bluuebunny/crossref_metadata_2025 huggingface dataset:
Public health services at community pharmacies and strategies for expanding the role of pharmacists
Authors: Kazaryan I , Sevikyan A , Amirkhanyan A , Vardanyan L
Published: October 2020

Pharmacy practice is evolving and the role of pharmacists in public health is expanding in many countries. The objective of this work was to analyse involvement of community pharmacy staff in public health activities, as well as to identify opinion of pharmacy professionals about strategies for expanding their public health role in Armenia.

Survey was conducted in different regions of Armenia. Pharmacists and technicians working in community pharmacies were asked to complete pre-tested questionnaire that includes questions about their involvement in public health activity, motivation and opinion on strategies for improvement of the situation. 162 pharmacy professionals completed the questionnaire. Data were analysed with SPSS statistical software, version 22.0.

76.5% of responders indicated that they agree that community pharmacy practice should involve provision of public health services. Only 22.2% of community pharmacists and technicians reported that they are currently engaged in any public health activity. The main reasons for providing public health services indicated by responders are professional responsibility (84.6%), patients' satisfaction (66.0%) and personal satisfaction (63.6%). 80.2% of responders suppose that providing public health services in community pharmacies can have an impact on improving population health. Respondents indicated strategies which could be effective for expanding pharmacists' role in public health: increasing public awareness (82.7%), expanding pharmacists' knowledge (82.1%) and guidelines (71.6%).

Only part of pharmacy professionals is engaged in public health activity. Many of them believe that certain strategies are able to improve the situation with involvement of community pharmacy staff in providing public health services in Armenia.

Key messages

Pharmacists are motivated to implement public health services. Special strategies should be introduced to increase engagement of pharmacists in public health.
Are large scale, urban, comprehensive CHW programs effective? The South African experience
Authors: Thomas L S , Buch E , Pillay Y , Jordaan J
Published: October 2020

Background

South Africa is an upper middle-income country, but has one of the widest GINI co-efficients in the world. It faces a heavy burden of disease and poor health outcomes remain a challenge for millions of South Africans. Slow economic growth, rapid urbanization and high unemployment could de-rail the efforts to improve access to health care and health outcomes amongst the most vulnerable in the country. Within this context, the introduction of large scale, comprehensive community health worker (CHW) programs, in urban areas are seen to be game changers. However, there is inadequate global evidence on whether such programs work.

Methods

This is a multi-method, quasi-experimental intervention study measuring the effectiveness of a CHW program in the Ekurhuleni health district; set in an urban province of South Africa, where CHWs support approximately one million people. Health indicator performance was compared in clinics with good coverage of CHWs and those with low or no CHW support. Poor and vulnerable households with CHW support were compared to those with no CHW support.

Results

Over a nine-year period since implementation, clinics with CHW programs improved better than clinics without; on identified pregnancy, child health, infectious disease and non-communicable disease indicators. Odds ratios showed that households with good CHW coverage had better social support, health-seeking behavior, morbidity and mortality than households without. p-values were statistically significant (<0.05) for social support, chronic disease diagnosis and chronic disease control outputs.

Conclusions

This CHW program has shown its worth as it has been effective in improving early screening, referrals, diagnosis and disease control across a number of health conditions in an urban setting.

Key messages

Large-scale comprehensive CHW programs are a good investment towards achieving universal health coverage for all by improving access and care to the poor and vulnerable. Community Health Worker services in households are effective and should be a legitimate level of health care delivery in developing countries.
“Transfer, Contestation and Conflict”: How Italian regional and national governments claim and challenge authority in mandatory vaccination policies
Authors: Rizzi M , Attwell K , Casigliani V
Published: October 2020

Background

This paper explores conflictual policy transfer in Italian vaccination policy 2007-2018. The region of Veneto formally suspended mandatory vaccination in 2007. Soon after, declining vaccination rates across the country sparked a public health crisis. Emilia Romagna adopted a new vaccine mandate for early education, which the national government adopted in 2017. Each policy decision invoked collaboration and contestation between governments. In showing the conflictual aspects of intra-state policy transfer, we offer lessons for multi-level health governance of contested issues.

Methods

We used qualitative documentary analysis of parliamentary transcripts, legislation and government reports, supplemented with semi-structured key informant interviews, using the coding software NVivo 12. We applied theoretical and conceptual scholarship to develop an analytical framework drawing out the key mechanisms through which contestation and conflict take place.

Results

Italian regional and national governments employed three key mechanisms to forcibly transfer or resist vaccination policy: ideas, evidence, and law. Ideas included “the nation”, “herd immunity” and “science.” Evidence included coverage rates and explanations of changes over time. Protagonists of Italy's coercive policy transfers used the law to claim and challenge authority. Contestations occurred in political and bureaucratic spheres. Discrepant historical and evidentiary narratives emerged between levels of government that had injected significant resources into acquiring or defending governance of vaccination policy.

