bluuebunny/crossref_metadata_2025 huggingface dataset:
Extra-pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)
Authors: Ben Nasrallah C , Kacem M , Grira S , Dhouib W , Bannour R , Zemni I , Ben Fredj M , Abroug H , Belguith Sriha A
Published: October 2020

Background

Tuberculosis (TB) is global public health problem and up to 25% of TB cases present extrapulmonary involvement. The incidence of extrapulmonary tuberculosis (EPTB) is increased worldwide. Our study aimed to give an update on the epidemiology, current trends of EPTB from 2000 to 2017 and to predict future trajectories of EPTB up to 2030 in Monastir, Tunisia.

Methods

We performed an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

During 18 years, 997 cases of TB were declared in Monastir. Almost 51% (n = 509) were EPTB. Sex ratio was 1.68. The main EPTB forms were lymph nodes in 234 (23.5%) cases, followed by pleural TB in 35 (3.5%) cases and bone and joints in 31 (3.1%) cases. CIR was 5.62/100,000 inhabitants (inh) for EPTB with a highest incidence in patients aged 60 years and above. A positive trend was showed for EPTB with a (b = 0.05; p < 0.0001) especially for lymph node localization. Up to 2030, EPTB would be increasing with an estimated incidence rate of 9.11/100,000 inh. Regarding lymph node TB, cases may continue to rise with an estimated incidence rate of 7.96 /100,000 inh.

Conclusions

Despite the availability of a treatment and knowledge on prevention measures, EPTB remains a public health problem. Thus, investigating and identifying patients at higher risk is needed in order to improve its management.

Key messages

Updated epidemiology is important for healthcare experts to improve planning policies attributed to EPTB. Our results are a tool for decision-makers to assess the efficiency of TB control programs.
Binge drinking in high school students from Fafe, Portugal: prevalence and associated factors
Authors: Fernandes S , Pardo M
Published: October 2020

Background

Binge drinking is defined, by 5 or more doses of alcohol on a single occasion (4 or more, in case of women). The excessive alchool consumption is the behavior with the most significant impact on youth mortality and morbidity. Binge drinking is a public health problem that can be preventable. The aim of this investigation was to estimate the prevalence of binge drinking and analyze the associated factors to this behaviour among high school students from Fafe, Portugal.

Methods

Cross-sectional study. Invited 1334 high-school students, aged between 15 and 19 to fill in an anonymous self-administered digital survey between May and June 2019, wich includes questions about alcohol sociodemographic characteristics, physical activity and smoking. Associations between binge drinking in the last 2 months and the several factors were analyzed through multivariated logistic regression, using IBM SPSS v.20, considering a significance level of 5%.

Results

A total of 786 students answered the survey (response rate 58.9%), 714 surveys were validated. The median age of participants was 17(1.074 sd) years and 54,8% were girls. The proportion of students from academic high school were 70.9%. Considering all the students estimated binge drinking prevalence was 28.6% (95%IC:25.35-31.79) and 41,5% (95%IC:36.9-45.8) within who have reported to drink. Binge drinking was associated with male gender (OR = 1.75; 95%IC:1.186-2.585), regulary cigarrete smoking (OR = 7.48; 95%IC: 3.422-16.347), being on 12th grade (OR = 2,677; 95%IC:1.625-4.412). There wasńt found association on binge drinking proportion between students from academic or vocational school.

Conclusions

Our study concluded that binge drinking is common among Fafe high school students. This study provides relevant information to public health authorities about the binge drinke behaviour on this population and makes possible to identify the most high-risk students of binge drinking in order to planning interventions.

Key messages

Binge drinking pattern is increasing among adolescents and young adults. Future preventive interventions on binge drinking are importante and should consider the associated factors of this behaviour.
Mobile-based and open-source infectious disease surveillance and outbreak management in Tanzania
Authors: Kassim I , Arinze C , Tom-Aba D , Adeoye O , Ihekweazu C , McHugh T D , Abubakar I , Krause G , Mwakasungula S , Masanja H , Aldridge R W
Published: October 2020

Introduction

The PANDORA-ID-NET consortium aims to build capacity for effective outbreak response in sub-Saharan Africa. Part of this mission is to develop a real-time data sharing platform for disease outbreaks that leverages centralised data management and uses mobile technologies for data gathering and feedback. We have committed to using open-source technologies, so that the platform can be deployed on regional IT infrastructure and further developed by local staff, and collected data can be stored and processed in the region of origin. This abstract aims to describe how we identified a state of the art open-source system that fulfils these criteria, and the process of how we are extending it to function within the current infectious disease control framework in Tanzania, under our partnership with the Ifakara Health Institute (IHI).

