bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with depressive episode among first year University students in Serbia
Authors: Čanković S , Čanković D , Radić I , Rakić D , Ukropina S , Nićiforović Šurković O , Tomašević T , Tamaš T , Mijatović Jovanović V
Published: October 2020

Background

Some findings indicate that university students are at higher risk of depression despite being a socially advantaged population, showing that 15 to 25% of them develop some type of mental disorder during graduation, and depression is one of the most prevalent. The aim of this study was to investigate the prevalence of depressive symptoms and its association with gender, material status, social health, and behavioral factors among university students.

Methods

The research represents a cross-sectional study conducted at the University of Novi Sad, Serbia. The research involved 455 first-year students. The average age of participants was 19.3 years (72.1% girls and 27.9% boys). Patient Health Questionnaire (PHQ-9) was used to measure depressive symptoms (cut point for depressive episode ≥10). Additional questions were focused on self-assessed material status, social health, and behavioral factors (smoking and alcohol use). The binary logistic regression model was used to estimate the association between depression and observed independent variables.

Results

The prevalence of moderate to severe depressive episode among students was 18.0%, with no gender differences. Out of the total, 11.0% of students had suicidal thoughts or thoughts of hurting themselves. Multivariable logistic regression showed that self-assessed poor material status (OR = 2.04; 95%CI: 1.06-3.89), self-assessed poor social health (OR = 8.9; 95%CI:4.87-16.42) and smoking (OR = 2.18; 95%CI: 1.09-4.39) were significant predictors of depression among first-year university students.

Conclusions

High prevalence of depressive episode among university students call for the action for the promotion of mental health, particularly among those of lower socioeconomic status, and points out the importance of social health and social network in the prevention of mental disorders.

Key messages

Students on the first year of University should be screened for depressive symptoms. It is important to educate students on how to create a strong support network and to implement intervention programs for improving mental health through fostering healthy lifestyles change.
Public Health Tracking to address the complexity of environmental health: The case of France
Authors: Medina S , Le Tertre A , Caserio-Schönemann C , Fouillet A , Leonardi G , Vardoulakis S
Published: October 2020

To address the complex relationship between environment and health, public-health professionals have recognized the benefits of building enduring interdisciplinary partnerships and of developing innovative Environmental and Public Health Tracking (EPHT) systems. In specific, EPHT can increase understanding of environmental health threats; improve comparability of risks between different areas of the world; enable transparency and trust among citizens and institutions; and inform preventive decision making. EPHT does so by sharing data and knowledge; and by identifying and supporting best practices.

In France, the concept of EPHT builds on the observation that our changing environment creates new risks that require both specific surveillance of the link between exposure and health indicators, and syndromic surveillance (SyS) of sentinel health indicators. A specific surveillance of air pollution and health has been informing French policies on air pollution for 23 years. France has also coordinated the European Apheis and Aphekom specific-surveillance projects. Using routine pollution and health data, these projects succeeded by being built on a Europe-wide collaborative network that facilitates decision-making on local and national levels.

In addition, since the 2003 heat wave France has developed syndromic surveillance for detecting the health impacts of new threats as diverse as environmental phenomena and emerging infectious diseases. France also coordinated the Triple-S project, which inventoried SyS activities in Europe; and produced guidelines for human and veterinary SyS in Member States and a proposal for a European SyS strategy. Examples of the complementarity between specific and SyS in environmental health in France include: heat and cold waves, air pollution, flooding, storms and industrial accidents. In today's world of open data, EPHT shows great promise for contributing to better informing decision makers and the population on environmental-health risks.

Key messages

Environmental and Public Health Tracking (EPHT) systems and enduring interdisciplinary partnerships provide an innovative way to address the complex relationship between environment and health. France has been in the forefront of applying innovative EPHT (Environmental and Public Health Tracking) by using complementary specific and syndromic (SyS) surveillance systems.
Stress is affected by a combination of work- and non-work-related stressors and social support
Authors: Larsen F B , Sørensen J B , Willert M V , Lasgaard M
Published: October 2020

Background

Work-related stress has received much attention. However, the relative importance of work- and non-work-related stressors on stress level has received less attention. The present study aims to determine the relative importance of work- and non-work-related stressors and social support on stress level at population level.

Methods

The study used data from the population-based health survey 'How are you?' in 2017 in Central Denmark Region (N = 32,417). Stress level was measured using the Perceived Stress Scale. Stressors were measured in nine domains including work situation and non-work related stressors. Furthermore, perceived social support was assessed. The study used dominance analyses based upon regression models with perceived stress as the dependent variable and stressors and social support as independent variables for describing the variance in stress level. Analyses were adjusted for gender, age, education and ethnic background.

