bluuebunny/crossref_metadata_2025 huggingface dataset:
Health literacy in higher education students: findings from a Portuguese study
Authors: Pedro AR , Rosário R , Monteiro I , Cerqueira M , Roque S , Assunção V , Brandão D , Escoval A , Ferreira PL
Published: October 2022

Background

Health literacy (HL) concerns the knowledge and competences of people to meet the complex demands of health in modern society. It is essential for health promotion, disease prevention and healthcare. Young adults can perform a very important role in taking a more active role in managing and protect their health, so this study aimed to identify the HL levels in the population of higher education students, according to the European Health Literacy Survey (HLS-EU-PT) and to evaluate its association with social and academic determinants.

Methods

A quantitative, observational, and cross-sectional study was carried out based on an online survey disseminated in Portuguese universities. Data were analysed using binary logistic regression, adjusted for age, income, parents’ education, gender, and chronic disease report.

Results

In total, 4801 students were surveyed, 76% female. Of those, 44% revealed a problematic or inadequate level of HL. Those students with higher income levels (OR (95% CI), OR = 4.5 (3.4; 5.9) and whose parents had higher education levels (OR = 1.3(1.1; 1.5) had higher odds of achieving sufficient or excellent levels of HL, even after adjusting for confounders. In what concerns academic determinants, data revealed that HL tends to be sufficient or excellent among those students from health-related courses (OR = 2.0 (1.6; 2.5). In the subgroup of students from non-health-related courses, it was found that HL levels do not differ in 1st year and last year's students. However, in students from health-related courses, data revealed that a last yeaŕs students had higher odds of having sufficient or excellent HL levels compared to a 1st-year student (OR = 1.7 (1.4; 2.2).

Conclusions

This study reveals low HL levels and addresses that socioeconomic and familiar context are determinants of HL in higher education students. Future intervention studies are needed, focused on these determinants so that adequate levels of HL are achieved in higher education students.

Key messages
Health literacy of organisations – a cornerstone for fair health outcome
Authors: Magnusson M
Published: October 2022

Unhealthy food habits are included in the factors behind several severe health conditions. Their unequal distribution in the population has a complex background. Putting the problem “How can we make our resources more reachable?” instead of “How can we reach these groups?” changes focus from individual to organisational health literacy which opens windows of opportunity. A public health unit with commission to contribute to close health gaps identified a need to systematically develop its own health literacy. Critical examining was conducted by the quan/qual tool Health equlibrium methodology. Reflections on accessability and acceptability of resources offered by the unit were documented and used for methodolocigal development. Aims were to develop professional judgment on how to contribute to fair health outcome and to improve support for healthy habits. Data used were collected 2019-2021.What hinders people from healthier food habits? How can we adjust our practice? Documentation included organised breakfast-talks, food-talk with cultural interpreters, lectures with sports-club health ambassadors, health groups with people of different maternal language, meetings with parents at open pre-school, staff in health promotion commissions and elderly. Problems identified were high costs on healthy food and on travels to vending points, traditional large sugar-intake, marketing of unhealthy food to children, failure to understand information from Swedish Food Agency (except the Keyhole food labelling which was much appreciated). A model for shop-walks with cultural interpreters, more accessible versions of leaflet-materials and dialogue-meetings about food in different settings were developed. Reflections on the unit's communication lead to change of settings for meetings and refined ways to talk about parenthood, women's role and aspects of ethnicity. Systematic self-reflection strenghtens organisational health literacy and may contribute to fair health outcomes

Key messages
Do newly arrived migrants represent a COVID-19 burden? Data from the Italian information flow
Authors: Sisti LG , Di Napoli A , Petrelli A , Diodati A , Cavani A , Mirisola C , Costanzo G
Published: October 2022

Background

Migrants who reach host countries irregularly are often perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route. During the pandemic, all migrants who disembarked on the Italian shores have been COVID-19 tested and quarantined. To investigate the incidence of SARS-CoV-2 infection in this population, the INMP, together with the Italian Ministry of the Interior, set a specific information flow collecting data about the infection and possible outcomes.

Methods

The observation period was from January 2021 to January 2022. COVID-19 tests used were molecular and antigenic. Positive cases detected both at the arrival and during the quarantine period, have been registered on an ad hoc INMP online platform. Migrants’ SARS-CoV-2 incidence rate (per 1,000) - with 95% CI - was therefore calculated. The Incidence Ratio (IR) was used to compare the migrants’ incidence rate with that of the resident population in Italy, in the same period and corresponding age group.

Results

Among 70,512 migrants (91% males and 9% females, all <60years old) who landed in Italy during the observation period, 2,861 tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. In the same period, an incidence rate of 177.6 (177.5-177.8) has been recorded in the resident population, with an IR of 0.22 (0.22-0.23). 89.9% of cases were males and almost half (49.6%) belonged to the age group 25-39years old. 99% of cases reported no symptoms, no relevant comorbidity has been reported and no cases have been hospitalized.

