bluuebunny/crossref_metadata_2025 huggingface dataset:
Public preferences for involvement in the governance of health data
Authors: De Freitas C , Amorim M , Leão Teles E , Maia T , Machado H , Silva S
Published: October 2020

Background

Public involvement in the governance of epidemiological and public health studies can foster needs-driven research, enhance participants' recruitment, reduce attrition and improve the quality of and ethics in research and surveillance. However, it can also reinforce health inequalities if it fails to ensure public representation across socioeconomic gradients. This study aimed to assess patients' and carers' preferences for involvement in collective health data governance, and its associated factors, to strengthen the evidence base for policy development.

Methods

Between June 2019 and January 2020, 644 people (157 patients and 487 carers; participation rate=89.3%) followed at two reference centres for rare diseases in a university hospital from Northern Portugal were enrolled in an observational cross-sectional study. Data about willingness to participate in data governance was collected through four intersecting options: periodic or sporadic meetings, by either giving opinions (consultation) or participating in decision-making (deliberation). Data were analysed using descriptive and inferential statistics.

Results

From a total of 629 respondents, 39% are willing to get involved through at least one of the four participatory options and 16% do not want to participate. Patients and carers do not differ in their preferences for involvement. Sex and education are associated with willingness to participate, after adjustment for participant type (patient/carer), occupation and trust in national and international institutions (OR:1.60; 95%CI 1.05-2.45 for men vs. women and OR:1.65; 95%CI 1.07-2.56 for >12 vs. ≤12 educational years). Participants' preferred option for participation is consultative sporadic meetings (29.5%).

Conclusions

Anticipating which social groups are likely to become under-represented in participatory exercises is crucial to inform policy aimed at promoting inclusive involvement in health data governance.

Key messages

Men and higher educated participants are more willing to participate. Forecasting potential for subgroup under-representation is crucial to develop policy for inclusive participatory data governance.
Research Fairness Initiative opens a new era for equitable and impactful research collaborations
Authors: Al-Khaldi M
Published: October 2020

The global collaborations and partnerships in research and science are evidently growing as an inevitable reality to tackle the mounting common global challenges. To overcome all of these challenges and create a balance between countries, institutions, stakeholders, and fields and to strengthen the research and science fair collaborations and boost institutional research capacities and potential, the Council on Health Research for Development (COHRED), developed an evidence-based tool, the Research Fairness Initiative (RFI). This paper investigates the RFI experience and application among the Middle East partners to propose better ways for better research and science collaborations. The COHRED team used two scientific methods to understand the region's stakeholders on research collaboration. 7 telecom. meetings were carried out with 7 academic institutions in the region and a literature review was implemented. Partners in the region were largely interested when the RFI was introduced to 7 academic institutions from five countries: Palestine, Egypt, Lebanon, Jordan, and Saudi Arabia. 3 have launched the work of the RFI and they will be potential RFI reporting institutions by submitting RFI report. Efforts seeking to build and strengthen research and scientific collaborations receive real attention and also evidently proves the lack of collaboration and partnership platforms and frameworks is a reality. The RFI was seen as a useful institutional instrument to develop the institution's capacity. The major reason behind this is that the institutions are lacking structural, technical, logistical, ethical, resource capacities to establish and develop regional and international research and scientific collaborations. Research collaboration is a global, regional, and national priority and RFI is evidently recognized as a realistic and forward-thinking tool in building collaborations based on fairness, integrity, impact, and transparency.

Key messages

RFI is one of the best institutional reporting tools that ensure equitable and fair research collaborations. Research collaboration is a global, regional, and national priority for the slow-developing countries (Middle East region).
The importance and challenge of carcinogenic air pollutants for health risk and impact assessment
Authors: Mudu P , Pérez Velasco R , Zastenskaya I , Jarosinska D
Published: October 2020

Along the years, the International Agency for Research on Cancer (IARC) has classified many air pollutants components as carcinogens, including solvents, diesel engine exhaust, metals, such as chromium, nickel, arsenic, and cadmium. The IARC list of Group 1 carcinogens includes benzene, diesel exhaust, benzo[a]pyrene (B[a]P, a polycyclic aromatic hydrocarbon [PAH]), indoor emissions from coal combustion, and 1,3-buta-diene. Sources, mainly combustion-related, that emit airborne carcinogens can be both in indoor and outdoor. In 2013, the IARC has classified outdoor air pollution and one of its major components, particulate matter (PM), as carcinogenic. In its evaluation, the IARC suggested sufficient evidence showing that exposure to outdoor air pollution and PM causes lung cancer and it noted that a positive association between such pollution and an increased risk of bladder cancer. The association between exposure to air pollutant and cancer risk has been investigated in cohort studies and the results are generally consistent, indicating that long-term exposure to air pollution can cause lung cancer and increase risks of cancer in other locations. The use of the information on carcinogenicity is fundamental to produce estimates to quantify risks and impacts on exposed population. WHO in several recent activities has addressed this issue. For example, it is also under consideration by various experts in the framework of the Task Force for Health (TFH) of the UNECE Convention on Long-range Transboundary Air Pollution. The discussion of this session will focus on the implications and the challenges to integrate toxicological and epidemiological evidence of identified air carcinogens in health in risk and impact assessment.
Re-imagining anti-racism in the health sector in Aotearoa New Zealand
Authors: Came H , Kidd J , McCreanor T , Baker M , Rodgers B
Published: October 2020