Results

Work-related and non-work related stressors along with social support explained 43% of the variance in stress level. The three most important contributors to the explained variance in stress level were 'disease', 'social support' and 'work situation'. Stratified by labour marked status, stressors and social support explained 38% (in work) and 46% (outside the labour marked) of the variance in stress level. Most important independent variables were 'work situation', 'social support' and 'disease' (in work), and 'disease', 'work situation' and 'financial circumstances' (outside the labour marked).

Conclusions

Stress was affected by work- and non-work-related stressors and social support. At populations-level 'disease' was the most important stressor. However, among respondents in work 'work situation' was the most important stressor, whereas 'disease' was the most important stressor outside the labour marked.

Key messages

Stress level is affected by a combination of work- and non-work-related stressors and social support. As a consequence stress prevention should not focus solely on work-related stressors.
People‘s perceptions of Alzheimer‘s disease in Lithuania
Authors: Jurgilaitė M , Beržanskytė A
Published: October 2020

Background

The achievements in health sector resulted in longer lifespan which makes modern society to face aging problems. Alzheimer disease is one of the most obvious health problems becoming more prevalent in humanity's future. The aim of the study was to evaluate people's perceptions of Alzheimer disease in Lithuania.

Methods

The data were collected by self-administered questionnaire of 27 questions using online social media platform. 737 respondents gave the feedback in limited time of one-week period. Cronbach α of privity was found 0.62. The relative frequencies and prevalence ratios were compared in groups by different sociodemographic categories. Non-parametric tests were conducted to establish statistical significance which was set at p < 0.05. Confidence intervals were used for prevalence statistics.

Results

56.1% of the respondents had insufficient awareness about Alzheimer's disease (95% CI: 52.2; 59.3%). The level of awareness depended on the education and person's occupation in health area. However, 47.1% of health professionals didn't have sufficient awareness. Respondents had problem recognizing Alzheimer's symptoms and risk factors. 51.7% believed that Alzheimer's disease is stigmatized in the society. More women and people with higher education agreed with this statement (p < 0.001). Alzheimer disease was ranked as third most intimidating disease. However just 37.9% knew it was fatal. 85% believed they could take care of the sick family member, but admitted the care should be done jointly by the family and the state (94.6%).

Conclusions

Awareness of Alzheimer disease is insufficient. People themselves have quite good perception of the disease, but think that there is stigma and little disdain in the society. Most of the respondents are ready to nurse their sick family members, however, they expect aid from the government. Nonetheless, respondents would prefer to be admitted to care institution if it would be their case.

Key messages

Age related diseases should become main problem to be solved in the future. One of them is Alzheimer’s disease, therefore the public health measurement should be taken now to prevent it. It is important to know people’s perception of the disease, before taking any preventive actions. It enables to see what areas need intervention and where can Public health measures help.
The ecopsychosocial provision for psychiatric environments
Authors: Chrysikou E
Published: October 2020

Environment affects quality of care. Yet there are very few evaluation methods to address such issues. The SCP model is a user-inclusive, multi-paramentric method for the planning, design and evaluation of psychiatric facilities. Its application to psychiatric wards indicated hiatus between top-down (designers, building commissioning authorities) vs bottom up (patients and staff) understanding of what constitutes a therapeutic environment. That generated the need to investigate the socio-spatial context of psychiatric wards. This research aimed to promote our understanding of psychiatric space in relation to social interaction. Two acute wards in the UK provided the locus. Each was evaluated using the SCP model institutional vs domestic checklist, open-ended interviews with 10 staff and 12 patients and auditing of the spaces. Then, a Space Syntax analysis using depthmap was employed to model social activity inside the wards. The SCP model analysis indicated that the wards, one of them new and purpose built and the other part of an old psychiatric campus soon to be replaced, demonstrated strong institutional features, even compared to previous samples using the same tools. The juxtaposition with space syntax demonstrated that areas mapped as integrated, i.e., socio-friendly, were areas where antisocial behaviours were observed. This could be interpreted by Goffman's theory on total institutions, as institutional spaces might be the context of reverse socio-spatial norms according to Hillier's social logic of space. Thus, institutional spaces could still house mental health provision. Integrated approaches for evaluating healthcare facilities for fit for purpose and social integration need to become part of a healthcare evaluation system. Healthcare provision should be evaluated for ecopsychosocially supportive environments.