Conclusions

Scholarship has predominantly considered coercive policy transfer at a supra-national or inter-state level. We demonstrate the political blood-spilling within a country when divergent regional policies become contested in a situation of national crisis. 'Evidence' and 'law' can be open to differing interpretations, with 'ideas' shaping the context in which policies prevail.
Impact of Australian mandatory policies on immunisation services, parental attitudes to vaccination and vaccine uptake in a tertiary paediatric hospital
Authors: Armiento R , Hoq M , Kua E , Crawford N , Perrett K , Elia S , Danchin M
Published: October 2020

Introduction

'No Jab, No Play' and 'No Jab, No Pay' mandatory immunisation policies were introduced in the state of Victoria and Australia nationally in January 2016. They restrict access to childcare/kindergarten and family assistance payments respectively, for under-vaccinated children. We aimed to describe the proportion of attendees to immunisation services of a tertiary hospital, the Royal Children's Hospital Melbourne (RCH), who were motivated by the policies to discuss or catch up vaccination. We also explored the association between policy motivation, vaccine hesitancy (VH) and intent to seek medical exemption, with vaccine-uptake. Referrals to the Specialist Immunisation Clinic (SIC) were also reviewed.

Methods

Parents/Guardians and clinicians completed surveys October 2016-May 2017 from the nurse-led immunisation Drop in Centre (DIC) or physician-led SIC. Vaccine-uptake was measured using the Australian Immunisation Register at baseline, 1 and 7 months post-attendance. The association between vaccine-uptake, policy motivation and VH was explored by logistic regression.

Results

Of 607 children included, 393 (65%) were from the DIC and 214 (35%) SIC. 74 (12%) of parents were motivated by the policies to attend immunisation services and 19% were VH. Only 50% of VH parents planned to catch-up vaccination for enrolment to childcare/kindergarten. Fewer children were fully immunised at 7 months if their parents were VH (difference 18%; OR 0.24, CI 0.1-0.54,p<0.001) or seeking medical exemption (difference 33%, OR 0.08, CI 0.01-0.6, p 0.015).

Conclusions

The 'No Jab' policies motivated attendance to a tertiary immunisation service but children of vaccine hesitant parents and those seeking medical exemption to immunisation were less likely to be fully immunised post attendance, compared to baseline. These data will be used to inform a comprehensive evaluation of the impact of the policies, particularly the educational impact from loss of early childhood education.
Frailty and social support: the care services response to aging in Russia
Authors: Kholostov E
Published: October 2020

In the twenty-first century, ageing of population, having become a global phenomenon, raised questions about the need to consider the social services of the elderly from an institutional perspective. Thus, the number of Russians over the age of 100 in 2018 exceeded 15.7 thousand people. In Moscow, as in the mega polis, in 2018 more than 3.4031 million people (27.2%) are older than working age.

Different countries have their own characteristics of social service systems, models and policies, it depends to a large extent on the traditions of assistance, sources of financing, the space of responsibility assumed by the State, society, the family and the individual himself.

New technologies to be applied for working with the elderly in Russia. Transition to the establishment of a system of long-term care at the level of multidisciplinary cooperation (reform of the residential care system; development of community based services, formation of Social Support Services for 75+, foster family for the elderly).Development of active longevityChanging the role repertoire of an older person (formation of new types of social roles previously characteristic of younger ages; changing of intergenerational link formats, etc.).The growing social responsibility of the State contributes to a more effective interaction between health and social care authorities, as well as a more active involvement of the NGO sector in addressing the problems of older persons.The increase in the number of older persons leads to the creation and active development of a silver economy that contributes to improving the well-being of people.Transfer of retraining and advanced training systems to the competent level according to professional standards (independent assessment of qualifications, personnel diagnostics, formation of individual trajectory of education, training of multiple disciplinary teams).
Prevalence of mild cognitive problems in Flemish Nursing homes
Authors: De Vriendt P , Gorus E , Bilsen J
Published: October 2020

Background

Mild cognitive decline in Nursing Home (NH) residents without dementia is often noted very late since cognitive demands are relatively low in this setting. Therefore, subtle cognitive changes could remain undetected. This study aimed to evaluate the prevalence of mild cognitive problems in NHs.

Methods

First, a file study was performed to exclude residents with a diagnosis of dementia or known cognitive problems (Mini Mental State Examination-MMSE < 24) in 16 NHs. Second, remaining residents were screened for cognition with the Montreal Cognitive Assessment (MoCA). Also, an evaluation of functionality (ADL-Questionnaire), mood (Geriatric Depression Scale), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire) and subjective memory complaints (Informant Questionnaire on Cognitive Decline) was performed.