Background

Racism and dishonouring of te Tiriti o Waitangi are significant contributors to ethnic health inequities in Aotearoa. It is unclear how health professionals can contribute to the disruption of racism.

Methods

This multi-disciplinary study draws on systems change tools, evidence from the health kaupapa Waitangi Tribunal claim (WAI 2575), a review of professional competencies documents, and focus groups with Māori and non-Māori health practitioners to identify how to strengthen anti-racism praxis in health services. The preliminary data collected in 2019 has undergone a thematic analysis and is being synthesised collaboratively with stakeholders to generate a complex continuum of anti-racism praxis. This will be applied via two site-specific action research projects.

Results

The pilot study has been completed but data collection is still underway on the main study. The initial cut of a continuum of practice grouped behaviours into i) problematic, ii) variable to iii) proactive. Problematic behaviors included examples of cultural and institutional racism, Variable behavior included engagement with Te Reo me ona tikanga (Māori language and protocols), and professional development and compliance. The proactive grouping included Māori leadership and workforce, responding to Māori realities, reflective practice and critical consciousness.

Conclusions

Initial findings suggest anti-racism continuum of practice may be useful to strengthen competency documents, curricula, policy and discipline-specific professional development planning.

Key messages

With the persistence of institutional racism in colonial settings like Aotearoa we need to imagine new ways to pursue anti-racism. Mapping anti-racism praxis is a useful way to identify variations in practice with a view to strengthening curriculum, competencies and ultimately practice.
Estimating diet costs: Bridging the gap between food supply price databases and dietary intake data
Authors: Luongo G , Tarasuk V , Yi Y , Mah C L
Published: October 2020

Introduction

The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices such as the Consumer Price Index (CPI). Our aim was to examine the nutritional significance of using food supply data to price dietary intakes in Canada.

Methods

We examined food groups and nutrients in dietary intakes captured by the CPI. For prices, we used 2015 Canadian CPI average monthly item prices. For dietary intakes, we used reported intakes from the 2015 Canadian Community Health Survey (CCHS)-Nutrition, 1st 24-hour recall (n = 20,487). i) 2015 CPI item prices ($/g) were matched to the 156 food items from the 2015 CCHS-Nutrition as full, partial, or non-match; ii) CPI capture (full or partial match) per total intake (g), without water, was calculated for each respondent; iii) descriptive statistics and quantile regression (α = 0.05) were used to compare intakes of Canadian Nutrient File food groups and nutrients by quantile of CPI capture.

Results

The CPI captured on average 74% of total dietary intake (g) without water. A greater proportion of protein and fat intake was captured by the CPI as compared to carbohydrate, sodium, fibre, and sugar intake. Intakes of beef, poultry, sausages, pork, and breakfast foods had among the best match; snack foods, nuts, veal, and alcoholic beverages had among the worst. Individuals in the poorest CPI capture quantile consumed the greatest fibre (g), carbohydrates (g), total sugar (g), fat (g), protein (g), and energy (kcal) as compared to those with best CPI capture.

Conclusions

The poorest quantile of CPI capture reflects individuals with high intakes of nutrients of concern including fat, carbohydrates, and sugar; potential bias in estimating fibre and protein intake was also detected. Researchers and decision makers should attend to differential misclassification bias and opportunities for tailored datasets to price dietary intakes.

Key messages

Given the proliferation of diet cost studies using food supply prices, this novel study highlights the importance of understanding the biases in using food supply data to price dietary intakes. Nutrition researchers and decision makers can use these findings to strengthen food supply price data to support the monitoring of diet costs in relation to diet quality and health outcomes.
Ownership and use of mobile phone and utilization of maternal health services in India
Authors: Gunamany S , Subramanyam M
Published: October 2020