Key messages

The project raised the question of the appropriateness of mental healthcare environments. The spaces for the treatment and care of psychiatric patients might not be fit for their social re-integration.
International medical student’s mental health: psychological distress and socio-cultural adaptation
Authors: Hachemi H , Dimitrijević M , Stojanović J , Cvjetković S
Published: October 2020

Background

The greater academic mobility and globalization have introduced a substantial number of foreign students to more universities. The lack of recent studies about their adaptation and signs of psychological distress arose an interest about this relevant issue. Recognizing the factors involved in the adaptation process are vital for international students, especially medical, as they are considered the future health-care workforce. Ensuring their well-being is essential for consumers safety, satisfaction and raising quality at lower costs. Thus, the aim of this research was to explore the predictors of psychological distress including socio-demographic variables and socio-cultural adaptation

Methods

A cross-sectional study was conducted at the University of Belgrade School of Medicine, where 124 (65 males and 59 females) international students from 32 countries were interviewed using a socio-demographic questionnaire and psychometric tools such as Revised Socio-cultural Adaptation Scale (SCAS-R) and Depression, Anxiety, Stress Scale (DASS-21). Statistical analysis included prevalence data and multiple linear regression.

Results

The prevalence of depression, anxiety and stress was found to be 39%, 55% and 41%, respectively. Maladaptation to a new environment by lack of participation in the community and focus on own interests were significant predictors of depression (β = −.39, p< .01) and stress (β = −.36, p< .05), while anxiety was associated with both female gender (β = −.30, p<.05), self-centration and absence of community involvement (β = −.37, p< .01).

Conclusions

There is a high prevalence of anxiety followed by stress and depression among international medical students. The results highlighted the importance of cultural adaptation for psychological distress. This shows a requirement for developing an adequate, accessible professional counselling and peer support services for foreign students that are necessary to achieve sustainable development goals.

Key messages

Encouraging researchers to further investigate the needs of international medical students. The development and implementation of health policies addressing student’s mental health.
Suicide among Brazilian adolescents - a growing reality
Authors: Saldanha R C O , Abe G M , Abe A H M , Mariano M E O , Pierson I D S , Santana B F , Lima P H R O
Published: October 2020

Introduction

In Brazil, suicide is an alarming and growing health problem among adolescents. The Sustainable Development Goals aims to promote mental health.

Methods

Descriptive epidemiological study regarding the proportion of deaths by suicide according to ICD-10 classification, gender, Brazilian region, place of occurrence, race and year in adolescents from 10 to 19 years old in the period of 2008 to 2017 in Brazil, through the national system of health data, DATASUS.

Results

From 2008 to 2017, there were 175,543 deaths in adolescents due to external causes in Brazil; voluntarily self-inflicted injuries were the second main cause with 8,028 (4.6%) deaths - Among them, 728 occurred in 2008, 672 in 2009, 706 in 2010, 733 in 2011, 792 in 2012, 786 in 2013, 814 in 2014, 854 in 2015, 897 in 2016, and 1047 in 2017. Cases of strangulation/hanging/suffocation were 5,429 (67.2%); self-poisoning by pesticides were 512 (6.5%); intentional self-harm caused by the firing of another firearm and an unspecified firearm were 456 (5.7%). The most affected gender was male, with 5,536 (69%) deaths; female was 2,492 (31%). Among regions, the Southeast Region had 2,238 (27.9%) death records, followed by the Northeast, with 2,128 (26.5%). The most reported place of occurrence was home, with 4,570 (56.9%) deaths, followed by hospital, with 1,627 (20.3%). Among races, brown people were 3,803 (47.4%) deaths, and whites were 3,023 (37.7%).

Conclusions

Suicide of adolescents is a growing tragedy, with an increase of 55% in the analyzed period. Expanding studies on the theme will favor better conduct and management by health professionals. The timely identification of adolescents with a suicidal tendency and its specialized follow-up may be tools to reduce this sad reality.

Key messages

The study of child and youth suicide is important to assess the aspects that promote it, propose effective interventions and evaluate, by monitoring, the problems caused at home. It elucidates a important topic to Brazilian public health: suicide among young people. Due to its prevalence, discussing it corroborates to develop new guidelines and conducts for managing patients.
Factors associated with dating violence in young university students of Veracruz - Boca del Río
Authors: Valencia Almeida S I , Villegas Domínguez J E , Villegas Vázquez E A , Leyva Chipol J C , Márquez Celedonio F G
Published: October 2020

Introduction

In the Mexican - American population, violence occurs between 10 and 40% of initial affective relationships. Veracruz is one of the main Mexican states that suffers violence and is the one with the largest number of femicides (3.44 per 100,000 women). Research question: what are the associated factors in the victimization in the courtship of young university students from the Veracruz - Boca del Río conurbation zone?