Conclusions

Our findings clearly highlight the low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population, encouraging the opportunity to investigate the reasons for such an observation. Moreover, our study confirms the “healthy migrant effect” in migrants reaching Italy by sea.

Key messages
Occupational role and Covid-19 among foreign-born healthcare workers: a registry-based study
Authors: Nwaru C , Li H , Bonander C , Santosa A , Franzén S , Rosvall M , Nyberg F
Published: October 2022

Background

Studies have shown an elevated risk of Covid-19 among foreign-born healthcare workers (HCWs), but data on the distribution of the risk in different occupational roles are lacking. Such data are needed for the effective control of Covid-19 risk among HCWs. Here, we examined the risk of Covid-19 infection and hospitalization in foreign-born HCWs in different occupational roles in Sweden.

Methods

We prospectively linked occupational data (2018-2019) of 783950 employed foreign-born (20-65 years) workers to Covid-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the risk of Covid-19 infection and hospitalization in foreign-born HCWs in eight different occupational groups compared to non-HCWs, and to assess whether the associations varied by region of birth. The analyses were adjusted for sociodemographic and socioeconomic factors, comorbidities, and Covid-19 vaccination.

Results

All HCWs had a higher risk of Covid-19 outcomes than non-HCWs, but the risk differed by occupational role. Assistant nurses had the highest risk both for Covid-19 infection (HR 1.80; 95%CI 1.74-1.87) and hospitalization (HR 1.85; 95%CI 1.57-2.18); other allied HCWs had the lowest risk (infection: HR 1.23; 95%CI 1.11-1.36; hospitalization: HR 1.02; 95%CI 0.63-1.67)). In some healthcare occupations, the relative risk of Covid-19 varied by region of birth. For example, physicians and dental nurses/hygienists of African and Asian origin had a higher risk of Covid-19 infection than European-born in the same occupation. In contrast, European-born assistant nurses had a greater risk of both outcomes than non-European-born in the same occupation.

Conclusions

The risk of Covid-19 among foreign-born HCWs varied by occupational role and region of birth. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help to reduce Covid-19 risk among foreign-born HCWs.

Key messages
Preoperative anxiety and health literacy in patients applying to the anesthesia outpatient clinic
Authors: Mutlu M , Mutlu A , Oktar D , Yelken B , Arslantas D , Unsal A
Published: October 2022

Background

Evaluation of preoperative anxiety and health literacy is important for healthcare professionals to understand the needs and expectations of patients and provide them with the necessary support. The study aimed to evaluate the preoperative anxiety levels of patients who applied to the anesthesia outpatient clinic and its relationship with health literacy.

Methods

A cross-sectional study was conducted on patients who applied to the anesthesia outpatient clinic of Eskişehir Osmangazi University Medical Faculty Hospital in March 2022. The questionnaire form, which was prepared by making use of the literature, was filled in by face-to-face interview method after obtaining the participants’ verbal consent. The 6 item Amsterdam Preoperative Anxiety and Information Scale (APAIS) in which the scores that can be taken range from 6 to 30 and higher score means higher anxiety was used to assess the level of anxiety, and the 16 item European Health Literacy Scale Short Form was used to assess health literacy. Descriptive statistics, Chi-Square test and Logistic Regression analysis were used to analyze the data.

Results

In the study group, 197 (50.3%) were female. Their ages ranged from 18 to 86, with a mean of 45.7 ± 17.2 years. The median (min-max) APAIS score was 15 (6-30). There was a moderate negative correlation between the scores obtained from the APAIS and the European Health Literacy Scale Short Form (r= -0.50, p < 0.01). According to the logistic regression analysis, preoperative anxiety was found to be 1.53 (%95 CI; 1.01-2.30) times higher in women, 3.49 (%95 CI; 1.23-9.94) times higher in those with low family income, and 1.61 (%95 CI; 1.07-2.42) times higher in those with type A personality.

Conclusions

More than half of the patients had preoperative anxiety. The level of preoperative anxiety decreased as the health literacy level increased.