Methods

To find state of the art open-source systems matching our criteria, we performed a rapid review of the literature. We screened 1022 articles and found 15 candidate systems, out of which only SORMAS satisfied the criteria. SORMAS was developed jointly by the Helmholtz Centre for Infection Research (HZI) and the Nigeria CDC, and was modeled on Nigeria's successful response to the Ebola outbreak. The system can be used for case management, contact tracing, surveillance, and laboratory sample management. Data is collected and synchronised using Android mobile devices (both online and offline) and data aggregation and analysis are performed in real-time via a web application

Results

Having chosen SORMAS, we established a collaboration between the SORMAS developer team and the PANDORA team. IHI are guiding ongoing work on adapting SORMAS to the Tanzanian health facility geography and the country's case definition guidelines for notifiable diseases.

Conclusions

Once adapted for Tanzania, SORMAS will fill an unoccupied niche in infectious disease control, improving the quality of collected case data and enabling better outbreak response

Key messages

A state of the art, mobile-based, open-source outbreak management and infectious disease surveillance system (SORMAS) is being deployed in Tanzania. We outline our experience with piloting SORMAS in Tanzania, building on the experience of our Nigerian and German partners, who rolled out this system nationally in Nigeria and other African countries.
Bladder cancer incidence and predictions: Observational Study (Monastir, Tunisia: (2002-2030)
Authors: Ben Nasrallah C , Zemni I , Bannour R , Aroua N , Dhouib W , Kacem M , Abroug H , Ben Fredj M , Sriha Belguith A
Published: October 2020

Background

Bladder cancer is a highly prevalent disease and is associated with substantial morbidity, mortality if not treated optimally. We aimed to describe bladder cancer incidence and trends from 2002 to 2013 and to estimate predictions up to 2030.

Methods

We performed an observational study from 2002 to 2013. Incidence was estimated by the crude incidence rate (CIR) and standardized incidence rate (SIR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results

A total of 1024 cases of bladder cancer was declared from 2002 to 2013 predominately among males with a rate of 90.4%. CIR was 16.79/100,000 inhabitants (inh) and SIR was 21.38/100,000 inh. By gender, SIR was 41.3/100,000 inh and 7.73/100,000 inh for males and females respectively. During our study period a significant positive trend was noted with a (b = 0.042, p < 10-4). In 2030, the predicted incidence rate would increase to 28.4/100,000 inh.

Conclusions

The findings have highlighted the positive trend and the increased predicted incidence of bladder cancer in 2030. Thus, developing primary prevention strategies is crucial.

Key messages

Our results are important for health-care professionals to improve planning policies related to bladder cancer. Identifying associated factors is crucial to guide preventive strategies measures.
Ambassad’Air: A French example of how citizen sensing can fuel the smart city
Authors: Dardier G , Jabot F
Published: October 2020

Low-cost sensors are considered as a promising tool to contribute to urban air quality policies. In some initiatives, based on citizen sensing, they are used to gather data and gain a better understanding of the problem, thus fitting in a technology-oriented smart city model. In others, closer to citizen science, they are used to engage citizens in finding solutions, therefore fueling a more citizen-oriented smart city model, the smart enough city. Although important, the political effects of such initiatives have not been widely analyzed so far. To address this issue, we have studied Ambassad'Air, a citizen sensing initiative led in Rennes since 2016: What are the political consequences of this project? And which smart city model does it fuel?

Based on a littterature review, we built an analytical framework for the two smart city models. Then, we realized 81 interviews with Ambassad'air's volunteers and managers to analyze the initiative's strategy, its implementation (participatory mechanisms; use of data) and its political effects (change in political agenda or projects; citizen mobilization).

Initially, micro-sensors were lent to volunteers with the aim of turning them into peer-educators able to raise awareness around them and into empowered citizens able to influence local air quality policies. However, the initiative faced implementation barriers (persistent blurring between citizen science and citizen sensing; limitations to produce problem-oriented, scientifically validated, mass data) that limited its short-term political effects. It has sparked a local interest, though, for micro-sensors, and it is questionning the management of citizen-produced data.

With no political mechanisms that transform citizen sensing from a practice to an input for risk regulation, Ambassad'Air is not quite yet a tool of a smart enough city. But as a way to produce sensitive environments that any citizen can interact with in real-time, it is a step towards a more senseable city.