Methods

A cross-sectional, prospective, observational and analytical study was conducted from August to November 2019. University students enrolled in a higher education educational program in public and private universities of Veracruz-Boca del Río, who have had the minus a dating relationship and those who did not agree to participate were excluded. Violence in dating was quantified with the “Questionnaire on Violence in Dating (CUVINO)” (Alfa Cronbach 0.91). The spss v22 software was used to analyze the data.

Results

680 participants were included, distributed in private schools (56.47%) and public schools (43.52%), with 444 (65.2%) women and 236 (34.7%) men. The prevalence of dating violence was 74.9%, however, only 21.6% of the participants considered having had such a relationship. The factors associated with dating violence were studying in a private school (OR = 0.62 IC95% 0.4-0.9), witnessing some act of violence in your family (OR = 1.47 IC95% 1.02-2.12), meeting a friend with a relationship violent (OR = 2.0 95% CI 1.4-2.9), believe that abuse exists in courtship (OR = 4.7 95% CI 2.9-7.4) and suspect that you may be in a violent relationship (OR = 4.67 95% CI 2.22- 9.83), while not witnessing any act of violence in your family (OR = 0.61 95% CI 0.4-0.8) is a protective factor to avoid violence in dating, all these values with p < 0.05. It was not associated with violence.

Conclusions

Violence in dating is associated with behaviors of family members and friends of the violent.

Key messages

The social situation close to a person influences the violence allowed in their courtship. Young people normalize violence in a relationship, since many of them do not identify it when living it.
Medicinal cannabis, a medicine. Characterization of the reality in Portugal
Authors: Garrido J , Martins T , Pedro A R , Santos I , Miranda R , Silva D
Published: October 2020

Cannabis has been used over the centuries for medicinal purposes. The first evidence dates from the third millennium BC in India and Chinese Empire, due to its analgesic, antiemetic and anticonvulsant properties. Nevertheless, its use is also associated to manufacture industry - hemp - translating a widespread function. However, through time, it is its recreational, additive and illegal purposes are the ones that we most quickly associate with it. This stigmatized its use in society and neglected the benefits. Its only in the XX century with the discover of the of the endocannabinoid system that allowed a new vision on the theme, challenging and revolutionizing the, until then, ingrained classic vision. In fact, its benefits in several pathologies or clinical symptons are well documented today. In light of the current debate on the use of cannabis for medicinal purposes worldwide and recently in Portugal with new legislation, a review of the available literature is required to explain the national reality and its context in the international reality. Due to the clinical and social relevance of the theme, the authors aimed to study, collect and systematize information in order to uptodate the state of art in: innovation, potential indications for its therapeutic use; understand the existing legal framework in Portugal, for cannabinoids and for the previous phases, such as cultivation and production; understand and compare the international reality and that existing in Portugal, namely in Portuguese hospitals; and, understand what are the future perspectives for cannabis as a therapeutic line.

Key messages

Clinical and social relevance of the theme and its legal framework. What are the future perspectives for cannabis as a therapeutic line nd the stigma of using it.
Characteristics of people with mental disorders differ between currently smoking and ceased smoking
Authors: Dahal R , Bharrarai A , Adhikari K
Published: October 2020

Introduction

Although the prevalence of smoking is higher among people with mental disorders compared to those without mental disorders, people with mental disorders are less successful for smoking cessation. This study examined the variation in characteristics of people with mental disorders across those who are current smokers and former smokers.

Methodology

This study used the Public Used Microdata File of the Canadian Community Health Survey 2012. (n = 25,113). People with any mental health disorder in the last 12 months were identified using the World Health Organization Composite International Diagnostic Interview instrument. Smoking status was classified based on self-report responses as: current, former, and never smoking. Multivariable logistic regression analysis was used to examine the association between the characteristics of people with mental disorders and smoking cessation (vs continuation).

Results

Overall, the prevalence of current smoking, former smoking, and nonsmoker were 37.5%, 33.6%, and 28.8% respectively. Immigrants compared to Canadian-born (OR = 0.6, 95% CI = 0.3, 0.8) and those who were single (either widowed or divorced or separated or single) compared to married or living with a partner (OR = 0.4, 95% CI = 0.1, 0.6) were less likely to quit smoking. Similarly, less educated and young people were also less likely to quit smoking.

Conclusions

Young people, living alone, less educated, and immigrants are less successful to quit smoking. Findings indicate the social disparity in smoking cessation among people with mental disorders. This may have been related to the barriers in accessing smoking cessation support among this group.

