In sub-Saharan Africa, more than one million HIV-positive women face the challenge of infant feeding due to limited access to treatment and safe water. The aim of this study was to understand the knowledge, attitudes, and practices of HIV-positive mothers in Africa to provide evidence for public health strategies.

Methods

We conducted a systematic review of studies on Knowledge, Attitudes and Practices of BF among HIV-exposed children in African countries, following the principles of the PRISMA statement and identified by searching major databases of records published between 2013 and 2023.

Results

Of the 498 articles identified, 21 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya. 95% of the studies were conducted in health care facilities. Mothers showed good knowledge, attitudes and practices regarding EBF of HIV-exposed children, but low knowledge and fear of continuing to practice BF later on. The HIV-positive mothers mentions a range of recommendations received from health workers, identified as their main source of information. Stigma against mothers who practice EBF was found. The primary reason for early cessation of BF was due to work.

Conclusions

Knowledge, attitudes, and practices of the infant feeding currently recommended by WHO for HIV-positive mothers was weak. There is little evidence of what happens in other African countries and in women with limited access to the health system. Public health policies need to be strengthened to ensure that health workers are trained in the current guidelines to improve HIV-positive women’s BF.

Key messages

• HIV-positive mothers are afraid to continue breastfeeding their babies after 6 months.

• More studies about the breastfeeding practices of children of HIV-positive mothers with limited access to health services are needed.
Screening for congenital Chagas disease in a non-endemic area: a cost-effectiveness analysis
Authors: Marraffa P , Dentato M , Angheben A , Barbera G , Nurchis M C , Heidar Alizadeh A , Olivo L , Damiani G , Gianino M M
Published: October 2024

Background

Due to climate changes, immigration, and globalization, Chagas Disease (CD) also afflicts nations without vector transmission. In Europe, congenital CD (cCD) is a significant public health issue, perpetuating the disease: it is crucial to perform CD screening in pregnant women at risk, as the treatment of infants is effective in eradicating the infection. Only a few European regions have a definite algorithm for diagnosing cCD, but no official guidance has been published at the national or European level. To support policymakers, this study aims to outline a cost-effectiveness analysis of CD screening in non-endemic areas, such as Italy, in pregnant women born or arriving from endemic countries and in their newborns.

Methods

To measure the economic impact of cCD screening, a decision tree model will be used to compare the test option (screening, diagnosis, treatment, follow-up) with no test option (no screening, progression of disease). Model parameters will be taken from relevant scientific literature. The primary outcome will be the Incremental Cost-Effectiveness Ratio (ICER) between the two options. Sensitivity analyses will be conducted to determine how changes in prevalence, transmission rate, screening adherence, and treatment adherence may affect the ICER.

Results

We expect the ‘test’ option to be cost-effective even with significant reductions in prevalence, transmission rate, adherence to screening or treatment. Threshold levels of these variables will allow to critically extend the results to areas with reduced immigration, patchy distribution of migrants at risk, health logistical limitations, and limited access to care for immigrants.

Conclusions

Our findings can help policymakers implement official screening programs and diagnostic algorithms for cCD in Italy and other non-endemic countries. This contributes to SDG 3 by combating the spread and burden of neglected tropical diseases and contributing to maternal, child, and migrant health.

Key messages

• Screening for congenital Chagas Disease in a non-endemic area may be cost-effective and cost-saving.

• Study findings could provide useful information for health policymakers to combat Chagas Disease in Europe.
Results of a 5 year Antimicrobial Stewardship program in a North Italian Hospital
Authors: Calzavara A , Tikvina S , Zavatta G , Miotti A M , Ruggeri A , Madia A , Marchiori M , Zilli E
Published: October 2024

Issue

A National Action Plan (PNCAR) to fight antimicrobial resistance has been launched in Italy in 2017, further revised in 2022. In order to reduce inappropriate exposure to antibiotics and infections from multidrug resistant bacteria, a structured system of surveillance and monitoring according to PNCAR standards has been set up in all Italian regions. In the Hospital of Cittadella (District of Padua, Veneto region), special focus has been given to the reduction of antibiotic consumption, in particular quinolones, third generation cephalosporins, carbapenems and macrolides.