Key messages
The Portuguese observatory on occupational psychosocial factors: contribution for public health
Authors: Fernandes C , Cotrim T , Pereira A , Silva CF , Bem-Haja P , Azevedo R , Antunes S , Pinto J Sousa , Silva I
Published: October 2022

To achieve the goal of sustainable employment, considering the profile of the Portuguese working population (PWP), is needed a range of strategies to ensure long, productive, and sustainable careers allied with a better quality of working life, health, and wellbeing, but also with public health policies grounded on scientifically validated and reliable data. This is possible through a comprehensive working system approach that ensures workers will be mentally and physically able to remain at work by the balance between work demands and individual resources allied with public health policies transfer into the workplaces by organizations’ leadership and policy makers. The Portuguese Observatory on Occupational Factors (Popsy@Work) aims at addressing this global challenge by: i) digitally collecting psychosocial data on the PWP; ii) implementing and strengthening of a psychosocial occupational health surveillance digital system; iii) providing reference values for the PWP concerning Psychosocial Health; iv) Transferring to society knowledge and best practices; v) Raising awareness on the importance of psychosocial management in occupational settings based on science. Popsy@work is a digital platform that collects and aggregates psychosocial data analytically and creates a visualization hub adding value to data on the PWP and giving science back to society in a usable way, empowering workers, strengthening organizations and grounding public policies. Pospy@Work considers the development of strategic intelligence on levels and inequalities of psychosocial health and well-being in occupational settings by robust metrics and reference data. Creating opportunities for national policy dialogue on inequalities, including the psychosocial health of the PWP through collaboration with diverse sectors identifying and mapping subgroups of populations whose unmet needs require specific outreach measures.

Key messages
Changing life expectancy in Europe 1990-2019: Global Burden of Disease Study 2019
Authors: Steel N , BauerStaeb C , Ford J , Gillam T , Schmidt J , Hughes AS
Published: October 2022

Improvements in life expectancy have slowed in high income countries, with uncertain causes. We assessed the contribution of different causes of death to changes in life expectancy, and changes in population exposure to major risk factors in 16 European Economic Area countries plus the 4 nations of the United Kingdom from 1990-2013 and 2013-2019, using the Global Burden of Disease Study. After decades of steady improvements in life expectancy, all countries experienced smaller annual improvements after 2013. Norway experienced the smallest mean annual rate of change in improvement from pre 2013 to post 2013 of 0.03 years, and Northern Ireland (followed closely by Scotland and England) experienced the largest annual reduction from pre to post 2013 of 0.25 years. The cause of death responsible for the largest reductions in life expectancy improvements after 2013 was cardiovascular disease, followed by neoplasms. The largest reductions in deaths from cardiovascular disease were attributable to seven major risk factors: high LDL cholesterol, tobacco, dietary risks, high fasting plasma glucose, high systolic blood pressure, high body mass index, and low physical activity. The risk factors for deaths from neoplasm were similar. Exposure to tobacco remains a high risk but exposure declined steadily. Exposure to the other risks generally worsened after 2013, particularly for BMI and high fasting plasma glucose. The European countries that had better maintained reductions in deaths from cardiovascular disease and neoplasms also experienced larger improvements in life expectancy. These changes were underpinned by changing exposure to major risks. Policy responses to the slowdown in life expectancy improvements should include reducing population exposure to major risks, including the broader risks from diet and low physical activity, through prevention and addressing the broad social and commercial determinants of health as well as adequate funding for health services.

Key messages
The impact of perceived discrimination on subjective health among adolescents
Authors: Kajikhina K , Koschollek C , Hövener C
Published: October 2022

Background

Interpersonal discrimination (disc.) plays an important role for physical and mental health, througoutthe life-course and in particular during adolescence. People can experience disc., e.g. due to their physical appearance or language preferences independently of having a migration background (mb, official statistical category in Germany). Aim of this contribution is to analyse the impact of perceived disc. on subjective health and its relation to mb.

Methods

Using data from from German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 2 (2014 - 2017), we analysed by logistic regression the impact of a) overall perceived disc. (≥ one indication of “sometimes” across eight dimensions), b) perceived disc. related to origin, skin colour, accent, language, dialect and c) one- and two-sided mb (one or both parents with own mb) on subjective health among adolescents aged 14 to 17 years.

Results

Among 3,558 adolescents, 21% perceived disc. in at least one of overall eight dimensions, 11% reported disc. related to their origin, skin colour or language. A one-sided mb was measured for 8,4% of participants, a two-sided mb for 20%. Perceiving overall disc. (OR = 3.29) and disc. related to origin, skin colour or language (OR = 1.91) was associated with reporting a (very) bad subjective health. Mb had no impact. Effects remain after controlling for gender, age and socioeconomic position of parents (overall disc. aOR=2.99; disc. related to origin, skin colour or language aOR=1.65).

Conclusions

Perceived disc. is associated with worse subjective health among adolescents, whereas no association with mb is observed. Epidemiological analyses solely focussing on one statistical category such as mb are insufficient as they do not consider those affected by discrimination but are not captured by mb. Differentiated analyses are necessary to elucidate explanatory mechanisms and protective factors.

Key messages
The frequency of UTIs in people who undertake intermittent catheterization: A systematic review
Authors: D'Ambrosio F , Orsini F , Scardigno A , Pappalardo C , Ricciardi R , Calabrò GE
Published: October 2022

Background

Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC.