Key messages

Findings underscore the disparity in smoking cessation among people with mental disorder. Implementation of tailored, personalized smoking cessation support may be helpful to address the challenges.
Use of alcohol associated with mental disorders in adult men
Authors: Bulgareli J , Souza C , Pereira A , Meneghim M , Guerra L , Cavalcanti D , Gondinho B , Checchi M , Mendes K
Published: October 2020

Background

This study aimed to identify the use of alcohol in adult men and to verify the association with socioeconomic, demographic and mental disorders.

Methods

A cross-sectional analytical study was carried out on adults aged 20 to 59 years old in the city of Piracicaba registered in the Family Health Units (FHU) in 2018. The pattern of alcohol use was investigated in the population through the application of the AUDIT (The Alcohol Use Disorders Identification Test) instrument. Through the modified socioeconomic questionnaire by Meneghim et al, socioeconomic and demographic factors were investigated. The brief investigation of the main mental disorders: major depressive episode and generalized anxiety disorder, was carried out with the Mini International Neuropsychiatric Interview (MINI). The sample was selected “post-hoc” considering the sample, with a significance level of 5% and test power above 80% (β = 0.20) (effect size = 0, 33). After contacting the FHU and selecting participants, the interviews were conducted over the phone in one step. The eligible sample had 227 participants. After descriptive analyzes, variables with p-value <0.20 in simple analyzes were studied in multiple negative binomial regression models (95% confidence intervals).

Results

There was a high prevalence of alcohol consumption, 26.9%. The AUDIT score increased with age (RM: 1.02; 95% CI: 0.99-1.03). Protestants and evangelicals had an average AUDIT score lower than other religions (RM: 1.78; 95% CI: 1.14-2.79). People with mental disorders have an average AUDIT score higher than those without disorders (RM: 2.30; 95% CI: 1.28-4.11).

Conclusions

It is concluded that alcohol in the adult male population was prevalent, increases with age, and religion has a protective effect. We highlight the importance of the USF in the development of strategies that investigate the conditions of its population, as well as the discussion and approach of interventions

Key messages

The adult male population is more vulnerable to alcohol use and its consequences. Thus, early detection and the search for associated factors is necessary to avoid possible damage to men's health. The application of the Mini International Neuropsychiatric Interview instrument, can act preventively and with early interventions in mental disorders and in association with alcohol use.
Cervical screening for HIV-positive women in the transition to primary HPV testing in Ireland
Authors: Kelly C , Mason-Mohan C , Doherty L
Published: October 2020

Background

CervicalCheck, Ireland's national cervical cancer screening programme, will transition to primary HPV testing in March 2020. CervicalCheck sought an evidence review to inform the screening pathway for HIV-positive women in this context, with regard to age of initiation and frequency of screening. Currently, HIV-positive women commence cervical screening at age 20 in Ireland with annual screening thereafter.

Methods

An electronic literature search was conducted to identify relevant peer-reviewed publications using the database Pubmed. A hand search of reference lists of suitable articles and international cervical screening guidelines was conducted to check for additional material. Publications pertaining to international cervical screening guidance and practice were sourced via internet searches using Google. The relevant grey literature was also explored.

Results

The prevalence of multiple and more persistent high-risk HPV types is higher among HIV-positive women compared to HIV-negative women. HIV-positive women are also at an increased risk of progression and post-treatment recurrence of HPV-associated cervical lesions. The degree of immunosuppression is a key factor in the relationship between HPV and HIV. There is significant heterogeneity internationally as regards cervical screening pathways for HIV-positive women. Many programmes commence screening at the time of diagnosis with HIV. Most developed countries screen HIV-positive women more frequently than HIV-negative women, although the screening interval varies.

Conclusions

HIV-positive women warrant special attention within an organised population-based cervical screening programme. The evidence synthesised in this review was used to inform change to the screening pathway for HIV-positive women as part of the planned transition to primary HPV testing. Cervical screening for these women using primary HPV testing will now commence at the time of diagnosis with HIV, with annual screening thereafter.

Key messages

HIV-positive women warrant special attention within an organised population-based cervical screening programme. The evidence synthesised in this review was used to inform change to the screening pathway for HIV-positive women as part of the planned transition to primary HPV testing in Ireland.
Palliative care and complex chronic conditions since the perspective of healthcare professionals
Authors: Doñate-Martínez A , Llop L , Garcés J
Published: October 2020

Background

According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750).

Methods

Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain).

Results

Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC.

Conclusions

Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles.