Key messages

Citizen sensing can fix the participatory breakdowns of the smart city while feeding its big data but it needs political mechanisms that recognize the role of citizen expertise in decision making. Micro-sensors can serve a wide range of strategies, from community-based environmental surveillance that seeks knowledge to gain power, to top-down citizen sensing that seeks data to gain control.
Does dialogue improve the sustainable employability of low-educated employees? A study protocol
Authors: Hazelzet E , Bosma H , de Rijk A , Houkes I
Published: October 2020

Background

There is a need to develop sustainable employability (SE) interventions that are better aligned to the needs of low-educated employees. This group needs to get a voice in intervention development and implementation. In this study, a dialogue-based approach is proposed consisting of an online step-by-step support toolkit for employers, 'Healthy Human Resources' (HHR). When intervening, this toolkit enables and stimulates employers to have a continuous dialogue with their low-educated employees. By improving the employees' job control, HHR is aimed at cost-beneficially improving SE. This paper describes the protocol of the evaluation study to evaluate the effectiveness and implementation process of HHR on the SE of low-educated employees.

Methods

The protocol of the evaluation study consists of: 1) an effect evaluation with a pretest-posttest design with a one-year follow-up in five work organizations deploying low-educated employees and with SE as the primary outcome and job control as the secondary outcome. The effect evaluation is expanded with a budget impact analysis; 2) a mixed-method process evaluation at six and twelve months after the start of HHR to evaluate the whole implementation process of HHR. This includes the experiences with HHR of various stakeholders, such as employees, human resource managers, and line managers.

Results

The upcoming effect evaluation, as described in this study protocol, will give insight into the effects of HHR on the SE of low-educated employees. The process evaluation, as described, will provide insight into the barriers and facilitators related to the (in) effectiveness of HHR.

Conclusions

By improving dialogue, we hypothesize that HHR, through enhancing job control, will strengthen the SE of low-educated employees. If HHR is proven effective, we also recommend the implementation of HHR on a wider scale, in order to tackle the socioeconomic health gap.

Key messages

This paper describes a protocol for the evaluation of a dialogue-based approach (Healthy HR) to improve the sustainable employability of low-educated employees. Healthy HR is expected to facilitate employers in the development of effective SE interventions in a true dialogue with their low-educated employees.
Early systematic communication between physician, patient and employer to promote return to work
Authors: Nordling P , Nordeman L , Skoglund I M , Björkelund C , Hensing G
Published: October 2020

Background

In the sickness absence and return-to-work process communication between stakeholders is beneficial but difficult to achieve. Addressing work-related issues early in the process could support decision making. The aim of this study was to test if early systematic communication about work and health between physician, patient/employee and employer facilitated by a communication tool, the Capacity Note, was feasible for patients with common mental disorders (CMD) in primary care.

Methods

In a pragmatic trial, physicians at primary health care centers (PHCCs) were randomized to control/intervention physician and were responsible for identifying eligible patients. In addition to usual care, intervention patients used the Capacity Note with their physician and were then instructed to use it with their employer and return it to the physician. Control patients received usual care. A study log book and sick leave data for each PHCC were used for process evaluation purposes.

Results

Eighteen of 24 PHCCs in the region were contacted; eight participated. At study start, 434 patients filled the basic inclusion criteria. Of these, 93 were identified as eligible by the physicians and were asked to participate. Around 40% declined participation, most commonly due to lack of energy or hesitation to talk to the employer. The final sample included 56 patients. Of the 28 intervention patients nine (32%) completed the intervention.

Conclusions

The study was negatively affected by suboptimal research conditions in primary care (e.g. severe time constraints). Also, the patients' hesitation to participate highlights the sensitivity of the topic and the difficulties in doing research in this vulnerable patient group. Thus, the feasibility was hampered by both organizational and patient related factors. It is of utmost importance to improve possibilities for social psychiatric research in primary care given the high prevalence of CMD and associated reduced capacity to work.

Key messages

Discussing health-related issues with the employer was seen as a sensitive matter among patients with common mental disorders. Research on best practices for sickness certification and return-to-work was difficult to achieve due to both personal and organizational factors.
Enabling self-direction in return to work of workers with high and low levels of education
Authors: Hoefsmit N , Pennings B , Houkes I
Published: October 2020

Background

Dutch legislation stimulates active participation of employees in their return-to-work (RTW) process. Earlier research showed that employees, particularly with low levels of education, are not always able to self-direct RTW. Empowering leadership may support this process. This study answers two research questions: (1) What differences and similarities do employers of employees with low versus high levels of education show in their management of RTW? (2) To what degree do the roles of employers in both types of organizations resemble empowering leadership?