Description

Multidisciplinary meetings have been monthly organized by the hospital Antimicrobial Stewardship Group, with the aim of coordinating the implementation of specific stewardship actions. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Regional data warehouse from 2019 to 2023 regarding all classes of antibiotics.

Results

Between 2019 and 2023 a clear decrease in the consumption of quinolones (from 8 to 5,8 DDD, -28%) and carbapenems (from 2,5 to 1,3 DDD, -48%) was observed but, at the same time, an increase in the consumption of third generation cephalosporins (from 9 to 15,7 DDD, +74%) has been reported. This can be explained as a direct consequence of the correct application of therapy guidelines, which in several cases suggest the use of ceftriaxone instead of meropenem. Finally, after an increase in the consumption of macrolides during the first COVID-19 pandemic wave, the consumption of this class of antibiotics has returned to pre-pandemic level.

Lessons

Constant monitoring of antimicrobial consumption and the identification of warning situations that may need to implement specific actions are the cornerstone of Antimicrobial Stewardship programs. Targets must be defined analyzing data of bacterial resistance rates and infections from multidrug resistant bacteria.

Key messages

• In Antimicrobial Stewardship programs it is important to adopt constant monitoring of antimicrobial consumption.

• Antimicrobial stewardship programs need to be adapted according to the characteristics of each hospital.
Antibiotic use and resistance: knowledge, attitudes and practices in Italian healthcare workers
Authors: Panattoni N , Renzi E , Di Simone E , Costantino S , Baccolini V , Migliara G , Marzuillo C , De Vito C , Villari P , Massimi A
Published: October 2024

Background

Antimicrobial resistance (AMR) is one of the most significant public health challenges globally. The misuse or incorrect use of antibiotics has led to the emergence of resistant bacteria, making it increasingly difficult to treat infections. This study aims to identify knowledge, attitudes, and practices among Italian healthcare workers (HWs) - medical doctors (MDs) and nurses - regarding antibiotics, antibiotic use, and antibiotic resistance.

Methods

Cross-sectional study; a validated questionnaire from the European Centre for Disease Prevention and Control was distributed via web survey starting from April 2024 to a voluntary sample of healthcare workers employed in Italy. Descriptive analysis and multivariable logistic regression were performed to investigate predictors of knowledge regarding antibiotic use and AMR. Ethical approval was obtained from the local ethics committee.

Results

So far, 154 HWs were enrolled, of which 132 were nurses (85.7%). The average level of knowledge regarding AMR and antibiotic use was 6.8/7 (± 0.2) for MDs and 6.1/7 (± 0.2) for nurses, with an overall score, among HWs of 6.19 (± 0.99), compared to a European average of 6.35. The multivariable analysis highlighted that the medical profession reported higher knowledge regarding prudent antibiotic use and AMR (aOR 6.90; 95% CI 1.83-26.01, p-value = 0.004), while concerning professional practice, the unavailability and difficulty of access to guidelines seemed to increase the risk of reporting inadequate knowledge (aOR 2.04; 95% CI 1.01-4.13, p-value = 0.046).

Conclusions

Our preliminary results provide an insight into the importance of structuring and actively disseminating procedures/protocols and guidelines to deepen the issues of AMR and prudent antibiotic use. Also, there appears to be a need to enhance the delivery of refresher courses targeting HWs, with particular attention to settings at high infection transmission risk. EU funding: Project no. PE00000007, INF-ACT.

Key messages

• Although a higher knowledge about prudent antibiotic use and AMR, more efforts are needed to increase access to guidelines.

• Constant updating of knowledge and practices is necessary to face the challenges of antibiotic resistance in public health.