Methods

A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included.

Results

Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted.

Conclusions

Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients’ quality of life and also reduce the impact of diseases associated with this procedure on health systems and society.

Key messages
Birth defects and associated antenatal care factors related with 1st trimester of pregnancy
Authors: Zile-Velika I , Ebela I , Rumba-Rozenfelde I
Published: October 2022

Background

Ultrasound (US) can help monitor normal fetal development and screen for any potential problems. The prenatal detection of fetal anomalies allows for optimal perinatal management.

Aim

The aim was to assess congenital anomalies at births and their associated antenatal care factors.

Methods

Data source - Health Care Monitoring Datalink (HCMD), including two data sources: Medical Birth Register and ambulatory care data provided by public and private health care providers about US. Screening was detected by specific manipulation code: 50694 - routine US screening in the 1st trimester of pregnancy. All singleton birth in 2018 (n = 12955) were included in the data analysis. OR (odds ratio) were calculated. Multiple regression model was adjusted for mother age, gestational age, living area and antenatal care factors.

Results

The mean mother age was 30.3 (SD 5.4) and gestational age 39.3 (SD 1.8). The use of ICD-10 code O28 - abnormal findings on antenatal screening of mother - was observed in a small number of cases. 2.4% (n = 305) abnormal findings on antenatal screening of mother were detected at ambulatory care visits. From these cases 7.5% (n = 23) were diagnosed congenital anomalies at birth. Totally 2.8% (n = 362) of births were registered congenital anomalies. Congenital anomalies at birth have higher and statistically significant odds of invasive diagnostic methods in pregnancy (OR = 2.0; 95%CI 1.2-3.6; p < 0.01) and abnormal findings on US screening (OR = 2.6; 95%CI 1.7-4.2; p < 0.001). Slightly higher frequency of congenital anomalies at birth but not statistically significant (p > 0.05) were observed for 1st trimester genetic screening (OR = 1.5), preterm deliveries (OR = 1.4) and living in urban area (OR = 1.3).

Conclusions

Pregnancy outcome as congenital anomalies at birth related with higher maternal screening examinations prenatally. Further studies are needed to analyze the efficiency of US examinations for early prenatal detection of congenital anomalies.

Key messages
Providers’ Experience with Artificial Intelligence-Based System During the COVID-19 Pandemic
Authors: Lintz J
Published: October 2022

Background

As the pandemic continues to spread worldwide, many of healthcare facilities are exploring new methods to keep their patients safe from potential hospital-acquired infections (HAIs) during the pandemic. This study explored the attitudes about artificial intelligence (AI) among providers who utilized AI-based hand hygiene monitoring system (HHMS) at a rural medical center during the pandemic.

Methods

A self-administered questionnaire was mailed to 48 healthcare providers at a rural medical center in north Texas, with a 75% percent response rate (n = 36). The survey collected information on providers attitudes about AI-based HHMS use. In addition, the study also examined the relationship between provider’s well-being and the level of satisfaction with the AI-based HHMS use. The lessons learned from this study will be used to determine important factors to consider when attempting to advance and expand AI technologies in rural healthcare settings.

Results

Results revealed that the integration of AI technology within the existing electronic health record (EHR) system remains a challenge for many providers. Plus, the lack of user-centered design approaches to incorporate the AI tool into existing workflows has reduced providers satisfaction about the new technology.

Conclusions

The findings suggested that although AI technology has great promise to reduce the number of hospital-acquired infections (HAIs), successfully implement of an AI-based tool that meets the expectations of users requires significant levels of consolidation to ensure that it fits within the existing workflows and is accepted by users.

Key messages

• AI application indirectly affects the well-being of providers, particularly in rural healthcare settings.

• A better AI application interface design that meets the expectations of providers is needed.
Thyroid cancer incidence in the female population of Georgia by regions and municipalities
Authors: Abesadze N , Tkeshelashvili V , Kereselidze M , Kvanchakhadze R , Beruchashvili T
Published: October 2022

Background

According to the NCDC (Tbilisi, Georgia), in 2015-2019, thyroid cancer ranked second in the cancer structure of cancer in Georgia. Additional studies are needed to identify the thyroid cancer incidence by regions and municipalities of Georgia.

Methods

E-dBase of cancer population registry for 2015-2019 (52,178 cancer cases), Tbilisi registry database for 2002-2004 (33,478 deaths from all causes), methodology recommended by IARC (Lyon) and UICC (Geneva), SEER program and 2014 Georgian census data were used in the study. Standardized cancer incidence and mortality rates (ASR, TASR, AAR, SRR, CR64, CR74, SIR, SMR, PIR, 95% CI) were calculated.