Key messages

Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.
The impact of Multidisciplinary Tumor Boards on breast cancer care: results of a systematic review
Authors: Castrini F , Specchia M L , Spina F , Carini E , Di Pilla A , Grieco A , Frisicale E , Ricciardi W , Damiani G
Published: October 2020

A Multidisciplinary Tumor Board (MTB) is a group of professionals from different clinical areas that meets to examine oncological patients to face multiple aspects of the pathology. MTBs represent an effective way for clinical decision making and management of complex diseases like cancer that needs an integrated approach. They have the potential to implement patient's care optimizing both evaluation and treatment. The aim of this study was to evaluate the clinical and organizational impact and benefits of MTBs on breast cancer cases.

The databases investigated to carry out the research were Pubmed and Web of Science. Only Italian and English articles focused on breast cancer patients evaluated through MTB approach were included. No time restriction was adopted. Articles about other types of cancer were not included; systematic reviews and non-peer reviewed papers such as editorial and commentaries were excluded from the study.

The research found 5163 publications; duplicated records were omitted. 5086 articles were excluded through the analysis of title and abstract; after full text reading 52 studies were excluded. Only 25 publications fulfilled the inclusion and exclusion criteria. Two articles considered the impact of MTB on overall survival; 1 publication studied the effect of diagnostic changes; 7 articles examined the impact of MTBs on cancer treatment; 2 studies analysed the effects on clinical performance. Other publications examined secondary outcomes and indicators.

MTB has been described to have a positive impact on breast cancer. It improves overall survival (substantial results for over 65), diagnostic accuracy (up to 65%) and treatment scheme making it more adherent to guidelines (28%-93,1%). Furthermore, MTB makes patient's management more functional and avoids inappropriate interventions.

Further studies are needed to deepen on some topics such as the economic aspects and the importance of the participation of general practitioners to MTBs.

Key messages

MTB could improve patient’s care and clinical management of cancer. It is necessary to study if greater accuracy in patient’s management could have economic impact as it avoids inappropriate procedures.
Long-term outcome after off-pump coronary artery bypass grafting: implication for public health
Authors: Rosato S , Barili F , D'Errigo P , Biancari F , Forti M , Cerza F , Cicala S D , Badoni G , Seccareccia F
Published: October 2020

Background

The debate on the benefits and limitations of off-pump (OPCAB) coronary artery bypass grafting (CABG) on long-term outcomes is not yet settled. This study aimed to compare the impact of OPCAB vs on-pump CABG on long-term outcomes and to evaluate possible public health implications linked to their use.

Methods

The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods.

Results

The study population consisted of 11 021 patients who underwent isolated CABG (27.2% OPCAB). The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). OPCAB had comparable late all-cause mortality to on-pump CABG (HR 0.94, 95%CI 0.85-1.03, p = 0.19), but it was associated to an increased risk of MACE (adjusted HR 1.14, 95%CI 1.06-1.23, p = 0.001). In particular, OPCAB had an increased risk of repeated revascularization with percutaneous cardiac intervention (PCI) (adjusted HR 1.33, 95%CI 1.16-1.53, p < 0.001) compared to on-pump CABG.

Conclusions

OPCAB does not affect long-term mortality, but it significantly increases the risk of MACEs. In particular, OPCAB had an increased risk of repeated revascularization with PCI. These findings may have important implications towards health resources allocation.

Key messages

Off-pump coronary artery bypass grafting strategy is associated with an increased long-term risk of MACE and repeated PCI. Off-pump strategy is mainly based on operator preferences and can have important implications in terms of healthcare costs.
Healthcare services use and costs for a cohort of high needs elderly diabetic patients
Authors: Caberlotto R , Buja A , Pinato C , Mafrici S , Bolzonella U , Baldovin T , Corti M C , Avossa F , Schievano E , Baldo V
Published: October 2020

Background

The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged >65 years. A recent study also found that almost 75% of adults with diabetes have two or more comorbid conditions. The aim of the study was to investigate the impact of comorbidities on health care service use and health care costs of an elderly diabetes cohort with high health care needs (HHCN), based on real-world data.

Methods

For the purposes of the present study, people with a diagnosis of diabetes, residing in the area served by the ex-ULSS4-Veneto LHU, and characterized as having HHCN, corresponding to ACG-RUBs 4 and 5 were considered. The comorbidities was assessed using clinical diagnoses that the ACG System assigns to single patients by combining different information flows. The presence of correlation between comorbidity classes and total annual health care costs and use was tested with Spearman Test. Moreover, the association between above mentioned variables was tested with a appropriate regression, adjusting for age and sex.