Results

On a total of 1339 residents, 229 persons (17.1%) had no diagnosis of dementia and an MMSE >23. Based on MoCA-cut-offs 2.7% (n = 36), 11.4% (n = 152) and 3.1% (n = 41) could be labelled as cognitively normal (>25), mild cognitive impairment (>16 and <26) and mild dementia (<17) respectively. This resulted in a prevalence of undetected mild cognitive problems of 14.5% (n = 193) in the total NH population. Significant differences between the 3 groups were found for functionality, mood, neuropsychiatric symptoms and subjective memory complaints (all p < 0.05).

Conclusions

Considering their advanced age NH residents are vulnerable to develop dementia. This study showed that an important part of them has unnoticed mild cognitive problems. NHs should be aware of this risk group in order to provide adequate prevention and support.
Examining ‘immunity passports’ from an ethics perspective – ten reasons why they are bad idea
Authors: Kofler N , Baylis F
Published: October 2020

The two panelists will elaborate on 'four practical problems and six ethical objections', which add up to one very bad idea, i.e., the 'immunity passport'. Such an idea is equal to restricting movement on the basis of biology threatens freedom, fairness and public health. Lessons from previous pandemics will be examined in the context of current measures being deployed, assessing practical and ethical aspects. For example, false negatives in people with few antibodies leading to immune individuals being incorrectly labelled as not immune or not having access to testing to demonstrate immunity. Additionally, the case of healthcare workers will be examined considering feasibility of testing, but also in terms of discrimination and stigma. Another aspect to be explored in detail is monitoring and how it erodes privacy, with the main aim of immunity passport controlling movement. Documentation systems are already presenting a serious risk to privacy, with China announcing the QR-code tracking systems is likely to stay in place after the pandemic ends.

Access issues to testing can contribute to further discrimination, whereas labelling people on their basis of their COVID19 status would create a new measure of dividing the society to 'immunoprivileged and immonodeprived' people. A labelling particularly disconcerting in the absence of a free, universally available vaccine. Furthermore, Social and financial inequities would be amplified, whereas divisions between nations could be fueled. Already people with HIV are subjected to restrictions on entering, living and working in certain countries with laws that impinge on the rights of those from sexual and gender minorities. Governments should instead invest on pandemic damage limitation - test, trace and isolate, and apps that empower individuals to make safe choices about their own movements should be prioritized. Also, the development, production and global distribution of a vaccine for SARS-CoV-is key. Universal, timely, free access to a vaccination becomes possible could allow for ethical recording of vaccination status in the context of certain activities. Threats to freedom, fairness and public health are inherent to any platform that is designed to segregate society on the basis of biological data. All policies and practices must be guided by a commitment to social justice.
Public health law and COVID-19: Human rights and global health security
Authors: Petelos E
Published: October 2020

The WHO has highlighted the technical challenges of assessing immunity status, cautioning against immunity passports. Similarly, the ECDC indicated that “current scientific knowledge that exists on the immunological response to SARS-CoV-2 (quality, quantity and duration of human antibodies) or the available testing methods (laboratory based and point-of-care)” does not support their use. Accordingly, the European Commission has emphasised the risks compulsory testing, noting that “border control [is not] an effective measure to limit the transmission of the virus, while the Council of Europe raises awareness of the interference of SARS-CoV-2 measures on human rights, underlining that “the major social, political and legal challenge facing our Member States will be their ability to respond to this crisis effectively, whilst ensuring that the measures they take do not undermine our genuine long-term interest in safeguarding Europe's founding values of human rights, democracy and the rule of law”.

Nevertheless, immunity passports and immunity registries are being discussed more than ever before, with governments under pressure to find a viable solution. This presentation will examine the GDPR, and current legislation protecting rights vs. legislation allowing testing, quarantine, administration of medicines, recording of immunity vs. vaccination. It will debate the legal nature of immunity passports and the relevance to fundamental European freedoms, linking key concepts to global public health law. Implications regarding the personal right in Health/right of Public Health and legal substance and human rights limitations will also be examined. Criteria and the use of immunity passports as limitations of human rights -prescribed by law, legitimate aim and necessary in a democratic society- with extrapolation in terms of discrimination will be discussed. Finally, the jurisprudential approach and control (national, European, ECHR, global) will be mentioned, along with a brief highlight to the implications for migrant populations and cross-border care.
Governance of conflicts of interest in the publication of health research – perspectives on ways forward from a journal
Authors: Chatfield C
Published: October 2020

Identifying corporate influence and biases in the publication of academic research is fraught with difficulty, as this presentation explores. Journals often rely on authors' own disclosures of interests, which may intentionally or unintentionally omit relevant conflicts. Financial conflicts of interests may be easier for authors and editors to identify, allowing some mitigation, but non-financial conflicts of interest and corporate influence can be harder to tease out. Both authors and journals make multiple judgements on which interests are relevant and it is easy for opaque conflicts to slip through the cracks.