Despite decades of maternal and child health programming, neonatal disorders, undernutrition, and iron deficiency, feature in the top ten causes of premature death or disability in India. With the increasing use of mobile phones, mobile health (mHealth) programs have been implemented to promote MCH services. As no study has examined the role of Indian women's ownership/access to mobile phones on their healthcare utilization, we assess whether ownership and use of mobile phones are associated with the utilization of antenatal care (ANC) and institutional delivery services in India. We analyzed data from a nationally representative household survey from India. Our analytic sample was 12047 women with data on mobile phone ownership. Mobile phone ownership and use (access to internet, texting facility) were the exposure variables. The outcome variables were having at least four ANC visits(ideal) and an institutional delivery. Survey-adjusted logistic regression models adjusted for women's autonomy, socioeconomic indicators, and access to mass media were fit. The unadjusted odds of having an ideal ANC were higher (OR = 1.5; CI = 1.35-1.62) among those who owned a mobile phone versus not. After adjustment for all covariates, mobile phone ownership was not associated with both outcomes. Women with access to the internet had higher odds (OR = 9.24; CI = 6.51-13.2.)of reporting an institutional delivery and of receiving an ideal ANC(OR = 2.99;CI=2.40-3.73). In the fully adjusted model, access to the internet was positively associated with having an institutional delivery (OR = 2.85; CI = 2.82-1.31) whereas ideal ANC was not(OR = 1.7;p=0.07). mHealth interventions targeting women in India, especially the rural, low-income subgroup, are unlikely to be effective unless simultaneous efforts are made to increase access to, and autonomy in, mobile phone use. The need to partner with social scientists during intervention design/implementation as well as other policy-relevant implications are discussed.

Key messages

Explains why it is important to address the disparities and barriers in the use of mobile phones before designing and implementing various mHealth interventions. Why is it important to include social scientists during designing and implementation of various technology-based interventions well as other policy-relevant implications are discussed.
Identification of Master Patient Index Record Challenges from Healthcare Professionals’ Perspectives
Authors: Lintz J
Published: October 2020

Background

A Master Patient Index (MPI) system is essentially a database that is built into an Electronic Health Record (EHR) system to maintain a unique identifier for each patient seen at the organizational or enterprise level. The current study is to identify the gaps between the revenue cycle and patient information functionalities used in Electronic Health Records (EHRs) in collecting and reporting patient information. Additional focus was on perceptions of healthcare professionals who are familiar with MPI systems on the impact of these gaps of ensuring maximum reimbursements and adequacy of services provided. The study also sought to glean their perceptions vis-a-vis key challenges in the EHRs that affect organizational workflow.

Methods

A semi-structured questionnaire was used to collect information from healthcare professionals responsible for the MPI. The population studied is healthcare organizations using EPIC as the Electronic Health Records (EHRs).

Results

This study confirmed systems gaps between EPIC and other downstream systems used by the healthcare organizations to process patient information, as well as the extent of patient matching challenges that healthcare professionals have encountered in the MPI. These challenges include varying methods of matching patient data; lack of data standardization; absence of policies and procedures; frequently changing demographic data; multiple required data points needed for record matching; and default and null values in key-identifying fields.

Conclusions

The study offered evidence found in the literature that implies that duplicate records continue to plague healthcare organizations. Widespread technological interoperability insufficiency among healthcare facilities points to future challenges for federal policy makers as they seek to promote interoperability programs to demonstrate meaningful use of certified electronic health record technology (CEHRT).

Key messages

The study confirmed that despite a low level of duplication in the MPI, the organizations have lost revenue during the last 6 months. Duplicate records in the EHR systems has led to downstream problems in the revenue cycle, including denials and insurance takebacks that impact hospital revenue cycle efficiency.
Do Internet influencers exert positive effects on health behaviours of their followers?
Authors: Szulc K , Duplaga M
Published: October 2020

Background

Internet lifestyle and fitness influencers (ILFI) are able to motive millions of followers. Due to their popularity, they achieve soaring revenues through the distributions of various health- and fitness related. Still, the impact of websites run by ILFI on health behaviours (HB) of their users has not been studied thoroughly yet. The study aimed at the analysis of the association between the use of such websites and HB of young adult women in Poland.

Methods

An online survey was carried out in the representative sample of 1030, 18-35 years old, women. The questionnaire used in the study consisted of 53 items asking about the use of ILFIs' websites, HB, health (HL) and e-health literacy (eHL), and socioeconomic (SE) status. The effects of ILFI on HB were assessed with logistic regression models after adjusting for HL, eHL and SE variables.

Results

The mean age (standard deviation) of respondents was 26.09 (4.85) years. There were 52.52% (n = 541) users of ILFI websites in the study group. The number of active smokers was 37.9% (n = 390) and of e-cigarettes users - 36.6% (n = 377). Of respondents, 42.5% (n = 437) consumed alcohol at least once weekly, 42.5% (n = 437) undertook some form of physical activity at least several times a week, and 43.9% (n = 452) consumed five portions of fruits and vegetables daily at least several times a week. The use of ILFI's websites was associated with higher physical activity (OR, 95%CI: 2.28, 1.66-3.13) and consumption of fruits and vegetables (1.72, 1.29-2.29), but not with smoking (1.04, 0.78-1.40) and alcohol consumption (1.12, 0.84-1.48). Interestingly, the followers of ILFI were more prone to use e-cigarettes (1.58, 1.08-2.31)

Conclusions

Women accessing the websites of ILFI show more favourable patterns of HB than non-users. Although ILFI are driven by economic motivation, they may be seen as allies in achieving health promotion goals.