Methods

We performed semi-structured, in-depth interviews with 10 HR professionals and supervisors working at a Dutch university. We also analysed transcripts from a study in which 13 HR professionals and supervisors from multiple Dutch industries (employing workers with low levels of education) were interviewed. We used purposive sampling to recruit participants. For question 1, the transcripts were analysed thematically. For question 2, pattern matching was applied.

Results

Preliminary results indicate that supervisors of both types of employees, show several similarities in managing RTW, such as the focus on possibilities instead of impossibilities, asking the advice of the occupational physician, and seeking support to increase employability. We also found that supervisors of employees with low levels of education have a stronger tendency to control and steer RTW and feel that possibilities for RTW are limited, while supervisors of high-educated employees tend to engage in dialogue more often and search for possibilities for work adjustments. Empowering leadership seems to be less common among supervisors of employees with low levels of education.

Conclusions

This study will benefit employers (of workers with both low and high levels of education) who aim to enable employees' self-direction in RTW, and help supervisors to develop more empowering leadership styles. This may lead to more sustainable RTW.

Key messages

Supervisors of employees with lower levels of education have a strong tendency to control and steer their employees’ return-to-work. Enabling employees’ self-direction in return-to-work requires empowering leadership.
Factors associated with psychoactive substance use among truck drivers
Authors: Abreu A , Costa R , Portela I , Jomar Rafael , Sousa A I , Souza M H
Published: October 2020

Introduction

The World Health Organization's report shows a growing concern about drug use and road safety worlwide.

Objectives

To identify sociodemographic, health and occupational characteristics associated with use of psychoactive substances among truck drivers.

Methods

This is a cross-sectional study conducted with 354 drivers from January to June, 2016. Data collection was based on a multidimensional questionnaire that included the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) and the Self Reporting Questionnaire (SRQ-20) instruments. The hierarchical approach was adopted for odds ratio (OR) adjustment. The variables that showed statistical significance with p ≤ 0.10 in the bivariate analyzes were selected for the multiple logistic regression analysis performed in the IBM SPSS software (v.19.0).

Results

The use of psychoactive substances in the last three months was associated to low family per capita income (OR, 2.59; 95%CI, 1.23-5.47) and poor self-reported health (1.96; 1.16-3.32), self-reported insomnia (2.9; 1.73-4.87), Common Mental Disorders (3.05; 1.62-5.75) and illness-related absenteeism (1,70; 1.02-2.85). Regarding work characteristics, the use of psychoactive substances in the last three months was observed among those with less than 15 years of work (1.78; 1.07-2.94), daily work journey longer than 6h/day (2.83; 1.69-4.74) and with less than 6 hours of daily rest (1.88; 1.12-3.14).

Conclusions

The results showed worrying vulnerability factors associated with the use of psychoactive substances among truck drivers in Brazil.

Key messages

The survey of 354 truck drivers described the vulnerability and risk factors, which are exposed, as inadequate work conditions associated with the use of psychoactive substances. It showed a greater chance of at least the use of one of the substances (alcohol, cocaine, amphetamine), among truck drivers and the importance in the development of public policies for this worker.
Home and Leisure Accidents in children and young people from 0 to 19 years old in Portugal 2018
Authors: Alves T , Rodrigues E , Mexia R , Neto M , Matias-Dias C
Published: October 2020

Background

Injuries and accidents are a challenge for public health considering their impact on victims and their families, especially in the younger, and also the potential for prevention and predictability. Due to specific characteristics of children and young persons related to the need of exploration and curiosity injuries namely those occur in domestic and leisure time, including the school setting are a topic of particular interest and study. This study aimed to characterize the occurrence of Home and Leisure Accidents (HLA) using hospital Emergency Department (ED) registered in EVITA system, in victims between 0 and 19 years old considering the injury mechanism, place of occurrence and products involved in the accident, in 2018, in Portugal.

Methods

Were analysed data from the EVITA system, fed by the HLA registry at the ED of the Hospitals National Health that participate in this system. The frequency and distribution of HLA were analysed according to the injury mechanism, place of occurrence and products involved.

Results and Discussion

In 2018, there were 38 528 ED attendances due to HLA 35,0% of the victims were between 10-14 years old; 23,7% had 5-9 years; 22,8% between 15 and 19 years old and 18,5% had under 4 years old. The results show more frequently HLA in males (59,0%) than in females (41,0%). In children under 4 years old 67,8% of the HLA occurred at home, due to fall (68,6%), having as products most involved the bed (10,2%) and chair or bench (7,5%). Between 5 and 9 years old, most HLA occurred at school (44,5%) due to fall (62,9%), involving ball (15,1%) and scooter/tricycle/bike (6,8%). In young people between 10 and 19 years old 47,7% of HLA occurred at school, due to fall (54,6%), having as main agents involved ball (28,7%) and scooter/tricycle/bike (20,3%). This information reinforces the importance of this problem but it is necessary future lines of research in order to point out the determinants of this mechanisms of injury.