Even if these conflicts of interests are declared, moreover, many journals rely on transparency to inform their policy on publishing research by authors with links to industry; this transparency assumes that readers are able to discern the potential bias arising from these relationships. However - while we know that readers consider research papers written by authors with declared financial links to industry to be less important, relevant, rigorous, and believable - this may lead readers to place unwarranted trust in research from authors whose conflicts are less clearly visible. For example, from authors aligned with academic institutions whose departments may experience corporate influence, but in a manner too indirect to be declared.

In order to consider these issues in context, delegates will be asked to make judgements on whether particular conflicts of interest statements would exclude authors from publishing with one leading journal, the British Medical Journal. They will hear how journals are now moving beyond transparency in order to better engage with these themes: via such initiatives as, for example, registries of interests; the re-definition of competing interests as relationships; and increasingly widespread policies that entirely exclude authors with financial ties to industry from publishing.
Impacts of climate change on Public Health of the Mediterranean population
Authors: Paz S
Published: October 2020

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. This populated region is characterized by significant gaps in the socio-economic levels, parallel with population growth and migration, increased water demand and forest fires risk. Consequently, the vulnerability of the Mediterranean population to human health risks as result of climate change increases significantly.

Climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events, changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed parallel with adaptation planning that become ever more imperative. In order to achieve these goals, it is essential to define indicators of vulnerability and exposure based on health impact assessment, as well as indicators that will promote adaptation planning and resilience for health risk management. In view of the climatic projections and the vulnerability of Mediterranean countries, such indicators will contribute to correct preparedness at the regional and national levels.
10.E. Workshop: Childhood obesity: how to tackle this wicked problem?
Authors:   Organised by: GGD Amsterdam (Netherlands),   Chair persons: Arnoud Verhoeff - Netherlands
Published: October 2020

The City of Amsterdam was awarded the City European Health Award 2019 with its Amsterdam Healthy Weight Approach (AHWA). The European Union stated that the AHWA contributes to a healthier environment for children in Amsterdam to grow up in. In this workshop we will share our insights and experiences with the AHWA as a Whole Systems Approach (WSA), supported by a multidisciplinary, innovative and dynamic research infrastructure.

More and more scientific knowledge indicates that key modifiable influences on overweight and obesity lie in our local environments. The FORESIGHT report (2007) illustrated the complex web of influences which are widely considered to foster overweight and obesity through the fundamental features of a complex adaptive system. These include long, non-linear causal chains which over time produce emergent properties and unintended effects in a dynamic system.

WSAs seem to be appropriate to contribute to the reduction of overweight and obesity which are embedded in a complex adaptive system.

The AHWA constitutes a WSA since it adopts the following working principles: actions aiming to modify the local political, physical, social, health education and careenvironment in multiple settings (the home, neighborhood, school and city);cross-sectoral working across municipal sectors and public, private, community and academicpartners to develop and implement actions;a learning approach to enable program adaptation in response to change in the complexadaptive system comprising the local environment (i.e. the Amsterdam context).

The objectives of the workshop are fourfold: Present the WSA of the Amsterdam Healthy Weight Approach.Present the learning cycle, with a key role for Sarphati Amsterdam as multidisciplinary research institute in which the City and the Amsterdam knowledge institutions (University of Amsterdam, VU University, Amsterdam Academic Medical Centre, Amsterdam University of Applied Sciences) cooperate.Share examples of participative research projects within the context of AHWA and Sarphati Amsterdam, through lived experiences.Invite participants of other cities for collaboration (City2City): shared learning to tackle this wicked problem is essential.

Key messages

Whole Systems Approaches are appropriate when tackling wicked public health problems. Whole Systems Approaches should be supported by innovative, adaptive, multidisciplinary research every step of the way.
Outflow management of health professionals in Serbia: survey results from a tertiary-level hospital
Authors: Šantrić Milićević M , Vasilijevic N , Vasic V
Published: October 2020

Background

Some rich countries are actively recruiting labour from abroad for lack of health workforce. A high-level tendency for emigration among health care personnel in Serbia has attracted the attention of policymakers. In the search for evidence that can support the interventions to manage the outflow of the health workforce, the objective of the study was to obtain the opinion of medical doctors and nurses about retention factors.