Key messages

The use of Internet influencers’ websites is related to more favourable health behaviours. Commercial lifestyle and fitness websites may play an important role in the promotion of healthy lifestyle.
Psychotropic drug interactions among drug-dependent people
Authors: Schuelter-Trevisol F , Zapelini do Nascimento D , Moreno Marques G , Trevisol D J
Published: October 2020

Background

Using psychiatric drugs to treat drug dependence and its comorbidities is very common. The objective of this study was to analyze the interactions between prescribed drugs for patients treated at a specialized mental health care center for drug addicts, located in southern Brazil.

Methods

A cross-sectional study was conducted on secondary data collected from 2010 to 2018. We reviewed the medical records of patients aged 18 years or older who took psychotropic drugs and had any type of substance dependence. The analysis of psychotropic drug interactions was conducted in three databases: Medscape, Drug Interactions Checker, and Micromedex.

Results

We included 1,022 of the 2,322 patients attending the care center during the study period. Psychotropic drug interactions were found in 779 (76.4%) study participants, and they presented 2,292 (100%) interactions, out of which 136 (6.0%) had minor clinical risk, 537 (23.4%) had moderate risk, and 1,619 (70.6%) had major risk for the patient, totaling 172 incompatible combinations between two psychotropic drugs. Of the total number of interactions, 128 were pharmacokinetic and 44 were pharmacodynamic.

Conclusions

The high number of psychotropic drug interactions is a serious public health issue. Psychopharmacological treatment should be carefully addressed to be safe for the patient.

Key messages

The implementation of clinical pharmacy services in outpatient clinics, hospitals, and mental health care centers can be considered the most effective alternative to avoid adverse reactions. Pharmacists are ready to assist the entire multidisciplinary team involved in the treatment of patients with mental disorders or substance dependence, and provide pharmacological treatment.
Polysubstance use among adolescents in Tunisia
Authors: Sahli J , Limam M , Zedini C , Ghardallou M , Mtiraoui A , Mellouli M , Ajmi T
Published: October 2020

Background

Poly-substance use is a global public health problem associated with significant adverse social and health effects. Adolescents are increasingly affected by this risky behaviour. The objective of our study was to describe the poly-substance use and to determine the association between the different types of substance use among middle school students in the Region of Kairouan in Tunisia.

Methods

A cross-sectional study was conducted in 2017 among middle school students in the Region of Kairouan in Tunisia using a self-administered questionnaire for data collection.

Results

A total of 494 students participated in the survey. Tobacco, alcohol, cannabis and psychotropic drug uses were reported respectively by 7.9%, 7.3%, 6.3% and 14.3% of the students. Among the surveyed students, the poly-consumption of the four substances: alcohol, tobacco, cannabis and psychotropic medication without medical prescription was reported by 2.83% of the students. Among these poly-consumers, 57.1% were male. Poly substance use was found to increase with the level of study (21.4%, 28.6% and 50% respectively in grades 7, 8 and 9). In our study, among the smokers, 64.1% reported alcohol use, 69.2% reported cannabis use and 43.6% reported psychotropic drug use. Associations between tobacco use and other substances use were significant (p < 10-3). This association was significant for both boys and girls. In addition, 71% and 26% of alcohol users were respectively cannabis and psychotropic drug users. Alcohol use was significantly associated with cannabis and psychotropic drug use (p < 10-3). This association was significant for both boys and girls.

Conclusions

Adolescents are particularly vulnerable to multiple risky behaviors including substance use. Appropriate prevention and control strategies based on a participatory approach involving parents, teaching and medical staff should be put in place to combat this scourge.

Key messages

Despite a relatively low prevalence of poly-substance use among the surveyed students, a particular attention should be drawn to the phenomenon of psychotropic drug use without medical prescription. There is an urgent need for the implementation of an effective substance use prevention program in school settings in Tunisia where monitoring is one of its core components.
Validation of the disease experience questionnaire for working age adults with chronic conditions
Authors: Galardi M , Houkes I , de Rijk A
Published: October 2020

Background

Working age adults diagnosed with chronic diseases are growing in prevalence and not all of them manage to stay at work. Chronic conditions need a long-term response from the (occupational) health care system, which, however, is structured mostly around acute episodes. The aim was to develop and validate a questionnaire tapping working age patients' lived experiences with their chronic disease.