Results

Ranking and proportion of thyroid cancer in female population of Georgia in 2015-2019 according to the regions and municipalities, its age specifics and dynamics were determined. Incidence of thyroid cancer in women in Tbilisi (ASR=52.4%000; AAR=64.1%000), compared to Georgia (ASR=34.4%000; AAR=41.0%000), indicates that Tbilisi is the geographically highest prevalence zone for this site cancer and the highest levels were observed in the 25-69 age group (TASR25-69 - Georgia = 110.8%000, Tbilisi = 190.1%000). In dynamics, the incidence of thyroid cancer in the 27-year period (2015-2019 vs 1988-1992) according to the SIR, increased by 66.4%. According to the cumulative risk index (CR64, CR74), the municipalities, where the risk of developing thyroid cancer is almost 1.5 times higher than the total rate in Georgia, were identified. According to the PIR, the ratio of thyroid cancer to the share of thyroid cancer in the structure of cancer in the regions of Georgia (including Tbilisi) showed that the proportion of thyroid cancer in Tbilisi (PIR=117.7) is 17.7% higher compared to proportion of total thyroid cancer in Georgia.

Conclusions

It is recommended that the epidemiological map of thyroid cancer incidence be used in planning national, regional, and municipal preventive programs.

Key messages

• It is recommended to continue study in this direction: retrospective review of histological and histochemical features of each case of thyroid cancer.

• It is recommended: to conduct molecular (oncogenes) studies in conjunction with histological and histochemical studies.
Key issues for implementation of Genomics in Healthcare: a Policy Brief
Authors: Costa A , Merchant A , Lopes MF , Konopko M , Cardoso ML , Sitjà X , Bourbon M , Scollen S , Vicente A
Published: October 2022

Issue/problem

Healthcare (HC) can significantly benefit from genomic information for earlier, accurate diagnosis, effective personalized treatment with less adverse events, and accurate profiling of individuals for disease prevention. However, European countries are currently at variable maturity stages regarding the implementation of genomic medicine (GM) in healthcare, hindering the equitable delivery of personalized medicine to citizens across borders.

Description of the problem

The European 1+Million Genomes Initiative (1+MG) aims to provide cross-border access to quality genomic information and related clinical data, to advance data-driven research and HC solutions to benefit citizens. This initiative is encouraging countries to develop national GM strategies, but guidance for successful implementation is needed. In this context, the Beyond 1 Million Genomes, a supporting action to the 1+MG initiative, organized three Country Exchange Visits (CEV) to discuss critical issues, share experiences and best practices, for the implementation of sustainable GM strategies in healthcare.

Results

The United Kingdom, Estonia and Finland, which have advanced GM programs, hosted CEV describing progress and lessons learnt. Representatives of 1+MG signatory countries participated in these events and were able to present country level progress. The resulting Policy Brief (PB) captures key issues discussed at the CEVs, with real-life examples, and proposes policy recommendations for the successful implementation of GM in European healthcare systems.

Lessons

Sustainable GM implementation in HC systems requires: 1) Patient and citizens trust and engagement; 2) Sustainable infrastructure and data regulation, with solid ethical and legal frameworks; 3) Capacity building of healthcare professionals; 4) A strong ecosystem involving all stakeholders, and encouraging synergies between healthcare, research and industry to promote continuous innovation.

Key messages

• The implementation of GM in healthcare will take countries further towards making personalized medicine a reality, with remarkable health and socioeconomic benefits for patients and healthcare systems.

• Promoting cooperation, capacity building and sharing of best practices is crucial to reduce asymmetries between countries, which constrains effective and equitable cross-border personalized medicine.
Health Emergency and Disaster Risk Management During the COVID-19 Pandemic: A Case Study from Italy
Authors: Lamberti-Castronuovo A , Parotto E , Ragazzoni L , Valente M
Published: October 2022

Background

The COVID-19 pandemic has profoundly impacted societies, influencing countries’ Health Emergency and Disaster Risk Management (H-EDRM) systems. By taking Italy as a case study, this research aimed to investigate the response to the pandemic focusing on challenges, response strategies, lessons learned and implications for H-EDRM, with an emphasis on health workforce, health services delivery and logistics.

Methods

This was a retrospective observational study using qualitative methodology. Data was collected via semi-structured interviews and analyzed according to the H-EDRM framework. Multiple interviewees were selected to obtain a holistic perspective on the Italian pandemic response. Stakeholders from five sectors (policymaking, hospital, primary care, third sector, lay community) from three of the most impacted Italian regions (Piemonte, Lombardia, Veneto) were interviewed, reaching 15 interviewees in total.

Results

With regard to human resources, the main themes concerned the shortage of personnel, inadequate training, poor occupational health, and lack of multidisciplinarity. Regarding health services delivery, interviewees reported weakness of public health, hospital, and primary care systems. With regard to logistics, the following themes emerged: inadequate infrastructures, shortage of supplies, issues with transportation systems, and weak communication channels. Lessons learned stressed the importance of considering pragmatic disaster preparedness and the need for cultural and structural reforms.