Methods

A 65-item questionnaire was distributed to 384 hospital physicians and nurses to explore their views on fourteen aspects for labour outflow management (recruitment, training, job, salary, benefits, managers' behaviour, career development, relationships, work conditions, institutional image, organizational support, and three types of organizational commitment). Any difference between physicians and nurses and their responses' scores was assessed with Pearson Chi-Square (p < 0.05) and Independent Samples t-test (p < 0.05).

Results

Few nurses (17.8%) and physicians (13.6%) are familiar with measures taken in the country to manage the migration of healthcare workers, but most would work abroad if given such opportunities (56.8% and 63.0%, respectively). The responses of physicians and nurses differ for many aspects of management; the best scored were managers' behaviour (11.9 v 10.4, respectively, p < 0.001) and organizational support (15.3 v 13.4, respectively, p < 0.001), while the least scored were job benefits (4.1 v 4.0, respectively p = 0.531), salary (5.9 v 5.8, respectively p = 0.459), relationships (5.3 v 5.3, respectively p = 0.911) and performance assessment (5.3 v 4.9, respectively p = 0.008).

Conclusions

The study has identified success and failure factors for the outflow management of health workers in Serbia. Hospital doctors scored higher than nurses almost all retention factors. There is a space to strengthen the policy and practice to retain hospital doctors and nurses in the country.

Key messages

Hospital nurses are in a worse position than hospital doctors in regard to almost all aspects of outflow management. Stakeholders should invest in retaining medical doctors and nurses in the hospital.
Nurse migration in Germany, the UK, and Australia: a comparative situation analysis
Authors: Ewers M , Smith J , Tomkins Z , Woodward-Kron R
Published: October 2020

Background

Nurse migration is increasingly seen as an appropriate response to address nursing shortages in overburdened health systems. This paper aims to analyse the situation in Germany, the UK and Australia and identify similarities and differences in the dimensions, perceptions and processing of nurse migration in different health systems.

Methods

A rapid evidence assessment and comparative situation analysis of routine data obtained from public health, education and labour market reporting systems, and academic and grey literature were carried out in Jan-Feb 2020. Primary outcome measures were key data of nurse population and migration, barriers and opportunities, and educational initiatives to support migrating nurses to meet the requirements to work in the destination country.

Results

Germany, the UK and Australia are confronted with an ageing and increasingly chronically ill population and severe nursing shortages. Skilled migration is seen as an opportunity to address these problems, but each country is faced with different contextual conditions and requirements. Data on the nurse workforce obtained from public health, educational and labour market reporting systems are more differentiated and extensive in the UK and Australia than in Germany. Furthermore, there is a substantial amount of published literature in the UK (n = 65) and Australia (n = 87) on nurse migration and on how the countries address challenges in this area; in comparison to the German context, where such research is limited (n = 7). Available research focuses on the economic, epidemiological and geographical impact and distribution of nurse migration. Qualitative dimensions and educational requirements are less well discussed.

Conclusions

Evidence on nursing migration is strongly based on quantitative factors and may not reflect current needs. More information about qualitative aspects of nurse migration is required to develop recommendations that support enhanced nursing workforce migration.

Key messages

Nurse Migration presents many challenges that have not yet been fully researched. Results of a comparative analysis of three countries offer the opportunity to highlight missed opportunities.
Why is syphilis rising in Europe? Multi-level modelling of alternative hypotheses in 31 countries
Authors: Mendez-Lopez A , Stuckler D , Noori T , Semenza J C
Published: October 2020

Background

Syphilis transmission has increased markedly over the past two decades in Europe, concentrated in men who have sex with men. We test alternative potential social and behavioral individual- and population-level determinants of this resurgence.

Methods

Two rounds of the cross-sectional European Men who have sex with men Internet Survey (EMIS 2010 and 2017, n = 272,902) were used to fit multi-level linear probability models to evaluate determinants of the incidence of self-reported syphilis, capturing risky sexual behaviours and pre-exposure prophylaxis use, among others, adjusting for potential sociodemographic confounders.

Results

Self-reported syphilis incidence rates rose by about 1.8 percentage points (within the last 12 months) and 3.9 (within the last 5 years) between the 2010 and 2017 waves, after adjusting for sociodemographic factors. HIV status was a major risk factor for syphilis infection (27.6 ppt higher incident rate, 95%CI: 24.7 to 30.5). A dose-response relationship was observed between greater numbers of condomless non-steady partners and syphilis infection, with more than 10 partners estimating increases in the probability of diagnosis of over 25 ppt (11-20 partners vs none: 24.5 ppt, 95%CI: 20.5 to 28.5); further, we observed evidence of mediation for number of condomless non-steady partners, which attenuated the estimated rise in 2017 vs 2010 by about 35%. STI testing uptake also accounted for a substantial increase in syphilis incidence signaling higher detection rates over time. While country-level PrEP use was linked to greater number of condomless partners, there was no substantial impact of population-wide factors, including GDP and PrEP use, on overall syphilis trends.