Methods

Based on a qualitative study, the 13-item Disease Experience Questionnaire (DEQ) was developed for persons in working age. DEQ taps 3 types of disease experiences: 1) Disruption: hopelessness and irreparable loss; 2) Meaningful: an opportunity to set new life priorities; 3) Episode: an inconvenient period to be overcome. Items were filled out online by 2,028 persons diagnosed with chronic headache, autism, HIV, neurofibromatosis, CKD or sarcoidosis. Several proxy variables and demographics were measured. Data were analyzed with PCA, reliability analysis, correlations with criterion variables and ANOVA to compare levels of disease experiences across groups differing in age, education and work status.

Results

Disruption was valid for all disease groups. Lower educated and non-working persons had significantly higher Disruption levels. Meaningful was valid for the total sample, the autism, HIV and sarcoidosis groups. Cronbach's alphas were .755 and .661 respectively. Episode was only valid for the HIV group (Cronbach's alpha .632). Levels of Meaningful and Episode did not differ in relation to age, education or work status. Correlations with criterion variables were in the expected directions.

Conclusions

DEQ is a valid tool for identifying disease experiences in working age adults with diverse chronic diseases. The disease experience of persons with HIV, for which also the Episode subscale can be helpful, differs from that of persons with other chronic diseases. The Disruption and Meaningful subscales can help to tailor (occupational) health care to patient needs.

Key messages

The Disease Experience Questionnaire (DEQ) is a valid tool to identify disease experiences in the working age population with chronic diseases. The DEQ Disruption and Meaningful subscales can help to tailor (occupational) health care to patient needs.
Breast cancer mortality rates trends by race in São Paulo, Brazil
Authors: Vale D B , Gozzi B , Marcelino A C , Oliveira J F , Cardoso-Filho C , Cunha G T , Batista P , Zeferino L C
Published: October 2020

Background

Breast cancer is the main cause of female death by neoplasia in Brazil. Although half of the Brazilian population is black/brown (BB), socio-economic disparities translate in a vulnerable situation to those women. Access to health care is an important barrier to improve the health of BB women. This study aims to investigate trends in breast cancer mortality rates regarding race and age.

Methods

This is a population-based study of trends evaluation on breast cancer mortality in São Paulo state, Brazil, from 2000 to 2017. The absolute number of deaths and population figures (including race) by age-groups and years were available online from government data. Data on race were not available by ten-year age-groups, so the figures were projected according to the female age structure by year. Total rates by year and race were age-adjusted to the 'World Population (2000)'. For trend analysis, linear regression was used, with 5% level of significance.

Results

In the period were observed 60,940 breast cancer deaths, 76.7% in white and 17.5% in BB women. The absolute number of deaths in white and BB women was respectively 2,095 and 333 in 2000, and 3,076 and 999 in 2017. The total age-adjusted mortality rates per 100,000 women of white and BB in 2000 were respectively 16.4, 17.2 and 7.5. In 2017 rates were 14.6, 16.6 and 16.1. There was a trend towards reducing the mortality rates of white women (P = 0.002) and in their age-groups from 40 to 79 years (P < 0.03). There was a trend towards increasing the mortality rates of BB women (P < 0.001) and in all their age-groups (P < 0.02).

Conclusions

Although breast cancer figures of death and mortality rates in BB women have more than doubled in 18 years, rates reached almost the same figures of white women in the period. Changes in behaviour risk factors may explain this result. However, it is very likely that access to health care to these women has been improved, reducing the disparities in the health system.

Key messages

Breast cancer mortality rates in black/brown women have reached almost the same figures as white women from 2000 to 2017 in São Paulo, Brazil. Access to health care in black women may have improved in São Paulo, Brazil.
The survival of mankind requires WATER centers & Water Quality and Quantity Index (WQQI)
Authors: Kozicki Z A , Baiyasi-Kozicki S J S
Published: October 2020

Issue

By 2025, half of the world's population will be living in water-stressed areas. Managing water quality and quantity is a worldwide concern that will require investing in WATER Centers and monitoring systems to improve the safety of drinking water and contribute to water conservation worldwide. Without reliable water policy climate change will threaten human survival.

Problem

There is no single measure that can describe overall water quality for any one body of water, let alone at a global level. Seven assessment methods used to measure water quality either on a national or global level, were reviewed and indexed. This index was examined and compared by objective, use, distribution and global location. Water centers need to review community water process, outcomes and outputs and also provide user populations with a Water Quality and Water Quantity Index (WQQI).

Results

United Nations Environment Programme UNEP research has revealed that “although there is no globally accepted composite index of water quality, some countries and regions have used, or are using, aggregated water quality data in the development of water quality indices.” 'Most water quality indices rely on normalizing, or standardizing data by parameter according to expected concentrations and some interpretation of 'good' versus 'bad' concentrations”.