Key messages

The National Injury Surveillance System provides information that allows to know the characteristics and underlying causes of HLA that occur in children and young people. These data provide useful information for public health professionals working in the field of injury prevention among this vulnerable group of young people.
Occupational exposure in acute-care hospitals, can we ensure equity in treatment?
Authors: Antinolfi F , Brunelli L , Malacarne F , Cocconi R , Brusaferro S
Published: October 2020

Background

Healthcare workers (HCWs) occupational exposure to vaccine-preventable diseases (VPDs) is a great challenge, especially for the risk of disease transmission to patients and general population. Our aim was to explore HCWs occupational exposure management within Friuli Venezia-Giulia (FVG) Region (Italy) in order to identify the most appropriate and equal strategies.

Methods

In December 2019 we collected data from the 7 acute-care hospitals of FVG. Total number of employees, methods to investigate on potential exposure to VPDs, immunity assumptions and management of occupational exposure were investigated.

Results

We obtained data from all FVG hospitals, for a total of 14,002 employees (average 2,000; range 551-4,336), including 12,557 HCWs (average 1,794; range 467-3,922). Four hospitals also include students, being academic centers (2) or research institutions (2). All hospitals conduct potential exposure investigation among HCWs, including patients, caregivers, visitors, non-HCW employees, but students are considered in 6/7 hospitals. Immunity of exposed subjects is assumed based on vaccination evidence or serological positivity. Exclusion from work is prescribed to exposed susceptible HCWs in 5/7 hospitals, while workers re-allocation to lower risk wards is required in 4 hospitals; in 2 cases HWCs are asked to wear a mask during their shift. When appropriate, 2 hospitals administer immunoglobulin, whereas a specific procedure for susceptible HCWs exposure was not always available. In 6 cases the exposure of non-HCWs subjects is notified to the occupational doctor or worker manager, and in 1 case serological positivity is directly tested.

Conclusions

There is heterogeneity in the management of VPDs occupational exposure within FVG, in particular regarding the surveyed categories and the actions required to the exposed subjects. The evaluation of potential adverse outcomes on patients would contribute in designing a more effective preventive strategy.

Key messages

The adoption of different strategies in the HCWs occupational exposure management could result in potential treatment inequality. Exploring occupational exposure management strategies adopted in hospitals is fundamental to standardize practices.
Directive 2019/904/EU. The need to raise awareness on plastic misuse and consequences on health
Authors: Aristei L , Villani L , Ricciardi W
Published: October 2020

The EU Directive 5 June 2019, n. 904, aims to promote sustainable reusable products and systems in a circular perspective, reducing the production of disposable products and waste.

Abandoned plastics take decades to disintegrate, never disappearing completely from the environment, with serious consequences for human health. A study conducted by the European Food Safety Authority (EFSA) has found that pollutants such as polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs) or bisphenol A (BPA) can accumulate in microplastics, which are swallowed by humans as well as inhaled or ingested reaching lungs. For instance, it has been estimated that every week we ingest the same amount of microplastics as a credit card. Furthermore, plastic kills and damages biodiversity. Aquatic animals are the most affected, as they are either trapped in man-made plastic waste or they swallow plastics with serious damage to their and the humans' health that eat them. Dangerous are also nanoplastics that can penetrate cell walls and are chemically more reactive.

However, Directive 2019/904/EU does not eliminate the use of plastic, setting the percentages of recycled plastics to be used in the manufacture of disposable plastic products. For instance, beverage PET bottles must contain at least 25% of recycled plastic from 2025 and 30% from 2030.

Despite the Directive has provided elements for states to legislate in favour of a society that makes less use of plastics, today no zero- plastic society has been created. In order to achieve this 'zero' it is necessary to start from the citizens, raising their awareness through awareness-raising campaigns and the distribution of leaflets and posters on the consequences of the mismanagement of plastic waste (and microplastics) on their health and on the environment.