Conclusions

Risky sexual behavior changes, particularly condomless sex with non-steady partners, appears to be a major contributing factor to rising syphilis incidence. Further research is needed to understand what accounts for this substantial behavior change.

Key messages

Increased number of condomless non-steady partners accounts for a substantial rise in syphilis trends. Population-level PrEP use was linked to increasing numbers of condomless non-steady partners but had no substantial impact on overall syphilis trends.
Characterization of emerging predominant HFMD pathogen, coxsackievirus A6 in mainland China
Authors: Song Y , Zhang Y , Xu W B
Published: October 2020

Hand, foot, and mouth disease (HFMD) had the highest yearly incidence, with over 10 million cases of HFMD annually reported in China. Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) have been regarded as the leading pathogens of HFMD outbreaks worldwide and in China; however, in recent years, the leading pathogens have been changing, as large outbreaks of CV-A6-associated HFMD have been reported worldwide. Since 2013, repeated large-scale HFMD outbreaks caused by CV-A6 happened in mainland China, where, as a result, CV-A6 has surpassed EV-A71 and CV-A16 as the leading HFMD pathogen in most Chinese provinces.

We sequenced the whole genomes of 158 CV-A6 clinical samples that were isolated between 2010 and 2018 from the HFMD Surveillance Network established in our laboratory. Our results showed that: seven recombination forms (RFs) of Chinese CV-A6 were detected; different CV-A6 RFs showed distinct virulence and transmissibility; VP1283T may play an important role in the virulence of Chinese CV-A6.

HFMD epidemics in China have become a serious public health problem over the past decade. In this research, we have attempted to explore the causes of the high transmissibility of the emerging CV-A6 in mainland China on the basis of CV-A6 evolution based on 336 whole-genome sequences, and we have yielded some fruitful results for the future research and surveillance of HFMD in China.

Key messages

HFMD epidemics in China have become a serious public health problem over the past decade. CV-A6 has surpassed EV-A71 and CV-A16 as the leading HFMD pathogen in most Chinese provinces.
A policy analysis of the chronic care policies in Belgium
Authors: Danhieux K , Martens M , Colman E , Remmen R , Van Olmen J , Anthierens S
Published: October 2020

Introduction

Chronic diseases form the largest burden of disease in European countries. Redesign of health systems towards chronic integrated care is needed, with more collaboration between first and second line, between medical and social services and support to prevention and self-management. What are the levers for change in such health systems? This study addresses this knowledge gap, through a policy analysis of barriers and facilitators for change towards chronic integrated care.

Methods

26 central level stakeholders were selected, based upon their influence in regulation and policy, financing, health care provision and community representation. Semi-structured face-to-face interviews were held covering assessment of past and current policies and implementation, barriers and opportunities for change.

Results

Reforms have taken place, such as the stimulation of local initiatives for chronic integrated care projects and the set-up of local care councils. Most stakeholders assessed the current Belgium's implementation of integrated care as low, despite a growing awareness for the need for change. A context factor often mentioned to constrain implementation was a state reform which led to a partial decentralization, fragmentation of decision power and a division of healthcare competences between federal and federated levels. Other barriers were the current financing system, the lack of investments in new models of care and the vested interests of providers.

Discussion

This analysis shows that chronic care reform in Belgium is constrained by partial decentralization of primary health care, and by the financing system and vested interests. It points to the need for coordination of health policy making and implementation. Disentangling the levels of decision-making and the financial leverage at these levels gives insights for change and change management, for the Belgium health system and other countries with a strong decentralized system.

Key messages

The current Belgium’s implementation of integrated care was assessed as low, due to different contexts factors such as division of health care competencies between different governmental levels. In a country as Belgium with a strong decentralized health care system coordination of health policy making and implementation is key in order to scale up integrated care for chronic diseases.
Association of long-term care utilization and functional ability in older adults
Authors: Kyaw K
Published: October 2020

Background

Healthy Ageing is the process of developing and maintaining the functional ability that enables wellbeing in older age as per the World Health Organization (WHO). Establishing foundations necessary for improvements in long-term care (LTC) systems for increasing the world's older adults is one of the public health priorities. LTC provides assisted daily living (ADLs), instrumental assisted daily living (IDALs), healthcare, and social services. This study aims to assess the association of LTC utilization and functional ability in the two industrialized countries with a globalized aging perspective. This study would guide to identify the approaches for establishing fundamentals, developing and sustaining a trained workforce to achieve high-quality, healthy aging.