Lessons

The survival of the human population requires policy changes regarding water management. The feedback humans need to survive can best be described as a Water Quality and Quantity Index (WQQI). With the growing scarcity of drinking water worldwide, proactive strategic thinking and planning is necessary. Message: Investing in WATER Centers ensures that the public health and economic benefits for all things related to water is optimized. The WQQI could also be useful in longitudinal and cross-sectional epidemiological studies.

Key messages

The survival of the human population requires policy changes regarding water management. Mankind needs real-time feedback about water quality to respond to threats to the water supply.
The impact of the policy of expanding coverage for 4 major diseases on out-of-pocket payments
Authors: Lee G R , Lee J H
Published: October 2020

In South Korea, Cancers, cardiac disease, cerebrovascular diseases and rare incurable disease cause high medical expenses which are putting a heavy burden on the household economy. They are called '4 Major Severe Diseases'. The government has established the plan of Expanding Coverage for Four Major Severe Diseases. The Policy of Expanding Coverage for the 4 Major Severe Diseases is to apply the necessary medical services including coverage for uncovered services to national health insurance payments in stages. This study aims to evaluate the effects of the policy implemented from 2013 to 2015 by comparing the changes in the out-of-pocket payments before and after the policy. Using the data from the Korea Health Panel(2012, 2016), the policy effect was evaluated by the Difference-In-Difference analysis. A total of 4,686 patients (2,343 in 2012 and 2,343 in 2016) were included, who are enrolled in National Health Insurance, and have at least one chronic disease. People who are under 20 years old were excluded. In addition, severity of disease was adjusted by CCI(Charson's comorbidity index). Compared to before the policy was implemented, the Out-of-pocket payments significantly decreased. In addition, there were significant differences in gender, types of health care system, disabled, economic activity, income level, and CCI. According to previous studies, the policy of Expanding health insurance coverage since 2005 has been criticized for its low effectiveness. However, It is revealed that the Policy of Expanding Coverage for 4 Major Severe Diseases has an effect in this study. Given that the policy needs time to work, this study showed the effect of the policy more comprehensively compared to previous studies evaluating the effectiveness for just one year.

Key messages

Due to the Policy of Expanding Coverage for 4 Major Severe Diseases, the out-of-pocket health expenditure were reduced in the policy group. Given that the policy needs time to work, this study has shown more comprehensive results than previous studies that evaluated the effect of policy carried out over a short period.
The impact of obesity on absenteeism among working adults in Portugal and its costs
Authors: Destri K , Alves J , Gregório M J , Dias S , Canhão H , Rodrigues A
Published: October 2020

Background

Obesity leeds to poor health and may afffect work productivity. We aim to investigate the association between obesity and absenteeism and its indirect costs.

Methods

Individuals employeed and actively working at baseline form the EpiDoC Cohort, a large portuguese population-based prospective study analized from 2011 to 2016. Body mass index was assessed during baseline appointment. Follow-up assessment was performed through a phone interview and self reported absenteeism defined by the question”did you have a sick leave in previous 12 months? yes/no”, followed by the number of days missed work due to sickness in the previous twelve months.(1) Negative Binomial Regression model estimated the association between obesity and absenteeism. Indirect costs were computed using the human-capital method.

Results

EpiDoC cohort had 4338 participants who were working adults at baseline. The prevalence of obesity among working adults was 15.2% and of absenteeism was 29.4%. Obesity was associated with an increase in absenteeism incidence rate ratio by 31% (p < 0.01). Obese individual miss 3.9 days per year (95% CI 3.1-4.5). This number is higher in women, 4.6 days per year (95% CI 3.6-5.6) and according to the professional categories women with white collar professions were 82% (p < 0.01) more likely to miss work than peers with their normal weight. Extrapolating for the entire working population, absenteeism due to obesity has an estimated cost of 236€ million per year.

Conclusions

Obesity is an independent risk factor for absenteeism among working adults wich leads to high societal burden in terms of costs. Food and nutrition policies are needed in order improve food patterns and reduce obesity levels among south european population.

Key messages

Obesity is an independent risk factor for absenteeism among working adults. Obesity increases absenteeism mainly in women and has a major impact on economies.
Quality of life of caregivers of cancer patients in home palliative care: a non-interventional study
Authors: Faggian E , Favero S , Gregori D , Martinato M
Published: October 2020

Background

caregivers of home-cared cancer patient during palliative phase are often under psychological and physical pressure. This can lead to a low level quality of life (QoL). This study assesses the QoL of this type of caregiver, more specifically it aims to outline which factors (age, type of palliative care, amount of time spent daily with the patient) affect positively or negatively the QoL score.