Conclusions

Implications that emerged from this study can inform advancements in disaster management in Italy.

Acknowledgments: This study was conducted in collaboration with the Department of Public Health and Health Policy, Hiroshima University, Japan and funded by the World Health Organization Kobe Centre for Health Development (WKC-HEDRM-K21001).

*ALC and EP are both first authors

Key messages

• Findings show that great interconnection of sectors is key in overcoming challenges and for future disaster preparedness.

• Lessons learned contribute to translating the H-EDRM precepts into practice.
Home care for vulnerable populations with special needs during a disaster in Germany
Authors: Ewers M , Lehmann Y , Köhler M
Published: October 2022

Background

In Europe, too, the risk of natural, technical, or man-made disasters and public health emergencies has been growing for some time. The situation of vulnerable populations with special needs receiving intensive home care such as people of all ages with oxygen therapy, peritoneal dialysis, parenteral nutrition etc. is rarely considered in this context. This issue is addressed by the sub-project “Safety and Nursing” of the AUPIK consortium on “Maintenance of home care infrastructure in crisis and disasters” funded by the German Federal Ministry of Education and Research.

Methods

Starting in April 2020, a systematic literature analysis was carried out, focussing on home care of populations with special needs during disasters. This was supplemented by an online survey with nurses and care workers (n = 101) and semi-structured interviews with managers of specialized home care services (n = 8). The survey data were analysed with descriptive statistics, the interview data with content analysis; results were cross-checked with the literature.

Results

Home care providers are at best prepared for everyday tasks; even minor disruptions have far-reaching consequences. Although the impact of disasters such as large-scale and prolonged power cuts are hard to imagine, the experience with the COVID-19 pandemic and other current events (e.g., floods, heat waves) could at least raise awareness of the problem. However, there is hardly any preparation for disasters in home care yet, but there are high expectations of support from civil protection organisations or local authorities. That these, in turn, are not prepared to deal with populations with special needs in intensive home care, is overlooked.

Conclusions

Home care infrastructure in Germany is currently inadequately prepared in terms of concept, staff, and equipment to care for vulnerable populations with special needs during disasters. Initiatives to improve disaster preparedness in home and long-term care are overdue.

Key messages

• The situation of vulnerable populations with special needs during a disaster is a pressing public health and disaster nursing issue which needs to be considered more carefully.

• Public health nursing and health services research must contribute substantially to improving disaster preparedness in all health sectors and for all populations.
True death toll of COVID-19 in Georgia: estimates of the number of deaths from COVID-19
Authors: Shakhnazarova M
Published: October 2022

Problem

Georgia, in terms of Covid-19 attributed mortality, ranks 8th in the World.

Description

In Georgia, there are no routinely conducted autopsies of the deceased. The identification of causes of death is based on the physician’s clinical decision. Absence of autopsies, lack of experience with Covid-19, are key issues of Covid-19 death certification. Considering COVID-19 as a primary cause of death led to over-reporting of COVID mortality among patients with severe comorbidities. This affects the identification of underlying cause of death (UCOD) and leads to misclassifications.

Results

2021 mortal cases with Covid-19 as the UCOD, were analyzed. Cases were grouped by the interval between testing and death: <1 day - 170 cases (1.5%), 2-44 days - 9468 cases (83.5%), 45+ days - 1694 cases (15%). The group of cases with time intervals of 2-44 days, was sub-grouped according to causes mentioned in death certificates: A - only U07 is indicated, B - U07&any chain-of-event condition (pneumonia, respiratory distress, respiratory failure, etc.), C - U07& 1 or more significant contributing conditions (diabetes, stroke, etc.). According to the analysis in the group, 2-44 days distribution was: A - 6%; B - 81%; C - 13%. U07 cases in groups A and C without any respiratory conditions mentioned were defined as ‘unlikely’ COVID-19 death (19% of total). From groups with time intervals of < 1 and 45+ days (1864) 72 cases were randomly selected for in-depth analysis by a panel of experts, using additional medical records. Out of these cases, the panel of experts considered 80%, as ‘non-COVID-19’ deaths.

Lessons

If ‘unlikely’ and ‘non-COVID-19’ deaths aren't counted, the number of deaths is reduced by 29.5%. Lack of duration of a disease represents a limitation. A similar revision of all/2-44 day’s interval COVID-19-related deaths is required to get a real number. Conduction of a verbal autopsy is necessary. Training on coding causes of death and existing regulations is important.

Key messages

• There is an over-registration of COVID-19 as a UCOD.