Key messages

Raise citizens awareness on the consequences of the mismanagement of plastic waste (and microplastics) on their health and on the environment is fundamental. The importance of the creation of a zero plastic society thanks to the application of Directive 2019/904/EU at international level.
The Tunisian societal dialogue for health reform (a qualitative study)
Authors: Ben Mesmia H , Chtioui R , Ben Rejeb M
Published: October 2020

Background

Tunisia is currently through its second phase of the Societal Dialogue for Health System Reform to develop a National Health Policy 2030. By contributing to the documentation of this process this work will allow the different partners to have an overview of its place in health planning as well as the success factors and the challenges of the model in relation to international norms and experiences.

Methods

This work was based on a qualitative analysis of semi-structured interviews with citizen juries and experts that took place from May 2018 to September 2018. The qualitative analysis was done according to a cross-matrix between the themes of the interview of the two groups of interviewees. The analysis of the data was mixed: a coding of the data collected was done beforehand. However this frame has been adjusted according to the transcriptions.

Results

The qualitative analysis of the data highlighted four axes: the context of initiation of the societal dialogue and the passage from the claim to the political instrumentalization, the citizen participation and the role of the various actors, the mixed perception of the societal dialogue and the crisis of trust, the methodology of the social dialogue process, especially the 'Citizen Jury' method. The main factors of success of the societal dialogue are the commitment of the actors, the political will, the inclusivity and the multidisciplinarity of the process and finally the communication around the process. The main challenges are the non-ownership of the process by the policies and the different stakeholders as well as the doubt about the achievement of these results.

Conclusions

It is important to introduce regular citizen and societal consultation so that it can credibly feed into policy review processes and inform policy makers on a regular basis. It would be important to think of a model for the sustainability of this approach. This involves finding the necessary financial and operational means.

Key messages

The promotion of citizen's participation in health is crucial in the new Tunisian democratic experience. A legal framework is needed to ensure the sustainability of the new approach of citizen's participation in health.
A single-payer health care system in Croatia: problem or solution?
Authors: Kujundžić Tiljak M , Orešković S , Tiljak H
Published: October 2020

Background

Andrija Štampar implemented innovative healthcare solutions in Croatia at the beginning of the 20th century, advocating principles of comprehensiveness, continuity, and availability. These principles are globally challenged at ideological, social and policy levels, reflecting discussions in the USA and EU on whether a single-payer, mandatory health insurance (MHI) system and universal health coverage (UHC) are optimal solutions for the sustainable health system of the 21st century?

Methods

Analyzing the impact of the Croatian Health Insurance Fund (CHIF) as a single-payer on the performance of Croatia's health care system through the analysis of the financial and health outcomes for the 2000-2020 period to assess allocative efficiency, organizational effectiveness, and economic sustainability.

Results

The CHIF is the single purchaser of all publicly financed individual health services, delivered through both public and private providers. Although the broad scope of the MHI scheme, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced in the last twenty years. The financial sustainability of the system is decreasing mainly caused by the model focusing on the tertiary care and payment scheme based on monthly hospital limits. However, the incidence of catastrophic and impoverishing payments is lower in Croatia than in many other EU13 countries.

Conclusions

The solution might be in the development of integrated health services, implementation of health promotion, education, and awareness, diseases prevention, and focus on the outcomes. The funding should follow the population needs in accordance with public health priorities and not only the structural demand of the existing system. The alternative is to face additional financial burden and impoverishment of the population in need of healthcare services.

Key messages

Modern universal health coverage strives to integrate health care and focuses on the outcomes. Single-payer system is not an obstacle for integration or source of fragmentation.
Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study
Authors: Di Pilla A , Bruno S , Carini E , Beccia V , Quaranta G , La Milia D , Masini L , Carducci B , Lanzone A , Laurenti P
Published: October 2020

Background

Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age.

Methods

A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session.

Results

Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention.

Conclusions

Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective.

Key messages

The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.
Prevalence of second-hand smoke exposure in houses in Turkey: a meta-analysis study
Authors: Kılınç A , Çam C , Önsüz M F , Metintaş S
Published: October 2020

Background

Second hand smoke(SHS) exposure means breathing the air polluted by someone else's cigarette smoke. The aim of the study was to perform a meta-analysis of studies about the in-house second hand smoke exposure prevalence in Turkey.

Methods

PubMed, Web of Science, Turkey Citation Index, TR Index and the Cochrane library databases in the screening of articles published in Turkish and English languages “second hand smoke”, “prevalence” and “Turkey” keywords were used. Studies who were original, were cross-sectional, had the number of participants and the number of people exposed to in-house SHS, used age groups and were conducted in Turkey were in accordance with our inclusion criteria thus included in the study. Global tobacco surveys and studies using data from them were also included. OpenMeta[Analyst] program was used to calculate the prevalence rate of the study groups. Since the articles were p < 0.001 in the heterogeneity test, prevalence rate and 95% confidence intervals were calculated from the number of cases using the random effects model in group analysis.