Methods

This retrospective longitudinal population-based study, individuals age 65 and above from the national data of the United Kingdom, UK, (English Longitudinal Study of Aging) and the United States, U.S, (Health and Retirement Study). The outcome is LTC: nursing home and home care. Predictors: functional status: scores of ADLs and IADLs, and declining ADLs and IADLs. Covariates are age, gender, marital status, income, chronic diseases. Multiple logistic regression analysis was carried out in SAS software version 9.4, p-vale (p) <0.05.

Results

LTC utilization (UK) is associated with declining IADLs (OR: 15.01, 95%CI: 1.62,139.23), p- 0.02 with adjustments for covariates. LTC utilization (U.S) is associated with declining ADLs (OR: 2.66, 95%CI:1.82,3.87) and IADLs (OR: 2.42, 95%CI:1.73,3.40), both at p-<0.001. With adjustment for covariates, LTC utilization (U.S) is associated with declining ADLs (OR: 2.20,95%CI:1.51,3.22), p-0.001 and declining IADLs (OR: 2.12, 95%CI:1.49,3.02), p-<0.001.

Conclusions

Declining functional ability is associated with LTC utilization. This study guide to improve LTC systems to develop personalized social and healthcare foundations, increase the trained workforce.

Key messages

To demonstrate the long-term care (LTC) utilization by declining functional capacity in the UK and the US older adults to a better understanding of the distribution of LTC utilization between them. To guide developing approaches in the improving long-term care system to achieve high-quality, healthy aging through evidence findings of this national study.
Maternal mental health and partner delivered massage: a pilot study
Authors: Hall H , Munk N , Carr B , Fogarty S , Holton S , Weller C , Lauche R
Published: October 2020

Background

Mental health problems place a significant burden on the health system and are an important public health issue. Many pregnant women experience anxiety and depression, which can negatively impact health outcomes for both mother and baby. Partner-delivered massage may provide a cost effective and accessible approach to support the mental wellbeing of pregnant women.

Methods

A feasibility randomised controlled trial was conducted to compare partner-delivered relaxation massage (intervention) with a self-directed stress management program (control), for pregnant women with mild anxiety. Women attended an initial workshop at 28-32 weeks gestation, followed by the completion of either the self-directed massage or stress management program. Qualitative feasibility and acceptability data (primary outcomes) were collected via online participant diaries and post-birth interviews. Anxiety, depression and stress symptoms (secondary outcomes) were assessed using the Depression and Anxiety Stress Scale (DASS-21).

Results

14 women/partner dyads attended the partner- delivered massage group and 13 women attended the self-directed stress management group. Participants from both groups reported the programs were feasible and acceptable. Mean scores on all DASS-21 subscales significantly decreased over time in both the intervention and the control group.

Conclusions

The partner-delivered massage program was feasible and acceptable. Both programs decreased women's symptoms of anxiety, depression and stress, with no significant between-group differences identified. An adequately powered, experimental study is needed to determine the effectiveness of partner-delivered relaxation massage.

Key messages

Many women experience anxiety and depression during pregnancy and this can have a negative impact on both mother and baby. Partner-delivered relaxation massage, at least once a week in the third trimester, may help reduce women’s symptoms of anxiety, depression and stress.
Mental health interventions in healthcare workers in infectious disease outbreak-A systematic review
Authors: Zace D , Hoxhaj I , Orfino A , Viteritti A M , Silvetti L , Di Pietro M L
Published: October 2020

Background

Extended evidence has established that healthcare workers face several mental health problems during a disease outbreak, which could have a long-term impact. To address these issues, elaboration and implementation of psychological/psychiatric interventions or strategies is of utmost importance. In this context, this systematic review aimed at identifying strategies to manage mental health issues in healthcare workers during infectious disease outbreaks.

Methods

PubMed, Cochrane, Scopus and Web of Science were searched to retrieve pertinent articles published in English until May 2020. Articles reporting measures, interventions, strategies, or recommendations to manage mental health problems in healthcare workers during an infectious disease outbreak, of any study design were included. The quality assessment was performed according to the study design of the included articles.

Results

Our search strategy produced a total of 2358 articles. After the screening process 33 articles met the inclusion criteria, addressing COVID-19 (40%), followed by SARS (21%) and Ebola Virus (15%). The findings emphasized that organisations should follow an evidence-based approach and establish comprehensive programs to assist hospital staff during disease outbreaks. The preliminary results show that the creation of a psychological response team, training, e-learning, courses, psychosocial counselling, screening instruments and telemedicine activities could improve the capacity of response and coping, and reduce mental health issues in healthcare workers.