Methods

The AC-QoL questionnaire has been completed by 25 caregivers of oncological patients in home care in north-eastern Italy. The questionnaire is made of 40 items divided into 8 subjects: support in care, choice of care, stress, economic issues, personal growth, sense of value, care skills and personal satisfaction. It has been administered during a home visit or during a follow-up phone call.

Results

The average score obtained is 71/120, which means a medium level of QoL. The factors which worsen the QoL are the psychological and physical stress (average score 5/15) and restrictions on caregivers' private life (average score 6/15). No significant differences in the QoL of the caregivers are related to social and personal variables (such as age, working condition, relationship with the patient, type of palliative care, amount of time spent daily with the patient).

Conclusions

These caregivers play a fundamental role in the management of an appropriate continuity of care and their health and QoL are important. Stress and restrictions on private life are the factors which worsen QoL, that's why nurses should evaluate the caregivers' wellbeing during home-visits. Caregivers usually feel able to offer adequate assistance if they have been adequately trained to by healthcare professionals: nurses should provide every useful tool to aloud the caregiver to feel able of and comfortable providing assistance to his/her relative trough an “empowerment process”.

Key messages

Caregiver of cancer patient in charge of home palliative care is fundamental for an appropriate continuity of care and his health and quality of life (QoL) are important to provide good assistance. Psycho-physical stress and restrictions on private life worsen QoL. Caregiver’s wellbeing should be assessed and useful tools should be provided by home care nurses to ease caregivers’ job.
Availability of family planning supplies in the Brazilian Primary Health Care Units
Authors: Fassa A , Ruivo A C O , Wachs L , Tomasi E , Facchini L A
Published: October 2020

Background

The availability of contraceptive methods is a main determinant of their use and diversification is necessary to meet the reproductive health needs of women at different stages of life, in a universal and equitable way. The study aims to evaluate the availability of family planning supplies in Primary Care Units (PCU) in Brazil that adhered to the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB) in three evaluation cycles (2012, 2014, 2018), as well as, its distribution according to the Human Development Index (HDI), population size, Family Health Strategy (FHS) coverage and geographic region.

Methods

A descriptive cross-sectional study, of the more than 10.000 UBS included in the external evaluation of the PMAQ-AB. Availability was assessed by the physical presence of the following supplies: ethinyl estradiol + levonorgestrel, norethisterone, norethisterone + estradiol, levonorgestrel, medroxyprogesterone, male and female condom, IUD and rapid pregnancy test. The availability of all supplies at the PCU was considered adequate availability.

Results

The availability of supplies increased in the evaluated period. The lowest availabilities were IUD, 34.4% and rapid pregnancy test, 41.8%; the greatest were male condoms, 96.9%, and ethinyl estradiol + levonorgestrel, 85.2%. In Cycle III, adequate availability was 10.9%. The North had the worst results, followed by the Midwest region. HDI had little effect and population size had no effect on adequate availability, while FHS coverage was associated with greater availability. The PCUs of municipalities with a lower HDI had the largest increases in adequate availability. Adequate availability was greater in the PCUs that participated in all PMAQ-AB cycles.

Conclusions

Policies aimed at strengthening PHC increased the availability of supplies evaluated with equity promotion, however, regional inequities remain. The availability of a rapid pregnancy test and an IUD should be increased.

Key messages

Policies aimed at strengthening PHC, focusing infrastructure, provision and training professionals and quality monitoring increased the availability of family planning supplies with equity promotion. Monitoring the availability family planning supplies is essential for detecting failures, as the low availability of rapid pregnancy test, an essential supply for the early start of prenatal care.
Primary prevention of cervical cancer in Bulgaria
Authors: Kostadinova P S , Kostadinov S D , Stoilova I Y , Georgieva S L , Kamburova M S , Atanasova G N , Ivanova S K
Published: October 2020

Background

The incidence and mortality rate of cervical cancer in Bulgaria are higher than in most European Union countries, with an upward trend in the last three decades. Bulgaria is one of the 98 countries that, since 2012, has implemented a nationally funded national program for the primary prevention of cervical cancer. The purpose of this study is to investigate how this program is implemented in Bulgaria and why it is ineffective in our country.

Methods

A documentary study and a direct individual survey were conducted among 161 GPs from the Pleven region. The questions concern the attitudes of GPs to carry out immunoprophylaxis and the causes of low coverage.

Results

The immunization coverage with a complete scheme of three intakes in 2013 was 23.83% and in 2014 - 19.6%. In 2015, it switched to a two-dose regimen and its scope dropped sharply below 10% in this and subsequent years. The survey found that 17% of GPs felt that vaccination was unnecessary. 26% have not immunized any of their patients and 32% have covered less than 10%. Only 22% of GPs report that they are actively seeking out patients. The main reasons for the low coverage that respondents include are: rejection by parents (74%) due to fear of complications (41%), do not believe in the benefit of the vaccine (19%), and consider the vaccines to be harmful (10%); poor awareness (43%); negative information on the Internet and media (38%).