Results

As a result of the scan, 59 articles were reached. Duplications were eliminated and summaries of the remaining articles were read as double-blind. Suitable for inclusion criteria and quality evaluation 11 studies were included in the meta analysis. Among them, 7 studies were conducted on people who are younger than 15 years. The meta analysis showed that the SHS exposure for those aged 15 and above was 12 097/30 138 (39.3%; 95% CI: 25.9-52.8) and for those younger than 15 was 57 028/112 547 (55.9%; 95% CI: 42.4-69.4).

Conclusions

As a result of the comprehensive literature research, it was found that the SHS exposure in houses is a huge problem for Turkey especially for the young people.

Key messages

The exposure to second-hand smoking in houses puts both youth and adult population’s health at risk in Turkey. Intervention programs should be commenced to tackle high exposure rates and in-house smoking.
2019-20 influenza coverage among healthcare workers: how a Northern-Italian Region tackles hesitancy
Authors: Antinolfi F , Brunelli L , Malacarne F , Bucci F G , Varadi G , Gallo T , Cocconi R , Brusaferro S
Published: October 2020

Introduction

WHO stresses the need to implement multi-component interventions to raise coverage among healthcare workers (HCWs). We investigated different HCWs influenza immunization programs within Friuli Venezia Giulia (FVG) Region hospitals (Italy) during 2019-20 flu season with the aim of identifying the most effective strategies to tackle hesitancy.

Methods

In December 2019 we collected from FVG hospitals: number of employed HCWs, vaccination strategies against flu and refusers management during 2019-20 flu season. We obtained data about HCWs flu vaccination coverage from the regional database; Chi-square test was used to find correlation between strategies and coverage.

Results

We collected data from 7/7 hospitals for a total of employed HCWs of 12,557 (average 1,794; range 467-3,922); 2 hospitals being academic centers and 2 research institutions. All hospitals promoted flu vaccination using emails, notice on hospital website and posters display; 3/7 organized training courses. Vaccination was always provided within the hospital in a dedicated easy and free access room; most hospitals (5/7) also offered ward on-site sessions, some allowing ward self-administration (3/7) or organizing on demand extra-sessions (2/7). No countermeasures were taken in case of refusal. Regional HCWs flu vaccination coverage resulted to be 24.9% (range 17-33.3). Multi-component intervention including passive and active offer, communication and education activities was confirmed to be significantly associated with higher HCWs flu coverage (OR 1.7; CI 1.6-1.9; p < 0.01), as well as being the hospital an academic center or a research institution (OR 1.3; CI 1.2-1.5; p < 0.01).

Conclusions

Different strategies to foster HCWs vaccination were adopted in FVG Region during 2019-20 flu season. The multi-component approach producing the best results should be further analyzed in order to identify the most effective recipe to be shared both nationally and internationally.

Key messages

Investigating the relation between HCWs flu immunization strategies and their effect is crucial to identify best practices. A multi-component approach including passive and active offer, communication and education activities seems the most effective way to tackle influenza vaccine hesitancy among HCWs.
Understanding hesitancy around vaccines and vaccination: an umbrella review
Authors: Giannakou K , Vachtsioli E
Published: October 2020

Background

Vaccination has been evaluated and was found to be the most successful and cost-effective interventions to preventing illness and improve health outcomes. However, internationally, an increase in vaccine hesitancy has led to a decrease in vaccination uptake. We conducted an umbrella review to assess the factors related to under-vaccination and non-vaccination from a global perspective.

Methods

PubMed, EMBASE and Science Direct were searched from inception to December 2019 for systematic reviews and meta-analyses that examined the factors affecting vaccination choices. No restrictions on language, publication date, vaccination type, setting, or population were applied. Narrative and extensive reviews were excluded. A narrative synthesis was undertaken to present the results thematically.

Results

Twenty-two systematic reviews met the inclusion criteria. The published evidence on this topic shows that, overall, a variety of complex factors exist related to vaccine hesitancy. Across all articles included, the main areas of concern were around vaccine safety and efficacy. Mistrust towards vaccine-related bodies (e.g. pharmaceutical companies, health professionals, researchers etc.), inconvenience, cost, and overall lack of information/knowledge were also identified as major barriers to vaccine uptake. Barriers vary depending on population, place and vaccines.

Conclusions

Our results show a variety of complex factors influencing the decision to accept, delay or reject some or all vaccines, indicating the necessity of a multi-faceted approach to address them in order to improve vaccine coverage.