Conclusions

To minimize the psychological impact of future infectious disease outbreaks, evidence-based intervention strategies should be implemented to retain mental health among healthcare workers. Our results may provide the necessary insights that could be applied during the COVID-19 pandemic.

Key messages

During infectious disease outbreaks healthcare workers are faced with mental health issues, that need to be addressed through tailored interventions offering coping strategies and increase resilience. Mental health related interventions or strategies include the implementation of professional training, psychosocial counselling, courses, and the creation of a psychological response team.
Youth-led efforts against infodemic
Authors: Uakkas S , El Omrani O
Published: October 2020

Problem

The IFMSA, voicing the opinion of 1.3 million medical students from 129 countries, acknowledges the importance of health literacy in driving social change. Today, there is a global epidemic of misinformation, spreading rapidly through social media platforms and other outlets, posing a critical threat for public health due to the COVID-19 outbreak. Also, it threatens the possibility of slowing down the progression of the virus. The fight against such misinformation requires continuous provision of the most reliable and recent information.

Description

A global study was conducted by IFMSA, in collaboration with the WHO, composed of a survey to get data about all the organizations, institutions, NGOs, and other entities that focus on fact-checking and correcting misinformation about COVID-19. The survey was filled by medical students from end of April to end of May who reported name, type, scope of work, languages, primary funding source, type and source of information shared by the organization.

Results

We discovered 182 initiatives from 62 countries worldwide that verified information in 48 languages. Social media, internet, radio, SMS, printed media and hearsay were identified as the main sources of misinformation. Video podcasts with experts, regular social media updates and newsletters, were described as best practices, in addition to debunking myths on a regular basis and verifying statements by public figures. Also quality of fact-checking differed between initiatives.

Lessons

Data showed that myths and false information are spreading through different means from public figures to daily social media outlets. Fighting misinformation should use innovative and accessible approaches. There is urgent need for national initiatives and political engagement for myth-busting. IFMSA and WHO are following up by designing a platform to share fact-checking initiatives and recommendations openly, and by creating an AI system with Amazon to analyze articles in social media.

Key messages

Fact-checking and myth-busting are essential to limit the COVID-19 related infodemic spreading through different media and social media platforms, famous figures and others. Initiatives worldwide are doing fact-checking. Yet, the quality and quantity of available fact-checking differ between countries and there is a need for more universal good quality fact-checking.
Sugary drinks, artificially sweetened beverages and cardiovascular disease in NutriNet-Santé cohort
Authors: Chazelas E , Debras C , Fezeu L , Julia C , Hercberg S , Deschasaux M , Touvier M
Published: October 2020

Introduction

Sugary drinks consumption has increased worldwide in recent years and evidence demonstrating their detrimental impact on cardio-metabolic health is accumulating. Artificially sweetened beverages (ASB) are marketed as a healthier alternative, but their cardio-metabolic impact is being debated in the scientific community. This study aimed to investigate the relationships between the consumption of ASB, sugary drinks and the risk of first incident cardiovascular disease (CVD) in a large prospective cohort.

Methods

The French NutriNet-Santé cohort was launched in 2009. Every 6 months participants are asked to fill 3 validated web-based 24-hour dietary records. All major health events reported by participants were validated based on their medical records by a committee of physicians. Data were also linked to national health insurance system and to the French national cause of specific mortality registry. For each type of beverage, 3 categories were defined as follows: non-consumers, low consumers and high consumers (separated by sex-specific median among consumers). Multi-adjusted Cox proportional hazard models with age as the primary time scale were performed.

Results

A total of 104,761 participants were included. During follow-up (2009-2019), 1,379 first incident cases of CVD occurred. Compared to non-consumers, higher consumers of sugary drinks had a higher risk of overall CVD (HR = 1.21, 95% CI 1.04 to 1.40, Ptrend=0.009). Higher consumers of ASB had also a significantly higher risk of CVD (HR = 1.30, 95% CI 1.00 to 1.71, Ptrend =0.04).

Conclusions

Both sugary drinks and ASB were similarly associated with CVD risk. The health effects of non-nutritive sweeteners is currently being debated based on contrasted epidemiological results. Mechanistic data suggests metabolic effects through gut microbiota perturbation and body weight gain. To imply a causal link, they need replication in other large-scale prospective cohort as well as further mechanistic investigations.

Key messages

Higher consumption of sugary drinks and ASB was associated with higher risk of CVD, suggesting that ASB might not be a healthy substitute for sugary drinks when considering cardiovascular health. These data provide additional arguments to feed the current debate on taxes, labeling and regulation of sugary and artificially sweetened beverages.