Results

Mean overall cost and drug cost ranged respectively from 6284 euro, 525 euro in a patient with only 1 comorbidity to 10752 euro and 1764 euro for a patient with more than 8 comorbidities. The study shows that all measures of health care services use (as emergency care accesses; number of outpatients visits; number of inpatients admissions) have a statistically significant correlation with comorbidities class. However, multivariate analyses revealed that no different use in hospitalization was associated with comorbidity class. A significant correlation was also detected among costs variables (total annual costs and pharmacy costs) and comorbidity classes.

Conclusions

The increase in total healthcare services use and costs due to the increased number of comorbidities was seen mainly for primary care services, highlighting the need of primary care to be strengthen in an ageing and multi-morbid population.

Key messages

Overall cost and drug cost for patients with more than 8 comorbidities are respectively almost doubled and more than threefold greater than those with only one comorbidities. The study revealed an increase in primary care services, suggesting an implementation of these services giving the aging population and the increase prevalence of comorbid diabetic patients worldwide.
Oral health care among patients with diabetes in Australia: A snapshot
Authors: Poudel P , Griffiths R , Wong V W , Arora A , Flack J R , George A
Published: October 2020

Background

Diabetes increases the risk of periodontal disease, which in turn negatively impact on diabetes control and complications. Therefore, awareness about the diabetes-oral health link and dental problems is important for people with diabetes. This study aimed to assess self-reported oral health status and knowledge of people living with diabetes.

Methods

A survey was conducted among patients who attended four public diabetes clinics in Sydney, Australia. The questionnaire included 10 knowledge items and a validated Oral Health Impact Profile (OHIP-14) scale. A convenience sample of 200 patients were recruited. The data were analysed using SPSS software with descriptive and Pearson's Chi-Squared tests reported.

Results

The mean age of participants was 62.4(±13.5) years. More than half were males (54.5%), born overseas (64%), not working (73%) and had type 2 diabetes (88%). More than half (55.1%) of the patients reported having one or more dental problems and this was negatively associated with their oral health-related quality of life (p < 0.001). The most common dental problems were: gaps between teeth, pain in teeth and dry mouth. Only 46.2% of the participants had adequate oral health knowledge (> the mean correct score 5.2 (±2.6). The main areas with poor knowledge were around the impact of gum disease on blood glucose levels (29.6%), effects of dry mouth on tooth decay (33.8%) and the link between diabetes and teeth and gums (44.5%). Only 13% of the patients reported receiving oral health information from diabetes care providers (diabetes educator, general practitioner/diabetes specialist and dietitian/nutritionist). Receiving oral health information was found to be significantly associated with higher oral health knowledge scores (p < 0.05).

Conclusions

Considering that a majority of patients with diabetes have dental problems and inadequate oral health knowledge, diabetes care providers should take the opportunity to educate patients about oral health risks.

Key messages

People living with diabetes found to have dental problems and inadequate oral health knowledge. Considering that diabetes and dental problems adversely affect each other, it is crucial to educate patients about good oral hygiene and regular dental visit.
Hospitalization costs related to long-term management of patients undergoing CABG (PRIORITY project)
Authors: Pagano E , Evangelista A , D'Errigo P , Rosato S , Seccareccia F , Biancari F , Badoni G , Forti M , Barili F
Published: October 2020

Background

Identifying potential tools that could help improving the standard of care and lead to a better allocation of economic resources represents a main objective of research in public health. Using data from the PRIORITY cohort, this study aims to describe inpatients costs after a discharge for isolated coronary artery bypass surgery (CABG).

Methods

The PRIORITY project was designed to evaluate the long-term outcomes of 2 large multicenter cohort studies on CABG conducted between 2002-04 and 2007-08. For each patient discharged alive after a CABG intervention, costs of hospitalizations were estimated as the sum of costs of all the admissions occurred during 3 years of follow-up. NHS reimbursement rates were used as standard costs (in Euros). Inpatients costs were analysed according to their baseline risk factors.

Results

Among the 7363 patients included in this analysis, the median 3-year hospitalization costs were 4341€ (IQR: 1865-11699). Median costs were around 4.000€ for subjects alive at the end of follow up but higher for patients dying within 1 (about 8.600€) and 2-3 years of follow up (about 20.000€). The presence of comorbidities (such as diabetes and cancer) lead to higher median hospitalization costs while the on-pump approach was associated to lower median cost. Sixteen per cent of patients were at zero cost having no re-hospitalizations during the 3 years of follow-up (97% alive). Subjects at zero cost received more frequently on-pump approach, had a lower frequency of cancer, arteriopathy and ictus, but a higher frequency of angina and infarction.