Key messages

The results of this review show that concerns regarding vaccine safety and efficacy were the most significant barriers. Further research, policies, programs, and community-driven initiatives are needed to enhance acceptability and uptake of vaccination.
Predictors of influenza vaccination uptake among elderly in Croatia
Authors: Miskulin I , Vcev A , Matic Licanin M , Vcev I , Vukoja I , Miskulin M
Published: October 2020

Background

Influenza vaccination (IV) is recommended for elderly but vaccination coverage in this group remains unsatisfactory in Croatia. The aim of this study was to explore IV uptake among elderly from Eastern Croatia and predictors that influence this uptake.

Methods

This cross-sectional questionnaire study was conducted during 2018/2019 influenza season in convenient sample of older adults aged 65 years or more from Eastern Croatia at the primary health care setting.

Results

The study sample consisted of 816 subjects (48.0% males and 52.0% females). The median age of all subjects was 73.0 years (interquartile range (IQR) 69.5 - 79.0 years). The overall prevalence of IV uptake was 33.3%. The IV uptake was statistically more frequent among females (P < 0.001) and old-old subgroup (85 years and older) (P < 0.001). There was no statistically significant difference in IV uptake considering marital status of subjects (P > 0.999). The median number of positive attitudes towards IV was 4.0 (IQR 2.0 - 4.0) and the median number of correct answers was 6.0 (IQR 4.0 - 8.0). The study revealed fair positive correlation between attitudes and IV uptake (rho=0.477; P < 0.001) and poor positive correlation between knowledge and IV uptake (rho=0.242; P < 0.001). The study further showed poor positive correlation between presence of comorbidities and IV uptake (rho=0.187; P < 0.001) and moderate positive correlation between previous year vaccination history and IV uptake (rho=0.669; P < 0.001).

Conclusions

The study showed that observed IV uptake is far below EU target influenza vaccination coverage among elderly of 75%. The study revealed that fairly good predictors of IV uptake in study population were gender, older age group, and previous year vaccination history while attitudes, knowledge and presence of comorbidities were fairly poor predictors. The good predictors of IV uptake among elderly should be taken into account during influenza vaccination popularization strategies development.

Key messages

Understanding the factors that could improve the acceptance of vaccination is crucial to design effective public health interventions. The structured communication campaigns on influenza and influenza vaccines should be developed and directed specifically to elderly as one of target groups for vaccination.
Prevalence of seasonal Influenza vaccination among Tunisian elderly
Authors: Kharroubi G , Cherif I , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J
Published: October 2020

Background

Surveys to determine the uptake of influenza vaccine (IV) among the at-risk groups are required to evaluate the advancement of national vaccination strategies and the level of awareness in the surveyed population. In this context, the present study aimed to estimate influenza vaccination uptake in elderly in Tunisia during 2018-2019 influenza season and to assess their perceptions toward influenza and IV.

Methods

It was a national cross-sectional study conducted in 2019 in primary and secondary health care facilities, among persons aged 60 years and over with chronic disease. Data were collected using a standard administered questionnaire including questions about IV uptake, general knowledge and attitudes about influenza and IV. Perceptions of participants toward general statements about influenza and IV were compared by vaccination status using chi square test.

Results

In total, 1191 older persons were included. Nearly one third of participants (34.8% [32.2-37.6]) were vaccinated at least once at the past and 19.4% [17.1-21.9] received the vaccine during 2018-2019 influenza season. Compared to unvaccinated elderly, vaccinated persons were significantly more convinced that influenza is more dangerous for elderly people (90.0% vs. 82.2%, p = 0.008), that IV is recommended for older persons (88.7% vs. 70.1%, p < 0.001) and for those with chronic disease (86.1% vs. 64.1%, p < 0.001) and that IV can protect elderly persons (87.9% vs. 71.9%, p < 0.001) and those with chronic disease (88.3% vs. 66.3%, p < 0.001). Regarding attitude about the safety of the vaccine, while 14.4% of unvaccinated persons agreed that IV is not safe for older persons, only 9.5% of vaccinated elderly approved that statement (p = 0.060).

Conclusions

Our study showed a low influenza vaccination rate among Tunisian elderly. In order to promote IV, campaigns should focus on educating elderly regarding the seriousness of influenza and the efficiency and the safety of IV.

Key messages

Efforts must be invested to improve influenza vaccination coverage among Tunisian elderly especially those with chronic diseases. Educating elderly regarding influenza and IV is necessary since knowledge is a basis for adopting relevant attitudes and practices.