• The lack of knowledge of death certification of cases with severe comorbidities and accidents leads to over estimates.
Tobacco control is integral to global COVID-19 response: an opportunity to accelerate toward SDGs
Authors: Chen DTH
Published: October 2022

Issue

Tobacco use intersects with the COVID-19 pandemic not only in terms of health consequences, but also on public health systems, economies, and the environment.

Description of the problem

The global tobacco supply contributes significantly to environmental pollution of the natural ecosystems. The damage is compounded by tobacco consumption and its resultant waste, which leaves a significant carbon footprint on the environment, undermining the planet’s ecological stability and intensifying climate change. Furthermore, tobacco use exacerbates inequalities and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic.

Results

he pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges and accelerate progress toward Sustainable Development Goals (SDGs). The MPOWER measures from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play an integral part to boost sustainable and equitable COVID-19 recovery — Monitor tobacco use (article 20); Protection from tobacco smoke (article 8); Offer help for tobacco cessation (article 14); Warn about the dangers of tobacco (article 11); Enforcing bans on tobacco advertising, promotion, and sponsorship (TAPS) (article13); and Raise tobacco taxes (article 6).

Lessons

To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and policy actions to emphasise tobacco control across equity, public health, climate actions, and counteract against the tobacco industry during and beyond COVID-19 as global authorities pledge to achieve the SDGs.

Key messages

• Global authorities must create better synergies on policies with a prime focus on reinforcing tobacco control to recover from the pandemic.

• The WHO FCTC MPOWER measures can play an integral part in COVID-19 recovery to fight tobacco use and accelerate progress toward SDGs.
Epidemiology of covid-19 in Mongolia: descriptive findings
Authors: Amartsengel O , Khishigjargal D , Glushkova N , Lkhagvasuren K
Published: October 2022

Background

Mongolia is a landlocked country, and has been divided into 21 provinces plus the capital city Ulaanbaatar. In our country, Covid-19 was the first internal case (15 Nov 2020) and the first wave of pandemic occurred (peak at 14 Jun 2021) ten months later on World’s first case and wave. The second and third waves were also delayed by two months, but the fourth wave occurred just in parallel (peak on 17 Jan 2022).

Methods

This study was a retrospective cross-sectional study. We have compared incidence rate (IR) and case-fatality rates (CFR) in provinces by age groups based on publicly available data reported by MoH from January to December of 2021.

Results

CFR in Mongolia was low (average 0.23%), and had a clear dynamic to drop from beginning to the present time (for I wave-0.49, and II-0.42, III-0.23, IV-0.04 correspondently). At the beginning of the III waves, we vaccinated 68.7% of the total population, and in the fourth wave, CFR significantly decreased. IR had two peaks: in the age group 30-34 (250.6) and over 85 (248.9). There was a strong correlation between age and morbidity. Up to age group 40-44 (0.12 %), there was a deliberate increase of CFR, further up to 65-69 ages (2.7%) gradual increase, and from age group 70-74 CFR rapidly increases reaching 10.5% at age group over 85. IR was higher in men aged 65 years and over. CFR was significantly higher in Ulaanbaatar city and Umnugovi province morbidity due to Covid-19 not being registered.

Conclusions

Vaccination in Mongolia was a key factor in declining fatality. Umnugovi province is crucial for exports to China, so we suppose, government decisions strongly affected in fatality rate in this province, in terms of the evacuation of severely diseased patients to the capital.

Key messages

• Vaccination is played important role in COVID-19 epidemiology.

• Burden of Covid-19 need to be investigated deeply in association with political decisions.
USCA service utilization in the city of Florence (Italy) during the COVID-19 pandemic
Authors: Buscemi P , Velpini B , Cosma C , Milani C , Landi R , Innocenti M , Baggiani L , Nerattini M , Lorini C , Bonaccorsi G
Published: October 2022

Background

In order to support primary care during the first pandemic wave (March 2020), the Italian Government instituted multiprofessional health teams called “USCA” (Special Continuity Care Units), which ensured continuity of care for COVID-19 patients who do not need hospitalization. The aim of our study was to compare the volumes of USCA service utilization in Florence (Tuscany, Italy) during the peak of home visits of three pandemic waves.

Methods

This single-center study followed a retrospective cross-sectional design. The USCA of the Heath District of Florence served a population of 366,190 people. The following data were collected: home medical visits, nursing home (NH) visits, visits in health-care hotels. The peak periods of three epidemic waves were considered in the analyses: the second wave (23 October - 20 November 2020), the third wave (25 March - 22 April 2021), and the Omicron period (27 December 2021 - 6 February 2022). The maximum 7-day moving averages of the daily number of visits during the three periods were calculated. Relative percent differences for visits comparing the considered periods were computed.