Conclusions

Inpatient costs after isolated CABG are affected by preoperative comorbidities and by operative variables that could be removed or managed. Identifying independent risk factors for re-hospitalization will lead to the definition of a preoperative clinical and decision-making path that will bring both a clinical advantage for the patient and an optimization of costs for the NHS.

Key messages

Inpatient costs after isolated CABG are affected by preoperative comorbidities and operative characteristics like the on-pump approach. Appropriate management of operative approaches mainly based on operator preferences can have important implications in terms of healthcare costs.
Overcoming multimorbidity: Chrodis Integrated Multimorbidity Care Model pilot implementation
Authors: Bliek-Bueno K , Gimeno A , Poblador B , Guerrero I , Cano M I , Bestué M , Rodríguez-Blázquez C , Forjaz M J , Prados A
Published: October 2020

Background

Multimorbidity (MM) has become one of the greatest challenges for patients and healthcare providers, calling for the development of care models that offer holistic, patient-centered care plans. Our objective was to assess the applicability and effectiveness of the Chrodis Integrated Multimorbidity Care Model (IMCM) to improve care for patients with MM in the Public Health System of Aragón, a region in northeastern Spain where MM affects 80% of people over 65 years of age.

Methods

We developed and implemented a set of actions (”change package”) to target three main improvement areas (i.e., care fragmentation, training of professionals and community care) covering all five dimensions of the model. We used key process and outcome indicators to evaluate each action, including healthcare service use (hospitalizations, emergency room visits), delivery of care (care plans, case managers), improvement in MM management skills of professionals (online training course), and patient self-perceived quality of care (ad-hoc questionnaire).

Results

291 patients of over 65 years of age with MM were recruited. At the end of the implementation every patient had a designated case manager and an individualized care plan, and 96.7% had their social situation assessed. During the 1-year pilot intervention, patients averaged 0.69 hospitalizations and 1.24 visits to the emergency room; 87.5% reported a self-perceived improvement of received care. 348 community resources were mapped and made available online in an official website. 89% of professionals who were offered to participate in the training programme agreed, reporting 8.3/10 satisfaction with the course, and improved their MM management skills from 7.36 to 9.18/10.

Conclusions

The IMCM is applicable in the context of the Spanish Public Health System and is effective in improving quality of care for patients and professionals alike.

Key messages

Reinforcing the mechanisms that integrate community, primary and hospital care is still necessary if we intend to reduce the negative health outcomes associated to care fragmentation in multimorbidity. The sustainability of the model requires the continued collaboration of key stakeholders and the awareness that multimorbidity is an issue that exceeds purely economic and structural barriers.
Availability of ultra-processed food associated with health outcomes: a systematic review
Authors: Pereira de Araújo T , Moraes M , Magalhães V , Afonso C , Rodrigues S
Published: October 2020

Background

Ultra-processed food (UPF) consumption increases worldwide, which can be harm to population's health. To establish associations between UPF and health outcomes, food consumption can be assessed individually or by using availability data, such as purchase lists or household budget surveys. The aim of this review was to search for studies on the availability of UPF related with mortality and morbidity from noncommunicable diseases or their risk factors.

Methods

PRISMA guideline was used. Searches were performed on PubMED, EBSCO, Scopus and Web of Science on December 2019. Search strategy included terms related with exposure (UPF) and outcomes (mortality or morbidity from noncommunicable diseases and their risk factors). Studies were selected based on the title and abstracts. Full texts were screened for eligibility and the snowballing method was used to find other relevant studies. To be based on UPF availability data and its relation with health outcomes were the inclusion criteria. Studies that assessed only food consumption at an individual level and did not present health outcome were excluded. Selection was conducted by two reviewers and a third helped when disagreement occurred.

Results

After duplicates removal, 560 records were analyzed. From the 11 eligible studies, 55% were conducted in more than one country. Others were performed in Brazil (27%), Guatemala (9%) and Sweden (9%). Studies were ecological (64%), cross-sectional (27%) and longitudinal (9%). All had representative samples, 45.5% were national samples, and the others were from particular population subgroups. In all studies, the only health outcomes that showed positive association with UPF availability were overweight and obesity prevalence.

Conclusions

Studies relating ultra-processed food availability and health outcomes are mainly focused on overweight and obesity. It is thus necessary to further explore the relationship between UPF availability and other health outcomes.

Key messages

It is necessary to further research association between ultra-processed food availability and other health outcomes, such as morbidity and mortality from cardiovascular diseases, diabetes or cancer. Purchase lists or household budget surveys are an important source of food availability data and can be used to relate the consumption of ultra-processed foods to health outcomes.