Conclusions

It is too early to take into account the effect of Cervical Cancer Immunoprophylaxis, conducted in Bulgaria, but the low coverage of those subject is alarming. It is necessary to undertake active health education activities among the population and additional training of GPs.

Key messages

Bulgaria has introduced a national program for primary prevention of cervical cancer, funded by the country. There is a very low coverage of subordinates due to insufficient awareness of the population, negative attitudes and insufficient commitment of GPs to implement the program.
Who is at risk for measles in Italy? Continued measles outbreaks in 2019 and barriers to elimination
Authors: Filia A , Bella A , Del Manso M , Baggieri M , Magurano F , Iannazzo S , Sabbatucci M , Nicoletti L , Rota M C
Published: October 2020

Background

Measles is a highly contagious vaccine preventable disease that can lead to serious complications, including death. All five regions of the World Health Organization have set targets to eliminate measles. In Italy, measles vaccination was introduced in 1976, with sustained low uptake in the 1980s and 1990s. Uptake improved in subsequent years but never reached 95% coverage required for elimination. Two doses of measles-mumps-rubella (MMR) vaccine are recommended (at 12-15 months and 5-6 years respectively). Since July 2017, MMR vaccine has become mandatory for all children up to 16 years of age. Large outbreaks continue to occur, with over 8.000 cases reported in 2017-2018.

Methods

We analysed measles cases reported to the national integrated measles and rubella surveillance system during January 1 - December 31, 2019.

Results

From 1 January to 31 December 2019, 1,627 cases (87% laboratory-confirmed), were reported from all 21 administrative regions. National incidence was 27 cases/million. Overall, 86% of cases were unvaccinated. Median age was 30 years but the highest incidence was in infants below one year of age. Ninety-six cases were reported amongst healthcare workers and transmission in the healthcare setting was frequent. Overall, 31% of cases reported complications, including three cases of encephalitis (in two adults and one child) and one death in an adult patient. Complications were more frequent in cases ≥20 years of age compared to younger patients. Forty-six percent of cases were hospitalised.

Conclusions

The median age of cases has increased further in 2019 compared to 2017 (27 years) and 2018 (28 years). The proportions of complicated and hospitalised cases are high, this may be due to the high median age of cases but also to underreporting from general practitioners who are likely to see milder cases. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.

Key messages

Measles is still endemic in Italy and large outbreaks continue to occur, with a significant public health impact. Wide immunity gaps among adults (including healthcare workers) and nosocomial transmission are major challenges to measles elimination in Italy.
Measles and young adults: the case of the Local Health Authority of Bologna over the last decade
Authors: Montalti M , Gori D , Dallolio L , Catalani F , Resi D , Fantini M P
Published: October 2020

Background

Measles is increasing globally, with a 300% increase in the first three months of 2019 in the WHO European Region. Measles cases recorded annually over the last decade in Italy have been cyclical with the last peak in 2017 with 84 cases per million inhabitants. In the same year, national coercive vaccination measures were introduced for access to educational services. Although the country is again achieving adequate vaccination coverage (VC) for the second dose of MRR (93.2% in 2018), outbreaks can still occur in communities with low VCs.

Methods

The aim of this study was to analyze measles epidemiology in Bologna Local Health Authority (LHA) from 2010 to 2018, focusing on age groups at higher risk of spread. Aggregate data on measles incidence were provided by Bologna HLA and VCs in residents were provided by the Emilia-Romagna Region (RER).

Results

The number of cases in the period of reference was 261 cases, 240 of which were laboratory confirmed (92%). The overall average age was 28.5 years (standard deviation, ds: ±14.73 years). The age group with the highest average incidence rate was 20-24 years (93 per 1.000.000 inhabitants), followed by 25-29 years (88) and 30-34 years (75). With regard to occupation at highest risk of prevalence, students represented the largest group with 22.6% of cases. VC data in residents in RER showed that in the age group 19-35 the fraction of the population not vaccinated with two doses of vaccine decreased significantly in the birth cohorts of the 1990s with a coverage of 6.9% for the 1984 birth cohort. None of the cohorts taken into consideration achieved a VC of 95% for the second dose.

Conclusions

Our results confirm the high proportion of measles cases among young adults. This highlights the need to consider catch-up actions and awareness campaign. For example, by focusing on students without previous documented vaccinations, considering that Bologna is home to tens of thousands of University students every year.

Key messages

The measles epidemiology analysis in the Local Health Authority of Bologna (Italy) over the last decade showed that the young adults (aged 20-35) have the highest average incidence rate of measles. Considering the need to focus on young adults in order to contain new cases of measles; checks on previous vaccinations, catch-up actions and improved awareness campaign are essential.