Results

Home visits during the third pandemic wave increased by 14% compared to the second wave (second wave: N = 1370, third wave: N = 1562), while a decrease was observed during the Omicron period (Omicron vs third wave: -21%; peak value: 41 vs 60). Visits in health-care hotels during the third wave doubled compared to the second wave. After the start of the COVID-19 vaccination campaign, NH visits steeply declined (third wave vs second wave: -95%; N = 323 vs 15; peak value= 14 vs 2 visits per day). During the Omicron period, NH visits increased by almost four times compared to the third wave period.

Conclusions

The USCA service utilization was significant in all the analyzed periods. In a pandemic context, it is necessary to strengthen primary care services such as USCA, which have proved to respond to rapidly changing health needs.

Key messages

• The USCA service is an innovative model of integrated home care that has proved to respond to rapidly changing health needs during all phases of the COVID-19 pandemic.

• The USCA service utilization was significant during all phases of the pandemic. The USCA service has introduced new ways of working and new relationships between services in primary care.
Resilience and life quality of health professionals in capital of Turkey during COVID-19 pandemic
Authors: Tonbuloğlu Altıner Ö , Uğraş Dikmen A , Gingir C , Özkan S
Published: October 2022

Background

COVID-19 pandemic has had significant effects on physical and mental health of health professionals. It is thought that resilience protects individuals against mental illness and helps individuals cope with difficulties and stress more effectively. In this study, it was aimed to evaluate resilience, life quality and related factors of health professionals during COVID-19 pandemic.

Methods

A cross-sectional study was performed among health professionals working at a tertiary hospital in Turkey’s capital Ankara. An occupation based stratified sampling was done with taking alpha 0.05 and 1-beta 0.80. A questionnaire that consists of sociodemographic information, COVID-19 Impact on Quality of Life Scale and Connor Davidson Resilience Scale was used to collect data. The results of scales were divided into two parts by taking the median values as cut off points. Descriptive/inferential statistics and logistic regression were performed on IBM’s SPSS 27.0 program.

Results

A total of 987 participants were surveyed. 66% of them were female, and the average age was 36. Multivariate logistic regression analysis results that physicians (OR:1.48, 95% CI:1.05-2.07, p = 0.024) and nurses (OR:1.46, 95% CI:1.08-1.97, p = 0.013) have lower resilience. The impact of COVID-19 on quality of life was higher for the following groups; physicians (OR:2.07, 95% CI:1.43-3, p < 0.001), nurses (OR:1.61, 95% CI:1.10-2.36, p = 0.013), who have bachelor/higher degrees (OR: 1.54,95% CI: 1.02-2.31,p=0.038), infected with COVID-19 (OR:1.33, 95% CI:1.02-1.74, p = 0.034), have COVID-19 related relative lost (OR:1.42, 95% CI:1.06-1.89, p = 0.016), and live with risk groups (OR:1.31, 95% CI:1.01-1.71, p = 0.042).

Conclusions

Physicians and nurses who take care of patients one-on-one have lower resilience and higher decrease in life quality due to COVID-19 impacts. This result indicates a significant quality drop in health services is inevitable during pandemics and should be considered by the policy makers.

Key messages

• Policies should be developed to increase the resilience of healthcare professionals so that they can effectively combat public health emergencies such as COVID-19 and not affect their quality of life.

• It is necessary to determine risk groups among health workers and plan training programs to increase resilience.
Does political stringency change students’ adherence to governmental recommendations?
Authors: Berg-Beckhoff G , Bask M , Jervelund SS , Quickfall A , Rabiee Khan F , Oddsson G , van der Wel KA , Sarasjärvi KK , Skalická V , Van de Velde S
Published: October 2022

Introduction

Knowing predictors for adherence to governmental recommendations is fundamental to guiding health communication in pandemic situations. This study investigated whether political stringency was associated with students’ adherence to the COVID-19 governmental measures in the Nordic countries (Denmark, Finland, Norway, Iceland, and Sweden) and the United Kingdom (UK).

Methods

We used data from a cross-sectional online survey, from university students in all Nordic countries and the UK (N = 10.345), in May 2020. Data on socio-demography, study information, living arrangements, health behaviors, stress, knowledge, and concern about COVID-19 infection supplemented with measures on political stringency from the Oxford Covid-19 Government Response Tracker were utilised. Multiple linear regression analysis methods were applied.

Results

Around 66% reported that they followed governmental measures. Our model explained only 10% of the variation of adherence. The main predictors for adherence were older age, female sex, and being worried about the COVID-19 infection. More days since lockdown and political stringency were also associated with adherence to governmental recommendations in all countries. Sweden had the lowest willingness to adhere to governmental recommendations even though the strength of the association between political stringency and adherence was similar to other countries.

Conclusions

Political stringency and congruent communication are important in ensuring adherence to governmental recommendations during the first wave of the COVID-19 pandemic.

Key messages

• Political stringency is important to ensure adherence to governmental recommendations.

• Congruent communication is important to ensure adherence to governmental recommendations.